APA Guidelines for Psychological Practice with Girls and Women

APA | Guidelines for Psychological Practice with Girls and Women I

APA GUIDELINES

for Psychological Practice

with Girls and Women

FEBRUARY 2018

II APA | Guidelines for Psychological Practice with Girls and Women

acknowledgment is given to the American Psychological Association. This material may not be reprinted, translated, or distributed electronically without

prior permission in writing from the publisher. For permission, contact APA, Rights and Permissions, 750 First Street, NE, Washington, DC 20002-4242.

This document was approved by the APA Council of Representatives over the course of its meeting February 2018 and is set to expire in approximately

2028. It is available online at http://www.apa.org/about/policy/psychological-practice-girls-women.pdf.

Suggested Citation

American Psychological Association, Girls and Women Guidelines Group. (2018). APA guidelines for psychological practice with girls and women. Retrieved

from http://www.apa.org/about/policy/psychological-practice-girls-women.pdf

APA GUIDELINES

for Psychological Practice

with Girls and Women

FEBRUARY 2018

APA | Guidelines for Psychological Practice with Girls and Women 1

INTRODUCTION

During recent decades, girls and women of diverse ethnicities and races, abilities, social

classes, sexual orientations, gender identities, and life experiences have encountered dra-

matic and complex changes in education, work, reproductive and caregiving roles, and per-

sonal relationships. Many of these changes have yielded increased equality, improved

opportunities, and enhanced quality of life. Still, girls and women continue to face challenges

and concerns that warrant the revision of the 2007 APA Guidelines for Psychological Practice

with Girls and Women in a way that takes these challenges into consideration.

Life experiences and contexts that continue to pose risks for girls and women are import-

ant for psychologists to understand, as they influence treatment, research, and psychologists’

views of what are strengths and what qualifies as resistance. Of note, in some cultures, resis-

tance is a healthy response to oppression. Particularly notable experiences and contexts

include interpersonal violence, unrealistic and stereotypical media images of girls and women,

discrimination and oppression, devaluation, limited economic resources, role overload, rela-

tionship disruptions, and work inequities. These contexts sometimes affect women of diverse

identities differently. We offer a brief review of some notably salient scholarship below with

an understanding that in a brief review, all identities, contexts, and life experiences of half the

population cannot be adequately represented, so we refer readers to an accompanying mono-

graph representing the comprehensive literature reviews completed to undergird and inform

the revision of these guidelines.

Violence and sexual violence against girls and women continue to occur with great fre-

quency. For example, United Nations data (2008) indicates that 70% of women experience

some form of violence in their lifetime, with more recent research estimating this figure at

90% for the United States (U.S.) (Kilpatrick et al., 2013). About 1 in 5 women are raped at

some point in their lives, most often by a male acquaintance or intimate partner (Black et al.,

2011); 1 in 4 college women experience sexual assault (Cantor, 2015); and girls are more likely

to have experienced sexual abuse in childhood than boys (Finkelhor, Shattuck, Turner, &

Hamby, 2014). Long-term effects of child sexual abuse in women include dissociation, soma-

tization, anxiety, depression, suicidality, substance use problems, and eating disorders (Briere

& Jordan, 2009; Briere & Scott, 2014). In addition, girls who experience abuse may be at risk

for experiencing additional trauma in adulthood (Parks, Kim, Day, Garza, & Larkby, 2011). Girls

frequently experience sexual harassment in schools (Hill, C. & Kearl, H.,, 2013) and physical

abuse in their dating relationships (Rennison & Addington, 2014). Women experience inti-

mate partner violence more frequently than men, and such violence is often preceded and/or

2 APA | Guidelines for Psychological Practice with Girls and Women

accompanied by psychological abuse (e.g., jealousy, controlling

tactics, verbal abuse; Breiding, Chen, & Black, 2014). Experiencing

any interpersonal violence is especially prevalent among women in

the military (Suris & Lind, 2008; Turchik & Wilson, 2010), adoles-

cent girls (Black et al., 2011), girls and women of color (Hien &

Ruglass, 2009), girls and women who are refugees (Bjӧrn, Bodén,

Sydsjӧ, Gustafsson, & Gustafsson, 2013; Grabska, 2011) and trans-

gender women (Human Rights Campaign, 2015). Elder abuse is

more common among women than men, with 22% experiencing

violence and 18% experiencing intimate partner violence after the

age of 65 (United Nations, 2013). In China, Israel, and the European

Union, research shows being female is one of the risk factors for

elder abuse (United Nations, 2013). Enduring interpersonal vio-

lence is associated with a range of health outcomes, such as

depression, post-traumatic stress disorder, chronic health prob-

lems, and physical injuries (APA, 2017a; Eshelman & Levendosky,

2012; Humphreys & Lee, 2009).

There are several kinds of stressors recently identified that have

a unique impact on women throughout their lifespans, most notably

social network–related stress and unemployment because of their

links to depression (Kendler & Gardner, 2014; Van Praag, Bracke,

Christiaens, Levecque, & Pattyn, 2009). Differences in sex role ori-

entation affect women’s coping styles and mental health (Lipińs-

ka-Grobelny, 2011; Nasit & Desai, 2014). The stress that accompanies

racial discrimination appears to have a particularly adverse impact

on the mental health of African American women (Greer, Laseter, &

Asiamah, 2009). This is also true for LGBTQ individuals (Balsam,

Molina, Beadnell, Simoni, & Walters, 2011). Additionally, race- and

gender-related discrimination exacerbate responses to other types

of stressors (Perry, Harp, & Oser, 2013). Multiple roles and role over-

load have been named as stressors for women (Glynn, Maclean,

Forte, & Cohen, 2009); for women who leave the workplace, the

same stressors can contribute to difficulties in re-entry (Lovejoy &

Stone, 2011). Women who occupy multiple roles often take home the

message that they should not “stress” and that they should learn to

“juggle” better, as Abrams and Curran (2009) found when they inter-

viewed low-income mothers. Finally, gender inequities are among

the many factors that affect women’s health and mental health

adversely (Gahagan, Gray, & Whynacht, 2015; Hawkes & Buse, 2013),

and therapists must recognize this fact if they are to do more than

help women adjust to the status quo.

Unrealistic and stereotypical media images of girls and women

continue to be of concern to psychologists and intersect in various

ways with girls’ and women’s vulnerabilities around self-esteem,

eating disorders, depression, sexual development, general well-be-

ing, and feelings of belonging (Allen & Gervais, 2012; Balantekin,

Birch, & Savage, 2017; Damiano, Paxton, Wertheim, McLean, & Karen,

2015; Murnen & Smolak, 2013; Rodgers, Wertheim, Damiano, Gregg,

& Paxton, 2015; Ward, 2016). In Western media, women and girls are

pervasively exposed to messages that encourage an appear-

ance-based appraisal of social worth (Mischner, van Schie, & Engels,

2013). Stereotypes and media representations affect girls and

women of various races, ethnicities, and sexualities, and those with

disabilities. As one example, stereotypes of veiled Muslim women in

the U.S. and Europe present a daily stress to girls and women (Everett

et al., 2015).

Although overt forms of sexism and racism may have appeared

to have decreased over time (Sue, 2010), more recently, a resurgence

of overt racism and sexism is apparent nationally and globally (Bock,

Byrd-Craven, & Burkley, 2017). Researchers have noted the effects of

political changes on individuals (Hatzenbuehler, Keyes, & Hasin,

2009) and documented the continuing presence of more subtle

forms of sexist and racist bias (e.g., microaggressions; Sue, 2010).

Women with diverse marginalized identities, such as bisexual, les-

bian, queer, and transgender women; women of color; and low socio-

economic class women face stressors that can result in considerable

psychological distress (Balsam et al., 2011; Chaney, 2010). Women

of color suffer from at least two intersected sources of discrimina-

tion—gender and race/ethnicity—and therefore are multiply margin-

alized (Carbado, 2013; Cho, Crenshaw, & McCall; 2013; Comas-Díaz

& Greene, 2013; Enns, Rice, & Nutt, 2015). Within the medical sector,

researchers have identified the influence of health care providers’

biases in perpetuating health care disparities among racial and gen-

der minorities (Chapman, Kaatz, & Carnes, 2013; Fitzgerald & Hurst,

2017; Igler et al., 2017).

Women’s friendships are important and continue to provide

them solace, support, and help in living happier lives (Comas-Díaz &

Weiner, 2013; Rose, 2007). Girls also tend to have supportive friend-

ships, notably more supportive friendships than boys, characterized

by equality, self-disclosure, and empathy (De Goede, Branje, &

Meeus, 2009; Rose et al., 2012). But difficulties in girls’ and women’s

relationships can engender and/or exacerbate mental health issues.

Researchers have demonstrated that the display of relational aggres-

sion is related to girls’ attempts to seek power and feel powerful in

ways that are deemed acceptable to society’s definition of what is

feminine—that is, in horizontal ways toward other girls, a safer target

than boys, adults, or unfair policies and practices (Brown, 2016).

A key factor that affects mental health for women, consistent

across heterosexual and same-sex relationships, is relationship qual-

ity (Leach, Butterworth, Olesen, & Mackinnon, 2013; Todosijevic,

Rothblum, & Solomon, 2005; Uecker, 2012). Relationship quality is

related to both positive and negative aspects of mental health, such

as depression, substance abuse, anxiety, and personal well-being for

both women and men (Barr, Culatta, & Simons, 2013; Proulx, Helms,

& Buehler, 2007; Whisman, 2013), but women, compared to men, are

more vulnerable to interpersonal stressors and they may be more

affected by decrements in relationship quality (McBride & Bagby,

2006; Whitton & Kuryluk, 2012).

Although overall, legal marriage confers greater mental health

benefits to all couples than to their counterparts not in legal mar-

riages (Wight, LeBlanc, & Badgett, 2013), relationship status alone

(e.g., married, dating, cohabitating) is not sufficient to understand

mental health among women in an intimate relationship. Marriage

equality is currently protected by federal law in the U.S., but lesbian/

queer couples and their families continue to experience the psycho-

logical effects of discrimination against same-sex marriage and the

withholding of legal and medical protections for same-sex families

(e.g., adoptive parent protection).

As women continue to be primary caregivers of children, it is

important to note that transition to motherhood for many women is

difficult and that most couples experience an increase in conflict as

well as a decline in relationship satisfaction after the birth of their first

APA | Guidelines for Psychological Practice with Girls and Women 3

child (Doss, Rhoades, Stanley, & Markman, 2009; Lawrence, Roth-

man, Cobb, Rothman, & Bradbury, 2008; Mitnick, Heyman, & Smith

Slep, 2009). For many women, there is a disconnection between the

discourse around the joys of motherhood and the lived experience of

parenting (Mollen, 2014). Moreover, the discourse may serve as a

way to cope with the strains and disappointments of parenting

(Eibach & Mock, 2011a; Eibach & Mock, 2011b). There continue to be

age penalties for motherhood in the workplace (Budig & Hodges,

2010) that affect women’s well-being.

Women are also overrepresented in caregiver positions for their

male partners, particularly during midlife (Glauber, 2017), and are

more likely than other women to be in a sandwiched position of car-

ing for children and elderly simultaneously (Suh, 2016). Primary

informal caregivers tend to be women (e.g., unpaid providers of care),

many of whom balance caring for their parents, parents-in-law, part-

ners, and friends, while simultaneously working full-time or part-

time (Lin, Fee, & Wu, 2012). Women of color are especially likely to

serve in filial caregiving roles (Miyawaki, 2016). Numerous research-

ers have found that caregivers experience significant emotional,

physical, and financial stresses (Penning & Wu, 2015). Nearly 10

million American women are caregivers of elderly people with

dementia who often experience significant stress with that respon-

sibility (Zauszniewski, Lekhak, Yolpant, & Morris, 2015).

Engaging in satisfying work is related to both positive mental

and physical health (McKee-Ryan, Song, Wanberg, & Kinicki, 2005;

Swanson, 2012) and is valued by many women for reasons beyond

the financial benefits it accords (Weisgram, Bigler, & Liben, 2010).

Basford, Offerman, and Behrend (2014) found that both women and

men could identify gender-based microaggressions directed partic-

ularly toward women in the workplace. Sexual harassment continues

to be a significant problem in workplace and educational settings

(Quick & McFadyen, 2017; Rosenthal, Smidt, & Freyd, 2016). In addi-

tion to sexual harassment, gender inequities in the workplace also

affect women’s health adversely (Stamarski & Son Hing, 2015). Mul-

tiple roles with regard to work and family are exacerbated for women

who are under financial stress. For example, chronic work, financial,

and caregiving stressors for Mexican American women are associ-

ated with physiological dysregulation (Gallo, Jimenez, Shivpuri, Espi-

nosa de los Monteros, & Mills, 2011).

