Male Psychotherapists Working with Female Clients in Female Dominated Environments

Understanding of anti-oppressive practice as this applies to the field of psychological therapy

Contents

Click to expand Contents

Introduction……………………………………………………………………………… p.5

Rationale………………………………………………………………………………… p.6

Part I. Literature Review

Search History…………………………………………………………………… p.7

Introduction……………………………………………………………………… p.7

Male motivations………………………………………………………………… p.8

Gender discrimination…………………………………………………………. p.9

Barriers encountered by male practitioners…………………………………. p.10

Female clients’ experience with male therapist…………………………….. p.11

Power vs. Anti oppression…………………………………………………… p.12

Conclusion……………………………………………………………………… p.14

Part II. Research Proposal

Research subject……………………………………………………………. p.16

Study design…………………………………………………………………… p.16

Sampling……………………………………………………………………….. p.17

Data collection………………………………………………………………… p.19

Pilot study……………………………………………………………………… p.21

Data analysis………………………………………………………………….. p.21

Validity and reliability………………………………………………………… p.22

Ethical issues………………………………………………………………….. p.24

Dissemination of findings…………………………………………………….. p.25

Decision making and accountability………………………………………… p.26

References……………………………………………………………………………… p.27

Appendix A……………………………………………………………………………… p.30

Appendix B……………………………………………………………………………… p.31

Appendix C……………………………………………………………………………… p.32

Appendix D……………………………………………………………………………… p.33

Introduction

Gender has always played an important part in counselling therapy. Female clients have not always had the chance to choose their therapists, the UK have faced many changes from the counselling services including counsellors’ gender. Although counselling and psychotherapy is essentially a female dominated career, there are a small percentage of male counsellors which have raised different opinions from staff and clients. However the ethos of counselling and especially the person centre approach advocates “clients’ centred care” which strengthens the foundation of this proposal. The proposed research study aims to identify the gap between the evidence and practice. The BACP, Counselling Directory, UKCP, and the CCPE strongly encourage counsellors and psychotherapists to empower clients in their choice of therapists by having registers where clients may have detailed information if their therapists to provide the best care they deserve.

The literature review clearly demonstrates a gap in male counsellors working with female clients in female dominated environments such as: family planning and fertility clinics or women prison, hence the need to implement the following research proposal. The author intends to conduct a quantitative study by using a survey as a data collection tool. The data collection and analysis will be carried out simultaneously by the author and a statistician to facilitate their interpretation and conclusion. In order to increase the credibility and accuracy of the data collection tool, a pilot study prior the main approach will be undertaken. The ethical requirements will certainly be considered in order to respect women’s informed choice, consent, confidentiality and anonymity.

Counsellors and psychotherapists are autonomous practitioners and must recognise their professional accountability and responsibility in their therapeutic relationships. Their techniques have an important influence and impact on clients’ therapeutic relationships and progress and therefore must be research evidence based.

Rationale

During the three years training as a trainee counsellor, the author had the great chance to work with counsellors and clients from different social, ethnic, culture, religious and even gender backgrounds.

Working as a male trainee counsellor has been a very interesting and an excellent opportunity to observe female clients towards male counsellors. Although the majority of female clients accepted working with male counsellors, few women requested to start or continue therapy with a female counsellor. According to Gehart and Lyle (2001), gender is an important but neglected variable. Clients may give many reasons for their choices of therapist mainly based on stereotyped views: men to perpetuate leadership values, or women to provide more nurturing kinds of skills. Therefore in order to make therapy a positive experience for female clients, the need to discuss their needs and accommodate as much as possible their choices is of paramount importance.

Some female clients request male therapists as they wish to build trust in men and need to experience a positive male role model. This need can start their healing process, from what they experienced at the hands of their fathers, brothers, lovers and husbands, be it physical, sexual or psychological abuse. Female clients wish to believe and behold a softer, nurturing, sensitive and understanding man to help restore their faith in men. This can be a huge responsibility on a male counsellor to represent a positive impression of the opposite gender, one in which the counsellor needs to be genuine and willing to be with their clients through their relationships with men.

The author will therefore review the literature to investigate male counsellors working with female clients in order for counselling services to offer and prepare the best care appropriate for all clients.

