Women’s Therapy Referral Service: 45 Years of Feminists Providing Mental Health Care
This retrospective was written to commemorate the 40th anniversary of the Women’s Therapy Referral Service.
The Women’s Therapy Referral Service (WTRS, or the Service) was founded in 1976 in response to a growing need for feminist therapists. Originally housed at the downtown YWCA in Seattle, the need for the Service became apparent when an increasing number of women began contacting the Y looking for therapists with a feminist consciousness—or simply for a therapist who was a woman.
To understand the roots of WTRS, it is helpful to understand the cultural milieu within which it was born. The drastic lack of women-focused therapists had been articulated some years earlier at the 1969 convention of the American Psychological Association (APA). Feminist therapists attending the convention formed their own group within the APA in response to widespread disregard for feminist issues within the larger organization. This new group, the Association for Women in Psychology (AWP), pressed for attention to feminist issues, including the need for research on the psychology of women and women’s sexuality, recognition of widespread discrimination in education, employment, and health care, and the perpetuation of sexist stereotypes by conventional models of therapy.
A landmark event marking the growing awareness of sexism in psychology was the publication in 1972 of the book Women and Madness. Written by feminist psychologist Phyllis Chesler, the book was a groundbreaking treatise on women and mental health. In her writing, Chesler explores the ways in which women are pathologized for stepping outside their defined roles. Chesler’s analysis drives home the need for therapists with feminist consciousness. Her descriptions inform, by inference, what therapy for many women was like at the time:
What does a feminist therapist do that’s different? A feminist therapist tries to believe what women say. Given the history of psychiatry and psychoanalysis, this is a radical act. When a woman begins to remember being sexually molested as a child, a feminist therapist does not conclude that the woman’s “flashbacks” or “hysteria” are proof that she’s lying or “crazy.
A feminist therapist believes that a woman needs to be told that she’s “not crazy”; that it’s normal to feel sad or angry about being overworked, undervalued, and underpaid; that it’s healthy to harbor fantasies about running away when other’s needs (demanding children, aging parents, needy husbands) threaten to overwhelm her.
…A feminist therapist tries to listen to other women respectfully and not in a superior or contemptuous way. A feminist therapist does not minimize the degree to which a woman has been wounded. Experiencing life as a second- or third-class citizen is not a minor occurrence with only minor consequences…
…A feminist therapist does not label a woman as mentally ill because she expresses strong emotions or is at odds with her “feminine” role… Feminists do not view women as mentally ill when they engage in sexual, reproductive, economic, or intellectual activities outside marriage—for example, when they have full-time careers, are lesbians, refuse to marry, commit adultery, want divorces, choose to be celibate, have abortions, use birth control, have an “illegitimate” baby, choose to breastfeed against expert advice, or expect men to be responsible for 50% of the child care and housework.1
In 1970, two years before the publication of Women and Madness, women comprised just over 20 percent of PhD recipients in psychology. Thus the majority of psychiatrists and therapists were males, and most were white and middle class. Many had been trained in theories of psychology that pathologized the lives and concerns of women, lesbians, gays, bisexuals, people of color, and blue collar workers. Standards for mental health were defined by the values and perspectives of white, middle class males. As a result, women in therapy were encouraged to remain in traditional roles. Many women in therapy reported that they were encouraged to be more feminine (selfless, demure, soft-spoken, docile, submissive, sexy, servile, and attentive to the needs of others). They were told that their depression, anxiety, fear, lack of confidence, unhappiness, and general dissatisfaction with life would be solved if they would become better wives and mothers, or find a man to marry and father the children they were supposed to bear and raise.
To further understand, it is important to recognize that the political landscape in the U.S. was dominated by men and non-feminist male perspectives. In 1967, the Senate consisted of 99 men and one woman. Of the 435 representatives in the House, 13 were women. Of the nine justices on the Supreme Court, all were men. (It would be 14 more years before the first woman was appointed to the court.)
