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Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2003 The Centre for Addiction and Mental Health
Received Day: 23 Month: September Year: 2002
Publication date: May 2003
Publisher Id: jgi.2003.8.8
DOI: 10.4309/jgi.2003.8.8

Reflections on problem gambling therapy with female clients
[This article prints out to about five pages.]
This First person account was not peer-reviewed.

Name withheld by request

I am an addiction therapist who works full-time with problem gamblers. In the course of my brief career, I have seen hundreds of clients, with a little more than one-third being female. When the e-journal editor asked me to write about my therapeutic experiences with women clients, I necessarily had to reflect on the many challenges this work holds for me. Some of these musings concerned what impacts me emotionally; what female clients bring to therapy that is unique; how their therapy unravels; how female clients mark success in treatment; and what they demand of me as their therapist.

It is abundantly clear to me that working with women poses some very distinct challenges compared to working with men. In describing overall experiences working with women and problem gambling in general, there is always the risk of stereotyping. So, I shall qualify my biases right up front. First, let me say that I really enjoy gambling. In my personal life, I am often up for a good outing at the casino. What I cannot abide is exploitation of people with gambling problems. I should also say that I am a feminist, female and I think women are fabulous. Still, when I work with them, the issues of transference and counter-transference can be overwhelming. The work can leave me infuriated and deflated, or revved up and rejuvenated. I find that women possess multilayered abilities to endure and survive all kinds of adversity. Their strength inspires me, while their wounds inflict pain.

Some of the unique emotional issues I see women bring to problem gambling therapy concern rebellion and autonomy. Almost every female client I have seen states that gambling is in some manner a way of her “letting go of her obligations”; “rebelling”; “doing what I want, finally, after taking care of everyone else all my life.” Many of my clients have experienced abusive relationships and lasting loneliness. Several are grandmothers, many are divorced, and a few are young and with partners. The crux of this rebellion seems to be the end result of feeling emotionally and physically responsible to others first and themselves last. When the pressure cap finally blows, and the woman says, “Screw you, world, watch me do what I want!” she finds herself “asserting” her autonomy in a casino or bingo game, etc.

My typical therapeutic challenge is to ask the woman to make sense of this for me: how is losing her money and her time liberating? I tell her I am confused as to how this anger is solved by an activity so filled with loss and regret. All the while, as I explore this thread, I know that as women, in our society, their real and imagined alternatives for expressing rebellion are very limited. This is a real issue that cannot be minimized or ignored in therapy.

It is always strange and disheartening for me to hear women say that gambling is the only activity they have that allows them to “enjoy a social outing alone” without being judged, scrutinized, approached sexually or harassed. One can only wonder what is occurring in a culture where casinos, bingo halls or racetrack or slot venues are the only places some women experience as safe and acceptable to go by themselves. How did it happen that games of chance, with their built in losses, became synonymous with “a nice outing for grandma”? I wonder about our cultural values. When my clients are urged to uncover alternative activities that meet the same criteria — safety, anonymity and social approval — they are hard-pressed to come up with any.

In sessions with clients, I have a difficult time not sharing my disappointment in our culture's values when I encounter this issue. I find myself having some “wicked” counter-transference, wanting to say: “But this is not right. Every social environment should offer you these possibilities, without costing your life savings.” Men can go almost anywhere for social activity and it is accepted. Except for maybe attending figure skating or something like that, but you catch my drift. It is still a man's world, and when women seek some autonomy, it seems strange that it comes at such a cost and in such a form. I have asked every female problem gambler if she feels she received the value of what she purchased by gambling. Each one has given an unqualified No: she paid for much more than she received in terms of a dollar value assigned for entertainment, escape or rebellion.

It is easy to see why women clients say that they need a socially acceptable outlet where they feel safe and anonymous in their activities. I have heard more stories of women feeling neglected, alone, abused, rejected and enslaved than I could possibly count. Usually, when I hear these tales, I find myself wondering how this person “escaped” these experiences with “only” a gambling problem. Of course, on exploration, it is obvious that many have more issues to deal with than gambling. When I hear these stories, I always marvel at women's resilience. Usually, women recount the same terrible tales that men tell of loss, loss, loss: financial devastation; shattered values and self-respect; lost jobs and homes. Women also speak clearly about losing their ability to connect with others emotionally and about losing their sense of connectedness, period.