Part I. Literature Review

Search History

The literature was initially reviewed by using counselling and psychotherapy personal textbooks. The online libraries catalogues were then used and few books on gender in healthcare were handpicked. In addition, the electronic database such as BACP Dissertation database and the Counselling Directory, were used with the search terms: “male therapists” and “male counsellor”. The search was also limited by: full text electronic journals, full text, print titles held and available online and in English language in order to ensure the reader and author readily gain access to the articles.

Introduction

Prior writing a research proposal, a literature review should be performed. The literature review aims to identify and explore what other researchers have discovered in the domain of interest (Rees, 2011). It also allows the researcher to analyse the information and identify any gap in knowledge (Cluett and Bluff, 2006).

The author aims to survey male counsellors working with female clients in female dominated environments. The analysis will focus on the care women receive throughout the start, middle and /or end of their therapeutic experiences with male counsellors.

The author understands that there is a limitation of evidence in this specific area due to the recent historical changes regarding male and female therapists in counselling and psychotherapy which emphasises the need to implement this research proposal. Therefore, the literature review will be expanded to male psychologists and nurses working with female only clients and patients in female dominated environments. The literature review will cover the following themes: male motivations; gender discrimination and stereotyping in female dominated healthcare environments; the barriers encountered by male trainee and staff; female clients’ experience with male therapist, power vs. anti-oppression and the counsellor role.

Male Motivations

With the rising of male practitioners in female dominated healthcare professions, research has demonstrated that gender stereotyping and discrimination in relation to men in female dominated environment is still present today (Keogh and Gleeson, 2006 and Murnaghan, 2013).

According to Foster and Lasser (2010, p.153), “the terms sex and gender have distinct meanings many use the terms interchangeably creating much confusion about these important identifiers. The biological status of being male or female marks one’s sex. Gender refers to the traits that culture ascribes to the biological sexes”. Although counselling and therapy in female dominated environments (e.g. family planning and fertility clinic; female prison services) are associated with female therapists, few men choose to practice within these female dominated healthcare professions for various reasons. Some men choose such practices out of their love for their role as care providers (Inoue et al., 2006 and Huebner, 2007), whereas others justify their interests through the economical need, the professional challenge, stability of the profession with its benefits or as a second choice after failing other job application. Regardless the motives behind male counsellors’ choice to work with female clients, it appears that once in the profession, male healthcare professionals do not stay long in clinical settings and tend to leave soon after qualification (McLaughlin et al., 2010).

Gender Discrimination

The reasons why male counsellors do not stay in female dominated environments or even leave the world of therapy could be explained by their fear of gender bias, discrimination and stereotyping. It is evident that males and females are biologically different but many believe they are also different in their ways of caring which could lead them to gender discrimination defined as when a person “A” treats or would treat less favourably a person “B” on the ground of the sex (Great Britain, Sex Discrimination Act 1975, 1975).

In fact, Keogh and Gleeson (2006) demonstrate that gender discrimination in relation to men already starts within the educational programs. Male students have reported that being a minority within the group emphasises the feminine image of the profession implemented by the most groundbreaking counselling services created by women in the 60’s. However, since the Sex Discrimination Act (Great Britain, Sex Discrimination Act 1975, 1975) allows male to apply, train and practise as counsellor and psychotherapist, male students and staff therefore should not face discrimination within the institution or trust.

Nevertheless, it is important to highlight that due to the low number of male applicants; very few men become counsellor opposite to Psychiatry where there are more applicants and therefore more male psychiatrists especially in mental health.

The fact that male students and healthcare practitioners face stereotypes and discrimination during their academic and practice courses may contribute their will to emerge in management roles. According to BACP (Brown, 2017), male counsellors who enter in management emerge as top managers more often than women and amongst these top positionsas chief executive, vice president. Although men rise in management role, figures show a low percentage of women in these areas perhaps due to gender stereotyping or discrimination.

Barriers encountered by male practitioners

The literature review also highlights the barriers and difficulties encountered by male trainees and staff in the faculties and clinical settings.