In the world of business virtually all CEOs and middle management personnel of major corporations were men. Typically, manufacturing plants were headed by men. University and college presidents, and most other high-level administrators, were men. Newspapers separated help wanted ads into two columns: “Help Wanted: Men” and “Help Wanted: Women.” Where women and men worked side-by-side—as custodians, for example; or where women did the equivalent work of men (factories), white women earned approximately 58 cents for every dollar that men earned; African-American women earned 43 cents.
The cultural landscape, as expressed through movies, TV, magazines and books, actively reinforced the dominance of men and the submissiveness of women. In fact, women were completely invisible in cultural statements such as statues in parks and images on paper bills and coins exchanged daily. At a time when language about sexism was in its infancy, these images were absorbed unconsciously, which served to increase the potency of the message.
Abortion was illegal throughout the country. Women who were beaten and raped were held responsible on the grounds that they had invited these acts of violence. The revelations and even the language for domestic violence, date rape, and human trafficking were years in the future.
Decades earlier, women in the “first wave of feminism” (1848 – 1920) struggled and fought for equal rights, including the right to vote. The second wave of feminism arose when the forces of history startled middle-class women into an awareness of the limitations of their lives. In the aftermath of World War II, these women, who had stepped out of their homes to perform vital roles for the War effort, were no longer seen as valuable in the work force. Their new patriotic duty was to be good wives and mothers.
In the civil rights movement, women demonstrated over and over their leadership capabilities, but were often denied the prominence afforded to men. The same phenomenon was repeated in the anti-Viet Nam War movement.
More and more women were becoming aware of the ways in which they were demeaned, coerced, controlled, and made invisible. By the mid-1960’s, feminist consciousness was growing by leaps and bounds. Betty Friedan’s The Feminine Mystique, published in 1963, set the stage for a dizzying expansion of feminist literature: Kate Millet’s Sexual Politics in 1969; Our Bodies Ourselves in 1970; Robin Morgan’s Sisterhood is Powerful in the same year, and, as mentioned above, Phyllis Chesler’s Women and Madness in 1972. Nineteen seventy-two also marked the launching of “Ms.” magazine, notable for being the first magazine whose articles and stories, reflecting a feminist and liberal point-of-view, were entirely under the control of women.
Writers of fiction and poetry contributed to telling the truth about the reality of women’s lives. Audre Lorde, Rita Mae Brown, Gloria Anzaldúa, Isabel Miller, Adrienne Rich, Cherrie Moraga, Lucille Clifton, Alice Walker, Diane de Prima, bell hooks, and Ana Castillo were among the many writers who brought the long ignored struggles of women, lesbians, and women of color into the realm of public discussion.
In addition to fiction, women devoured articles and books published by small presses from coast to coast; the writings included theoretical works analyzing the origins of cultures of dominance; theories of class, race, and feminism; aging; the strict gender socialization of women and men; the misinformation about women’s sexuality; the forgotten stories of women’s contributions to science, literature, the arts, athletics, government, law, religion, the military, and business; the relentless pressure on women to conform to narrowly defined standards of beauty; the pressure on women to defer to men; the double standards for sexuality (he is sowing his wild oats, she is a slut); for behavior (he is assertive, she is aggressive), for attire (business suits and pain-free shoes for men; frilly blouses, skirts, and high heels for women).
In the emerging climate of feminism, white middle-class women were rebelling against traditional roles. Consciousness raising groups were springing up all over the country. Women met in their homes to share their feelings, their insights, and their struggles, and to encourage each other to live their feminist values. And they wanted guidance and support from feminist therapists. There was a great need for women to be listened to from a point of view that empowered them and encouraged their voice.
The Women’s Therapy Referral Service filled this need in this time of awakening. WTRS recruited therapists who identified as feminists. Among those recruited, there was diversity of opinion about what feminism was. At that time, the feminist movement was largely focused on the needs of white, middle-class women. It would be another decade before the voices of women of color, poor women, lesbians, bisexuals, and transgendered women were heard. Their stories and perspectives later drove the movement to embrace a broader concept of feminism.
