Note: This article has been published in the Asian Academy of Family Therapy Newsletter, Jan 2021, Issue 3.

“Violence against women and girls is one of the most prevalent human rights violations in the world. It knows no social, economic or national boundaries. Worldwide, an estimated one in three women will experience physical or sexual abuse in her lifetime. Gender-based violence undermines the health, dignity, security and autonomy of its victims, yet it remains shrouded in a culture of silence.” (United Nations Population Fund, 2019)

As psychotherapists, we are not unfamiliar with the idea of “gender inequality” or “gender-based violence” that permeates the world we live in, and therefore often these phenomenon also get re-enacted inside the therapy room. As gendered individuals, we are also not invincible to the harm of gender inequality and relational violence. A recent incident of sitting in a case presentation reminded me how susceptible we are, in spite of all our training and dialogues on gender, to become part of a violent system, and yet unknowingly remaining silent about it.

In the case presentation, the presenter shared, with much enthusiasm and excitement, about an intercultural marriage couple with sexual difficulties. His enthusiasm was infectious, as the case discussion became zeroed-in on the trauma history of the couple, and more specifically, on the part of the female partner’s sexual dysfunctions. Some male participants became consumed with the sexual symptoms and incest in the family, raising questions like: why did the father rape child #1 and not child #2 also? Whilst the content may seem valid, the flippant way that the questions were raised and responded were symptomatic, if not an isomorphic reflection of the gender-based violence in the case itself, and probably in the larger society. There was minimal genuine empathy shown for the generational trauma in the family, where members had been reported as both perpetrators and victims of violence, inside and outside of their respective homes and nations, tracing all the way back to the days of first and second World Wars.

Herein lies the first ethical issue: how do we talk about our clients (especially in their absence)? How do we respond to other people’s trauma and suffering, especially those who have suffered structural prejudice, discrimination, oppression and abuse? A simple checkpoint is, would this be how we want our own family members to be talked about or our family trauma discussed in such a manner?

Sitting in the room that day were participants from different parts of the world. Majority of the people were from Asian region, whereby their parents or grandparents generation had lived through war periods and some may have even witnessed or suffered the atrocities of war crime, including the raping and exploitation of women. There were also participants from the Western-European region; they too were not unfamiliar with the impact of war, colonialism and racism on the women in their own countries and the countries that were colonized. These are historical wounds that are kept hidden, but they are still bleeding and very raw to many families, even though most people try to keep silent about their families’ pain and suffering.

I wonder if the presenter had even considered who his audience was, and how his presentation could evoke secondary trauma to those who were present. When I asked my female colleagues privately, many reported that they had mentally checked-out; some reported somatic reactions like “I have pounding headache”, or “I felt my vagina constricted”. One even said that “my soul has left the room!”.

When I tried to raise my concerns with the presenter, he deflected the issue to merely his presentation style and suggested that I have misunderstood his intention. He continued to stand by his position despite receiving further feedback from others. He even further suggested that those who felt uncomfortable with his presentation should perhaps reflect on themselves more and “take better care” emotionally. Subsequent to that, even when he was offered opportunities for further dialogue after his presentation, his repeated message to his audience was: “I’m really trying my best here… you misunderstood me…” To those who raised their concerns with him, his responses were insinuating to people being either not understanding enough, not mature enough, not professional enough, or not emotionally strong or open enough to receive his kind of work.

A presentation can be boring and unhelpful. But when it becomes harmful to the audience,  especially when it was feedbacked to him, the least that the presenter could do was to take responsibility and apologize for the harm that he had caused, even if it was not his intent. This reveals a severe lack of self-reflective awareness and reflexive practice, which is a core competency expected in the training of psychotherapists. When psychotherapists do not engage in the hard work of reflecting on their own experiences and their impact on others, they also cannot incorporate feedback thoughtfully to improve the interactional process for the benefit of their clients. Worse still, they might actually cause harm to others and still claim innocence! Avoiding self-reflection and reflexive practice is an ethical problem.

Next, how should a therapist use sexually explicit materials in a professional setting? After the presenter was given feedback about his lack of sensitivity to gender-based violence in his case presentation, he decided to show more of his slides in defense of himself. This included “educating” his psychotherapists audience some common sex therapy techniques using sexually explicit pictures of male and female coital positions. What was shown on screen was a full frontal display of the female’s body, whereas the male’s genital area was covered or hidden behind/under the female’s body. Clearly the presenter did not think there was any problem presenting what he considered as “normal” sexual positions or “textbook” way of teaching sex therapy.

When psychotherapists are not mindful of the social-historical context of gender relations, we can easily turn a blind eye to what may come across as a total disrespect for women and disregard for gender equality. For example, the pictures that the presenter chose – was it not a reflection of the patriarchal norms of objectifying women’s body for public viewing pleasure? One has to be curious – was men’s genitals well covered in the pictures to protect its sacredness or avoid shame? And when these pictures were flashed in a conference like this, unwilling participants were forced to sit through the display and endured the discomfort, lest they had to mentally check out or physically leave the room. If this is not sexual harassment, I don’t know how else to call it.

As fellow therapists, we are standing at the frontier of leading change. If we want our community and profession to progress, we need to question our current position and attitude towards status quo. We cannot continue to take for granted that the “mainstream” values that we have accepted as “normal” is truly acceptable to all people, especially when they are inherently doing violence to certain groups of people. How can we create a safer community for ourselves and for each other?

Secondly, what can we do as a community, when we see our brother and our sister hurt by the system that we share space in? How do we stay present to our own pain, and still hold the space to talk about our pain and shared history, without numbing, avoiding or blaming?

And last but not least, how do we stay true to our personal and professional ethics as helping professionals? How do we use our current position and resources to make our lived reality more aligned with our inner vision?

Let us BE the change that we want to see and hope to create!

“Don’t ask what the world needs. Ask what makes you come alive and go do it. Because what the world needs is people who have come alive.” —Howard Thurman

Article by Ng Wai Sheng, Psy.D. 

Image by Gerd Altmann from Pixabay