Male trainee counsellors who choose female dominated careers often experience concerns from their entourage. Family and friends do not initially support the idea of their son and friend becoming a male counsellor working with female clients by fear of discrimination and stereotypes attached to the profession (Wilson, 2005). In addition to their fear of discrimination, family and friends base their concerns when discovering that counselling resources rarely if not never include or cover the historical contributions of male staff (Brown, 2017). Male trainee counsellors have also highlighted that counselling and psychotherapy lacked male professors and clinical instructors who they could relate to (Brown, 2017). Therefore male trainees found difficult to relate to other male health care professionals, a puzzling situation which highlights the importance of including male’s contribution in feminine dominated healthcare environments such as counselling and psychotherapy. However, such change can appear to be challenging. Male counsellors and psychotherapists represent a small numbers on the BACP register perhaps due to the fact there are a small number of male applicants for the course.

In addition to this, McLaughlin et al. (2010) expose the anti-male remarks made in class and clinical settings. Male counsellors working with female clients have often complained about their colleagues, tutors and clients opinions that wonder and question the rationale behind their motivations of working in female dominated environments. Therefore the reasons stated above could explain why male trainees do not complete the course, leave soon after registration or choose management roles.

Female clients experiences with male therapists

Today’s female clients’ opinions towards male counsellors and psychotherapists are still much divided. In 1975, Sher examined the counselling feedback of 36 college students at a university counsellor centre. This study shows that there are no important differences in the student’s rating that are associated with sex of clients. However, Person et al (1974) investigation which included male and female student counsellors exposed conflicting results. Their study demonstrated that therapists and clients from the same gender share more positive feedback. Similarly, Howard et al. (1970) research reported that women who were seen by a female therapist demonstrated greater positive experience and feedback opposite to those who were seen by a male therapist. In addition, male therapists have often disclosed seeing unpleasant reactions from their female clients and colleagues. The study also demonstrated that female therapists had greater and more successful therapeutic relationship with female clients who were single and depressed. Furthermore, Gehart and Lyle (2001) explain that there are still occasions when differences of gender are an obstacle between the client and the therapist even if the counsellor is very experienced. Therefore the debate of whether a male therapist can really understand his female clients is still open (Felton, 1986).

The real reasons for clients to choose their therapists are quite vague. In 1979, Feldstein was one of the first researchers who developed an interest in studying whether sex or gender has a crucial importance in the therapeutic relationship. In his study, 84 undergraduate college students were randomly separated into 4 different groups (determined by their gender identity) and asked to attend counselling therapy. Opposite to the previous study, results shown that male clients shared more therapeutic information to feminine female therapist opposite to male therapists. Also, it appears the study shown the same results regarding female clients who disclosed more information to male therapists. The feedback clients expressed were that male therapists were more assertive, controlled and action oriented whereas feminine therapists were projected more supportive and emotional. Therefore clients that perceived empathy from their therapists were more initially active in the therapeutic process, facilitating a strong therapeutic relationship much sooner than those who perceived their therapist to be more direct.

Unfortunately, very few studies have looked at client perceptions of gender after treatment has been completed. In an attempt to increase external validity, Lyddon and Henderson (1997), attempted to assess the gender role’s importance once clients were discharged from therapy. The study looked at 57 clients who volunteered to be part of the study. They were asked to complete a demographic and attitudes towards women form preceding therapy. Once the therapy was completed, they filled a therapist rating form. As seen in previous studies, male clients did not rate their therapists as positively compared to female clients, although female clients shared more information and were more open in the therapeutic relationship regardless the therapist’ gender. These findings suggest rapport and relationship building may need to be more of a priority with female clients 1.10

Power vs Anti-oppression

One cannot discuss about male / female relationships without mentioning “power”. White (1990) explains that power is not simply a technique used by the powerful to oppress those beneath them, but a set of techniques used through the implementation of institutional “norms” leading people to believe they are guardians of their own behaviour. He also explains that very often in male / female relationship the men is more often the instruments of the normalising gaze opposite to the female seen more often as their objects. Counselling like other fields very often involves male / female relationships. Counsellors, psychotherapists and clients have a unique relationship in which the quality, level of intimacy and sense of personal connection may vary. Counsellors and psychotherapists always aspire towards an anti-oppression approach in their therapeutic work and have positively evolved over the century.

Many years ago, the interaction between the therapist and the client was very little. The clients did not have much choice in their therapists and were expected to discuss their issues with very minimum feedback from their therapist apart from few sign of comments. However, today’s therapy has changed where the relationship between the therapist and clients is more collaborative. Although therapists are trained to hear many kind of issues, clients have not often heard of counselling and do not know what to expect which makes them to believe discussing their issues with a stranger very strange, daunting leading them to worry and fear to feel judged or uncomfortable. Therefore it is of primordial importance that counsellors receive appropriate trainings promoting different types of therapeutic approach whether it is person centred (Carl Rogers), Psychodynamic, Gestalt C.B.T etc….