Therapists who joined the Service understood that beyond the beliefs, roles, and expectations arising from one’s family of origin lie social and economic forces that determine how women think about themselves and their place in the world. These larger forces often remain unnamed and unconscious; one of the great contributions of feminist theory was to bring to light the specific ways in which these forces subtly and not-so-subtly mold and limit women’s lives.
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Founded on principles of feminist leadership, WTRS was structured as a non-hierarchical, collaborative organization. Cameron Justam, who founded the organization and served as its first Referral Coordinator, notes that tasks such as budgeting, marketing, and publicity were rotated among members. She describes the meetings: “We met in people’s homes. Different members hosted the meetings as part of their contribution to the Service. It was very much a consensual and cooperative approach. It was really very beautiful. We sat around in a circle on pillows on the floor and made decisions about where we were going. We were embodying feminist principles of collaboration. Relationship was very important.”
From the very beginning, WTRS instituted a practice unique in Seattle, that of client-therapist matching. The matching process was initiated in recognition of the fact that resonance between client and therapist is necessary for clients to build trust as they enter the intimate terrain of therapy. This matching process continues to be the heart and soul of WTRS. Then, as now, when clients – women, men, or couples – contact the Service, they are invited to an in-depth, face-to-face interview with the Referral Coordinator. In the interview, the Coordinator helps clients clarify their goals and identify the therapeutic orientation best suited to their needs. Clients also receive education about the culture and process of therapy, and are encouraged to talk with their therapist if questions come up about the process itself or the therapeutic relationship. The Referral Coordinator also coaches the client on how to interview therapists. Based on the client’s needs, personality, goals, and values, the coordinator matches the client with three therapists, and the client has the opportunity to interview each. Thus, WTRS offers clients a unique, valuable, and efficient process for finding a therapist who is right for them.
In 1979, three years after founding the Service, Cameron Justam left her position as Referral Coordinator to pursue further professional training. While the Service had flourished at the Y, its presence was not without controversy. According to Justam, the leadership at the Y was focused more on the critical task of ameliorating racial discrimination than on facing injustices arising from sexism. The Y leadership also tended toward moderate approaches to solving social problems. Justam’s perspective was that WTRS leaned toward exploring a radical redefinition of what it meant to be a woman living in the United States.
Justam, although not officially “out,” had not tried to hide her sexual orientation. It was Justam’s perspective that the Y wanted to distance itself from lesbians; the Y was afraid they would lose funding if lesbians were associated with the Y leadership. This was not uncommon. The National Organization for Women (NOW) also did not want to be associated with lesbians.
Even with these tensions, the Y and WTRS peacefully co-existed during the Service’s early years. However, when Justam resigned, the Y leadership, while acknowledging that Justam had done an outstanding job in developing the Service, nevertheless decided to bring the Service more into line with the political preferences of the Y.
The Y hired as the next Referral Coordinator a heterosexual, non-feminist woman whom Justam perceived as having an authoritarian style. She did not understand that WTRS functioned as a collaborative organization, nor did she understand the importance of feminism as a criterion for therapists who applied to be part of the Service. For her, the more therapists, the better (numbers mattered for funding), and she proceeded to include therapists who were not feminists.
In response to the selection of this new Referral Coordinator, a group of WTRS therapists met with the director of the Y. They expressed their dissatisfaction with the new coordinator and requested that WTRS be separated from the Y. The director of the Y declined. When Justam returned from California in 1980, she met with members of the Service who were committed to re-establishing the original philosophy of the Service. They approached Seattle Central Community College, which agreed to house the Service. The name was changed to the New Women’s Therapy Referral Service. The original members had worked to develop WTRS into a solid, collaborative organization, and they carried that model to Seattle Central. To pay the coordinator’s salary, which until then had been paid by the Y, the Service initiated a quarterly membership fee for therapists.