While this brief introduction cannot do justice to all the research

on girls and women and their intersecting identities to which these

practice guidelines should be responsive, there are several groups

that deserve special attention given continued invisibility in the liter-

ature and/or a current focus based on need: gender-nonconforming

identities, older women, female veterans, and girls and women with

disabilities. We refer readers to an accompanying monograph for

research on other identities and on particular disorders not ade-

quately described in this introduction.

Currently there is a dearth of research examining transgender

women regarding mental illness or maladjustment. However, as

noted by the American Psychological Association (APA)(2015a),

the etiology of mental health problems may or may not be linked

directly to a person’s gender identity but to pervasive experiences

of minority stress. Transgender and gender-nonconforming individ-

uals are at increased risk for suicide attempts (i.e., 41% as com-

pared to 1.6% in the general population), in part because of

bias-related experiences such as sexual and physical victimization

(Grant et al., 2011). Transgender women and feminine-of-center

individuals who were assigned male at birth are impacted by heav-

ily gendered societal pressures.

Psychologists and members of the public tend not to be aware

of the psychological benefits of aging for women in the U.S., including

feeling freer of gender-role stereotypes and gendered roles (Rosen-

thal, 2014); however, there are psychological issues for older women

that practitioners need to be aware of, including problems with finan-

cial resources (Szanton et al., 2008), abuse (Cooper & Livingston,

2014; Daly, Merchant, & Jogerst, 2011), racial and ethnic bias (Ng et

al., 2014; Stone, 2012), and bias against those with specific disabili-

ties associated with aging (Jeppsson Grassman, Holme, Taghizadeh

Larsson, & Whitaker, 2012). Compared to older men, they are more

likely to be living in poverty, suffer from disabilities, and experience

elder abuse and neglect (Yan & Brownell, 2015). Women account for

70% of all older adults with incomes below the poverty level (Admin-

istration on Aging, 2013). Older women can be especially at risk for

depression, alcohol problems, and loneliness (APA, 2004; Kim, Rich-

ardson, Park, & Park, 2013). In addition, ageism persists (Nelson,

2016). Women of all ages face powerful negative stereotypes of who

they will become as they grow old (Gergen, 2009; Mitchell & Bruns,

2011). Older women are seen, even by psychologists, as less compet-

itive, less competent, less assertive, and less willing to take risks than

younger women (Cuddy, Norton, & Fiske, 2005).

Female military veterans are a group of women particularly at

risk. The nature of military service coupled with high rates of violence

and trauma experienced throughout the female veteran’s life can lead

to a number of challenges. Nearly 90% of female veterans have

endorsed at least one traumatic event in their life, a rate higher than

their male counterparts as well as the general population (Zinzow,

Grubaugh, Monnier, Suffoletta-Maierle, & Frueh, 2007), and approx-

imately 40% experience military sexual trauma (Kintzle et al., 2011;

Turchik & Wilson, 2010). Female veterans reported the highest rates

of lifetime and past-year post-traumatic stress disorder (PTSD) com-

pared with female civilians, male veterans, and male civilians

(Lehavot, Katon, Chen, Fortney, & Simpson, 2017), and military

trauma contributes to the likelihood of developing PTSD (Kintzle et

al., 2011). Although female veterans often enlist in the military to

escape highly dysfunctional and violent backgrounds (Sadler, Booth,

Mengeling, & Doebbeling, 2004), the combination of their earlier

histories of interpersonal trauma and the various aspects of military

service places them at increased risk for subsequent re-victimization

(Suris & Lind, 2008; Vogt, King, & King, 2007). These experiences

are not only associated with an elevated risk of PTSD but also other

disorders, particularly those characterized by symptoms of distur-

bances of affect regulation, self-perception, interpersonal relation-

ships, somatization, and systems of meaning (Luterek, Bittinger, &

Simpson, 2011).

The World Health Organization (WHO)(2011) estimates more

than 1 billion people worldwide live with some form of disability.

According to the WHO report, there are 200 million individuals who

have difficulty functioning. Girls and women with disabilities still

tend to be underrepresented in our understanding of psychological

practice. Children from under-resourced communities are more likely

to be disabled and excluded from education around the world (Croft,

4 APA | Guidelines for Psychological Practice with Girls and Women

2013). Girls and women with disabilities are at greater risk of being

abused (Alriksson-Schmidt, Armour, & Thibadeau, 2010; Robin-

son-Whelen et al., 2010) in the U.S. and internationally. Women with

disabilities are less likely than temporarily abled women to receive a

college education (Steinmetz, 2006). Of the women living with dis-

abilities ages 21 to 64 years, 30.8% are employed and 28.4% live in

poverty (Erickson, Lee, & von Schrader, 2014; Nazarov & Lee, 2012).

Women with disabilities were also paid significantly less than men

with disabilities and were also more likely to be unemployed (Office

of Disability Employment Policy, 2014). With regard to disability

caused by chronic pain, large-scale epidemiologic studies demon-

strate a higher pain prevalence in women compared with men,

although health care professionals are less likely to take women’s

pain complaints seriously (Igler et al., 2017).

These contexts, experiences, and identities form an important

backdrop for psychologists to consider when treating girls and

women. They also contribute to vulnerabilities regarding the devel-

opment of diagnoses and maladaptive coping responses. For exam-

ple, women who experience interpersonal violence are more likely

to be diagnosed with psychosis (Fisher et al., 2009). Substance use

and abuse among women and girls continues to rise (National

Council on Alcoholism and Drug Dependence, 2012) as well as

deaths from drug use among women (Reinberg, 2013). There has

been an increase for women with respect to rates of incarceration,

independent of male incarcerations (Hall, Golder, Conley & Sawning,

2013). Girls in the juvenile justice system have increased levels of

mental health issues (Marston, Russell, Obsuth, & Watson, 2012).

Recently, researchers have begun to discuss thepipeline to prison

for marginalized individuals, particularly people of color and those

disadvantaged by social class. The initial harms from sexual abuse

can result in mental health problems for girls that, depending on

their context (e.g., ethnicity, sexual orientation, gender identity,

class), can lead to the juvenile justice system rather than mental

health treatment (Conrad, Tolou-Shams, Rizzo, Placella, & Brown,

2014; Goodkind, Ng, & Sarri, 2006; Saar, Epstein, Rosenthal, & Vafa,

2015). With regard to body image and eating disorders, by the age

of 5, most children are aware of dietary restrictions, including fast-

ing and purging as a means to lose weight, and many have begun

to express negative messages about people with larger bodies

(Rodgers et al., 2015). Adolescent girls are susceptible to extreme

dieting, particularly when their mothers and friends tease them

about their weight, when their friends diet, and in response to

media influence (Balantekin et al., 2017).

In terms of psychological vulnerabilities, researchers have con-

tinued to find that women are significantly more likely to experience

depression, are more vulnerable to depression relapse, and endure

longer depressive episodes than men (Essau, Lewinsohn, Seeley, &

Sasagawa, 2010; Oquendo et al., 2013). Girls also experience depres-

sion at a greater frequency than boys, with girls who reach puberty

earlier particularly vulnerable (Llewellyn, Rudolph, & Rosiman, 2012).

Women who are subjected to individual and group discrimination are

even more likely to experience depression (Klonis, Endo, Crosby, &

Worell, 1997). Girls and women are also 10 times more likely to have

eating disorders than boys and men (American Psychiatric Associa-

tion, 2013; Striegel-Moore et al., 2009). In addition, women are more

likely than men to be diagnosed with nearly every anxiety disorder,

including panic disorder, agoraphobia, and PTSD, compared to men

(APA, 2017a; McLean, Asnaani, Litz, & Hofmann, 2011).

Moreover, girls and women tend to bear the brunt of problem-

atic diagnoses (Marecek & Hare-Mustin, 1998; Ussher, 2013). Spe-

cific diagnoses that have been analyzed in terms of overdiagnosis

among girls and women as a result of gender bias include histrionic

and borderline personality disorders, depression, dissociative disor-

ders, somatization disorder, and agoraphobia (Bekker, 1996; Cos-

grove & Caplan, 2004; Eriksen & Kress, 2008; Garb, 1997; Hartung

& Widiger, 1998; Lerman, 1996; Ussher, 2013). Disorders diagnosed

in childhood and adolescence, in particular attention deficit–hyper-

activity disorder (ADHD) and autism spectrum disorder, as well as

PTSD and antisocial personality disorder, are examples of potentially

underdiagnosed disorders resulting from gender bias, such as failing

to account for possible differences in presentation across genders

(e.g., less overt symptomatology among girls and women; Becker &

Lamb, 1994; Crosby & Sprock, 2004; Bruchmüller, Magraf, & Schnei-

der, 2012; Dworzynski, Ronald, Bolton, & Happë, 2012; Fish, 2004).

Finally, premenstrual dysphoric disorder and female sexual disorders

have received attention as disorders specific to females that may be

misapplications of pathology or disorder labels onto distress through

its relation to the biology of the reproduction system (Tiefer, 2006;

Ussher, 2013). While these diagnoses are often studied in isolation,

patterns of misdiagnosis also appear across diagnoses (e.g., the

under-diagnosis of one disorder coupled with the overdiagnosis of

another) and point to the broader, systemic influence of bias on diag-

nostic assessment.

Girls and women draw on a considerable array of strengths and

resilience to cope with these and other gender-based adversities.

Throughout their lifespans, girls and women demonstrate marked

resilience. (Desjardins, 2004).Women live longer than men and as

they get older are less likely to be impacted by isolation. (Singh & Misra,

2009). While women are more likely to experience poverty, their rela-

tionships and strengths can mean they are less harmed by its effects

compared to men (Clark & Peck, 2012; Stark-Wroblewski, Edelbaum,

& Bello, 2008). Girls enjoy more supportive friendships characterized

by equality, self-disclosure, and empathy (De Goede et al., 2009).

Women are generally more sexually fluid over the lifespan (Diamond,

2008; Katz-Wise & Hyde, 2014), which may allow greater opportuni-

ties for more varied loving and/or sexual relationships.

The majority of those seeking mental health services continue to

be female (Cox, 2014; Wang et al., 2007) and given the experiences

and contexts described and the diversity of backgrounds may have

unique treatment needs, particularly in areas of growing concern such

as substance abuse and stress disorders (Trimble, Stevenson, Worell,

& the APA Commission on Ethnic Minority Recruitment, Retention,

and Training Task Force Textbook Initiative Work Group, 2003). The

new Guidelines for the Practice of Girls and Women aims at including

a broad range of girls and women in the U.S. and globally.

Purpose and Scope

The purpose of these guidelines is to assist psychologists in the pro-

vision of gender-sensitive, culturally competent, and developmen

tally appropriate psychological practice with girls and women across

APA | Guidelines for Psychological Practice with Girls and Women 5

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. These guidelines provide general recommenda-

tions for psychologists who seek to increase their awareness, knowl-

edge, and skills in psychological practice with girls and women. The

guidelines address the strengths of girls and women, their intersec-

tional identities (see Appendix A for a definition of intersectional and

other important terms, as well as an explanation for the use of the

word fat), the challenges they face, and lifespan considerations, as

well as research, education, training, and health care. The beneficia-

ries include all consumers of psychological practice, including clients,

students, supervisees, research participants, consultees, other

health professionals, the media, and the general public. The guide-

lines and the extensive body of scholarship upon which they are

based are applicable to psychological practice in its broadest sense.

Documentation of Need

This document is a revision of the 2007 Guidelines for the Psychological

Practice with Girls and Women. APA policy states that guidelines for

practice expire within 10 years of adoption. Review and revision rou-

tinely occur within 2 years of expiration or when new laws and other

developments require earlier review and revision. Divisions 17 and 35

appointed a Task Force for the revision of Guidelines of Psychological

Practice with Girls and Women in 2013. These guidelines reflect such

revisions and updates and are based substantially on more research

on girls as well as women than earlier guidelines, emphasizing the

intersectionality of girls’ and women’s diverse identities while care-

fully considering their impact on development and psychological

health. Additionally, the revised guidelines underscore global and

transnational issues as they relate to girls’ and women’s psychologi-

cal functioning, as well as an inclusion of gender-variant and trans

girls and women. Moreover, these guidelines identify the high expo-

sure to trauma in girls’ and women’s lives and the need for the inclu-

sion of psychological ways to address such trauma. Finally, the

revised literature and guidelines attempt to bring focus to girls’ and

women’s strengths and resilience. To this end, an additional guideline

has been added to the 2007 guidelines. We encourage readers to

pursue, under separate publication, the extensive documentation,

including the complete history of the development of the first set of

guidelines and the updated literature review that undergirds the

current guidelines.

Distinction between Standards and Guidelines

The Professional Practice Guidelines: Guidance for Developers and Users

defines guidelines as “statements that suggest or recommend spe-

cific professional behavior, endeavor, or conduct for psychologists”

(APA, 2015b, p. 824). Guidelines differ from standards such that

standards are mandatory and are generally enforceable, whereas

guidelines are aspirational in intent. They are intended to facilitate

the continued systematic development of the profession and to help

assure a high level of professional practice by psychologists.