Although it is very important for counsellors to be aware and able to practice different of therapeutic approaches, it is far more crucial that today’s therapists are able to continuously conduct a non-judgmental and anti oppressive approach during their therapeutic sessions. In today’s world were violence and hate are always of actuality, vulnerable clients need to feel valuable and most importantly listened to without feeling or noticing that what bothers them is wrong or abnormal. Therapists have the responsibility and duty of care to all clients regardless their gender, social and economical background, age, ethnicity, religion or even sexual orientation. They must abide by the BACP Ethical Code of conduct which highly promotes anti-oppressive behaviour.

Personal opinions and thoughts are not to be shared as they will have no therapeutic values for clients who seek help and support. Furthermore, it is for these reasons that all counsellors and therapists must attend supervision and personal therapy as often as they can in order to feel the clients’ feelings of being in therapy. This suggests the therapist to be able to enable the clients to discuss feelings and thoughts rather than focusing upon the clients issues. These skills will not diminish the abilities of the counsellor in any way, on the contrary, they will be the basics tools of building an alliance between the therapist and the clients in order to work together towards common goal. (Fowler,  2016) 1.9

Conclusion

Although the recent re – entrance of men into counselling, the literature review has conveyed an overview about male therapist working with female clients in women dominated environments. Male therapists have and are still facing gender discrimination, stereotyping and barriers from staff and female clients which lead them towards management roles. However, considering their low numbers, the majority of female clients have generally a positive opinion about male counsellors and would not mind seeing them although few researches show they would rather see a female therapist for diverse reasons. Regardless their gender, counsellors and psychotherapists are clients’ advocates, therefore must respect their choices and accommodate their needs. Counselling and Psychotherapy which finds its roots with Sigmund Freud has witnessed and experienced significant changes over time, especially with the entrance of female therapists. The world of counselling and psychotherapy will still continue to change and care for all clients whether they are male or female 1.8

Based on the explored and exposed literature review, the researcher has identified gaps in male therapists working with female clients in women dominated environments. As a result, the author would like to propose the following research study.

Part II. Research Proposal

Research subject

Female clients’ opinions of male therapists working with female clients in female dominated environments.

Study design

According to Rees (2011) qualitative research captures data through dialogue which mainly provide descriptive information, whereas quantitative designs wish to answer a specific question by finding a relationship between variables. In quantitative research, the numerical data are measured statistically to either prove a cause and effect between variable or demonstrate a null hypothesis (Matlby et al., 2010). The author will therefore conduct this research study by using a quantitative approach to assess women’s views of male counsellors working with female clients in female dominated environment.

In order to do so, the author will use a social survey in the form of questionnaire (Appendix D). Descriptive surveys appears to be the most suitable to answer the research question as they allow the observation of a certain phenomena from a chosen population generating descriptive measures (Bowling, 2009). Although surveys are very common in quantitative studies, they tend to be very descriptive and heavily depend upon the participants’ reliability (Polit and Beck, 2010). However, this study design has the advantages to be easy to complete for the participants, extract data for the researcher and economical (Baldwin, 2011). The uses of surveys also allows the generation of numbers which after collection and analysis will create statistics (Grove et al., 2012). These statistics applied to the general population will then emphasise the study’s strength (Gerrish and Lacey, 2010) whereas a qualitative approach will focus on the depth of narrative and subjective participants’ experience (Polit and Beck, 2010)

Sampling

As part of the methodology, sampling is one of the most important and influential aspect of the study (Polit and Beck, 2010). According to Matlby et al. (2010), the sample is a group of selected people from a population which has for purpose to represent it. Qualitative and quantitative approaches have two distinct different sampling methods.

