CBT is fundamentally about a cause and effect approach. When someone begins CBT, it will be important to look at the circumstances that shaped their life in order to understand their problems.

In essence, we look at is whatever happened in the past (cause) which has led to them leading their life now in the present (effect). However, one of the problems with this model is that this focus is too individualistic, and we can end up missing those aspects of the individual which reflects their social identity.

Social identity and mental health

Social identity is often overlooked, if our social identity works for us – then we do not question it. Grayson Perry in his book The Descent of Man calls it a default identity. Not only do we not question it, but we also fail to see its relevance in others.

Gender is possibly our deepest-rooted social identity. The description ‘deeply rooted’ is one which needs to be focussed on. When we use this term, we are often thinking about essentialism. Essentialism is a term that implies that there are innate characteristics in certain groups, and in terms of gender it speaks of the unique differences between men and women.

Again, when we think about this, we need to focus on what we mean by difference. We often speak about the differences between anatomy, or secondary sexual characteristics, as though they signify something deeper. This leads to the idea that because these differences exist between men and women, therefore their brains must be different. This then begins to exert an influence on the ways that the social roles of men and women are delineated. And inevitably we underestimate how far they influence our perceptions.

During pregnancy, the question which is always asked is whether ‘it’ is a boy or a girl. The baby, whether it is a boy or a girl will learn through absorbing and fitting in with whatever social group they happen to be in. The consequences of this are profound and are summed up by the quote from Reshma Saujani who said that: ‘We raise our boys to be brave, and girls to be perfect’.

Within mental health problems, bravery can mean not showing emotions, and perfection can mean fear of failure. The consequences of this are reflected in the statistics within mental health services.

These statistics show that the incidents of depression and anxiety are higher in women, whilst the incidents of suicide are higher in men. What is important to remember is that such patterns are socially constructed and are not reflections of essential differences between the genders.

Predictive, plastic, and permeable brains

Gina Rippon’s work within neuropsychology has confirmed that the physical differences between the male and female brain are negligible. For therapists, this is important, for if the physiology of the brain is not a factor, then we need to consider the wider environmental context that the men and women we work with and look at how dominant ideas about gender may be relevant to their mental health problems.

The work that Gina Rippon has undertaken on the actual ‘hard-wiring’ of the brain can also be helpful. Her 3P model states that brains are ‘predictive, plastic, and permeable’. Predictive means that brains like to anticipate what may happen in the future. In doing so, they construct explicit and implicit rules for dealing with the world. When perfectionism and fear of failure is an issue, these rules can sometimes be inflexible.

Brains are also plastic. Plasticity means that people can continue to ‘learn and change’. The plasticity of the brain has been revealed in research on people who have undertaken long term mindfulness practice. The final P returns us to the social identities. Brains are permeable and will like sponges absorb social influences which will, of course, include the perceptions of how men and women should be.

The permeability of brains is the part that therapists need to consider. Individual rather than social identity is prioritised in therapy. The social identity of gender is often the ‘unseen hand’ which is behind many problems in mental health and we as therapists must give it the consideration it deserves.