From Freud to today, does a therapist’s gender matter?

Therapy used to be a boys’ club.

Once upon a time, therapy was the domain of men with beards, cigars, and a habit of pathologising women’s emotions. Freud called women ‘hysterical.’ Jung turned the feminine into an archetype. Adler, well, he had his own theories about power and inferiority.

Women weren’t just left out of shaping early psychotherapy, they were often the subjects of it. Their distress was diagnosed as ‘hysteria.’ Their resistance was labelled ‘defence mechanisms.’ Their trauma was reframed as fantasy, most infamously when Freud abandoned the seduction theory and decided that women’s reports of abuse were just misplaced desire.

Despite women being the majority of therapy clients, early psychology was built on a foundation that often minimised, misunderstood, or outright dismissed their experiences. And when women did enter the field, they weren’t always recognised for their work.

The women who shaped therapy (but weren’t always given credit)

The first women in psychology had to fight to be heard.

Anna Freud developed child psychoanalysis but remained in the shadow of her father (surprise, surprise!). Melanie Klein revolutionised object relations theory but faced intense resistance. Karen Horney directly challenged Freud’s ideas about ‘penis envy’ and suggested that perhaps men envied women’s ability to give life instead. Marie Bonaparte, a literal princess, contributed to psychoanalysis while also working to prevent Freud’s persecution by the Nazis.

Many other women, like Margaret Mahler, Virginia Satir, and Inez Beverly Prosser (the first Black woman to earn a psychology PhD), shaped modern therapy. Their contributions were essential, yet they were often overshadowed, dismissed, or left out of history entirely.

Now, most therapists are women, so - wait - has therapy changed?

Fast forward to today, and women make up the majority of therapists. In my own training, 97% of us were women (this number is made up but there were literally 3 men to tens of women).

This shift didn’t happen by accident. Therapy has become more relational, more attuned to emotion, and in some spaces, more trauma-informed, qualities often associated with feminine-coded skills (whether this makes any sense, is another matter). At the same time, therapy remains relatively low-paid compared to other medical and psychological professions, making it less appealing to men (again, huge generalisation, but one of the reasons often quoted), who are still more likely to pursue higher-status roles in psychiatry and clinical psychology. The flexibility of private practice has also made the profession attractive to women balancing caregiving responsibilities.

But is that enough?

Because while the field is no longer dominated by men, the frameworks it still operates within often are. The theories we still reference were mostly developed by men, often based on male experiences. The ways we measure ‘progress’ in therapy are still shaped by those early models. And the biases that existed back then haven’t entirely disappeared.

The gender bias in therapy (and the age question)

Does a therapist’s gender matter?

It depends. But gender never exists in isolation: it intersects with age, race, class, sexuality, neurodivergence, and other identities.

Studies on gender bias suggest that men are often perceived as more competent in professional settings, while women are expected to be warmer and more nurturing. In therapy, this plays out in ways that shape client expectations.

Women therapists are sometimes assumed to be ‘natural caregivers’ rather than skilled professionals. Male therapists, by contrast, may be seen as more authoritative or decisive, even when they take the same therapeutic approach.

Then there’s the question of age. Young women therapists, in particular, often experience a credibility gap. Clients, or colleagues, may subtly or overtly question their expertise, assuming they lack experience or authority (it happened to me during my training and almost broke me). Meanwhile, older male therapists are more often assumed to be established, knowledgeable, and authoritative. Status characteristics theory explains how people unconsciously attribute more authority to those who fit traditional power models: older, male, cisgender. The more you diverge from that, the more you have to ‘prove’ yourself.

Therapy isn’t just gendered – it’s intersectional

Many clients specifically seek out a therapist of a certain gender.For some, this is about safety, particularly for those with trauma histories. For others, it’s about lived experience or a sense of being understood. But gender alone doesn’t determine therapeutic fit.

Therapy has long struggled to fully integrate an intersectional approach. Black women, for example, often face stereotypes of being ‘strong’ or ‘resilient,’ which can lead therapists to overlook their distress. Men may struggle to access emotionally safe therapy without feeling like they have to ‘perform’ masculinity. Non-binary and gender-diverse clients frequently find themselves educating their therapists rather than being supported by them. Disabled and neurodivergent clients often experience therapy that centres around ‘fixing’ them rather than understanding them. Even with a more diverse therapist pool, these biases persist if therapy itself doesn’t evolve.

What about queer-affirming therapy?

Queer people have a complicated history with therapy. The field wasn’t just unwelcoming, it was literally used against them.

Conversion therapy, pathologisation, and the branding of queerness as ‘deviant’ were all legitimised by psychology. Homosexuality was considered a mental disorder until 1973, which is uncomfortably recent. For decades, the mental health profession was complicit in queer oppression, often reinforcing the very distress it claimed to treat.

Queer-affirming therapy isn’t just about ‘not being homophobic.’ It requires a deeper understanding of the specific mental health challenges queer people face, including minority stress, internalised stigma, and discrimination. It means recognising the impact of medical trauma, family rejection, and community loss. It involves not assuming a client’s gender identity or sexual orientation, and making therapy a space where queer and trans people don’t have to explain or justify their existence (same goes for therapists, right?).

Some of the earliest openly queer therapists fought to shift the field from within. In 1971, Betty Berzon became the first psychotherapist in the U.S. to come out publicly as gay, using her position to advocate for affirmative therapy practices. Don Clark, the first openly gay psychologist, challenged the profession’s biases and pushed for approaches that actually supported queer clients rather than trying to ‘fix’ them. Richard Pillard, the first openly gay psychiatrist in the U.S., helped shape more inclusive perspectives in psychiatric practice. These therapists, and many others, didn’t just come out; they actively reshaped the conversation around queerness in therapy.

Today, therapists who are queer themselves, or who practise from a lived-experience perspective, often bring a depth of understanding that traditional training doesn’t cover.

But for therapy as a whole to be affirming, it needs more than individual therapists doing the work—it requires systemic change.

That means rewriting outdated frameworks, confronting the biases that still linger in training and practice, and ensuring that therapy doesn’t just tolerate queer existence but fully affirms it.

So, does a therapist’s gender matter?

Yes and no.

For some clients, gender is a crucial factor in safety, comfort, or shared understanding. A trauma survivor might feel safer with a therapist of a particular gender. Someone working through complex family dynamics might unconsciously replicate old relational patterns with their therapist, making gender a meaningful part of the transference. From a psychodynamic perspective, gender can sometimes shape the therapeutic relationship in ways that are important to explore rather than avoid.

But for many clients, gender isn’t a defining factor.

What matters more is the therapist’s capacity to listen, attune, and create a space where the client feels understood. A therapist’s theoretical orientation, lived experience, and approach to power and identity often have a much bigger impact than gender alone. The idea that male therapists offer authority while female therapists provide warmth is a stereotype, not a rule. Therapy is about the entire lens a therapist brings to the room—not just who they are, but how they think, relate, and hold space.

Therapy isn’t a boys’ club anymore. But the work of making it truly inclusive isn’t done yet.