For the purpose of this quantitative study, a consecutive sampling approach will be chosen. Considering the potential bias factors, the author intends to send invites in the study to the participants from an accessible population over a fixed period (Polit and Beck, 2010). By doing so, the author aims to greatly reduce the risk of bias. Other sampling approaches such as non-probability sampling methods will not suit the research proposal due to the fact they are less likely to produce representative samples and therefore not able to provide a probability (Polit and Beck, 2010) 1.1

The target population for this proposal is female clients attending counselling in a female dominated clinical practice. The reason of choosing female dominated environments is because the female clients do not often expect to see or imagine a male counsellor providing therapy for them in such female dominated environments. Throughout the booking female clients do not necessarily ask who the counsellor is and therefore attend the session assuming it would be a female therapist. As a result, the beginning and the end of therapy will be the ideal time to collect women’s views of male therapists working with female clients in female dominated environments.

In this research study, the author will have an initial sample size of 500 participants. Although this may seem large, sample size in quantitative methods are generally abundant in comparison to qualitative studies. According to Gerrish and Lacey (2010) a large sample size reduces the possibility of errors, gives and generates scientific results crediting the validity of the study. In order to design the sampling method, collect and analyse the data the author will consult a statistician who is an expert in quantitative studies. The sample will also involve inclusion and exclusion criteria to either “include” participants in the study or “exclude” them if they do not possess the inclusion factors (Grove et al., 2012). Quantitative research aims to generalise the data it collects opposite to qualitative studies which aim to gain an in depth understanding of a phenomenon (Matthews and Ross, 2010). However this can only be achieved if the author accesses participants and encourage them taking part in the study in order to increase response factor. 1.2

Therefore the researcher intends to contact counsellors via an internal e-mail (Appendix A) to ask their participation in the research. The author aims to explain the purpose of the research and how important is their participation for its success. Counsellors will be asked to accurately mention the study to the women they are seeing during their therapeutic sessions with their clients. If the appointments are set in a clinical environment, the researcher intends to place posters on the wall of the clinic to attract women’s attention and at the same time to remind the counsellors of the study. An information sheet will be provided to participants who are interested in taking part in the research (Appendix B) and for those who agree, a consent form will be given to sign and return to the researcher (Appendix C).

Data collection

Researchers who perform quantitative studies have often already prepared their data collection process prior conducting the research (Rees, 2011). According to Grove et al. (2012) a data collection is a method which has for purpose to gather all the data and present them in a form of statistics in order to answer the research question. One of the most common data collections in quantitative research is the use of surveys whether through interviews or forms of questionnaires (Bowling, 2009)

Cluett and Bluff (2006) define surveys as a non-experimental approach used to gather, analyse and interprete descriptive data from a target population. According to (Steen and Roberts, 2011, p. 93) carrying out a survey will involve the 12 following steps:

1. Define the problem
2. Choose those to survey
3. Choose the type of question
4. Design the questionnaire
5. Undertake a pilot survey
6. Make amendments and update the questionnaire
7. Undertake the main study
8. Commence data entry
9. Follow up non-response
10. Check the data input for errors
11. Analyse the data
12. Present the findings

In order to amplify the value and importance of quantitative studies, researchers need to invest most of their time and efforts in two aspects of the approach: the quality of the sample and the design of the survey questionnaire (Manning and McMurray, 2010). With the sampling method previously discussed, the author aims to design an appropriate and suitable questionnaire for the study (Appendix D). Although interviews allow depth in participants’ answers, this type of survey method will not suit this study due to the large sample size and lack of resources. Questionnaires have the advantages to be suitable for large sample size, easy to complete and analyse, and inexpensive (Gerrish and Lacey, 2010).Therefore, for the purpose of this study, the author will use a survey in a form of questionnaire which will include open and closed questions and ranking lists to evaluate women’s views of male therapist working with female clients in female dominated setting. By doing so, the researcher will be able to collect data more effectively, in a standardised manner and therefore to measure the different aspects of the participants’ answers (Gerrish and Lacey, 2010) 1.3

In addition, questionnaires are one of the best method to protect participants’ identity and therefore enhances the confidentiality aspect of the study, however with the rise of technology, more and more researchers use internet for their on-line questionnaires compared to the traditional postal survey (Steen and Roberts, 2011). Although on-line surveys are cheaper they require participants’ e-mails address who may not see the survey due to their e-mail account settings. Consequently the author of the study will use the common postal survey in order to maximise participants’ access to the questionnaire and therefore their responses. The author will also add the information sheet to the questionnaire reminding them the purpose of the study and their possibility to withdraw at any time. A prepaid envelope with the researcher’s address contact details will also be provided for the return of the questionnaire.