Guidelines may not be applicable to every professional and clinical

situation. They “are not mandatory, definitive, or exhaustive . . . [nor]

intended to take precedence over the professional judgments of

psychologists” (APA, 2015b, p. 828). Federal or state laws may

supersede these guidelines. For more information about the develop-

ment of professional guidelines, see http://www.apa.org/practice/

guidelines/index.aspx.

Compatibility

The following guidelines were written and revised to be compatible

with the APA’s Ethical Principles of Psychologists (APA, 2010) as well

as existing APA guidelines, including the more recent the Clinical

Practice Guidelines for the Treatment of Posttraumatic Stress Disorder

(PTSD) in Adults (APA, 2017a), Guidelines for Psychological Practice

with Lesbian, Gay, and Bisexual Clients (APA, 2012b), Guidelines for

Psychological Practice with Transgender and Gender Non-Conforming

Clients (APA, 2015a), and the revised Multicultural Guidelines for the

21st Century (2017b).

We strongly encourage individual readers, departments, agen-

cies, organizations, and institutions to discuss ways these guidelines

may be applied to their speciﬁc settings and relevant activities. APA

recommends guidelines will need to be reviewed and updated at

least every 10 years (8 years is recommended) to consider changes

in practice, research, and the effects of changing contemporary

social forces and context. The following represents the first revision

of the original guidelines.

It should be noted that many of the guidelines and recommended

practices addressed in this document apply to individuals of all

genders with diverse identities. For example, many of the guidelines

encourage psychologists to understand the consequences of gender

role development and its interactions with other social identities,

such as race, ethnicity, sexual orientation, and ability, because not

only women and girls but people of all genders experience

sociocultural constraints related to their gender (APA, 2014a; Enns

et al., 2015; Pittman, 1985; Pleck, 1995), and these processes

influence the mental and physical health of people of all genders

(Addis & Mahalik, 2003; Courtenay, 2000; Sierra Hernandez, Han,

Oliffe, & Ogrodniczuk, 2014). Hence, the recommendation to

integrate an understanding of how gender roles are produced into

the practice of psychology should not be limited to working with

girls and women. To advance this issue, APA developed the Guidelines

for Psychological Practice with Boys and Men (2018) as well as the

Guidelines for Psychological Practice with Transgender and Gender Non-

Conforming Clients (2015a).

Practice Guidelines Process

Divisions 17 and 35 appointed three task force co-chairs—Sharon

Lamb, Debra Mollen, and Lillian Comas-Díaz—in October 2013 to

revise the set of guidelines published in 2007. The original guidelines

were also drafted under the leadership of three task force co-chairs:

Roberta L. Nutt, Joy K. Rice, and Carol Zerbe Enns. Implicit in this

6 APA | Guidelines for Psychological Practice with Girls and Women

charge was the mandate to disseminate the revisions for extensive

review and submit it to APA for adoption. The three co-chairs divided

the project into two overarching tasks: to examine and update the

literature review sections at the beginning of the published guide-

lines, and to revise, as needed, the guidelines themselves and the

rationale and application that followed each guideline. Those who

contributed to the revisions of the guidelines, their rationale, and

their application were the co-chairs in collaboration with a large

number of volunteer clinicians, academics, and students. The guide-

lines team had five additional volunteers, including a student, clini-

cians, and academics (see Appendix B). Interested readers can

access the extensive literature review upon request.

Selection of Evidence

Research and scholarly literature on the topic of psychological practice

with girls and women is extensive and continues to increase. The brief

literature review of the revised guidelines, as well as the guidelines

themselves, present information about gender bias, life stresses, and

mental health issues specific to girls and women with particular atten-

tion to diversity, intersectionality, and international considerations.

The task force members focused primarily on peer-reviewed publica-

tions and complemented these sources with books, chapters, and

psychological practice case reports that were gendered and culturally

valid. Consistent with more recent practice guidelines’ streamlined

format, a great deal of literature review was removed from the guide-

lines and will be published separately as a companion piece.

Key terms within these guidelines are defined in Appendix A.

APA | Guidelines for Psychological Practice with Girls and Women 7

GENERAL PRACTICE WITH

GIRLS AND WOMEN

For the purposes of this document, psychological practice is defined broadly to include activ-

ities related to all applied areas of psychology. Psychological practice, for the purposes of

these guidelines, includes clinical practice and supervision, consultation, teaching, research,

writing, work in social policy as a psychologist or on behalf of psychologists, and any of the

other professional activities in which psychologists may engage as psychologists.

8 APA | Guidelines for Psychological Practice with Girls and Women

Guidelines for

Psychological Practice

with Girls and Women

APA | Guidelines for Psychological Practice with Girls and Women 9

GUIDELINE 1

Psychologists recognize girls’ and

women’s strengths and resilience

and work to honor and cultivate these.

Rationale

While girls and women face considerable

adversities due to the effects of sexism,

oppression, discrimination, and prejudice,

and while the struggles they face are ampli-

fied when they are members of other margin-

alized groups (e.g., girls and women of color,

fat girls and women, lesbian and bisexual

girls and women, girls and women with dis-

abilities, low income girls and women), girls

and women are also often well equipped to

confront and surmount the challenges in their

lives. Specific advantages include biological,

psychological, developmental, and relational

strengths. There is widespread and substan-

tial evidence, for example, that women live

longer than men in nearly every society

(Clark & Peck, 2012), women’s immune sys-

tems respond especially well to treatment for

HIV (Maskew et al., 2013), and older women

are less impacted by social isolation (which

also affects chronic inflammation) than older

men (Yang, McClintock, Kozloski, & Li, 2013).

Although girls and women exhibit higher

suicide attempt rates than boys and men,

boys and men are approximately 4 times

more likely to die by suicide. African American

girls and women have the lowest suicide

completion rates of all ethnic groups in the

U.S. (American Association of Suicidology,

2012). Girls enjoy more supportive friend-

ships characterized by equality, self-disclo-

sure, and empathy (De Goede et al., 2009),

perhaps in part because they have greater

expectations for friendships, value talking

about problems, and self-disclose more often

compared to boys (Rose et al., 2012). Girls

show less sexual prejudice than boys, partic-

ularly to gay men, and they become less

prejudiced toward gay men over time

(Petersen & Hyde, 2010; Poteat & Anderson,

2012). Women are generally more sexually

fluid throughout the lifespan (Diamond,

2008; Katz-Wise & Hyde, 2014), which may

allow greater opportunities for more varied

loving and/or sexual relationships.

Girls and women can become well

equipped to overcome adversities in their

lives and make significant contributions to

society. Evidence of resilience has been

identified in diverse samples, including sex-

ually abused girls living in foster care set-

tings (Edmond, Auslander, Elze, & Bowland,

2006), African American girls grieving the

loss of a friend to homicide (Johnson, 2010),

and African American girls in an urban,

under-resourced environment (Trask-Tate,

Cunningham, & Lang-DeGrange, 2010).

Researchers have found resilience among a

group of low income, HIV-positive women in

Mexico (Holtz, Sowell, & Velasquez, 2012);

a group of rural female senior citizens

(Stark-Wroblewski et al., 2008); female

survivors of a tsunami and a hurricane (Fer-

nando & Hebert, 2011); and a largely non-

White group of homeless women who had

experienced considerable childhood and

adult physical and sexual victimization

(Huey, Fthenos, & Hryniewicz, 2013).

Application

Psychologists are encouraged to incorpo-

rate a strengths-based perspective in their

work with girls and women without denying

the adversities they face. They accomplish

this by being especially cautious of the ten-

dency to pathologize girls and women (see

Guideline 7); employing diagnoses spar-

ingly while considering the gendered, multi-

cultural context of girls’ and women’s lives;

and initiating discussions about coping

mechanisms, resources, resilience, agency,

and hardiness. Intersecting identities are

strengths and resources for girls and women.

For example, when providing treatment for

girls and women who have experienced

interpersonal abuse, instead of focusing

only on mental health problems related to

the abuse, psychologists should also strive

to reflect qualities and exemplars of resil-

ience and survivorship in their clients and to

explore moments of agency even within

victimization. Anger, resentment, and other

similar emotions can be conceptualized and

explored as signs of resiliency and engage-

ment. Thus, psychologists are also cau-

tioned not to ask women to move to forgive

too quickly, especially when their rights

have been violated (Lamb, 2006). When

working with women who present with sex-

ual problems, psychologists should also

refrain from over pathologizing and medi-

calizing these, and instead consider contex-

tual and cultural factors, such as fatigue

resulting from competing role demands

(Kaschak & Tiefer, 2002) or reliving previ

ous sexual trauma. In the former case, psy-

chologists can illustrate the strength

required in performing multiple roles and

assist clients and their partners in working

toward more egalitarian domestic environ-

ments to alleviate women’s fatigue. For

trauma survivors, psychologists can help

clients examine their sources of strength

that helped them endure and work toward

reclaiming their right to sexual agency.

Especially with non-majority, marginalized

girls and women, psychologists should

make concerted efforts to identify, enumer-

ate, cultivate, and encourage strengths in

order to counteract sexist and other oppres-

sive labels and descriptions that can demor-

alize or erode self-confidence. For instance,

when working with a heterosexual woman

who has a disability and is fat (for a discus-

sion of our intentional use of this word, see

Appendix A) and is seeking treatment for

substance abuse after having her children

removed from her care as a result of her

substance abuse and, discriminatorily, her

disability, a psychologist recognizes the

strength it requires to seek treatment for

substance abuse, understanding the impor-

tance of the psychologist earning the client’s

trust, and highlights other signs of resilience

and successes in her life. These may include

personal (e.g., areas of mental and physical

health), relational (e.g., areas of connection,

love, and empathy), cultural (e.g., sizeism,

ableism, sexism), spiritual, educational, and

vocational strengths. Psychologists may use

a variety of therapies shown to be useful

regarding addictions (e.g., motivational

interviewing) but do so keeping in mind the

strengths noted above. Supervision also can

be strengths-based. For example, when an

older African American supervisee commu-

nicates a complaint, the supervisor who is

not African American might recognize the

courage it takes to speak up given stereo-

types about the “angry black woman”

(Childs, 2005). She thus is especially cogni-

zant of supporting the supervisee in

expressing her concerns. Psychologists

should be aware that while girls and women

have numerous strengths on which to draw,

some women may have had to assume dis-

proportionate responsibility for coping with

discrimination and oppression (Walker-

Barnes, 2014) and may therefore have had

to assume de facto positions of strength.

When this is true, psychologists situate and

10 APA | Guidelines for Psychological Practice with Girls and Women

discuss such strengths within a sociocul-

tural understanding of how they developed.

GUIDELINE 2

Psychologists strive to be aware

that girls and women form their

identities in contexts with multiple,

contradictory, and changing

messages about what it means to

be female.

Rationale

Gender role socialization was one of the

most powerful explanatory devices from

the 1970s to 1990s when gender roles were

being challenged. It refers to the process

through which children learn culturally

prescribed behaviors, which most often

reinforces gender stereotypes (Bronstein,

2006; Bussey & Bandura, 2004) such as

communal qualities of nurturance, passiv-

ity, helplessness, and preoccupation with

appearance to girls and women; and agen-

tic qualities such as assertiveness, inde-

pendence, ambitiousness, and confidence

to boys and men (Carothers & Reis, 2013;

for the difference between proscriptive and

prescriptive norms, see Prentice &

Carranza, 2002). The idea of socialization

may be somewhat limiting today given the

postmodern influence in psychology in

which different theories suggest processes

other than social learning in which gender

norms are conveyed and come to be instan-

tiated in people. In spite of major changes in

Western women’s participation and roles in

the workplace and politics, traditional gen-

der prescriptions (and proscriptions) persist

regarding femininity and heteronormativity

(England, 2006), resulting in resulting in

differential outcomes for men and women

including health (Hartke, King, Heinemann,

& Semik, 2006), performance in math and

science (Tomasetto, Alparone, & Cadinu,

2011), interest in athletics (Hively & El-Alayli,

2014), and career aspirations (Fogliati &

Bussey, 2014). In spite of pressure to con-

form to gender norms of femininity, those

women who can defy gender stereotypes,

who grow up to embrace feminist ideals and

express moral outrage against social injus-

tice, will do better individually and in rela-

tionships with others (Yoder, 2012; Yoder,

Snell, & Tobias, 2012). Likewise, in a classic

study, women who learned the sociopoliti-

cal causes of the discrimination were able to

overcome the impact of the discrimination

they experienced (Landrine & Klonoff, 1997).