Most of the therapists from the old Service joined the New Women’s Therapy Referral Service. Ultimately, what was left of the Service at the Y disintegrated, and the new Service reclaimed its original name.
Within two years, the Service’s growing success enabled them to function independently. No longer needing the institutional support of Seattle Central, the service opened an office in Pioneer Square. In addition to the coordinator’s salary, new costs such as rent and utilities were incurred. Against the objections of some of the original members, a business model was adopted. This was a major transition for the organization. As part of the business model, the Service instituted a sliding-scale client fee for the initial interview. In the mid-1990’s, the Service affiliated with the Northwest Cooperative Federation for a few years until that organization disbanded. Eventually, the WTRS relocated to Wallingford, where it remains today.
Over time, the Service changed in other ways. Some of the original members retired. The tradition of meeting in people’s homes gave way to meeting in a community hall. Some committees dissolved; new committees formed in response to changing needs. WTRS now runs successfully by combining a collaborative model with a more traditionally-structured business model.
In the 40 years since WTRS was founded, the understanding of what defines feminism has been challenged and broadened. This Bridge Called My Back: Writings of Radical Women of Color (eds: Cherrie L. Moraga and Gloria E. Anzaldùa), published in 1981, challenged the idea of universal sisterhood championed by white Western feminists. Building on previous articles by women of color, the book advanced the concept of independent identities such as ethnicity, class, and gender identity, and how they intersect in one’s life. Offering a global perspective, the book critiqued the idea that the feminism developed by white, Western middle-class women is the norm, and sparked the beginning of Third World Feminism.
In 1983, Angela Davis, in her book Women, Race, and Class, posited that without an understanding of racism and without a critique of capitalism, feminism could not succeed. She documented the working conditions of black women during and after slavery, the racism in the women’s suffrage movement, and the implicit racism expressed by the most prominent leaders of the feminism of the 1960s and 70s.
Most recently, bell hooks articulated this concept: “Feminist thinking teaches us all, especially, how to love justice and freedom in ways that foster and affirm life.” 2
As feminists, therapists in the Service embrace the understanding that empowerment is deeply entwined with race and class. The words “feminism,” sexism,” “racism,” or “classism” may never come up in a session, yet therapists hold in their minds an understanding of the consequences of these oppressions.
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As we reflect on our history, we recognize and honor the strengths that have enabled our organization to thrive. At the heart of WTRS is the unique therapist-client matching process, which assists clients in finding a therapist who can best meet the client’s needs. In addition, the commitment to the feminist principle of collaboration has been key in sustaining the organization. The high quality of therapists, the commitment by members to maintain the community through volunteering, and the opportunity for older and younger therapists to energize each other, all contribute to the resilience and sustainability of the organization. Finally, through the lens of feminism, therapists understand that each client has the innate ability to heal. In partnership with their clients, WTRS therapists help draw out the inner wisdom that guides each client in their journey toward wholeness.
Rosen, Ruth. (2000) The World Split Open: How the Modern Women’s Movement Changed America. New York, New York: Penguin Books.
Smelser, N.J., Wilson, W.J., and Mitchell, F. (Eds.). (2001) Racial Trends in Labor Market Access and Wages: Women. In: Smelser, N.J., Wilson, W.J., and Mitchell, F. (Eds.), America Becoming: Racial Trends and Their Consequences. Volume II, pp. 124-125. National Research Council. https://doi.org/10.17226/9719 and https://www.nap.edu/read/9719/chapter/7
1. Chesler, P. (1972). Women and Madness. Garden City, New York: Doubleday. pp. xxi-xxiii
2. Hooks, bell. (2015). Feminism is for everybody. New York and London: Routledge Press. p. 71
Mary C. Waters, a former Seattle resident, lives in Ukiah in northern California. Her work has appeared in Raven Chronicles, The Dalhousie Review, Curve Magazine, and Persimmon Tree. Susan Levine, Seattle therapist and member of WTRS, initiated the idea for this retrospective. She co-authored sections of the article and served as editor and consultant.