Handbook of Gender and Sexuality in Psychological Assessment

Virginia Brabender, Joni L Mihura

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317669272
• Edition: 1
• Topic: Psychology
• Subtopic: Human Sexuality in Psychology
• Index: Psychology

Handbook of Gender and Sexuality in Psychological Assessment brings together two interrelated realms: psychological assessment with gender and sexuality. This handbook aids in expanding the psychological assessors' knowledge and skill when considering how gender and sexuality shapes the client's and the assessor's experiences. Throughout the six sections, gender and sexuality are discussed in their relation to different psychological methods of assessment; various psychological disorders; special considerations for children, adolescents, and older adults; important training and ethical considerations; as well as several in-depth case discussions.

Part I

Introductory Chapters

1
The Construction of Gender and Sex, and Their Implications for Psychological Assessment

Virginia M. Brabender and Joni L. Mihura

A female client calls a male psychological assessor to make an appointment for an assessment. From the first moment of hearing the client’s voice on the phone, the assessor registers one critical piece of information about the client—his or her gender. The assessor gauges from the caller’s tonal quality that he was speaking to a woman. The client probably already knows the assessor’s gender before making the call. Gender-related information possessed by client and assessor is likely to shape the assessment in many ways. From the client’s standpoint, it may affect his or her attitude in coming to the assessment. If, for that client, masculinity is associated with authority, then an assessor’s maleness could provide a measure of comfort and encourage the client’s willingness to appear for a first meeting. It may even affect the client’s willingness to follow through with the assessment. Another client may associate that assessor’s maleness with dominance and find the prospect of meeting with the assessor more intimidating than if he were to be assessed by a woman.

The assessor is also likely to think about the client in gender-based terms throughout the stages of the assessment. Based on his or her own fund of assessment experiences, knowledge of base rates, or other reading of the literature, the assessor might understand the client and interact with the client based upon the assessor’s assumptions about men and women and how they differ. This phenomenon is gender bias (Crosby & Sprock, 2004; Koenig & Eagly, 2014; Sprock, Crosby, & Nielsen, 2001). For example, Samuel and Widiger (2009) found that when practicing clinicians rated a male or female version of a case vignette using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association [ApA]), they were less likely to see the female case as antisocial and the male case as histrionic—a finding consistent with gender bias.

Basic Terms

Sex, Gender, and Gender Identity

In using the term gender, we are differentiating it from sex. Note that the assessor identified the individual as a woman based upon her voice quality. In other words, he associates femaleness with particular vocal characteristics that are different from those connected to maleness. This assignment is part of gender. It differs from sex in that a person’s sex is the label the person is given at birth and is based strictly on physical characteristics (World Health Organization [WHO], 2014). These sex characteristics usually lead to a classification of male versus female, but they are by no means the only possibilities. Individuals may manifest the physical characteristics of both males and females in varying ways, a status labeled intersex. Gender is a broader notion that includes all of those characteristics and roles, interests and sensibilities that members of a given society ascribe to a particular gender (McCreary & Chrisler, 2010). For example, the psychologist, reflecting the views of society, might have certain assumptions about his female client, such as possessing certain interests or personality characteristics.

Over the history of psychological assessment, considerable focus has been placed on gender. Yet, to know about the client’s gender is not to know enough. That client who called the assessor for an appointment may be called Jane and may have the primary and secondary sex characteristics of a woman. Perhaps the entire world sees Jane as a woman. But this designation may feel wrong to Jane. Even though Jane has never communicated this idea to another person, she senses herself at her core to be male. Her reason for pursuing a psychological assessment is the constant malaise she feels, her lack of interest in her everyday activities. If the assessor gathers evidence from a variety of psychological tools and methods showing that Jane does have a considerable fund of emotional misery but never explores its potential link to her hidden identity, never sees her gender dissonance, then the assessment may not only fail to fulfill its potential to increase Jane’s self-understanding but also may foster a sense of alienation.