Each girl and woman learns the dis-

courses of gender or internalizes gender role

stereotypes from her unique context that

includes country and region of origin, family,

neighborhood, and community and is influ-

enced by her multiple group memberships,

including socioeconomic status, race, eth-

nicity, body size, and ability status. Girls and

women of color and those raised outside of

the U.S. may especially have to integrate a

complex and sometimes contradictory set

of messages or ideologies related to gender:

one that represents dominant White Euro-

pean Christian norms, and another that

represents her specific sociocultural con-

text and life experiences. Some researchers

have found, for example, that Black girls’

prescriptive gender roles include both com-

munal characteristics such as nurturance

and caretaking as well as agentic character-

istics such as self-reliance and assertive-

ness (Buckley & Carter, 2005; Reid, 2002).

Girls and women who were assigned male

at birth, genderqueer girls and women, and

other nonbinary girls and women face par-

ticular challenges, including linguistic lim-

itations of the gender binary coupled with

socially constricted expressions of gender

fluidity, in navigating and crystalizing their

identities (Kuvalanka, Weiner, Munroe,

Goldberg, & Gardner, 2017).

Application

Psychologists strive to recognize and com-

municate how gender expectations come

about and how stereotypes of gender may

influence the overall health and well-being

of girls and women in the U.S. and interna-

tionally. Psychologists endeavor to be

attuned to the ways that these processes

are connected to sociocultural factors, mul-

tiple and intersecting group memberships,

and individual difference variables that may

influence the degree to which a girl or

woman internalizes societal pressure to

regulate her behavior according to often

inflexible gender standards. Psychologists

recognize that girls and women receive

competing and contradictory messages and

help clients in teasing apart various pro-

scriptions, prescriptions, and meanings. For

example, for Black and Latina young women

today, being sexy can mean being visible in

a culture in which the predominant sexy

images have been of White women or in

which being sexy can mean being confident

and sure of oneself (Lamb et al., 2016).

However, these young women may pursue

these meanings while simultaneously aware

that White society can view displays of sexi-

ness as confirmation of the stereotyped

hypersexuality of Black and Latina women.

Again, at the same time, the visibility that is

so attractive might conform to a stereotype

of heteronormative sexuality (see Appendix

A) defined by men and could have degrading

elements in it. In this way, the competing and

contradictory messages about what is sexy

and sexual for Black and Latina girls are mul-

tiplied and quite possibly confusing. A psy-

chologist, in this example, should not only

bring nuance to girls’ and women’s prescrip-

tions for acting female and being sexy but also

help clients explore other dimensions of their

identity that may even reject social and main-

stream prescriptions. In so doing, psycholo-

gists work to create identity safety for all girls

and women since research has shown that

contexts which recognize and affirm a broad

range of identities and differences can offset

threats related to negative stereotypes

(Steele, Spencer, & Aronson, 2002). A

strengths-based approach recognizes that

talking about identity, prescriptions, and pro-

scriptions can increase a client’s identity

safety and enhance the therapeutic relation-

ship (Day-Vines et al., 2007).

APA | Guidelines for Psychological Practice with Girls and Women 11

GUIDELINE 3

Psychologists strive to recognize,

understand, and use information

about structural discrimination

and legacies of oppression that

continue to impact the lives and

psychological well-being of girls

and women.

Rationale

Discrimination is embedded in and driven by

organizational, institutional, and social struc-

tures in multiple areas of society, including

families and couples, language, schools, the

workplace, health care systems, religious

institutions, and legal systems. It can consist

of exclusion, marginalization, devaluation of

girls and women, and violence.

Despite advances in society, sexist

discrimination persists. This discrimination

manifests itself in the lived experiences of

girls and women and may affect girls and

women differently based on their race or

ethnicity (Moradi & DeBlaere, 2010), age

(Neumark, Burn, & Button, 2017), size (Puhl

& Heuer, 2009), sexual identity (Friedman

& Leaper, 2010), and ability status (Kava-

nagh et al., 2015).

Discriminatory practices can begin in

grade school if not earlier, when some girls

are harassed and bullied and subjected to

discriminatory testing and counseling

while receiving lower levels of encourage-

ment and mentoring (Brown, 2003; Rueger

& Jenkins, 2014), with compounding

effects of racial identity (Cogburn, Chavous,

& Griffin, 2011) and both sexual and gender

identity (Mitchell, Ybarra, & Korchmaros,

2014). In the workplace, women continue

to experience discrimination and sexual

harassment (Brunner & Dever, 2014;

Kabat-Farr & Cortina, 2014; Mainiero &

Jones, 2013), creating an unsafe work envi-

ronment as well as unfair hiring and pro-

moting practices. Workplace discrimination

may also be influenced by a woman’s sex-

ual identity, with workplace discrimination

laws not protecting queer-identified

women. Fat women experience discrimina-

tion in hiring practices because of their

bodies, a particularly insidious example of

the intersection of sexism and sizeism

(Puhl & Heuer, 2009). Women and girls

continue to experience barriers to access-

ing services and gaining advanced posi-

tions in religious institutions (Hill, Miller,

Benson, & Handley. , 2016) and the justice

system (Covington, 2007; Martin & Jurik,

2006; Pasko, 2013). In mixed-sex relation-

ships, women continue to assume dispro-

portionate responsibility for childcare,

elder care, household management, and

partner/spouse relationships (Donald,

2014). Men’s violence against women, a

particularly troubling form of discrimina-

tion, continues to occur at disproportion-

ate levels and across international contexts

(Bostock, Plumpton, & Pratt, 2009; Wong

& Mellor, 2014; WHO, 2013). Transgender

women are at a notably higher risk of vio-

lence than their cisgender counterparts

(Langenderfer-Magruder, Walls, Kattari,

Whitfield, & Ramos, 2016; Langenderf-

er-Magruder, Whitfield, Walls, Kattari, &

Ramos, 2016), especially transgender

women of color (Meyer, 2015). Finally, use

of noninclusive and masculine-based lan-

guage continues to be an additional sys-

temic form of discrimination against girls

and women (Johnston-Robledo, McHugh,

& Chrisler, 2010).

Experiences of sexist discrimination

have consistently been shown to negatively

affect girls’ and women’s psychological

health, for example by contributing to

increased psychological distress (Fischer &

Holz, 2010; Landry & Mercurio, 2009).

Women who experience individual and

group discrimination are more likely to

experience depression (LaSalvia et al., 2013)

and both decreased self-esteem and sense

of identity (Nadal & Haynes, 2012), as they

may be inclined to internalize negative cul-

tural messages. Psychologists can help

others become aware of the connection

between broader societal messages and the

harmful results of their internalization. Dis-

crimination contributes more to women’s

negative perceptions of their psychiatric

and physical symptoms than any other envi-

ronmental stressor (Klonoff, Landrine, &

Campbell; 2000; Moradi & Subich, 2002),

with recent research confirming this finding

while simultaneously highlighting the com-

pounding effects of a lack of control and

self-silencing on the relationship between

sexist discrimination and decreased

well-being (Fischer & Holz, 2010; Hurst &

Beesley, 2013). Discrimination may also

negatively affect girls’ and women’s physi

cal well-being (Pascoe & Richman, 2009).

Although spirituality and religion can often

function as a protective, health-promoting

factor (Hurlbut, Robbins, & Hoke, 2011; Jur-

kowski, Kurlanska, & Ramos, 2010), girls’

and women’s spiritual well-being may also

be negatively influenced by discrimination.

Discrimination from multiple identities in

addition to gender identity can put girls and

women in double or triple jeopardy, thus

reflecting the compounding effects of dis-

crimination (Moradi & DeBlaere, 2010).

This may be particularly true for Muslim

girls and women in the West (Everett et al.,

2015). Women who have recently emigrated

from cultures with more blatant sexism

such as being submissive to men and not

being allowed to pursue education, drive,

travel, or make other personal choices, and

to what extent women may have internal-

ized such perspectives, can affect their

experience of the Western world. Accord-

ingly, psychologists are encouraged to

understand this experience, what it is like to

adjust to a different culture, and understand

any biases that emerge.

Recognizing, understanding, and using

this knowledge about the effects of struc-

tural discrimination and legacies of oppres-

sion on lives and psychological well-being of

girls and women can enhance psychologists’

efforts in their multifaceted roles.

Application

In working in their multifaceted roles with

girls and women, psychologists strive to

understand the impact of legacies of

oppression and structural discrimination on

the well-being of those with whom they

work. They accomplish this by educating

themselves about the forms of discrimina-

tion and legacies of oppression in the con-

text of girls’ and women’s intersecting

identities and within a global framework.

Psychologists also engage in conscious-

ness-raising and support resistance against

oppression and activism toward change.

Psychologists strive to accomplish these

goals through a culturally competent and

gender-affirmative lens. They endeavor to

use gender-fair research results to inform

their practice and use inclusive language that

reflects respect for all their clients and stu-

dents. As supervisors and teachers, psychol-

ogists ensure that they infuse their education

12 APA | Guidelines for Psychological Practice with Girls and Women

and training with information about the

impact of discrimination on girls’ and wom-

en’s lives and ask that their supervisees

attend to these issues with their clients.

Assistance from a psychologist may

help women develop awareness of discrimi-

natory experiences within, for example, the

legal or educational system, and create

strategies to resist or overcome the effects

of those experiences. They may help clients

work with systems, e.g., in obtaining equita-

ble divorce settlements and adequate child

support or equal opportunities for educa-

tional advancement and leadership. For

example, while working with a young Chi-

nese American girl who reports bullying by

peers at her elementary school, the psychol-

ogist’s awareness of interpersonal and struc-

tural racism, coupled with the systemic

conditions that support bullying and hori-

zontal violence, may help the girl to both

stand up for herself and garner support from

others, including family and friends, to

change a toxic environment. When a Latina

client discusses an experience of sexual

harassment and blames herself, the thera-

pist explains the law, normalizes self-blame,

and challenges it by putting the client’s expe-

rience in the context of greater structural

inequities, explaining how self-blame is part

of the mechanism of these structures to

release those in power from responsibility.

The therapist brings empathy to the situa-

tion in helping the client discuss whether to

report the harassment, empowers the client

to make her own decision about reporting or

talking to the individual, supports the deci-

sion the client makes, helps the client antic-

ipate reactions from those around her,

discusses where she might get support in

the workplace or at home, and also explores

her stated feelings of guilt from a dynamic

view, a cultural context, and/or a cognitive

view (e.g., negative cognitions about female

flirts). The therapist may also explore with

her or his client cultural messages about

women’s sexuality. In these ways, psycholo-

gists engage in consciousness-raising and

enact the principles of liberation psychology

(Lykes & Moane, 2009) with the girls and

women with whom they work, while at the

same time using the common factors of psy-

chotherapy (e.g., alliance-building, empathy,

reflections) to aid them in developing the

means to challenge and overcome those

experiences of discrimination.

Psychologists also attend to the inter-

secting identities of individuals with whom

they work, understanding that these iden-

tities have different legacies of oppression

and privilege. For example, a psychologist

may need to understand a client’s dismissal

from a job by acknowledging a number of

discriminatory practices related to various

identities intersecting with her gender. She

may be a lesbian who was harassed

because of her sexual identity and who

may have been fired because she is a les-

bian mother who missed work because of

her child’s illness. A U.S. Muslim woman

may be fearful and/or depressed because

of discriminatory statements or violence in

the news toward women wearing hijabs, or

about religious practices or media repre-

sentations of Muslim women.

Psychologists are encouraged to

acknowledge and be open to learning about

legacies of oppression from their clients and

initiate such discussions with an under-

standing that these legacies may intersect

with presenting problems. Moreover, psy-

chologists are encouraged to become

knowledgeable about gender, racial, sexual

orientation, elitist, ageist, and other types of

microaggressions in order to avoid engaging

in these behaviors within their professional

roles (Nadal & Haynes, 2012). Microaggres-

sions are “micro” alone, but over time and

because of their frequency and intensity

present an ongoing stress to minority

women and girls. An illustration of a micro-

aggression during the clinical hour is when

the psychologist asks a Korean American

girl or woman which country she is from,

assuming she is foreign. This signifies a

stress, however micro, in that the girl or

woman is made to feel other in her own

country. Psychologists pay attention to

power dynamics and engage in educating

supervisees and students about the impact

of power inequities in the lives of their cli-

ents, students, and research participants.

The APA

Multicultural Guidelines for the

21st Century (2017b) offer in-depth analysis

of examples that focus on intersectionality;

psychologists and the general public are

referred to these.

GUIDELINE 4

Psychologists are encouraged to

use interventions and approaches

with girls and women that are

affirmative, developmentally

appropriate, gender and culturally

relevant, and effective.

