New APA guidelines for girls and women put focus on strengths

The empowering #MeToo hashtag didn’t exist yet when the American Psychological Association (APA) issued its first practice guidelines for treating girls and women in 2007. Now, the updated version of these APA guidelines acknowledges the strength and resilience many girls and women possess to overcome adversity from the effects of sexism, oppression, discrimination, and prejudice.

Released in May, the new APA guidelines follow the release of recommendations for treating boys and men published last year. Previous guidelines for psychological practice include those for working with racial and ethnic minorities, older adults, LGBT clients, and people with disabilities.

“We don’t mean to say that because they’re resilient they’re doing fine,” said Sharon Lamb, Ed.D., Ph.D., a professor of counseling psychology at the University of Massachusetts, Boston, one of three co-chairs of the working group that updated guidelines focused on girls and women.

“There’s a lot of suffering out there. It’s just that we want to appreciate the strengths that girls and women bring to their own mental health and attempts to do better for themselves and for other people.”

APA guidelines are intended to be updated every 10 years to reflect social and cultural changes and new developments in evidence-based treatments. APA’s Division 17 (Society of Counseling Psychology) and Division 35 (Psychology of Women) appointed a Task Force to lead the revision in 2013.

More than 40 contributors, including practitioners, scholars, and grad students, worked over five years on developing these guidelines, Lamb said. The working group’s other two co-chairs were Debra Mollen, Ph.D., a professor of counseling psychology at Texas Woman’s University, and Lillian Comas-Diaz, Ph.D., a clinical professor of psychiatry and behavioral sciences at the George Washington University School of Medicine and executive director of the Transcultural Mental Health Institute.

The guidelines state that their purpose “is to assist psychologists in the provision of gender-sensitive, culturally competent, and developmentally appropriate psychological practice with girls and women across APA the lifespan from all social classes, ethnic and racial groups, sexual orientations, abilities and disabilities, and other diversity statuses in the U.S. and globally.”

The updated version reflects newer research on gender-variant and trans girls and women suggesting that mental health problems among this population may be attributed more to minority stress than gender identity.

Another new recommendation comes as the result of evolving thinking about language for describing physical size: The use of the term “fat” is favored over “obese” or “overweight,” words that are increasingly seen as medically marginalizing.

The focus on strengths developed early on after the team of collaborators noted that the 2007 guidelines had a heavy emphasis on sustained trauma, harassment, and disadvantages faced by half the world’s population.

“It’s been received really favorably because it’s true,” Mollen said. “There’s a lot of research that supports the incredible resilience that girls and women have to come by to cope with adversity.”

Women are less likely to be impacted by isolation as they grow older and while women are more likely to experience poverty, their relationships and strengths can mean they are less harmed by its effects than men, according to research findings.

Girls and women also enjoy more supportive friendships.

The #MeToo movement, which drew attention to the prevalence of sexual harassment and assault and prompted policy changes and consequences for perpetrators, blossomed coincidentally just as the finishing touches were put on the new guidelines, Comas-Diaz said.

“The world changes,” Comas-Diaz added. “That’s what we want the guidelines to capture because everything is in flux. We almost had a woman president but then we didn’t.”

Lamb said that the #MeToo movement and the 2016 presidential election may have led to the misperception that the women’s movement was over and that equality had been reached.

Despite increased recognition of women’s experience of sexual violence and abuse, research still indicates that most women experience some level of violence or harassment during their lifetime and therapists need to understand the risks.

Therapists also need to recognize that gender inequities can have adverse effects on women’s physical and mental health, the guidelines state.

Moreover, the guidelines note, interpersonal violence is especially prevalent for women in specific demographic groups, including military women, girls and women of color, and female refugees of any age.

The guidelines also acknowledge that elder abuse is more common among women than men.

Jill Betz Bloom, Ph.D., associate professor in the clinical psychology department at William James College in Newton, Massachusetts, who was not involved with drafting the revised guidelines, said she will be posting the guidelines for her students in the course she is teaching this summer in diversity and cultural psychology.

Bloom serves as director of the school’s Global Mental Health Program and co-director of Center for Multicultural and Global Mental Health.

“Starting from strength rather than from weakness, I think that that’s a useful shift in framework,” Bloom said. “I was very impressed.”

The three lead authors are still trying to negotiate with the APA to develop an annotated bibliography on the vast body of research reviewed during the development of the new guidelines. The original 200-plus page draft had to be condensed to a final product of about 32 pages because, while APA guidelines draw from literature, more recent versions have had fewer citations.

That meant cutting much of what Mollen called a “pretty intense” review of literature, including research on trauma and refugees and other women affected by war and global issues.

“All that good literature, we don’t want to go to waste,” Mollen said.