What were the perceptions of strengths-based case management shared by the study’s participants?

Conquering the Black Girl Blues Lani Valencia Jones and Beverly Guy-Sheftall

An examination of the literature on epidemiology, etiology, and use of services for this pop­ ulation reveals an insufficient application of culturally congruent approaches to intervening with black women. An exploration of the social work practice literature and other relevant fields indicate that black feminist perspectives offer the opportunity to gain a clearer under­ standing of the intersection and influence of oppression among black women struggling with psychiatric issues and provide a useful framework for mental health practice with this popu­ lation. This article discusses the evolving black feminist thought and summarizes the schol­ arship on black women’s mental health services needs and utilization issues. The article includes a discussion of black feminisms as an emerging mental health perspective, arguing that black feminist perspectives in therapy provide an ideal framework for services that are responsive to the values and health needs of black women. The article concludes with a case vignette that illustrates some of its points.

KEY WORDS: black feminism; black women; feminist therapy; social work practice; women and gender studies

The complex and busy nature of women’s lives inevitably has an impact on their men­ tal health. Domestic burdens of child bear­

ing and caretaking, combined with work–life balance, all create difficult environments in which women are expected to cope. In addition to expe­ riencing these typical domestic and work challenges, black women in particular also endure “multiple” oppressions associated with racism, sexism, classism, and heterosexism ( Grote, Bledsoe, Wellman, & Brown, 2007; Kwate, Valdimarsdottir, Guevarra, & Bovbjerg, 2003; Thomas, Witherspoon, & Speight, 2008). Black women report experiences of alienation, isolation, and denigration in association with their identified “isms” ( Boyd­Franklin, 1991; Jones & Warner, 2011; C. B. Williams, 2005; Woods­Giscombé & Black, 2010). In an effort to manage stressors associated with their complex and demanding roles as well as their experiences of gender oppression, many women seek out mental health services that are empower­ ment focused and women centered. Feminist therapy is one such mental health service.

Feminist therapy is the practice of mental health informed by feminist political philosophies and anal­ ysis, and incorporates the psychology of women ( Miller, 1986), developmental research ( Gilligan, 1982), cognitive–behavioral techniques ( Worell & Remer, 2003), multicultural awareness ( Comas­Díaz & Greene, 1994), and social activism ( Brown, 2010) in a systematic platform. The principles of feminist

therapy assert that social inequality between genders is a root cause of mental health problems among women ( Greene, 1997). Feminist therapy acknowl­ edges that sex roles, female socialization, and wom­ en’s minority status in a patriarchal society are sources of psychological difficulties. The historical backdrop of the feminist movement and the different waves of feminism provide a context for understanding how feminist therapy has been adapted in the field of mental health.

With women gaining voices and visibility through their activism in the 1960s, feminists began to chal­ lenge existing societal gender biases. As feminist therapy began to evolve, the civil rights movement and the Stonewall rebellion also were forthcoming, all combining to form an atmosphere that triggered change in human rights ( Marecek, 2001). Feminists formed unique avenues of advocating for their agenda through activism, politicization, and consciousness raising. In fact, early models of feminist therapy were patterned after consciousness­raising groups, which provided a vehicle for exploring women’s experiences of sexism and discrimination, as well as the creation of a platform for social and political activism ( Enns, 2012).

In the early 1970s feminist therapy emerged as one of the responses to second­wave feminism, which among many issues was focused on the guaranteeing of economic and social equality and full humanity, regardless of gender. The imbalance of power and

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its impact on the behavior of men and women has served as the focus of traditional feminist therapy ( Cammarat & Larsen, 1988; Marecek & Hare­Mustin, 1991). Feminist therapists began to draw attention to the damage women suffered in traditional, patri­ archal structures of the therapeutic process. They criticized the imbalance of power in the male ther­ apist–female client relationship, in which the man is seen as the expert and the woman must conform to patriarchal norms of gender roles. Feminist ther­ apists argued that a woman’s self­concept, identity formation, and overall emotional well­being were overlooked or ignored in previously established therapeutic models. As an alternative, they advo­ cated for gender­neutral and sensitive approaches that put gender and power at the center of the therapeutic process ( Brown, 2010). For this reason, many feminist therapists are also engaged in social activism to affect policies and structures outside of the therapy office to improve the quality of life for all citizens.