Rationale

Theories of psychotherapy continue to show

biases that affect practice with girls and

women. These include (a) overvaluing indi-

vidualism and autonomy and undervaluing

relational qualities, (b) overvaluing rational-

ity instead of viewing mental health from a

more holistic perspective, (c) paying inade-

quate attention to context and external influ-

ences on girls’ and women’s lives, (d) basing

definitions of positive mental health on

behaviors that are most consistent with mas-

culine stereotypes or life experiences, and (e)

overemphasizing certain aspects of girls’ and

women’s lives (e.g., bullying) or depicting

other aspects (e.g., mothering) in problem-

atic ways. Approaches to mental health that

have been identified as noninclusive or as

containing subtle biases include humanistic

(Serlin & Criswell, 2014), psychodynamic

and object relations (Tummala-Narra, 2013),

cognitive–behavioral therapy (Hays, 2009),

and couples and family therapies (Nutt, 2013;

Patterson & Sexton, 2013).

No matter the model of psychotherapy,

teaching, or supervisory practice, psychol-

ogists’ practice is enhanced by knowledge

about the challenges, strengths, social con-

texts, and intersecting identities of girls and

women, as well as interventions that are

gender and culturally valid and associated

with positive outcomes (Enns et al., 2015).

Gender-valid, gender-relevant interven-

tions are strengths-based, multidimen-

sional approaches to treatment that

acknowledge the social and cultural factors

(e.g., poverty, race, gender inequality, dis-

proportionate experiences of sexual vio-

lence) that influence women, and use this

knowledge to create an environment that

demonstrates an understanding of the real-

ities of women’s lives. Datchi and Ancis

(2017) made recommendations for gen-

der-relevant treatment of girls involved in

the juvenile justice system, including gen-

der-relevant treatment for girls with other

diverse social and cultural identities.

APA | Guidelines for Psychological Practice with Girls and Women 13

Psychologists are encouraged to uti-

lize evidenced-based or evidence-sup-

ported interventions while recognizing that

such interventions may be incongruent and

inapplicable for diverse populations, spe-

cifically people of color (Whaley & Davis,

2007) and women (Goldenberg, 2006),

given the overrepresentation of White,

young, able-bodied, verbal, intelligent, and

successful clients in treatment efficacy and

effectiveness studies (Carter & Goodheart,

2012; Maríñez-Lora & Atkins, 2012). Politi-

cal forces may create an environment in

which treatments that are gender and cul-

turally valid for some girls and women are

those lacking the political, institutional,

social, and financial support to demon-

strate their effectiveness and efficacy in

mainstream ways (Goldenberg, 2006).

Application

Affirmative practice might be best accom-

plished using an integrative approach to

treatment orientation that includes princi-

ples of feminist therapies, methods devel-

oped with the specific needs of diverse

groups in mind, and international perspec-

tives when appropriate (Berger, Zane, &

Hwang, 2014; Brown; 2014; Enns, 2004;

Enns et al., 2015; Frey, 2013; Rutherford,

Capdevila, Undurti, & Palmary, 2011).

Psychologists also need to attend to the

varied experiences of their clients based on

differing intersecting identities that may

cause some inner conflict. For example, a

psychologist conducting a therapy group

focused on sexual identity issues for lesbian,

bisexual, and queer women needs to under-

stand that sexual minority women of color

often struggle with tension between their

sexual identities and their racial and ethnic

identities and may feel like they must

choose one identity over another, a struggle

typically nonexistent for White sexual

minority women (Brooks & Quina, 2009;

Pachankis & Goldfried, 2013). Psychologists

practice with the knowledge that some

interventions for girls and women have yet

to be empirically supported and are still

determined to be effective. For example,

psychospiritual approaches, such as those

described in Feeding Your Demons (a Tibetan

Buddhist approach; Allione, 2008) or

notions of the feminine sacred, are under-re-

searched and underfunded areas of study,

yet therapists who work with these

approaches report anecdotal clinical effi-

cacy. Psychologists who undertake inter-

ventions that have not yet been tested nor

are amenable to testing under traditional

empirical methods do so after their own

research and initially with supervision.

GUIDELINE 5

Psychologists are encouraged

to reflect on their experiences

with gender and on how their

attitudes, beliefs, and knowledge

about gender, and the way gender

intersects with other identities,

may affect their practice with girls

and women.

Rationale

Self-awareness is recognized as an import-

ant component of psychological training.

Self-awareness pertaining to attitudes and

beliefs across differences related to gender,

race, socioeconomic status, size, sexual

orientation, age, and ability status is also

critically important. Achieving self-aware-

ness is a lifelong pursuit rather than a finite

set of skills. It may require more than

self-examination and include investment in

activities such as continuing education, psy-

chotherapy, and supervision. It also

strengthens psychologists’ ethical practice

(Bowers & Bieschke, 2005; Pope, Sonne, &

Holroyd, 1993).

As with all members of society, psy-

chologists have attitudes, beliefs, and

knowledge about gender that extend far

beyond what training as a psychologist has

provided them. There will always remain

personal, familial, and culturally based

beliefs and attitudes that inform relation-

ships with people of all genders. These atti-

tudes and beliefs are simultaneously shaped

by multiple factors related to gender such as

race, ethnicity, socioeconomic status, ability

status, sexual orientation, physical size, age,

and education (Fouad & Brown, 2000; Ped-

ersen, 2008). Predispositions and assump-

tions can influence psychologists in their

practice whether in providing psychother-

apy or training, or in conducting research.

Because implicit gender stereotypes are

ubiquitous, they can affect a psychologist’s

perceptions of others without intent or the

conscious realization that they have done so.

Female and lesbian, gay, and bisexual

supervisors, as well as those supervisors

who report an active commitment to femi-

nism, are more likely to report collaborative

relationships with supervisees and to

address power differentials in the supervi-

sory relationship than male and heterosex-

ual supervisors. They are also more likely to

address diversity issues in the context of

supervision (Szymanski, 2005).

For nearly four decades, researchers

and clinicians have addressed the notion of

bias within the context of therapy. The

monograph that accompanies these guide-

lines, for example, presents the literature on

bias in diagnosis. Other research has found

that therapists can express gender bias

about women who express nontraditional

female behaviors or hold nontraditional

careers (Crosby & Sprock, 2004; Trepal,

Wester, & Shuler, 2008) and about girls and

women who do not conform to societal gen-

der norms, such as vulnerability or heter-

onormativity (Bowers & Bieschke, 2005).

This can be especially problematic given the

differing gender role expectations within

and between particular cultural groups

(Blake, Lease, Olejnik, & Turner, 2010; Coo-

per, Guthrie, Brown & Metzger, 2011;

Thomas, Hacker & Hoxha, 2011). Thus, psy-

chologists have a particular responsibility to

consult and consider this literature as a way

to check for biases.

Finally, researchers have found that the

majority of cases of sexual misconduct from

a therapist to a client involve older, male

therapists and younger, female clients (APA

Ethics Committee, 2013; Kirkland, Kirkland,

& Reaves, 2004; Pope, 2001; Pope et al.,

1993).This most common profile involves a

therapist engaging in a sexual boundary

transgression with one client in a single

incident or as a relationship that develops

over time (Celenza, 2007; Celenza & Gab-

bard, 2002). Whether a check on entitle-

ment, boundaries, or mental health is

necessary, psychologists’ self-awareness

about countertransferential feelings should

be included in this guideline.

Application

Psychologists endeavor to become aware of

how their own personal and familial experi-

14 APA | Guidelines for Psychological Practice with Girls and Women

ences across their multiple identity groups

influence their psychological practice with

girls and women. Beyond increasing

self-awareness, psychologists are encour-

aged to build their knowledge about racial,

sexual orientation, elitist, ablest, ageist, and

other types of microaggressions and how

these intersect with their beliefs and atti-

tudes about girls and women. As an exam-

ple, a psychologist who is self-aware may

recognize that she or he is experiencing

gender bias toward her client who has

decided to prioritize her career advance-

ment by returning to work quickly following

the birth of her newborn baby. This may

intersect with feelings that her client, who

also has a disability, may not be able to han-

dle the stress. Her feelings about this deci-

sion may vary depending on the class and

ability of the woman, and in supervision she

might seek out why she feels differently in

these cases. Peer or individual supervision

might help this psychologist to explore the

source of attitudes and beliefs that could be

influencing working with this client as well

as her or his own biases. By discussing these

beliefs in supervision, the therapist may be

less likely to unconsciously transfer, project,

or displace negative feelings onto a client

based on gender biases. Supervision might

also suggest self-compassion and under-

standing about having these biases given a

world that promotes negative stereotypes in

subtle and overt ways. Recent thinking on

optimal development recommends an

approach that teaches not only self-scrutiny

but also self-compassion (Germer & Neff,

2013; Neff, 2009).

Gender sensitivity training in combina-

tion with diversity training is recommended

for psychologists in the form of continuing

education. Research has shown that gender

sensitivity and diversity training enhance

therapist skills for working with girls, women,

and families (Guanipa & Woolley, 2000).

Psychologists might also educate them-

selves regarding feminist supervision

approaches that attend to issues of power

and include exploration of the self of the

supervisee in the context of the practice.

GUIDELINE 6

Psychologists strive to foster

therapeutic practice that promotes

agency, critical consciousness, and

expanded choices for girls and

women.

Rationale

For girls and women, feeling powerless is asso-

ciated with myriad physical and mental health

issues, problems in relationships, and negative

impacts on overall functioning. Symptoms of

depression, disturbed body image and eating

disorders, and dependency can emerge in a

context of powerlessness (Filson, Ulloa,

Runfola, & Hokoda, 2010; Peterson, Grippo, &

Tantleff-Dunn, 2008). Experiences with coer-

cion and fear of interpersonal violence (e.g.,

sexual assault, physical abuse) may under-

mine and limit girls’ and women’s full partici-

pation in society. They can negatively impact

work performance, contribute to passivity and

poor coping, and reduce self-confidence and

agency (APA, 2005; Banyard, Potter, & Turner,

2011). Feelings of powerlessness and lack of

self-efficacy may be compounded by other

experiences relating to social class, race and

ethnicity, sexual orientation, income and edu-

cational levels, physical illness, age, size, and

physical ability (Pachankis & Goldfried, 2013;

Potter & Banyard, 2011; Wong & Mellor, 2014).

Although there are numerous deleteri-

ous effects of trauma, not all survivors of

trauma develop adverse symptomatology

(Briere & Scott, 2014). In fact, across similar

forms of trauma, women tend to report

more post-traumatic growth than men,

although the effect size is modest (Vish-

nevsky, Cann, Calhoun, Tedeschi, & Demakis,

2010). Such changes often include increased

empathy for others with similar histories, as

well as positive changes in self-image, rela-

tionships with others, and spiritual and/or

religious connection (de Castella & Sim-

monds, 2013; Frazier, Conlon, & Glaser,

2001). In addition, self-defense training—an

empowerment-based approach—may fos-

ter women’s resiliency because it enhances

women’s beliefs in and their actual abilities

to cope and successfully defend themselves

(Ullman, 2007), while decreasing vulnera-

bility to sexual assault (Senn et al., 2015)

and trauma symptoms (Brecklin & Ullman,

2005; David, Simpson, & Cotton, 2006;

Gidycz & Dardis, 2014; Rozee, 2008).

Empowerment is more than an individ-

ual or internal process, as self-efficacy and

self-confidence are both enhanced within

relationships and systems wherein girls and

women gain support and are treated justly

(Bay-Cheng, 2012). Critical consciousness

increases empowerment and entails being

aware of social oppression and working with

others to bring about social change (Freire,

1970; Kelso et al., 2014). A relational and

action-oriented approach to critical con-

sciousness and empowerment may be cor-

rective of the negative effects of social

oppression, particularly with African Ameri-

can women (Kelso et al., 2014). Researchers

have found that African American, HIV-pos-

itive women with high critical consciousness

showed less HIV disease progression; the

researchers posited that critical conscious-

ness may serve to combat the powerlessness

that can result from discrimination and lead

to psychological distress and poor physical

health. Moreover, liberation psychology has

been used effectively with transgender cli-

ents (Singh, 2016). Researchers have found

that lesbians or bisexual women who suffer

psychological distress in the face of political

oppression, such as anti-LGB marriage

amendments, find hope and display resil-

ience through engaging in political activism

(Rostosky, Riggle, Horne, Denton, & Huelle-

meier, 2010).

Girls’ and women’s activism can some-

times take the shape of giving social support.

This prosocial behavior can be a major emo-

tional resource for women and is associated

with increased well-being, positive mental

and physical health, increased self-confi-

dence in abilities to cope with adversity and

stressors, and improved romantic relation-

ships (Goodman, Smyth, & Banyard, 2010;

Graham & Barnow, 2013). Under some con-

ditions, however, girls’ and women’s gender

roles (e.g., caregiving) can also contribute to

the depletion of emotional resources,

decreased work productivity, fatigue, physi-

cal and mental health problems (e.g., chronic

pain, depression), and a lack of self-develop-

ment, independence, and personal choice

(Farran, Miller, Kaufman, Donner, & Fogg,

1999; Juratovac & Zauszniewski, 2014;

Morse, Shaffer, Williamson, Dooley, & Schulz,

2012). Thus, psychologists are cautioned to

find expanding ways in which girls and

women can come to understand giving and

helping others.