What is being described in Jane’s case is the identity variable of gender identity, which concerns how a person experiences his or her own identity. Gender identity tends to be particularly inconspicuous because in the vast majority of the individuals in the population, the cisgender population, a match exists between an individual’s apparent gender, typically based on primary and secondary sexual characteristics, and his or her felt gender. Yet, by no means do cisgendered individuals encompass the entire population. A group of individuals referred to by the terms transgender and gender nonconforming lie outside of the cisgender population. According to the American Psychological Association (APA, 2011, 2015), transgender is an umbrella term for “persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth.”¹ Among the subpopulations within this group are transsexuals, whose primary and secondary characteristics are incongruous with their gender identities. Cross-dressers² are individuals who dress in a manner that differs from that customarily associated with the sex they were assigned at birth and might identify as transgender. Also present within this population are individuals who have a more flexible gender identity, either identifying with each gender simultaneously or who experience their gender identity in different ways at different times. A still separate group is constituted of those individuals who do not see themselves as relating to the male-female distinction. Individuals who do not ascribe to the gender binary are sometimes referred to as gender-queer. These individuals teach us the valuable lesson that the gender binary is more of a convenience than an accurate representation of the range of ways in which individuals identify themselves with respect to gender. They also help us to see that the gender identities of male and female are not polar in the sense that one necessarily precludes the other.

Individuals who are not among the cisgendered members of society have equal entitlement to competent psychological assessment as those who are. Such competence requires the assessor’s fine-tuned grasp of the psychological issues these subpopulations face. The broad terms of transgender and gender nonconforming can obscure the fact that each group has very specific stressors and challenges. Moreover, although all of these groups are vulnerable to discrimination based on their departure from gender norms, the degree of negative bias from group to group can vary greatly (APA, 2011; Serano, 2007). It is imperative that the psychological assessor recognizes the particular character of each group’s burdens.

Gender Expression and Related Concepts

The client’s gender identity does not tell us how that identity will be expressed. For example, a client may have a very strong sense of himself as being a male. At the same time, the client may express his maleness in ways that others regard as not highly masculine. This point speaks to the separateness of a client’s gender identity from gender expression or how the person manifests his or her gender identity. Two clients may each have a strong female identity but manifest that identity in completely different ways. Gender expression may or may not conform to gender stereotypes (APA, 2014), and this aspect distinguishes it from masculinity-femininity, a term that has had a very long history. In their empirical work on this concept using data on the Masculine-Feminine scale of the MMPI-2, Martin and Finn (2010) found that this personality characteristic is not redundant with other characteristics that can be identified through this introspective technique. Moreover, it appears to be composed of three subfactors: (1) an endorsement of stereotypically feminine interests, (2) a disavowal of stereotypically masculine interests, and (3) gender identity. The construct gender conformity relates to the extent to which an individual embraces a gender stereotypic role. Gender conformity can produce gender role conflict in which an individual’s ascription to gender roles has negative consequences for that individual or those around him or her (O’Neil, 1990).

Sexual Orientation

Gender identity and gender expression, however, do not complete the story. Understanding gender also involves an appreciation of the client’s sexual orientation and how it interacts with other gender characteristics to influence a person’s fund of experiences and behaviors, including those emerging within the assessment situation. Sexual orientation is determined by the gender of the other person that elicits sexual attraction and intense positive feelings from a person. Vrangalova and Williams (2012) describe it as the “sexual attraction, identity, arousals, fantasies, and behaviors individuals have for one sex, the other sex, or both sexes” (p. 5). They note that whereas researchers often place individuals into discrete categories of heterosexual, gay, or bisexual, the data suggest more of a fluid-continuum model of attraction to one or both sexes. For example, some individuals are mostly heterosexual (or mostly gay/lesbian), whereas others are wholly heterosexual (or wholly gay/lesbian) (van Lankveld, 2014), a notion that has been supported by multiple studies (e.g., Diamond, 2007; Epstein, McKinney, Fox, & Garcia, 2012). Still others may be variable in their sexuality and abstain from placing themselves on a continuum of sexual preference. Another group of individuals are distinguished by lacking sexual attraction to either men or women (Foster & Scherrer, 2014), which is termed asexuality. According to Bogaert (2015), an individual with an asexual designation might nonetheless have sexual feelings (simply not sexual attraction) or romantic inclinations. He further points out that of all of the sexual orientations, this identity status is the least studied.