And when women tell these stories, they further relate their mental health diagnoses and struggles with violence from the past. They speak to me about how these issues are connected. A female client told me how, with scratch tickets, “I felt like I was scratching the abuse away, and all thoughts of the abuse. If only I could keep scratching… .” When I explore what the material concerns are in their daily lives, I often discover that they are working, taking care of practically every household detail, dealing with children and in-laws and, additionally, dealing with ghosts of the past. Invariably, male clients do not deal with all of these issues; they just gamble and work. It seems so easy for the men that I wonder how all of them can't suddenly experience full recovery in a hurry. And many do, as a matter of fact. But the women: they have so damn much to do in a day that even the all-consuming nature of problem gambling does not allow them to avoid.

This is why I may be called biased. I think women deal better with both the daily and emotional tasks of life. The men get off easily compared to the women. The men usually have the goal of getting their finances in order first, their relationships second, which, alone, they often consider treatment success. On the other hand, many women clients not only have gambling-related and financially related goals but also real, current and explicit concerns about dealing with underlying issues. The men rarely want to deal with those: with abuse, feelings invoked by encounters with their fathers, and the like. Women often tell me they need to deal with these issues, as their unresolved emotions are triggers to gamble. Women see the connections between all of their difficulties, while men more easily compartmentalize their problems — this is gambling over here, that is my relationship over there. The lines of demarcation are rarely so black and white for the women.

Women, on the other hand, come to therapy with much less concrete goals and are much harder on themselves in evaluating success than men. This makes working with women much more challenging for me. The treatment goals are more elusive and the client's measure of success harder to pin down. Her goal will rarely be “to stop gambling” in and of itself, and she will usually be much harder on herself than her male counterpart if she has a setback. For female clients, measures of success are typically so large that, clinically, it is one of my greatest challenges to help the client make treatment goals that are measurable and humanly achievable.

Emotionally, I have many experiences that are exclusive to working with female clients. Counter-transference for me looks like this: I expect a lot from women, more than I expect from men. Referring to the fact that women seem to contend with all that men contend with on a daily basis plus a hearty dose more, I have the distinct feeling women need to be tougher to survive in the world, period. When I see a female client become so trapped in a cycle of victimization that she has no hope or willpower left, sometimes I feel angry at the woman herself. This troubles me. I was taught early that girls had a lot to deal with and they had to be twice as good as boys to be given close to the same respect. So, when I have this feeling of “Come on, lady, toughen up or the world will eat you alive,” I am actually confronting my own past. My own childhood awareness of discrimination and victimization suddenly stares me right in the face.

Men do not evoke this response but I cannot avoid encountering it when I work with women. I observe this feeling in myself in most sessions with women who are really struggling. It takes great vigilance, and presence with the client, to ensure I do not recreate for her an experience of “failure,” wherein she does not measure up to some “superwoman” standard for me, her therapist.

Female clients also seem to have pretty high expectations of me. I have yet to feel any woman wanted me to “mother” her, as I often find with male clients. I do feel, though, that female clients expect me to join them in a way that men do not. This can be painful and it is certainly rigorous. It involves me being open to their experiences and reflecting them with absolute presence. With men, you can often get the job done quite nicely by offering cerebral interpretations of events and some good, pragmatic behavioural assignments. Not so with women; at least, not usually.

I feel I am called upon to help women clients sort through so many competing issues, real and current, that all of my great CBT* techniques are not enough. The women want good strategies from me, but this is not what I feel they demand most. They seem to want to know that I am there with them, to acknowledge that I see their pain and I am not afraid of them; that I can bear their stories and carry them, and that I will attend to them when they feel unworthy. I feel I am asked to testify to their survival; to help them see what I see: a person, deeply injured, and with great, unbelievable resilience.

Notes Footnotes

*cognitive behavioural therapy

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