Coche, Judith

Dr. Judith Coche.

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“I have to admit this has been a bit of a battle.” Short, tawny hair streaked with gray gave Adrian the appearance of greater wisdom than she felt.

The backbone of the Radiology Department at a hospital, Adrian worked unobtrusively, giving credit for the stellar reputation of the department to the balding physician listed and reimbursed as the head of the unit, but those in the know credited Adrian for the thoroughness produced as needed. 

For three decades, I have studied and led psychotherapy groups for high-functioning adults. Clients value them so deeply that they travel from Manhattan, the Jersey shore, and Washington in order to attend. The groups meet monthly in Philadelphia.  

Clinical research informs us that group psychotherapy is as effective as individual psychotherapy when led by deeply-skilled clinicians. A special level of distinction in group psychotherapy is certification.

I supervise graduate students and psychiatric residents. Many have gone on to exercise leadership in group psychotherapy.

Because of the skill of her group, Adrian’s confidence in her ability increased. Adrian was highly valued by her group, for her tenacity and insight.

As she began to discuss her concern about differential gender-based respect, her group members supported her progress. Each had experienced unfair treatment in the course of their career advancement. 

“Adrian, get out there and make stuff happen.” Karen had pioneered fair treatment in medicine as a loyal member of the Physicians’ Moms Group (PMG). “I know exactly what you mean. Women physicians are accustomed to self-doubt and guilt. Until we had each other, many of us experienced isolation. “ 

The Physicians Mom’s Group (PMG) has more than 67,000 members, with strong representation from all medical specialties and from all 50 states and other locations. One study, recently in JAMA Internal Medicine, found that 78 percent of those responding had experienced gender or maternal discrimination, often manifest as disrespectful treatment, and diminished pay and benefits compared to male peers.

As long as the social structures around them reinforce inequity, all professional women require a culture change, broad-scale recognition of bias, and systems that treat parenting supportively. PMG is an example of the level of professional support that creates results.

In 1993, I co-authored a book, "Powerful Wisdom: Voices of Distinguished Women Psychotherapists." In this clinical research study of 200 colleagues, we learned that women love their profession despite their expectation of being underpaid, undervalued, and treated, at times, with disrespect.

In the last 15 years, women have risen to well-deserved levels of power and responsibility within mental health, including psychiatry. Other fields are slower to follow.

One group member, Karen, needed to speak. “Adrian, take charge. Show them who’s boss.”

“Karen, I would get fired if I challenged too directly. The power will shift sooner or later, and, in the meantime, I have the fortune to be deeply respected for my work. It means the world to me.

"Sure, I want a higher salary. Sure, I would be happy to be out front when formal credit is given to leadership. But it is too soon and, if I am impatient, we all lose ground.

"Progress goes as quickly as the comfort of those in charge, and men are in charge. Better to be grateful and bigger than the situation that surrounds us.” 

Heather Sarsons, a Ph.D. candidate at Harvard, looked at economists seeking tenure from a top Ph.D.-granting university. Her research validated my own personal experience that co-authoring with a male can diminish the perceived power of a female co-author.

Heather found that co-authoring with men could contribute to a lower probability of receiving tenure. She believes this to be the result of unconscious bias favoring male economists. She found that women who worked alone or with other women were more likely to receive full credit.

I listened to the group, sat back, and waited. I knew this conversation well from years helping female colleagues in academic psychology attempt to get tenure.

I also know that the “Me Too” movement regarding sexual harassment indicates that the power balance is shifting too slowly to feel fair to many.  In the final stage of growth, power will be less gender-based than it is now, and genders will continue to be more fluid than they used to be. Until then all of us, male and female and any variations thereof, need to be on the lookout for unfair treatment of others we care about and of ourselves.

To consider: Have you ever been the object of gender discrimination? How has it felt? What would you like to have done about it? Did you? Why or why not?

To explore: The references above lead you to a rich and varied world of expertise. 

ED. NOTE: Dr. Coche practices clinical psychology in Stone Harbor and Philadelphia. She invites responses through her website,