APA | Guidelines for Psychological Practice with Girls and Women 15

Application

Psychologists are encouraged to make

efforts to help women and girls develop an

improved sense of initiative, resilience, and

personal power and expand their non-ste-

reotyped alternatives and choices. One

example might be to encourage a girl who

loves math and science to consider engi-

neering or other nontraditional career

choices. Another example might be for a

therapist to address imbalances of power in

intimate relationships by finding ways to

increase female clients’ self-worth and

explore ways to increase their level of auton-

omy in their relationships (Filson et al.,

2010). Given the research on the benefits of

activism, a woman who has left a relation-

ship in which she was abused by her partner

might be encouraged to assist other women

by volunteering for a hotline or working at a

women’s shelter. Helping women feel a

sense of personal power in many areas of

their lives (e.g., relationships, education,

work, self-image) may allow them to resist

internalizing unhealthy, oppressive societal

messages that can lead to feelings of pow-

erlessness (Peterson et al., 2008).

Embracing a process that privileges neither

autonomy nor communality but includes

both can help women navigate recovery

(Tiefer, 2014). These goals can certainly be

accomplished in individual therapy, but

group therapy can be a powerful tool for

empowering clients, as research has shown

that women participating in groups learn

from other members’ experiences, find new

perspectives about themselves and the

world, and acquire critical consciousness

that allow them to make positive changes in

their lives (Stang & Mittelmark, 2009).

Heeding Bay-Cheng’s (2012) directive that

empowerment is more than just self-im-

provement, connecting girls and women to

organizations and projects that will enable

them to help others will aid in changing the

systems that have oppressed them and con-

tinue to oppress other girls and women (see

Guideline 10 for additional ideas).

To promote autonomy and agency, psy-

chologists strive to foster relationships that

reflect attention to gender roles, power dif-

ferences, and differences in privilege

between themselves and their clients, stu-

dents, and supervisees in light of Guideline

3 as well. In so doing, they empower their

clients, students, and supervisees through

the therapy, teaching, or supervisory rela-

tionship. For example, although cognitive

behavioral therapy (CBT) is an empirically

supported treatment for depression,

emphasizing that depressive symptoms are

caused by dysfunctional cognitions could

feel discounting and unhelpful to a low

income, single mother who has no stable

housing for herself and her children (Good-

man et al., 2010). This client might benefit

more from therapy if her psychologist vali-

dated her difficult circumstances and the

systemic forces that contribute to it. At the

same time, the psychologist would attend to

all the personal, relational, and physical

factors known to contribute to ongoing

depression and not reduce the depression to

merely an outcome of circumstances.

Instead of adopting an expert stance, the

psychologist may better serve clients as an

ally collaborating with the client to meet the

client’s needs (Goodman et al., 2010). The

psychologist might also share research find-

ings about the effectiveness of CBT and

other approaches used and discuss their

limitations. Psychologists who give the cli-

ent a choice of strategies contribute to

empowerment. Clients who see their thera-

pist more as an equal and who are less

dependent and more secure in their own

agency may have better therapy outcomes

(McElvaney & Timulak, 2013).

Consent also empowers clients. APA’s

(2010) Ethical Principles of Psychologists

and Code of Conduct requires that psychol-

ogists practice informed consent, which

includes open discussions of several import-

ant issues (e.g., the psychologist’s approach

to treatment and supervision, understand-

ing of the problem, course of treatment,

alternative options, fees and payment,

accessibility, and after-hours availability;

see also Feminist Therapy Institute, 2000).

Such transparency conveys respect for the

decision-making capacity and personal

agency of girls and women. It also empow-

ers girls and women by providing the infor-

mation needed to make educated decisions

regarding therapy, education, and personal

and career choices.

GUIDELINE 7

Psychologists strive to assign

diagnoses to girls and women only

if and when diagnosis is necessary,

use unbiased assessment tools,

and bring to bear an understanding

of the history of misuses and

gender biases and diagnoses and

assessment.

Rationale

Psychologists have identified gender bias in

the following areas of assessment and diag-

nosis: clinical judgment, theoretical founda-

tions of assessment, diagnostic processes,

psychological assessment measures, and

the conceptualization of developmental

experiences (Ali, Caplan & Fagnant, 2010).

Many psychologists have criticized the

increasingly biological nature of theories of

psychopathology, the expansion of both the

number of diagnostic categories and their

boundaries, and the selective identification

of distress as pathological or nonpathologi-

cal depending on its degree of fit with cul-

tural stereotype or expectation (Angell,

2004; Kirschner, 2013). Others have cau-

tioned against diagnostic systems that

overemphasize a narrow, unrealistic view of

pathology and underemphasize lived expe-

rience and contexts that inform distress

(Andreasen, 2007; Bluhm, 2011; Hornstein,

2013; Kirschner, 2013). Given that diagno-

ses in DSM-5 (American Psychiatric

Association, 2013) are not differentiated

based on the source of distress (i.e., psycho-

logical, environmental, from other sources,

or from a combination of sources), individu-

als’ contexts, their identities, their experi-

ences of oppression and its impact on

distress, all factors need to consideration

and integration in a psychologist’s work

(Enns et al., 2015).

The literature review on diagnosis,

found in the accompanying monograph to

these guidelines, shows that many specific

diagnoses have been problematically

applied to women and/or girls, including but

not limited to histrionic and borderline per-

sonality disorders, without consideration of

critical contextual factors. Experiencing

events punctuated by high levels of betrayal

and trauma, for example, are associated

with characteristics of borderline personal-

16 APA | Guidelines for Psychological Practice with Girls and Women

ity disorder (Kaehler & Freyd, 2012; Sauer,

Arens, Stopsack, Spitzer, & Barnow, 2014).

Along with poverty, race and ethnicity

increase the likelihood of being diagnosed

with certain disorders, such as schizophre-

nia among African American women com-

pared with White women. The diagnosis of

gender dysphoria (previously gender iden-

tity disorder) has spurred debate about the

role of diagnostic systems in reinforcing

certain notions of gender (Sennott, 2011).

Psychologists assess girls and women

for a variety of reasons beyond diagnosing.

Forensic psychologists assess for the courts

in matters such as competency, custody,

and criminal responsibility. Other psycholo-

gists assess in order to provide feedback to

employers, agencies, treatment centers,

and clients themselves. Assessment can but

does not necessarily include testing. Many

psychologists perform an assessment to

understand their clients better and inform

their treatment. To this end, there are sev-

eral ways of performing assessments that

look at girls and women in context. Multicul-

tural assessment that uses a process-ori-

ented approach including tools such as

cultural genograms may be particularly

useful in work with girls and women as they

emphasize assessment of various contexts,

such as ethnocultural heritage (Comas-

Díaz, 2012).

Some tests used to assess girls and

women have been normed on populations

that include girls and/or women as well as

populations that match the race and/or eth-

nicity of the clients. Psychologists also need

to be aware of bias in testing. Individual

tests that are constructed to be “gender

neutral” might mask differences at the

extremes of scales, and “gender-based

norms” might invite sexist interpretations

(Baker & Mason, 2010). On the other hand,

when MMPI-2-RF (Ben-Porath & Tellegen,

2008) was released, not using gender-based

normative comparisons, there was critique

of this approach (Butcher & Williams,

2009). They state that some women score

significantly higher on the D scale (depres-

sion) and the Fake Bad Scale (FBS) and that

using non-gendered T scores could result in

biases. With regard to the FBS, the gender

differences in response may not reflect

actual faking and may instead reflect greater

symptomatology in women with disabilities

and physical illnesses, and those exposed to

highly traumatic situations (Butcher, Gass,

Cumella, Kally, & Williams, 2008). Psychol-

ogists are cautioned to find research on

gender differences in various assessment

tools before relying on tests that use

non-gendered scoring.

Regarding standardized clinical scales

pertaining to gender (e.g., Scale 5 on the

MMPI-2), there has been criticism (Marin

and Finn, 2010) suggesting that they carica-

ture gender roles, see gender as dichoto-

mous and unchanging, and show little

correlation with gender identity or gender

role–related behavior. (Woo & Oei, 2007) In

assessing girls and women, psychologists

should also be aware of the history of

achievement tests favoring boys over girls

and men over women through language and

examples that favor experiences more

familiar to boys and men (Le, 2000). Psy-

chologists should also be aware that there

are biases regarding the reference norms

the client uses in responding to various

questions. For example, for questions that

ask a person to compare herself to other

people, women often compare themselves

to a generic male rather than to other

women (Deaux & LaFrance, 1998). Certain

scales had been originally produced to

define a construct in men, and then later

used to assess women (Schmidt, McKinnon,

Chattha, & Brownlee, 2006). It is also

important to note that while normative

samples may be comparable to the U.S.

population and provide norms for the “aver-

age American,” the average American is

often assumed to be White; as such, it may

be inappropriate to apply these to African

Americans, Asian Americans, Latino(a)s,

indigenous individuals, or people of other

non-White racial and ethnic groups.

Application

Psychologists, therefore, strive to diagnose

by considering multiple relevant aspects of

the experiences of girls and women and

with an awareness of the biases inherent in

the diagnoses themselves. Psychologists

should include questions about life and

developmental experiences in diagnostic

interviews as well as questions about iden-

tity, group membership, social support sys-

tems, health, and abuse and traumatization.

In applying or avoiding diagnoses, psychol-

ogists should take into consideration pov

erty and economic inequality as contextual

factors influencing symptoms, as they influ-

ence the incidence of depression among

women (Watson, Roberts, & Saunders,

2012). Psychologists also should be cogni-

zant of ways in which diagnoses may help or

hinder treatment and how they may unin-

tentionally support stereotypes of girls and

women through injudiciously applying cer-

tain diagnoses. They are also encouraged to

describe the process of diagnosis in detail to

their clients as well as problems inherent in

the process of diagnosing, and share with

their clients why they have chosen certain

diagnoses over others. Psychologists are

encouraged to include in their assessment

ways to collect data on the strengths of girls

and women, their coping capacities, and

their past accomplishments.

Psychologists are also aware of other

stigmatizing labels that appear through

assessment. For instance, a personal com-

munication from a psychologist told of

an African American post-menopausal

woman whom he referred to a new internist

for a checkup and was told by her doctor, a

White man in his mid-30s, that she had to

make lifestyle changes because she was

obese. The woman replied that she preferred

to be told that she was fat instead of obese.

When the doctor replied that obese was a

medical term, the woman stated that obese

sounded like beast to her. She reiterated she

preferred the term fat instead of obese

when he referred to her. Thus, the patient

experienced this difference in communica-

tion as a microaggression. The psychologist,

upon hearing this client’s story, acknowl-

edges the stigmatizing label, validates the

woman’s feelings of being disregarded and

insulted, and shares resources and informa-

tion with other professionals about sizeism

and its intersections with other identities.

Psychologists strive to make unbiased,

appropriate assessments by using several

methods and multiple instruments that

have been shown to be valid and reliable and

which have included girls and women in the

populations that established norms. When

using tests, psychologists familiarize them-

selves with the normative samples on which

the norms for various tests were produced.

Psychologists also strive to integrate testing

results with multiple relevant aspects of the

experiences of girls and women and with an

awareness of the biases inherent in the tests

themselves. Psychologists are urged to seek

APA | Guidelines for Psychological Practice with Girls and Women 17

out research that presents new normative

data for older tests (e.g., the R-PAS interna-

tional data set for the Rorschach) and that

examines the validity of certain tests with a

variety of populations.

GUIDELINE 8

Psychologists strive to understand

girls and women in their sociopolitical

and geopolitical contexts.

Rationale

There is a full range of familial, sociopolitical,

and geopolitical factors necessary for the

contextualization of girls and women

(Tummala-Narra & Kaschack, 2013).

Oppressive circumstances, structural

inequalities, and power differentials may

hasten and sustain problems for girls and

women, limit their agency, and/or blame

them for their problems. For example, it is

normative among certain cultural contexts,

such as in some immigrant populations and

conservative religious traditions, for women

to tolerate domestic abuse as a survivalist

mechanism due to sociopolitical pressures

(Tummala-Narra & Kaschack, 2013). Fear of

deportation may prevent immigrant women

in the process of applying for U.S. residency

from reporting partner abuse. 

Girls and women around the world are

subjected to oppression and abuse. Many

are victims of familial and interpersonal

violence, sex trafficking, sexual violence,

maternal mortality, female infanticide, acid

attacks, and other forms of gendercide, the

daily slaughter of girls worldwide that in a

decade kills more girls and women than all

of the 20th century’s genocides (Kristof &

WuDunn, 2009). Moreover, it is normative

in some cultural contexts for women to be

physically coerced into marriage. Psycholo-

gists’ perceptions of the social status, cul-

tural identities, and sociopolitical status of

girls and women, as well as their own unex-

amined worldviews, personal biases, inter-

nalized privilege, and cultural identities,

may affect their assessment of the psycho-

logical functioning of girls and women.