An early contribution to the literature on psychological assessment and sexual orientation was a chapter in which Pope (1992) presented a series of cases of individuals whose sexual orientations had implications for their experience of their psychological assessment. One of his clients was seeking to gain entrée into a specialized program within mental health. Admittance required a psychological assessment. The candidate was gay and apprehensive about a possible heterosexist bias on the part of the faculty. He believed that the (original) Minnesota Multiphasic Personality Inventory ([MMPI] Hathaway & McKinley, 1943), which was a component of the evaluation, provided information that could reveal his sexual orientation. The student carefully responded in a way that he believed would steer the committee away from recognizing his sexual orientation. In the process, he produced an elevation on scale 9 (Hypomania) that was absent on a subsequent occasion when he took the MMPI after being accepted into the program. As we will explore, the client’s sexual orientation potentially figures into the assessment in many ways. As this example illustrates, it can affect test-taking set in high-stakes testing when, in the eyes of the client, the outcome could be affected by sexual orientation. In assessments that are not perceived by the client as high stakes, the sexual orientation of a gay, lesbian, or bisexual client could still influence the assessment if the individual wondered how the assessor might regard him or her were the sexual orientation to be disclosed. This uncertainty could add a level of stress to the assessment that might be absent for individuals who are not members of sexual minorities.

The Person of the Assessor

The assessor’s gender and sexual identities are also material to the assessment. Consider a lesbian psychologist who provides psychological services in a rural community with conservative values. This psychologist might harbor a worry that the client’s awareness of her lesbianism might lead that client to be more resistive than he otherwise might. Might not the assessment psychologist’s wariness affect other behaviors, such as showing warmth and other means of building rapport with the client? Likewise, an assessor’s gender role conformity may exert its influence if the demands of the assessment were experienced as at odds with the assessor’s allegiance to a gender stereotype. For example, in the clinical interview, the female assessor might refrain from asking important questions in relation to sexuality because it violated the assessor’s own sense of delicacy connected to her feminine ideal. Conversely, the assessor might be spurred by the impulse to reject a feminine stereotype and broach sexual material in an aggressively probing way.

Also pertinent to the contribution of the assessor is that assessor’s tolerance for exploring identity facets related to gender identity and sexual orientation. The assessor’s identities that are similar to or different from the client are brought to the fore for the assessor to behold. Some identities may be the source of discomfort. The assessor who has never thought deeply about his or her own gender and sexuality may fear the final destination of such explorations. In fact, for some, it may be a cause of the confusion that arises in relation to many facets of identity—the way, for example, that gender expression is confused with sexual orientation. This defensive posture is of course not unique to assessors: We may find it in any professional providing services to a diverse group of clients. However, for assessors, this self-protective reaction limits their capacities to garner and work productively with identity information about the client. Ultimately, it prevents the assessor from accomplishing the central task of the assessment—understanding the client.

In his or her quest to understand a person fully, the psychological assessor has the challenge of grasping all that makes up the individual’s identity and recognizing the presence of different identity elements in the assessment. It entails knowing how the client regards him or herself in terms of gender, gender identity, masculinity and femininity, and sexual orientation. It encompasses recognition of these characteristics as others, including the assessor, perceive them. However, the assessor, too, must have a cognizance of how his or her own gender characteristics in interaction with those of the client create a dynamic field that can both affect the quality of the assessment and be a rich terrain for harvesting insights about the client. The assessor must engage in the potentially difficult process of identifying gender and sexual biases that he or she might bring to the assessment situation, biases yielding subtle cues to which the client may respond. This task is integrally related to the topic of stigma. Even the most compassionate, broad-minded assessor may be at risk for bringing stigma into the assessment situation.

Stigma as an Element Within the Client’s Life and the Psychological Assessment Process

This volume shines a light on aspects of identity that tend to figure prominently in an individual’s view of self. The last section defined these aspects—sex, gender, gender identity, gender expression, and sexual orientation. Over the history of personality assessment, the identities of gender identity, gender expression, and sexual orientation have been addressed minimally. When they were considered, it was generally to ill effect. For example, psychological assessment was used to determine a client’s sexual orientation, sometimes using most famously the MMPI Masculinity-Femininity (Mf) Scale (Hathaway, 1956/1980).³ However, this attempt confused sexual orientation with gender expression. Psychological assessors would also use assessment findings as a basis of recommending the denial of...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of Contributors
• Preface
• Acknowledgments
• Part I Introductory Chapters
• Part II Assessment Tools
• Part III Personality, Psychopathology, and Gender-Based Issues
• Part IV Case Illustrations of Gender-Based Issues
• Part V Gender, Sexual Orientation, and Development Status
• Part VI Looking Forward
• Name Index
• Subject Index