Does it matter that 80% of MFT interns are women?

If you have been to see a therapist lately, I’d bet good money I can guess the therapist’s gender based on their licensure. You saw a psychiatrist? Probably male (75 percent as of 1996, though declining since). Anything else? Probably female. The shift among psychologists has been most overwhelming: 72 percent of 2005 doctorates were women, compared to just over 20 percent in 1970. Clinical social workers, professional counselors, and family therapists are all likely to be women.

It would be naive, at best, to say that women are more naturally drawn than men to “helping professions.” Lots of professions could be categorized as “helping,” including surgery — one profession that is still fairly gender-balanced. So what actually causes the discrepancies in psychotherapy?

Education. In social work and family therapy, the female majority continues to swell, due in no small part to larger trends in education. Women are now significantly more likely than men to start college, finish college, and go on to graduate school. In California, among those who have their graduate degrees and are working toward licensure as MFTs, a whopping 83 percent are women. An even larger 86 percent of those working toward clinical social work licenses are women.

Money. Are men staying out of these professions for simple economic reasons, the same reasons they seem to stay away from craft-selling web sites? Perhaps. Some evidence suggests that as professions shift toward higher proportions of women, pay rates in those professions decrease. If men are making career choices based on improving their chances of good pay, family therapy is something of a gamble. Pay averaged about $55,000 per year as of 2002, but varies widely based on work setting. It is certainly possible to make a six-figure salary in the psychotherapy world — I know some who were able to do so even very early in their careers — but it is not common.

Attitudes. Women in medical school in the UK demonstrate more positive attitudes toward mental illness, psychiatry, and psychiatric patients than men do. This mirrors findings from the general population in the US, where men are more likely than women to see mental illness as a personal failure. This issue gets more complicated once other gender stereotypes are thrown into the mix: In one recent study, men and women were both less likely to view “gender-typical” mental health symptoms (a man with alcoholism, a woman with depression) as genuine mental disturbances, and less inclined to help, compared with gender-atypical symptoms.

Relational factors. More than men, women in the US believe it is their responsibility to be caretakers of relationships. This element alone may be enough to explain the disproportionate gender balance in psychotherapy, as women appear to be more attuned to relational issues generally and health issues specifically.

All of these possible explanations lead us to the bigger question: So what?

Does it matter that such a large majority of therapists, especially early-career therapists, are women?

In a word, yes. It matters. It matters because graduate school continues to become more expensive, and if the genderization of the field puts downward pressure on salaries as noted above, it may become harder for therapists to make a living.

It matters because men already are unlikely to come to therapy in spite of its likely benefits; male therapists (and this is certainly arguable) may be better able to convince men to come to therapy, and to stay in therapy long enough to benefit.

It also matters because of the larger message it sends — if men and women truly share responsibility for the success of their marriages and families, how is that message reinforced with a marriage and family therapy profession that is practiced largely by women, for female clients?

Of course, none of this should be read as a value statement about therapists of either gender. We are seeing in the MFT world a trend mirrored throughout higher education and social services professions. It is important that we start asking now what this genderization will mean, whether it is a trend worth trying to change in MFT (certainly not a foregone conclusion; this could be well argued either way), and if so, how that might be done. I welcome your thoughts.