Pilot study

According to Steen and Roberts (2011), a pilot study is a trial run of the research study but on a smaller scale. Although it can be done for a qualitative or quantitative, pilot studies are highly recommended to resolve any doubts in the steps encountered by the researcher such as question applicability (Manning and McMurray, 2010). Their purposes are to assess the research design in order to evaluate any issues and make appropriate improvements prior conducting the main study. Therefore the researcher will perform a pilot study on 50 women booked by another similar counselling service to avoid contaminating the main sample. However prior conducting the pilot study, the author will certainly gain ethical approval and informed consent from participants.

Data analysis

Following the data collection is the data analysis. According to Gerrish and Lacey (2010) data analysis is the most intellectually challenging step of the study. It involves data examination, conversion and interpretation by the researcher in order to provide sound and logical information (Rees, 2011). The data transformation requires editing and coding which can be performed via the use of statistical tools (Rees, 2011).

However it is important to highlight that there is a chance participants may not fully complete the questionnaire. Participants who do not answer all the questions create missing data. Although 5% of missing data is considered acceptable, the author intends to disregard the questionnaire if more than 5% is missing (Manning and McMurray, 2010)

For the purpose of this study, the author aims to work with a statistician who is an expert in data collection and analysis. With the statistician’s knowledge and expertise, the author will appropriately enter the collected data using a Statistical Product and Service Solutions (SPSS) statistical package to create composite variables and perform a descriptive analysis (Saks and Allsop, 2013). The descriptive analysis performed by the computer program permits the transformation of pure data into information which will ease interpretation and understanding (Rees, 2011). It involves statistical tests and other calculation techniques to present the data under means, averages, frequency and percentage distributions (Saks and Allsop, 2013). Although the data are summarised and presented as statistics, their analysis and interpretation are still the author’s duty and responsibility. 1.8

The researcher may present the data in different ways. Quantitative studies often display tables and charts to present their findings in order to facilitate their interpretation and understanding (Rees, 2011). It also allows the reader to have a picture of the data and therefore a descriptive summary. The author intends to use score and average for means and medians and table and histograms to present frequencies through data on categorical scale of measurement. Cross tabulation will also be used to introduce relationships between two or more chosen variables in addition with graphs which will demonstrate standard deviation and correlation (Manning and McMurray, 2010)

It is after data collection, analysis and interpretation that the author will establish an answer to the research question.

Validity and reliability

As part of a quantitative study research critic, validity, reliability and generalisation are important aspects along with bias and rigour.

According to Matlby et al. (2010) validity relates to procedures used by the researcher to measure the variables from the experiment. Although the instruments used in the study may not be involved in the study’s validity assessment, researchers often defined validity as “accuracy” highlighting the credibility of measurements from instruments (Matlby et al., 2010). Therefore, to optimise the study’s credibility the author will mention the importance of honesty in participants’ answers. Also, in order to increase the study’s accuracy, the author will decrease the bias factor of the research by not having preconceived ideas during the data analysis (Rees, 2011). However, Rees, 2011 argues that validity in quantitative studies is difficult to achieve although researchers ensure the measurements from the method tool correspond to the believed measurements of the researcher.

The reliability yet refers to the instrument’s ability to provide the same results if same tests were performed by another researcher (Baldwin, 2011). In research, it is crucial to have efficient and consistent measurements from the instruments used during the data collection process as they will relate to the study’s stability (Rees, 2011). Therefore, the author will integrate in the questionnaire few questions similar to each other regarding a specific topic in order to achieve similar results and therefore enhance reliability. The author will also look at the correlation between variables in order to measure the consistency of the study and consequently assess its reliability (Manning and McMurray, 2010)

Finally, the generalisability of a quantitative study allows the conclusion. The term is defined as a “measure of the extent to which research findings based on a sample in one organisational context can be applied to other similar settings” (Manning and McMurray, 2010, p.42). The findings from the data collection and analysis will be expended to a larger population from which the sample was taken (Manning and McMurray, 2010). Therefore results would gain more value if they could be generalised from a context to another hence the importance of good quality controlled random sampling method. Although, random sampling methods are associated with errors (Baldwin, 2011), the author intends to control and limit the chance of error by developing a logical research sample method prior undertaking the study