National human rights policies, state

and federal laws (e.g., immigration laws,

marriage equality), international relations

policies, and other geopolitical factors influ-

ence girls’ and women’s well-being (Enns et

al., 2015). Girls’ and women’s life satisfac-

tion differs by sociopolitical and geopolitical

context and by cultural definitions of life

satisfaction. Life satisfaction is highest

among nations typified by gender equality

(Crompton & Lyonette, 2005; Tesch-

Roömer, Motel-Klingebiel, & Tomasik,

2008), as well as care for human rights,

political freedom, acceptance of diversity,

and access to knowledge. Developmental

life stages, including the stage precipitated

by immigration, must be considered regard-

ing well-being.

Application

Psychologists strive to integrate sociopoliti-

cal and geopolitical factors such as national

origin, immigration/acculturation, legal

status, and other contextual information

into their psychological conceptualizations

and interventions of girls and women in their

families. For instance, while working with an

immigrant girl who is respectful of her father

and wanting to contribute to the family

income, a psychologist might worry about

her working long hours for her family’s busi-

ness and whether it interferes with her

schooling. Psychologists engage the girl

and/or family with a consideration of the

intersection of gender expectations and

cultural and sociopolitical contexts

(Tummala-Narra & Kaschack, 2013). In the

U.S., considering changing immigration

laws, psychologists need to bear in mind the

additional stress of their clients regarding

their own and family members’ legal status,

and the way in which changing laws and

hate speech create confusion and fear,

whether realistic or not. In working with girls

and women from countries at war, psychol-

ogists can reframe fear as a mechanism of

survival. They need to assess the existence

of trauma—particularly gender-based

trauma, as raping girls and women is a com-

mon weapon in war (Kristen & Yohani,

2010)—and if possible, initiate trauma work.

However, psychologists should also bear in

mind when treatment may pose safety haz-

ards for their clients and understand their

clients’ adaptations and reactions to lack of

safety. When working with refugees, thera-

pists must assess for experiences of loss,

violence, and rape specific to women that

may have been part of the experience in

refugee camps or in fleeing one’s country of

origin. Psychologists must also be mindful of

grief reactions and take particular care not

to pathologize these nor impose time limits

for presumed appropriate grief.

GUIDELINE 9

Psychologists strive to be

knowledgeable about, use, and

provide support for relevant mental

health, education, and community

resources and, when indicated, folk,

indigenous, and complementary or

alternative forms of healing for girls

and women.

Rationale

The APA ethics code’s (2010) principle of

fidelity and responsibility states:

“Psychologists consult with, refer to, or

cooperate with other professionals and

institutions to the extent needed to serve

the best interests of those with whom they

work” (p. 3). Gaining information about the

availability of community resources has

also been identified as a culturally and

socio-politically relevant factor for cultur-

ally competent work with girls and women

in consideration of all their intersecting

identities. Acknowledging and using a

range of healing practices encourages psy-

chologists to meet the unique needs of the

girls and women with whom they work

based on their worldview and perspective

of holistic health (Brown, 2009; Iwasaki &

Byrd, 2010). These forms of healing should

be applied using an international perspec-

tive to help attend to the lived experience

of girls and women (Rutherford et al., 2011).

Complex psychological problems with

multiple causes might be best addressed by

collaborative approaches that draw on per-

sonal, interpersonal, educational, spiritual,

trauma-informed, and community resources.

Community-based, culturally competent,

collaborative systems of care can comple-

ment and enhance therapeutic, educational,

and research efforts, although psychologists

are cautioned to exercise particular care

when using practices that have not been

vetted through traditional empirical

18 APA | Guidelines for Psychological Practice with Girls and Women

research. These resources include, though

are not limited to, women’s support and

consciousness-raising groups; women’s

centers, shelters, and safe houses; psycho-

educational experiences for girls and

women; work/training experiences; spiri-

tual and faith-based communities; and

public assistance resources. Further, alter-

native forms of healing and complementary

and alternative medicine can facilitate

wellness (Comas-Díaz, 2013; National Cen-

ter for Complementary and Alternative

Medicine, n.d.). These include modalities

such as art therapy (Pretorius & Pfeifer,

2010), wilderness therapy (McBride &

Korell, 2005), dance/movement therapy

(DuBose, 2001; Malkina-Pykh, 2012; Mee-

kums, Vaverniece, Majore-Dusele, &

Rasnacs, 2012), religion (Barrera, Zeno,

Bush, Barber, & Stanley, 2012; Comas-Díaz,

2006), and music therapy (Rüütel, Ratnik,

Tamm, & Zilensk, 2004).

Many alternative and complementary

approaches to treatment have demon-

strated efficacy. Dance and movement

therapy have been shown to be effective in

supporting girls and women with eating

disorders (DuBose, 2001), and wilderness

therapy has been shown to be an effective

approach to helping female survivors heal

from trauma (McBride & Korell, 2005).

Further, a study of effective treatment

methods for female survivors of intimate

partner violence found that alternative

healing approaches such as prayer, medita-

tion, yoga, other mindfulness practices,

and art therapy in a group format contrib-

uted to decreased symptoms of post-trau-

matic stress for the participants (Allen &

Wozniak, 2011).

Overall, when psychologists use and

provide support for these alternative and

indigenous forms of treatment, they can

promote healing in a way that attends to the

unique, intersecting identities of the girls

and women with whom they work in their

multifaceted roles.

Application

Psychologists educate themselves about

community resources and alternative forms

of healing that can enhance the work they

do in their multiple roles. They accomplish

this goal by seeking out not only evi-

dence-based practice in alternative healing

but also community resources and indige-

nous forms of healing. Psychologists remain

open to alternative forms of healing that

may have not yet been researched or may

not yield themselves to typical effectiveness

studies, while ensuring they do not practice

beyond the scope of their psychology prac-

tice training, instead collaborating with and/

or referring girls and women to other profes-

sionals and healers when indicated. When

psychologists receive training in alternative

forms of healing, they are clear with clients

regarding the evidence of its effectiveness

and describe their training as per the APA’s

ethics code (2010).

Psychologists recognize that healing

occurs both within and outside their offices.

Psychologists consult with other profes-

sionals who have expertise about alterna-

tive forms of healing that can support the

girls and women with whom they work in all

capacities, including but not limited to cli-

ents, students, and supervisees. When rele-

vant, they may seek out opportunities to

work with a trusted and recognized leader or

healer in a community as a form of co-ther-

apist (Hays, 2009). Likewise, psychologists

encourage women’s supportive relation-

ships such as sisters of the heart, sister/friends,

hermanas del alma, comadres, and others

(Comas-Díaz & Weiner, 2013; Comas-Díaz

& Weiner, 2014).

One example of the application of this

guideline follows. A White supervisor visits

her White student at her student’s intern-

ship site, a treatment center serving Native

Americans on tribal land in the U.S. South-

west, for an evaluation. Before providing

supervision, the supervisor researches the

culture and finds that the people who live on

this land are markedly private and do not

share much about their culture, choosing to

transmit their history orally among them-

selves for religious reasons. Language, oral

history, religion, and secular government

are all closely intertwined in this culture, and

regardless of how much information is

researched, the meaningful core of the cul-

ture may not have been shared with anthro-

pologists or others writing about the people.

In order to be an effective supervisor, the

supervisor should do her homework first,

which should minimally include review of

the history of exploitation and genocide of

many tribes since first contact and the par-

ticular suffering of girls and women. There

may be literature, in general, about gender,

relationships, and power and intimacy

between women and men. The supervisor

can ask her supervisee to consult with the

members who work in her clinic and ask

them about the best way for the supervisor

to come to the clinic and land so as not to

infringe on tribal practices, which could be

experienced as a lack of respect. While

there, the supervisor spends time partici-

pating in rituals, when invited, that the clinic

has devised in an effort to combine treat-

ment with cultural practices. She also takes

a tour of the tribal areas of significance

when offered. She discusses with her super-

visee the issues that have emerged for her

regarding her status as a White woman

treating Native women and how she might

invite discussion about these differences

and similarities in a group she leads. She

invites her supervisee to research colonial

trauma response, which is “a constellation of

characteristics associated with massive

cumulative group trauma across genera-

tions” (Brave Heart, 1999) and to apply this

to the particularities of being a Native

American woman who may have experi-

enced gender-related violence as well.While

the clinic staff does treat clients with sub-

stance abuse disorders, the supervisor pro-

actively cautions her supervisee not to

define individuals by this disorder and to

understand that there is considerable nega-

tive stereotyping about Native Americans

and alcohol that is contradicted by scholar-

ship; for example, total abstinence rates

exceed the general population and rates of

use are similar (Cunningham, Solomon, &

Muramoto, 2015). She finally discusses with

her supervisee how extant, evidence-based

substance abuse treatment strategies com-

plement or need to be adapted to work

effectively within this culture and with

women who have endured ongoing grief,

“soul wounds” (Duran, 2006), and quite

possibly gender-related trauma as well.

Psychologists are also encouraged to

develop a list of current resources on finan-

cial, legal, parenting, aging, reproductive

health, religious and/or spiritual, profes-

sional, social service providers, and other

organizations relevant to the needs and

experiences of girls and women, as well as

to the needs of boys and men for whom

women so often provide care. Many col-

leges and universities maintain onsite

resources to help increase women’s knowl-

APA | Guidelines for Psychological Practice with Girls and Women 19

edge of supportive resources in the commu-

nity and help women develop a sense of

agency to make positive changes in their

lives (e.g., re-entry centers to provide edu-

cational and employment resources for

women), which psychologists could encour-

age the women with whom they work to

utilize. A psychologist working with a

woman who identifies as queer or lesbian

who may be struggling with a conflict with a

disapproving religious community can pro-

vide resources of affirming religious institu-

tions or affirming religious support groups

in the community.

Psychologists may also maintain lists

of online resources to assist in identifying

and evaluating electronic- or web-based

information and support structures, such as

social media and discussion boards, as

potential resources for girls and women. In

their role as supervisors, psychologists can

inform their supervisees about community

resources and alternative forms of healing

for their own well-being as well as for con-

sideration in their own work with clients. In

this way, psychologists promote growth and

healing at multiple levels and facilitate heal-

ing based on their clients’ worldview.

Finally, when appropriate, psycholo-

gists are encouraged to collaborate with,

consult with, and/or refer their female cli-

ents, students, or supervisees to other heal-

ers and resources in their community.

Psychologists recognize that the scope of

providing psychological services may be

enhanced when they consult with other

healers and resources in their communities

and acknowledge the particular needs of

girls and women in an international context.

They may also obtain further training them-

selves in areas such as dance and art ther-

apy, spiritual approaches, and other

complementary approaches to

psychotherapy.

GUIDELINE 10

Psychologists engage in work to

change hostile environments and

institutional, systemic, and global

discrimination that interfere with

the health and well-being of girls

and women.

Rationale

Systemic injustice continues to diminish the

well-being of girls and women. Psychologists

work to improve the status and welfare of

girls and women and promote a more egali-

tarian society by engaging in a multitude of

prevention, education, and social policy

activities. As directed by the APA’s ethics

code (2010), psychologists “recognize that

fairness and justice entitle all persons to

access to and benefit from the contributions

of psychology and to equal quality in the

processes, procedures, and services being

conducted by psychologists” (p. 4). In addi-

tion, beyond their own practice, psycholo-

gists “seek to safeguard the welfare and

rights of those with whom they interact

professionally and other affected persons”

(p. 3). This injunction clearly guides psy-

chologists to pursue a commitment to social

change and justice within health, mental

health, political, religious, familial, neighbor-

hood, economic, legal, educational, and

societal institutions, a view consistent with

many leading psychologists and organiza-

tions (Brabeck & Ting, 2000; Enns &

Williams, 2012; Feminist Therapy Institute,

2000; Johnson, Barnett, Elman, Forrest, &

Kaslow, 2012; Rodríguez & Bates, 2012).

The need to establish institutional climates

that reflect advocacy, diversity, and support

at all levels are also reflected in the APA’s

guidelines for lesbian, gay, and bisexual cli-

ents (2012b), multicultural guidelines

(2017b), and guidelines for people with

disabilities (2012a).

Recognizing that global well-being and

prosperity requires advancing the status of

women worldwide, the United Nations,

through its Commission on the Status of

Women, has developed a list of global prior-

ities (United Nations, 1995, 2017). They

include economic, social, political, gen-

der-role, and workforce equity and the ces-

sation of physical and sexual violence

against girls and women. Examples of orga-

nized efforts to influence public policy

within psychology have included APA task

forces on male violence against women

(Gracia, 2014; Koss, 1993), violence within

the family (APA, 1996), women and poverty

(Chin, Lott, Rice & Sanchez-Hucles, 2007;

Heppner & O’Brien, 2006), and the sexual-

ization of girls (APA, 2007).