Whereas feminist therapy has become a viable treatment option for women and men, having risen dramatically from receiving almost no attention to a position of considerable popularity, of concern is the lack of attention to the integrated realities of black women in the practice of and research on feminist therapy. Scholars argue that feminist thera­ pies have historically excluded and devalued the experiences of black women and that there have been misguided interpretations of their realities at the conceptual, theoretical, and methodological levels ( Brown, 2010; Fulani, 1988; Jackson & Greene, 2003). In particular, feminist therapies have been criticized for their limited focus on the cultural con­ text of white middle­class women and the exclusion of women of color and other oppressed groups such as black women ( Brown, 2010; Comas­Díaz, 2011; C. B. Williams, 2000). The argument is that these practices often reinforce the same racial discrimina­ tion and sexist denigration that have often brought black women into treatment. Hence, we arrive at a place in the 21st century where the field of social work and other mental health fields are faced with the critical task of providing culturally relevant ser­ vices to women who are routinely ignored by the dominant feminist movement.

A number of black feminist scholars and practitio­ ners have challenged universalizing, hierarchical, and dualistic limitations of feminist therapy to be more inclusive of race, class, and sexual orientation in the

development and utilization of black feminist pers­ pectives ( Boyd­Franklin, 1991; Fulani, 1988; Greene, 1997; Jackson & Greene, 2003; Mays, 1985; C. B. Williams, 2000). Black feminist therapists adopted an urgent mandate to address all forms of marginalization and discrimination simultaneously, instead of privileg­ ing gender issues alone. Furthermore, black feminist therapists advocated for therapeutic processes and methods that reflect the psychological and multiplica­ tive oppressions faced by women within their social– cultural contexts ( Sparks & Parker, 2000). These are processes and methods that offer more complex con­ ceptualizations of gender and its intersections of dif­ ference and incorporate a fundamental understanding of black women’s historical, sociocultural, familial, and developmental heterogeneity.

Such therapeutic methods as outlined by Fulani and black feminist practitioners would not only help black women to reconstruct negative self­images con­ structed by patriarchal therapeutic ideologies, but also assist them in consciousness raising regarding their socially constructed identities and to reject socially induced shame and degradation. Hence, the incor­ poration of culturally specific therapeutic practice perspectives that raise consciousness and foster resil­ ience and empowerment among black women will serve to decrease psychosocial stressors and promote positive coping strategies ( Boyd­Franklin, 1991; Greene, 1997; Jones & Ford, 2008; Woods­Giscombé & Black, 2010). With few connections between black feminism and therapy present in the social work prac­ tice literature, we suggest that a black feminist per­ spective may be a useful starting framework for understanding the multiplicative impact of black women’s oppression on their psychological well­ being.

A crucial component of black feminism is the identification and rectification of gaps that address the life concerns and possible futures of black women; hence the purpose of this article is to address the aforementioned existing gap in the feminist therapy literature. We hope that this article will stimulate more debate and discussion on the mental health status of black women and lead to development of culturally responsive treatment initiatives and poli­ cies that place black feminist ideologies at their core.

LITERATURE REVIEW Black Feminist Thought Guy­Sheftall’s work on black feminist thought (1986, 1995) has informed a black feminist approach

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to therapy and mental health services. The argument that African American women confront both a “woman question and a race problem” ( Cooper, 1892, p. 134) captured the essence of black feminist thought in the 19th century and has reverberated among intellectuals, journalists, activists, writers, educators, artists, and community leaders, both male and female, for generations. Although feminist per­ spectives have been persistent and important com­ ponents of the African American literary and intellectual traditions for generations, scholars have focused primarily on its racial overtones. This ten­ dency to ignore long years of political struggle aimed at eradicating the multiple oppressions that black women experience resulted in erroneous no­ tions about the relevance of feminism to the black community during the second wave of the women’s movement. Rewriting black history using gender as one category of analysis should render obsolete the notion that feminist thinking is alien to black women or that they have been misguided imitators of white women. An analysis of the feminist activism of black women also suggests the necessity of recon­ ceptualizing women’s issues to include sexuality, poverty, racism, imperialism, lynching, welfare, eco­ nomic exploitation, sterilization abuse, decent hous­ ing, and a host of other concerns that generations of black women foregrounded.