Ethical issues

Another important aspect of research is ethics, especially when it involves human participants (Steen and Roberts, 2011). It is obvious evidence, the researcher must obtain approval from local research ethics committees in order to protect and secure the wellbeing of those who are willing to take part in the study (Matlby et al., 2010). The rationale behind ethical approval is based on the fact previous research studies raised serious concerns as they were not done with integrity (Gerrish and Lacey, 2010). Therefore the ethical framework that the researcher needs to follow must include “beneficence” and “non-maleficence” (Lo, 2010). Beneficence is defined as good actions aiming to do good for the benefit of the patient whereas “non-maleficence” are those which may unintentionally harm the patient (Lo, 2010) 1.4

In order to respect these two valuable ethical principles, the researcher intends to explain and provide all the information regarding the study so that an informed consent may be obtained by participants. Although a consent form to sign and return will be given to participants (Appendix C), it will also inform participants that the possibility to withdraw from the research study will be available at all times giving them autonomy and freedom of choice.

In addition, as part of the ethical code, all data and information collected by the researcher will be accessed, secured and safely stored by the author in order to protect participant’s identity and therefore maintaining confidentiality (Baldwin, 2011). This research proposal has the advantages to have a large sample size and use surveys. These two strengths highly increase participants’ anonymity opposite to qualitative studies which have small sample size, use face to face interviews or diaries and therefore do not optimise participants’ confidentiality (Rees, 2011) 1.5

Dissemination of findings

As previously mentioned, the purpose of this study is to present women’s views of male therapists working with female clients in female dominated settings. The rationale behind this research proposal is to increase knowledge about male therapists and indirectly other male healthcare providers in order to provide the best and most appropriate care to all female clients during their therapeutic journey. Considering the poor literature review regarding male therapists in the UK, it is hoped that this research will fill the gap.

The author believes the study will also be a strong benefit to counselling services and contribute to the generation of more research in this area. With more knowledge in this domain, counsellors and psychotherapists will be able to discuss more efficiently their counselling services with women and therefore be able to accommodate their needs and choices. The other advantages of conducting this study would be to increase women’s awareness about male counsellors and indirectly other male healthcare professionals who would potentially be involved in their care. By doing so, women would be able to ponder and psychologically prepare themselves about the possibility of having a male healthcare provider attending them.

With this in mind women will be capable of making informed choices and consequently either accept or decline their care. Regardless women’s decision, this research study will certainly remind all counsellors of their roles as clients’ advocate. Counsellors and psychotherapists have duty of care to all clients including women and this research proposal aims to highlight counsellors’ accountability to listen to their clients’ needs and respect their choices without judgemental behaviour.

The author intends to present the research findings throughout a viva to the members of the multidisciplinary panel of the counselling services undertaking the study. It will be then highly valuable to publish the results in therapeutic journals and governmental organisation websites available for clients in order to reach counsellors and all clients. 1.6

Decision making and accountability

According to the BACP, counsellors have the responsibility and duty of care to all clients throughout their therapeutic relationship. In order to do so, counsellors’ decisions and therefore practice must be upon the most evidenced based research (Craig, 2011). As a result, it is essential for therapists to be able to read, understand and critically analyse published studies. With the most updated evidence practice, counsellors will be able to make appropriate therapeutic approaches and therefore provide gold standard care to all clients. 1.4

From this research, it appears women’s views and attitudes towards male healthcare providers are much divided. Nevertheless, counsellors are accountable to all clients and respecting and accommodating women’s choices is part of their responsibilities. In addition to women, counsellors are also accountable to the BACP and must think, act and behave in accordance with the BACP professional Code of Conduct by respecting the training, the practice and supervision. It is by listening to clients, discussing their therapy with them, and following the therapeutic approach necessary for them that counsellors will provide the gold standard individualised care that all clients deserve. 1.6

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Appendices

Appendix A

e-mail to counsellors

From: Counsellor Anonymous

To: Counsellor at the counselling service

Subject: Research study: women’s view of male counsellors working with female clients in female dominated setting.

Attached documents: Research study information sheet

Consent form for participants

Body of the e-mail:

Dear Counsellors

There is currently in this Counselling centre a study upon women’s view of male counsellors working with female clients

The research proposal aims to explore and understand women’s attitudes towards male therapists (along with other male healthcare providers) such as either their acceptance or decline of care.