Application

Psychologists are encouraged to participate

in advocacy, prevention, education, and social

policy as forms of psychological practice that

improve the mental health and lives of girls

and women. Opportunities to participate in

such activities occur at local, county, state,

national, and international levels. The nature

and extent of psychologists’ participation is

likely to be influenced by their expertise, inter-

ests, spheres of influence, and the focus of

their psychological practice (e.g., teaching,

psychotherapy, research, consultation).

Psychologists are encouraged to advo-

cate for unbiased, nondiscriminatory, and

health-promoting practices for clients, stu-

dents, supervisees, and colleagues within

the institutions and agencies in which they

work. For example, when working with girls

and adolescents in school systems, psychol-

ogists should become knowledgeable about

the prevalence of sexual and racial harass-

ment (Bucchianeri, Eisenberg, & Neu-

mark-Sztainer, 2013) and homophobic

name-calling (Rinehart, Doshi, & Espelage,

2014) and work with teachers, administra-

tors, students, and victims to raise aware-

ness, create a more supportive and

respectful climate, and develop enforceable

effective policies. They may also contribute

their expertise in these settings by promot-

ing leadership opportunities, helping

develop nonsexist materials, and monitor-

ing how testing meets the needs of girls and

adolescents, while ensuring such testing is

racially and ethnically unbiased. When

working in school-based mental health clin-

ics in areas where students are impacted by

poverty and neighborhood violence, psy-

chologists may advocate in the community

for their clients’ social and safety needs in

addition to addressing their therapeutic

needs. Psychologists may also address the

consequences of unequal power dynamics,

questioning agency policies or colleagues’

practices that appear biased toward clients,

students, or supervisees, or by assisting

clients who are intervening on their own

20 APA | Guidelines for Psychological Practice with Girls and Women

behalf. For example, psychologists seek

ways for their agencies to better serve immi-

grant girls and women, both culturally and

linguistically, while also cautioning against

supervisees or colleagues of color serving as

de facto translators for the organization.

They also seek the adoption of treatment

practices that ensure that the particular

experiences of immigrant and refugee

women, including sexual trauma, witness-

ing violence, grief and loss, economic dis-

crimination, and intimate partner violence

are identified and addressed.

When facing discriminatory world-

views or abusive practices, psychologists

can provide interventions and collaborate

with legal systems to establish standards of

practice and public education for cases

involving abuse of girls, intimate partner

violence, economic discrimination, work

exploitation, sexual harassment, sexual traf-

ficking, hate crimes, or other victimizations

of girls, women, and others.

In public policy, psychologists are

encouraged to apply psychological research

findings to major social issues, such as fam-

ily leave, work–family interface, poverty,

discrimination, homelessness, foster care,

intimate partner violence, affirmative action

policies, the effects of trauma, services for

older adults, and media depictions of girls

and women.

At a minimum, academic psychologists

incorporate diversity and social justice

issues in lectures and presentations and

may go on to conduct research that consid-

ers the problems of individual girls and

women in social contexts. Psychotherapists,

school psychologists, consultants, and other

psychologists may provide pro bono ser-

vices and consultation to community orga-

nizations and work within organizational

contexts and with other constituent groups

to ensure effective service provision and

increase access to psychological practice in

its many forms.

Finally, psychologists are also encour-

aged to support their clients’ contributions

to positive microlevel and/or macrolevel

actions that increase a sense of their own or

other girls’ and women’s empowerment. At

the macro level, these activities may involve

helping at the state, regional, national, or

international level to change policies related

to women’s issues and the lives of girls such

as rape, intimate partner violence, pornog-

raphy, sexual harassment, pay inequity,

trafficking, and media objectification. At the

micro level, the activities a psychologist

may support could include naming sexism

or the intersection of sexism with other

-isms in a classroom or among friends, or

stepping in rather than bystanding in situa-

tions where a girl or woman is at risk. When

psychologists support their students, super-

visees, and clients to address injustice or

promote social justice related to women’s

issues, they contribute to the overall

well-being of girls and women.

Conclusion

These practice guidelines, applying as they

do to half the population, cannot be consid-

ered complete. They must be considered

alongside other practice guidelines of the

APA, particularly the multicultural guide-

lines (APA, 2017b), the guidelines for PTSD

in adults (APA, 2017a), the guidelines for

persons with disabilities (APA, 2012a), the

guidelines for lesbian, gay, and bisexual cli-

ents (APA, 2011), and the recent guidelines

for transgender and gender-nonconforming

clients (APA, 2015a). In spite of the acknowl-

edged limitation of the incompleteness of

this revision, these guidelines help direct

psychologists in their work with girls and

women by encouraging them to be wary of

diagnosis, focus on strengths and resilience,

consider the social and situational factors

that disrupt their well-being and normal

coping, and serve as advocates and cata-

lysts for change for their clients, supervis-

ees, students, organizations, and local and

global communities.

APA | Guidelines for Psychological Practice with Girls and Women 21

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APA | Guidelines for Psychological Practice with Girls and Women 31

APPENDIX

Deﬁnitions

Since the 1970s and until recently, the term sex has been used to refer

to biological aspects of being male or female, and gender to psycho-

logical, social, and cultural experiences and characteristics associ-

ated with the biological aspects of being female or male (Unger,

1979). This differentiation was made to show that a person’s sex

assignment does not have a fixed meaning but rather one impacted

by history, culture, and social circumstances (Magnusson & Marecek,

2012). Gender theorists have disputed the two-sex model (Fausto-

Sterling, 2000) and anthropologists have identified social groups

that use more than two sex categories (Magnusson & Marecek,

2012; Markus, 2008). Gender-related attitudes are often embedded in

complex and unconscious beliefs that are shaped and reinforced by

social interactions, institutional practices, and power structures in

society (Bem, 1993). This document uses the term gender to refer

primarily to the social experiences and expectations associated with

being identified or identifying oneself as a girl or woman.

Gender bias is a construct that frequently occurs in psychological

literature to refer to beliefs, attitudes, and/or predispositions that

involve preconceived and stereotypical ideas about the roles, abili-

ties, and characteristics of women and men. Gender bias is modified

by and intersects with biases related to race, ethnicity, class, culture,

age, ability, size, and sexual orientation (APA, 2010; Caplan & Cos-

grove, 2004; De Barona & Dutton, 1997; Fikkan & Rothblum, 2012;

Hall & Greene, 2003; Hartung & Widiger, 1998; Marecek, 2001;

Ratey & Johnson, 1997; Ross, Frances, & Widiger, 1997). While it is

impossible to live in a gendered culture without gender bias, psychol-

ogists need to cultivate a consistent awareness of these biases in

themselves and the lives of the people with whom they work.

INTERSECTING IDENTITIES

The term intersectionality was coined by a Black feminist theorist

(Crenshaw, 1991) and explored recently by psychologists (Cole, 2009;

Shields, 2008; Warner & Shields, 2013). Identities are differentially

formed, evolved, and claimed, and one’s gender identity impacts and

is impacted by one’s race, ethnicity, physical and mental ability, culture,

geographic location, sexual orientation, class, age, body size, religious

affiliation, acculturation status, socioeconomic status, and other socio-

demographic and personal attributes and variables. These other cate-

gories also have variable meanings based on gender.

Ethnicity refers to a group identity that may differ in terms of

language, traditions, immigration history, and religious practice

(Markus, 2008); however, ethnic groupings change over time as

does the concept of ethnicity itself (Peterson & Ahlund, 2007; Smed-

ley & Smedley, 2005). Ethnic group is a phrase often used to describe

non-White people, a manifestation of White privilege such that

White people are typically taught to see themselves as lacking an

ethnic group and to envision themselves as typical or normative

(McIntosh, 2014).

Fat is used as a descriptor of one’s physical size. Heeding schol-

ars such as Lee and Pausé (2016) and McHugh and Kasardo (2012),

the term fat is used rather than those that suggest pathology such as

overweight, which “implies that there is a correct weight,” and obese,

which “denotes a medical condition” (Abakoui & Simmons, 2010, p.

317). We recognize that fat has been used as an insult and pejorative word,

a form of oppression in itself. But language evolves, and current thinkers

argue that words such as overweight and obese carry with them their own

medicalizing and marginalizing effects. These scholars have advocated

for a reclaiming of the word fat, much like the word queer was reclaimed,

to free women and girls from body shame.

Sexualities and Heteronormativity. Psychologists today understand

that heterosexuality is not the only legitimate sexuality and that it has

been defined in a way that prioritizes men’s interests (Magnusson &

Marecek, 2012; Tiefer, 1991). There is diversity, however, of human

sexual practices, meanings, and identities across history, time, and

location where more than two sexes are recognized and sexual prac-

tices are broader and more fluid than traditional heterosexual practices.

Heteronormativity is the assumption that everyone is, or should be,

heterosexual (Kitzinger, 2001). Sexual objectification is a process

through which women’s bodies are perceived as objects and valued for

their use by others (Szymanski, Moffitt, & Carr, 2011), and one that

impacts women’s sexuality.

For the purposes of this document, the terms transgender, gender

variant, gender nonconforming, and/or assigned male at birth have been

used. It is acknowledged, however, that women use these and a variety

of other identity terms to describe their gender expression or presen-

tation. Moreover, it is probable that as the guidelines age over the next

10 years, these terms will change also and will need updating.

The term microaggression was first coined by psychiatrist Ches

ter Pierce in the 1970s (Sue & Rivera, 2010). In 2004, it was revived

as part of the concept of aversive racism, which described people of

privilege and in particular well-intentioned White people who con-

sciously believe in equality but unconsciously act in a racist manner

(Dovidio & Gaertner, 2004). Microaggressions can occur against

people of any marginalized identity. Racial microaggressions are

“brief and commonplace daily verbal, behavioral, or environmental

indignities, whether intentional or unintentional, that communicate

hostile, derogatory, or negative racial slights and insults towards

people of color” (Sue et al., 2007, p. 273).

Oppression includes discrimination against and/or the systematic

denial of resources to members of groups who are identified as different,

inferior, or less deserving than others. Oppression is most frequently

experienced by individuals with marginalized social identities. Oppres-

sion is manifested in blatant and subtle discrimination such as racism,

ageism, sexism, and heterosexism, and it results in powerlessness or

limited access to social power (Burnette & Hefflinger, 2017; Comas-

Díaz & Bryant-Davis, 2016; Watson, DeBlaere, Langrehr, Zelaya, &

Flores, 2016). By contrast, privilege refers to sources of social status,

power, and institutionalized advantage experienced by individuals by

virtue of their culturally valued social identities (McIntosh, 2014).

32 APA | Guidelines for Psychological Practice with Girls and Women

ACKNOWLEDGEMENTS

The members of the task force included two teams of individuals. Those who contributed to

the revisions of the guidelines, their rationales, and their application were the three co-chairs,

Sharon Lamb, Debra Mollen, and Lillian Comas-Díaz; and Tamara Buckley, Stefanie Dykema,

Erin McKeague, Allie Minieri, and Natalie Porter, each assuming lead authorship of various

guidelines. Those who contributed to the revising and the writing of literature reviews were

the following clinicians, scholars, and students (in alphabetical order): Dena Abbott, Virginia

Arlt, Martha Banks, Dana Becker, Madeline Brodt, Lyn Mikel Brown, Sonia Carrizales, Donna

Castañeda, Andrea Celenza, Caroline Clauss-Ehlers, Lillian Comas-Díaz, Deborah Dorton,

Haley Douglas, Rachel Feldwisch, Rona Fields, Lisa Frey, Sam Gable, Yilei Gao, Melinda Green,

Beverly Greene, Alaa Hijazi, Sharon Horne, Arpana Inman, Justine Kallaugher, Chesleigh

Keene, Ladan Khatibijah, Annette S. Kluck, Sharon Lamb, Kathy Lustyk, Meredith Maroney,

Debra Mollen, Jennifer Mootz, Marta Pagán-Ortiz, Noelany Pelc, Asmita C. Pendse, Suni

Peterson, Allayna Pinkston, Aleksandra Plocha, Sara Powers, Trisha Raque-Bogdan, Pamela

Remer, Royleen Ross, Lisa Rubin, Rakhshanda Saleem, Doreen Salina, Angela Salzmann,

Louise Silverstein, Noël Su, Sarah Ullman, Monique Ward, Laurel Watson, Emily Wheeler, Sue

Whiston, Sherrie Wilcox, Lauren Woolley, and Jinzhao Zhao. Those who helped with other

tasks including editing, reviewing portions of the manuscript, and recommending changes

were Madeline Brodt, Sam Gable, Julii Green, Jane Litovchenko, Sapna Patel, Royleen Ross,

Natasha Shukla, Sarah Taylor, Eleonnora Turdubaeva, and Lindsey White.

APA | Guidelines for Psychological Practice with Girls and Women 33

34 APA | Guidelines for Psychological Practice with Girls and Women