Black feminism is not a monolithic, static ideol­ ogy, and there is diversity among African American feminists, but certain premises are nevertheless con­ stant: (a) black women experience a particular kind of oppression and suffering in the United States— one that is racist, sexist, homophobic, and classist— because of their multiple identities and their limited access to economic resources; (b) this “multiple jeopardy” has meant that the problems, concerns, and needs of black women are different in many ways from those of both white women and black men; (c) black women must struggle for black lib­ eration and gender equality simultaneously; (d) there is no inherent contradiction in the struggle to erad­ icate sexism and racism as well as the other “isms” that plague the human community, such as classism and heterosexism; and (e) black women’s commit­ ment to the liberation of black people and women is profoundly rooted in their lived experience.

In 1977 the Combahee River Collective, a group of mainly black lesbian feminists such as Audre Lorde, Pat Parker, Margaret Sloan, and Barbara Smith released a statement that attempted to define

black feminism, as they saw it (first published in Eisenstein, 1978). The collective’s work was grounded in a feminist perspective, addressed homophobia, and called for sisterhood among black women of diverse sexual orientations. A fundamental belief of theirs was that “black women are inherently valuable and that our liberation is a necessity not as an ad­ junct to somebody else but because of our need as human persons for autonomy” ( Eisenstein, 1978, p. 2). Furthermore, they argued that sexual politics are as pervasive in black women’s lives as are the politics of class and race, and because race, class, and gender oppression often operated simultaneously in black women’s lives, it is often difficult to separate them. Underscoring their affinity with black men, however, they felt linked to them in their common struggle against racism at the same time that they felt that black women must often struggle with black men over the issue of sexism.

Collins’s (1990) landmark Black Feminist Thought identified the fusion of activism and theory as its dis­ tinguishing characteristic and analyzed the core themes outlined by Guy­Sheftall (1995). These core themes of analysis are identified by Collins as (a) the interlocking of race, class, and gender oppression in black women’s personal, domestic, and work lives; (b) the necessity of re­creating positive self­ definitions and rejecting denigrating, stereotypical, and exter­ nally imposed controlling images (mammy, matri­ arch, welfare mother, whore), both within and without the black community; and (c) the need for active struggle to resist oppression and realize indi­ vidual and group empowerment ( Collins, 1990). The Collins text would further establish, along with Bambara’s (1970) The Black Woman and hooks’s (1999) Ain’t I a Woman, a continuous black femi­ nist intellectual tradition going back to the publica­ tion of Cooper’s (1892) A Voice from the South.

Black Women and Mental Health: Service Needs and Utilization Issues Over the past two decades, the importance of cul­ turally congruent services has gained support from federal initiatives that have focused on advancing research that addresses racial and ethnic minority health and mental health disparities. Specifically, these strategies have included career development programs for underrepresented groups; strategic plans; requirements for enrolling minorities in clin­ ical trials; and, most recently, the establishment of the National Center on Minority Health and Health

Jones and Guy-Sheftall / Conquering the Black Girl Blues 345

Disparities, which has recently been renamed the National Institute on Minority Health and Health Disparities. The salience of these initiatives for im­ proving services for black women is underscored by epidemiologic data about the disproportionate bur­ den of stress­related illnesses, such as cardiovascular disease, depression, and anxiety ( Artinian, Washing­ ton, Flack, Hockman, & Jen, 2006; Grote et al., 2007; Kwate et al., 2003; Thomas et al., 2008). However, when black women seek out professional mental health services, research indicates that they are less likely than white women to obtain profes­ sional care ( Alegría et al., 2002; Jackson & Greene, 2003); they are more likely than others to have reached a crisis point; are more likely to be misdi­ agnosed ( Carrington, 2006); and may delay or with­ draw from treatment early because their ethnic, cultural, or gender needs go unrecognized or mis­ treated ( Blazer, Hybels, Simonsick, & Hanlon, 2000). One consistently highlighted shortcoming is that therapeutic treatment models are culturally inap­ propriate or inadequate to meet their specific needs ( Greene, 2000; Jones & Warner, 2011). Alegría and colleagues (2002) argued that mental health systems and treatment models are based on racist patriarchal concepts of mental health, and new models must be developed to accommodate the pressing needs of women across all racial backgrounds. The treatment and prevention of psychosocial distress among black women requires practitioners to make use of strate­ gies that are based on culturally congruent, positive mental health paradigms that stress the strengths of the clients and recognize the deficits in the environ­ ment ( Jones & Warner, 2011; Thomas et al., 2008; Woods­Giscombé & Black, 2010).

