Everything You Need to Know about Gender Responsive Care

0:00:13 William Moyers
Hello! And welcome to Let's Talk, a podcast series brought to you by Hazelden Betty Ford. It's a new season, too. And we are glad you've tuned in. I'm your host, William C. Moyers. Today we are joined by Dr. Stephanie Covington, whose expertise spans the gamut of issues related to addiction, treatment, and recovery. But specifically today, we talk about how these issues affect women and the importance of gender responsive care. Thank you, Stephanie, for joining us today. And I thought I would start by asking for your insight on how it is that trauma affects women differently than men.

0:00:53: Dr. Stephanie Covington
Well trauma affects women differently just like addiction impacts women differently. With trauma, women are much more likely to have interpersonal violence that—that the abuse that they often experience in their childhood continues into their relationships as adolescents and then as adults. Which is very unusual for a man. So different—different kinds of abuse and trauma in the lives of men and women.

0:01:17 William Moyers
And what about the big T versus the little t that you talk about? I mean obviously, a sexual violence against a woman would be a big T. What are some of the other traumatic experiences that a woman might have?

0:01:30 Dr. Stephanie Covington
Yeah when we talk about big T, big T are the things that are life-threatening. Where you have a fear you're going to lose your life. Small t are the kinds of traumatic events that when you experience them, they have a negative impact but they're not necessarily life-threatening. So, we find that, you know, more often boys are bullied, girls are teased. If we look at what happens on cell phones, girls are stalked in ways that boys generally are not. So there's a different kind of traumatic experiences for youth. And for women, same thing with women are more often stalked than men are in their adult lives.

0:02:12 William Moyers
When did our field become cognizant of the need to take a different approach to clinically treating women?

0:02:19 Dr. Stephanie Covington
Well it's been a slow evolutionary process. [Moyers nods] And it really started in the '70s with the Women's Movement. And women came together in the seventies and they talked about—in small consciousness-raising groups—they talked about the realities of their lives, and we heard about domestic violence, childhood sexual abuse, addiction to alcohol and other drugs. And in the '70s, the federal government set up twelve demonstration projects—addiction treatment for women around the country. And then from there, we moved into the '80s and people started talking about gender responsive treatment. And then in the '90s, I developed a definition for gender responsive treatment. And so it's been a process. It's just like most things in life, it's been a developmental process.

0:03:08 William Moyers
Give us that definition please if you would about gender responsive care.

0:03:12 Dr. Stephanie Covington
Sure. So, initially the definition was this: creating an environment through site selection, staff selection, program development, content and materials that reflects an understanding of the realities of the lives of women and girls. And it deals with their strengths and challenges. And then we, after doing all this work with women and people—we kept saying to people, if we get it right with women, this is going to improve services for men. So then we talk about being gender responsive for men. Same definition. You think about the site, you think about the staff, you think about the materials. You think about the realities of men and boys' lives and what are their strengths and challenges. And now more recently, we've expanded that to include the transgender non-binary community. So it's still thinking about how people express gender and think about how that relates to helping them heal and recover.

0:04:12 William Moyers
So much of the treatment in the United States and so much of the recovery process is oriented around the Twelve Steps. And yet in the Twelve Steps is an emphasis on powerlessness. How does that square with what many women experience, or transgender people experience, about powerlessness in their own lives?

0:04:35 Dr. Stephanie Covington
Right. Well, think about what that—what that first step—'We admitted we were powerless over.' You can't talk about powerlessness unless you talk about the word 'over.' The Twelve Steps don't ask me to say I'm powerless. They want me to acknowledge that I'm powerless over drug of choice, people, places, and things. It's paradoxical. When I could admit where I'm powerless, I actually get an increased sense of internal sense of power. In my life. So, you know, early on, many feminists critiqued the Twelve Steps for women and said it's not good 'cause you're telling women they're powerless. They said no you're understanding what it says. It doesn't—it doesn't say that. And we want people to have an internal sense of—but it's also about humility. It's that, 'I have my own internal sense of power, and when I look at that compared to the enormity of the universe I see how small that is.' So it's a both/and.

0:05:43 William Moyers
Are there other pathways to recovery for women that are not the Twelve Step-based pathway?

0:05:50 Dr. Stephanie Covington
Sure! I think, you know, I think that's one of the pieces that's been hard for the addiction field because it was founded in a way on the Twelve Steps in this country. To understand that people recover in a variety of ways. And there have been several programs that have been developed for women that are not Twelve Step-based. I happen to be a proponent of the Twelve Steps because I don't think anyone recovers, any woman in particular, but I don't think anyone recovers in isolation. And the Twelve Steps provide for a sense of community. And where can you find a group of people who are managing their lives without alcohol and other drugs and you can go and it's free. And what in this country has value that's free? I mean, we charge for everything. So, it's actually quite a radical program when you think about it. Non-hierarchical, free, and spiritual. [Moyers smiles, nods]

0:06:47 William Moyers
Is there room for male clinicians in a gender responsive care setting that is specifically focused on women?

0:06:55 Dr. Stephanie Covington
Sure! I mean, in that definition it says staff selection. And early on we said that only women should work with women. And quite honestly, pretty soon we met women that shouldn't work with people. [chuckles] So, that wasn't such a good plan. Certainly there are roles for men in women's treatment. And some of the most powerful roles for men really are non-traditional roles. If you—if you can have a man running a group on domestic violence, or running a parenting program, let me tell you—women really listen. Because very few of them have ever met a man who's interested in those two issues. So there's definitely a role for men in women's treatment. Now I have to say, the caveat being, the materials I write are written so the groups are facilitated by women. Not because of the skills of men, but women need this role model. Very—a strong female role model. And the topics that we talk about, women are often uncomfortable talking about with men. So, there is a role for men in women's treatment, in the materials I write I prefer that the groups are run by women.

