I am a Medical Family Therapist Intern at a medical clinic for low-income patients and often conduct psychosocial assessments as part of our integrated care treatment plan. One 
day, like any other day, I walked into an exam room and began my assessment. However, what began as an assessment of the patient, turned into an assessment of my own expectations and ideals. The patient was a statuesque, elderly African American woman and with her regal turban and wise words, she turned my ideas of gender equality upside down.
She let me into her world and talked about the struggles she had as an ex-drug abuser and convict. She said her body was deteriorating because of her years of drug abuse and she had no one to blame but herself for the chronic pain she lived with. She continued to talk about the lessons she has learned from her difficult life experiences and specifically mentioned expectations that African American women should have in relationship. I’ll never forget what she said, “As long as your man comes home every day, brings home money, and doesn’t give you a disease, you should be happy.” Those were the things that mattered to her. There was no mention of equality, mutuality, emotional caring, etc. She learned that when people are struggling to survive, put food in babies’ mouths, live with some measure of a roof over their head, expectations within a relationship become defined and minimal. Equality is not even a consideration when survival is at stake.
It led me to wonder, as a woman living within a middle class socio-economic status (SES), is it my privilege to expect equality in my relationships? Does the expectation of equality depend on my financial situation? Is equality a privilege rather than a right?
I also, began to examine my goals as a therapist. Am I, as a therapist, helping my patients who come from a background where equality may not be a consideration when I bring up the issue? Or am I just promoting unrealistic expectations within the realm of all they need to handle on a daily basis?
After some thought, I have come to the conclusion that equality and mutuality can be defined in many ways, depending on the particular couple involved and their social context. Feminists have been critiqued for imposing expectations and definitions of equality on women who do not feel the need for equality in their relationship. In our assumed belief that healthy, happy relationships include egalitarian ideals, I wonder if we are discounting other perspectives and definitions of mutuality. Perhaps my patient felt that her relationships were mutual because her expectations for her man and his expectations for her were met. Could another definition of equality be: Met expectations from both partners?
I left that exam room with my head reeling. Our conversation truly impacted me. I continue to think about her words and feel deeply saddened that I could even for a moment forget how privileged I am in so many ways.
What are your thoughts and reactions? What do you think about her words? How would you address the questions that came up for me? Do more questions and comments arise within your mind and from your SES perspective?
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Great article! I appreciate how Mayuri went beyond the surface. She assessed the many dimensions to this woman and did not just see her as “all the other” and I think because of which the woman probably left feeling totally validated and empowered!
Thank you to all who have posted comments. Your reflections are invaluable. I really resonated with Melissa’s thought from Epston about people impacting therapists. The interaction with my patient was very meaningful to me. Also, Aimee’s question about how to balance truly respecting and valuing various perspectives while still wanting people to feel like they can expect more in their relationships is a good one…. I’m sure people want to be in a relationship and feel mutually supported, loved, cared for emotionally as well as physically. How do we navigate affirming those wishes while still recognizing that people deal with daily struggles that often leave them with no energy for any other consideration other than surviving from day to day?
I was struck, as I read your post, that an important part of the feminist perspective is witnessing the suffering of others and providing a sense of mutual support, a sense that this pain is not just one person’s load to carry, a sense that a caring community brings with it the possibility of hope in an otherwise hopeless situation. Is it possible that by respectfully witnessing such suffering that the dignity of the sufferer can shine? I noticed in your description of this woman her nobility, courage, and awareness of what she is entitled to in her local world. I also noticed that in your effort to witness this woman’s suffering you shifted from an analytical perspective that might possibly denigrate human suffering and objectify the person. Instead, you seemed to privilege the woman’s voice and experience. I imagine the load of her suffering lightened a bit as you connected with her story of a world far different from your own. David Epston has said that sometimes persons can inspire and bring out the best in a therapist. I wonder if this therapy session had that effect for you. By the way, I love your expanded understanding of equality and mutuality.
I too was struck by the quality of the therapeutic stance Mayuri took with her patient. I found myself pulled in two very different directions. The first was a desire to honor the experiences of the patients we serve and not see their differences as problematic. At the same time I should we just settle in the face of what seems like an impossible obstacle for those less privileged? Is there a way to instill a belief that this woman deserves more than just not being infected with a sexually transmitted infection without making her feel that her low expectations are her fault? Or that we are forcing an ideal on her that may not be her own?
Great job with the post! Anyone who has a low income I’m sure struggles with basic survival, and it is much harder to reach the expected ideal in a relationship because of time and emotional energy constraints, which is affected by financial constraints. I do think that most women would recognize a picture of standard equality as something they desire. I think it is extremely rare to find a perfectly equal couple, but it is something we could all strive for in our own ways, no matter what our income. For the woman in a low-income environment, she may just need to realize what is attainable in her relationship and start with baby steps.
Dipika highlights an interesting concept: the idea that we all have limited energy and thus prioritize where that energy goes. Often when living with severe financial stress, priorities are pretty clear and working on the quality of a relationship may not be high on the list of things to do. Having said that, I would like to stress that there are couples living within a lower SES who have found ways to create beautiful, fulfilling relationships while dealing with multiple daily stressors. My mother recently mentioned that in India she has witnessed couples living in poverty care for each others’ physical and emotional needs in a mutual, egalitarian manner. It would seem that both partners, both being the key word, were committed to each other and their relationship despite external pressures.
This article just points out the sad truth that women should be content with any man who treats her somewhat decently, accepting what she can get, and settling for something that is perhaps better than how other women are treated, while men are encouraged to only be with someone who meets their needs and makes them happy! When women are not happy in their relationships, they are told to compare their relationship with others, and often told that they should be grateful that they “at least have a man who….. (insert verbs here…doesn’t hit her, cooks, cleans, watches the kids “for her, etc”).” However, when a man is not happy, he is often told that he shouldn’t have to be in a relationship that he is not happy in, and that he should seek out someone who does make him happy, or who meets his needs.
I do think there is a gendered component, Brenda. It makes me wonder how the intersection of gender and SES impact couples relationships… I had focused on women’s experiences in lower SES but not men’s. It would be interesting to hear how SES impact their expectations in relationship.