The field of social work has progressively given attention to the needs of diverse groups through the cross­cultural practice literature, with the intention of rethinking practice frameworks and adapting ex­ isting practice models to serve women and people of color ( Comas­Díaz, 2011; Lum, 2010; Sue & Sue, 2013). In short, cross­cultural practice efforts equip practitioners with cultural knowledge about race, gender, and class aimed at increasing cultural literacy to improve the level of understanding that mental health practitioners bring to their work with clients from different cultures ( Husband, 2000). Although this attention is a step in the direction toward cultural sensitivity, it overlooks the importance of developing and relying on practice interventions that reflect the lived experiences of black women.

Black Feminisms as an Emerging Mental Health Treatment Perspective The emphases on black women’s historical struggles, the “personal is political,” and on empowerment and social change have been at the core of black feminist theoretical frameworks. These principles represent themes that emerge from black feminist literature, research, and the lived experiences of black women in the United States and resonate with the work of black feminist practitioners in the field ( Greene, 1997; Jones, 2008; Vaz, 2005; C. B. Williams, 2005). Black feminist therapists question the application of tra­ ditional mental health theories and methods applied to black women, positing that the approaches lack congruence with their life experiences. Black fem­ inist therapeutic perspectives are offered as an alter­ native to traditional mental health treatment that often views black women as “other” and whiteness, maleness, heterosexuality, and middle­class status as the norm, which resulted in biased psychological frameworks, perspectives that consistently fail to acknowledge experiences that differ from dominant patriarchal perspectives ( Jackson & Greene, 2003). According to Comas­Díaz (2011), feminist therapist must have an understanding of the culture of each of his or her clients as well as knowledge regarding gender role standards for members of that cultural group and should adapt techniques accordingly. This perspective recognizes different ways of seeing black women’s reality from a positive standpoint and helps to forge a greater understanding of their strengths, resilience, and struggles. The use of black feminism as a philosophy in therapy intentionally acts as a strat­ egy that gets to the heart of the inequalities suffered by black women.

Black feminist practitioners and scholars note that the use of these perspectives in therapy appreciates and reflects an integrated analysis of race, gender, sexuality, class, and other “isms,” offering a lens through which to view the multiplicity and simul­ taneity of oppressions and emotional struggles that black American women experience ( Bowleg, Huang, Brooks, Black, & Burkholder, 2003; Coleman, 2006; Collins, 1990; Eisenstein, 1978; Jackson & Greene, 2003; King, 1988; Thomas et al., 2008). They advo­ cate for theories and practice interventions that as­ sist black women in sorting out their personal struggles from the structural constraints of racism, sexism, classism, and homophobia and move from models of pathology to those of risk, reliance, and wellness. Postulating that therapeutic interventions

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developed from a black feminist perspective must help black women recognize how the internalization of stereotypes and negative notions of black woman­ hood contribute to their negative psychological symptoms (for example, depression, anxiousness, low self­esteem, and decreased sense of mastery and control) ( Jackson & Greene, 2003; Jones & Warner, 2011; King, 1988; C. B. Williams, 2005). This unique form of therapy allows black women to be liberated from internal psychological distress and societal bar­ riers and promotes skills that assist them to be self­ actualizing in their goals, their willpower, and their way power.

Black feminist therapeutic analysis and interven­ tions of race, gender, and class role analysis; sexual identity; consciousness raising; exploration of power imbalances; social action; and empowerment are key modes of change in the therapeutic process ( Greene, 1997; D. S. Williams, 1993). In working therapeu­ tically with black women, it is essential for pra cti­ tioners to help them, regardless of the present ing problem, to build skills to resist negative cultural messages and thereby alleviate their psychiatric symp­ toms. That may include assisting black women in identifying gender role expectations and messages that influence their attitudes and behaviors, teaching con­ structive assertiveness and active coping skills to assist in overcoming perceived barriers, assisting in under­ standing how societal and political forces affect their mental health dilemmas, and encouraging social and political action against all oppressions. Following this logic, black women’s greater likelihood of suffering from mental health difficulties may be an inevitable result of the many conflicts these women face as they navigate multiple roles and identities in a  patriarchal system of domination. According to C. B. Williams (2005), black women’s depression and other difficul­ ties should be seen as an outgrowth of multiple conflicting socially defined roles and identities and that a true understanding of the nature of depression in this population is best gained from reshaping the therapist’s views from one of pathology to one of risk and resilience.