0:08:08 William Moyers
How about in a LGBTQ community—should patients be working with clinicians who have the same sexual orientation or not?

0:08:18 Dr. Stephanie Covington
I don't think it has to be the same—for the LGBTQ community, there needs to be some staff members that are part of this community. I mean, staff really should reflect the clients that they're treating. Whatever that might be. And so, for everybody on the staff to be cisgendered heterosexual, treating LGBTQ, I don't think so. I think—I think staff needs to reflect the clients that they're working with.

0:08:48 William Moyers
I know that the topic of gender responsive care is what we are focused on today, but what about gender responsive recovery? What is your perspective on how women or others apply their recovery pathway? Should it be gender—should they be sensitive to gender responsiveness in that—in that regard too?

0:09:12 Dr. Stephanie Covington
Well sure. I mean, think about it, I have—I think and maybe you and I will agree or disagree on this, we're both in recovery. [Moyers nods] I think it's really important in my recovery that I attend some women-only meetings. And my recommendation that you as a man, it'd be really good for you to attend some men-only meetings. [Moyers nods] Because I think people talk differently when they're not in a co-ed setting. And I think there's a different level of honesty and a different level of conversation. So yeah, I think it makes a difference.

0:09:51 William Moyers
One area that you've really risen in terms of being a public advocate at the national level is around gender and justice. Can you explain where that comes from?

0:10:01 Dr. Stephanie Covington
Well, you know, again, everything just evolves, right? I start working in the addiction field, then I see the connection to trauma. And I become really interested in women in the criminal justice system. And it was one of the flukes of life really. I was in North Carolina and I was speaking in a women's conference and standing in a group of women. And a woman had on a tag that said 'Warden,' her name tag. And I was like, I don't know any Wardens. And I ended up being able to talk her into letting me live for a couple days in the women's prison. The next year. And when I left the women's prison, I knew it was my work. [puts hand up for emphasis] You know, just, how we know things. You know? And so that led me to doing work in prisons starting with women's prisons and then, now, men's prisons. But also, juvenile justice, boys and girls.

0:11:01 William Moyers
Hmm. So you saw somebody at a conference with the Warden name tag on, you went and spent a couple of days locked up?

0:11:10 Dr. Stephanie Covington
Yes. [smiles]

0:11:11 William Moyers
What did you come out—how did that change you?

0:11:15 Dr. Stephanie Covington
[takes deep breath] You know, I—I will not say that because I chose to go in and was lucky enough she let me do it, and put on a uniform for two and half or three days that I really know what it's like to live in a prison. But, it was an—it was a life-changing experience for me. What was one of the most impactful pieces was what it was like to be connected to women that I never would have met in my life. And that was a very powerful experience. And the other was how the criminal justice system is designed in ways that do not help. And what a waste. [shakes head] And I just knew it was work that I wanted to do. And so, you know, at the time I was actually redesigning women's treatment at Betty Ford out in the desert. [Moyers nods] And I knew that when that contract was over, somehow I was going to move into the criminal justice system. Didn't know yet how or why—I knew why but I didn't know how.

0:12:20 William Moyers
So what are you doing to change how women not just are treated but get treatment when they're locked up?

0:12:29 Dr. Stephanie Covington
Work on multiple levels. I mean and the amount of work and the levels of the work really depends on what state I'm in or what country I'm in. One level is the programming we provide the women. So, provide trauma treatment, we provide trauma services to the women. The healing trauma. I have another intervention Beyond Trauma. We have Beyond Violence for women who've committed violent, aggressive crimes. The work with trauma in the women's prisons, particularly here in California, led California to now we're doing trauma work with the men in the men's prisons. And then California has just picked Helping Women Recover and Helping Men Recover as the core to their new substance use disorder treatment in 35—all of the 35 prisons.

0:13:18 William Moyers
Wow.

0:13:18 Dr. Stephanie Covington
So we've—we've incorporated that. And in other places like England, we've also trained correctional—twelve women's prisons, seventeen high-security men's prisons in England. We trained staff in trauma, how to become trauma informed. Create guide teams in prisons for them to begin to look at how they operate and where they can make changes. And then we also provide services. So it's multiple levels.

0:13:46 William Moyers
That's encouraging! We only have about a minute left but if people wanna learn more about gender and justice element of your platform, where do they do that?

0:13:58 Dr. Stephanie Covington
Well, we have a website called the Center for Gender and Justice. And that talks a lot about the work we do. Like I said it was originally focused on women and girls, but it's expanded to men. Or my website also has a lot of materials and articles and research and so forth. And also shows the materials we've developed for the criminal justice system.

0:14:21 William Moyers
Well thanks, Dr. Covington, for your insights and your time. That's all the time that we have for today. And thanks to all of you for tuning into this podcast. If you liked it, make sure to tell your family and friends, colleagues and fellow travelers to check out our podcasts. And if you didn't like it, shoot me an email and tell me why. On behalf of my colleague and the Executive Producer Lisa Stangl, we hope that you remain safe and healthy and resilient in these challenging times. And remember, together we are building a healthier, wholesome, and happier tomorrow, one day and one life at a time. See you soon.