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Doctor of Philosophy (PhD)

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Menstruation is an important, recurrent event that marks developmental milestones, indicates pregnancy, and may be associated with negative symptoms. In spite of its importance for women, many people are uncomfortable with the topic and it is seldom discussed openly. The purpose of the present study was to explore the reactions of psychotherapists to the discussion of menstruation in psychotherapy and to explore the impact that its discus-sion has on the course of the therapy.

Questionnaires were sent to 151 female and 150 male randomly selected licensed Ph.D. psychologists from a nationwide register. In addition, 11 female and 12 male psychotherapists were each interviewed for between one and two hours. The content areas of the questionnaire and interview were approximately the same; background informa-tion, case material, general thoughts, and personal experiences with menstruation. Data were analyzed descriptively, and the most prominent themes in terms of either frequency or importance were then summarized and discussed.

On the average, menstruation was discussed in approximately 45% of the therapists' female caseloads and 15% of their male caseloads. Discomfort with menstruation was both subtle and widespread. This discomfort was frequently manifested in the topic's not being discussed despite the therapists' perceiving it as relevant. Therapists who were particularly uncomfortable with the topic or who had special personal history issues around menstruation often had a low incidence of discussion of the topic in their therapies. Generally speaking, male therapists reported more discomfort discussing menstruation with their female clients than did female therapists. Evidence was available to support the psychoanalytic literature on the origins of menstrual taboos, most notably that of Reik (1964) and Devereux (1950) concerning male attraction to and dread of women. Explanations given by therapists for their own and their clients' difficulties in discussing menstruation included uneasiness with sexuality and body issues, gender issues, cultural prohibitions, and feminist views.

Therapists may need to demonstrate a willingness to discuss menstruation with clients who assume that the subject is taboo. In addition, therapists need to be aware of their own attitudes towards menstruation in order to be able to deal sensitively with the topic in their therapies.