Explanations and efficacy as to how black feminist perspectives are integrated into the ongoing dia­ logue of therapy are limited; however, there are numerous conceptual examples of black feminist thought in the context of healing and psychological recovery that appear in the mental health literature ( Boyd­Franklin, 2010; Comas­Díaz & Greene, 1994; Greene, Boyd­Franklin, & Spivey, 2013; Guy­Sheftall,

1995; Jackson & Greene, 2003; Jones & Warner, 2011; Taylor, 1998). Specifically, practice frameworks re­ garding the utility of black feminist perspectives in mental health and substance abuse treatment can be found in the literature. To highlight a few, Roberts, Jackson, and Carlton­LaNey (2000) discussed the use of a black feminist therapeutic approach that assists drug­abusing black women to explore the negative controlling images of “mammy,” “matri­ arch,” “welfare mother,” and “Jezebel.” Using con­ sciousness raising, a key construct of black feminist perspectives in treatment, women were able to gain an understanding of these negative societal images and participate in a redefinition of the self as a source of empowerment in recovery. In a similar but inde­ pendently developed framework, C. B. Williams (2000) presented black feminist therapeutic tech­ niques of consciousness raising and empowerment to assist women in drawing connections between their everyday life difficulties and the historical ex­ perience of African American women. She advo­ cated for an integrative approach to working with black women through an examination of the psy­ chological, social, and cultural context surrounding their search for wellness. Using the superwoman schema and strong black woman script frameworks, Woods­Giscombé and Black (2010) focused on black women’s unique stress experiences affected by “strength” obligations (for example, emotional sup­ pression, extraordinary caregiving, and self­care postponement), suggesting the use of culturally de­ rived mind–body interventions that emphasize a gender role analysis, another key construct of black feminism. Woods­Giscombé and Black offered an analysis of socially and culturally ingrained gender roles and reframed strength from a stance of weak­ ness to a place of empowerment. Jones and Warner (2011) examined the efficacy of an evidence­based, culturally relevant intervention grounded in black feminism and psychosocial competence perspectives to reduce depressive and stress symptomatology; decrease externality of locus of control; and increase active coping among black women in shelter, sub­ stance abuse, and mental health programs.

The following vignette is offered as an example of the use of a black feminist perspective in a group therapy program titled Claiming Your Connection. Key black feminist features of the intervention are (a) the incorporation of accurate cultural knowledge and attention to the multiple cultural influences of black women’s mental health, (b) systematic focus

Jones and Guy-Sheftall / Conquering the Black Girl Blues 347

on and discussion of cultural themes to enhance engagement, and (c) discussion of the psychological implications of oppression (racism, sexism, classism, heterosexism) to heighten black women’s awareness of psychosocial dynamics that often contribute to depression and psychosocial stressors.

CASE VIGNETTE Lola is a 32­year­old African American woman, a mother of two, separated from her spouse; she re­ cently lost her job as a vice president of development at a technology firm. At intake she stated, “I com­ mitted myself to my job, I gave them three miserable years of my life, and they told me in a five­minute meeting that they were moving in a different direc­ tion.” She reported poor sleeping and eating pat­ terns, tearfulness, decreased energy, and decreased concentration over the past few months.

At the start of the group, Lola rarely participated in group conversations without prompting and did not offer feedback to the other participants. The third session of the group program focused on the role of stress and coping in the lives of African American women. During this session the group leader provided a definition of psychological stress. The group leader then asked the members to iden­ tify their emotional and physical reactions to stress. The group members listed several reactions, such as “I’ve lost my patience,” “I can’t breathe,” “I am over­ whelmed,” “I am exhausted,” “I get irritable,” “I am eating too much,” and “I’m having a nervous break­ down.” The group leader asked members to identify possible stressors related to them as black women. Lola abruptly stated,

Since our first meeting y’all been whining about how your boss treats you, you’re always letting this shit get in your way, you’ll need to bulldoze down your issues and the people in your way. You have no control over these negative things that happen.

Group members glared at Lola, with disappoint­ ment and annoyance. A participant responded, “If you were perfect, you wouldn’t be here.” The group immediately responded with agreement.

This statement opened up the floor for Lola to engage in further disclosure. Lola stated, “Have you ever been in love with a man who didn’t love you, so you looked for love in your work? Have you ever been stripped of your hard work and dedicat

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