The author intends to use a survey which will be sent by post to participants willing to take part in the study.

The research is interested in motivated newly qualified and experienced counsellors who are willing to take part in the study and currently working at the counselling centre. Counsellors will be encouraged to discuss the study female clients at the beginning and end of their therapeutic journey and provide the information sheet and consent form attached to this e-mail.

If you are interested or would like more details about the research proposal, please do not hesitate to contact the author of this e-mail via the contact details below.

Mr. Counsellor Anonymous

e-mail: counsellor.anonymous@counsellor.centre.co.uk

Mobile number: 077xxxxxxxx

Looking forward hearing from you.

Kind Regards

Counsellor  Anonymous.

Appendix B

Research study information sheet

The following research study is being carried out by Mr. Counsellor Anonymous: qualified and registered counsellor at Counselling centre.

Research proposal: Women’s view of male counsellor working with female clients in female dominated environments.

The purpose of the study is to present to counsellors women’s view of male therapists (along with other male healthcare providers) and to increase clients’ awareness about male therapists and other male carers who would be involved in female clients’ care.

In order to conduct the study, participants will be asked to honestly complete a questionnaire which will be sent by post. Once completed, the information will be accessed and safely stored by the researcher so that participants’ anonymity and confidentiality are respected at all times.

Finally, women’s participation is purely voluntarily and possibility to withdraw from the study will be available at all times.

Looking forward your participation

Many thanks

Kind Regards

Mr. Counsellor Anonymous

Appendix C

Consent form for participants

Please tick as appropriate.

Title of research proposal: Women’s view of male counsellors working with female clients in female dominated environments.

I confirm that I have read and understood the above information sheet based on the above study:                                                            Yes                       No

I have had the opportunity to discuss any issues regarding the study and my participation.

Yes                        No

I understand that my participation is on a voluntary basis and that I may withdraw at anytime without giving any reason.

Yes                        No

I agree to take part in this study.                  Yes                        No

Signature of Research Participant                                                       Date  __ / __ / __

Signature of Researcher                                                                      Date  __ / __ / __

(Example taken from Matthew and Ross (2010))

Appendix D

Survey participants will receive by post.

1. Which category of age found below do you belong?

16-19

20-24

25-29

30-35

35-39

40+

2. What is your ethnicity?

White – English / Welsh / Scottish / Northern Irish / British

White – Irish

White – Gypsy or Irish Traveller

White – Any Other White background

Mixed / Multiple ethnic group – White and Black Caribbean

Mixed / Multiple ethnic group – White and Black African

Mixed / Multiple ethnic group – White and Asian

Mixed / Multiple ethnic group – Any Other Mixed / multiple ethnic background

Asian / Asian British – Indian

Asian / Asian British – Pakistani

Asian / Asian British – Bangladeshi

Asian / Asian British – Chinese

Asian / Asian British – Any other Asian background

Black / African / Caribbean / Black British – African

Black / African / Caribbean / Black British – Caribbean

Black / African / Caribbean / Black British – Any other Black / African / Caribbean background

Other ethnic group – Arab

Any other

Not known/not provided

Other (please specify)

3. How many children do you have?

None (currently pregnant)

1

2

3

4

5+

4. How likely would you be to accept a male counsellor at the beginning of therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

5. How likely would your partner be to accept a male counsellor at the beginning of therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

6. How likely would you be to accept a male counsellor during therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

7. How likely would your partner be to accept a male counsellor during therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

8. How likely would you be to accept a male counsellor after therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

9. How likely would your partner be to accept a male counsellor after therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

10. Are your previous answers inspired from a previous experience with a male healthcare provider?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

11. Would the opinion of your partner influence your decision to accept or decline care from a male counsellor at the beginning and end of therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

12. Would the opinion of your partner influence your decision to accept or decline care from a male counsellor after therapy?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

13. Would your view change in times of crisis counselling?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

14. If given the choice, would you accept care from a male counsellor?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

15. How likely would you feel comfortable with a male counsellor?

Highly likely

Likely

Neutral

Unlikely

Highly unlikely

(Survey inspired from survey: Attitudes towards male midwives, available at: http://surveymonkey.com/s/6ZFJDTM (Accessed: 28/04/13))