NOTES
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Corey, Chapter 12
Feminist Therapy

Feminist therapy does not have a single founder.

Introduction:
This chapter provides an alternative perspective to many of the models considered thus far in Corey’s book.  Feminist therapy puts gender and power at the core of the therapeutic process.  It is built on the premise that it is essential to consider the social and cultural context that contributes to a person’s problems in order to understand that person.

A central concept in feminist therapy is the psychological oppression of women and the constraints imposed by the sociopolitical status to which women have been relegated.  Our dominant culture reinforces submissive and self-sacrificing behaviors in women.  The socialization of women inevitably affects their identity development, self-concept, goals and aspirations, and emotional well-being.

Feminist therapists have challenged the male-oriented assumptions regarding what constitutes a mentally healthy individual and raised some critical questions:  Why are women more frequently diagnosed with depression than are men in our society?  Can theories developed by White males from Western cultures appropriately serve the needs of women clients in counseling?  The needs of women of color?  Of others who experience marginalization and oppression in our society?

Feminist therapists believe psychotherapy is inextricably bound to culture, and increasingly they are being joined by thoughtful leaders in the field of counseling practice.  Early feminist thought focused on the oppression of women and primarily reflected the views and experiences of largely middle-class White women.  Modern feminism emphasizes an integrated approach that includes an understanding of multiple oppressions, multicultural awareness, and multicultural competence.  Today’s feminists believe that gender cannot be considered apart from other identity areas such as race, ethnicity, class, and sexual orientation.

History and Development:
Feminist therapy has developed in a grassroots manner, responding to challenges and to the emerging needs of women.  The beginnings of feminist therapy can be traced to the women’s movement of the 1960’s, a time when women began uniting their voices to express their dissatisfaction with the limiting and confining nature of traditional female roles.  Consciousness-raising groups, in which women came together to share their experiences and perceptions, helped individual women become aware that they were not alone in their views.  A sisterhood developed, and some of the services that evolved from women’s collective desires to improve society included shelters for battered women, rape crisis centers, and women’s health and reproductive health centers.

Self-help, rather than “professional” help, was considered the most efficacious mode for helping women break free from role constraints and attitudes resulting from their early socialization.  Because the therapeutic relationship is hierarchical, with the therapist in the power position, psychotherapy was viewed as a means of maintaining the oppressive status quo.  Changes in psychotherapy occurred only when women therapists participated in consciousness-raising groups and were changed by their experiences.  They formed feminist therapy groups that operated from the same norms as the consciousness-raising groups, including nonhierarchical structures, equal sharing of resources and power, and empowerment of women that could be achieved by practicing new skills and ways of being in a safe environment.  

They viewed therapy as a partnership between equals.  They took the stance that therapy needed to move away from reliance on an intra-psychic psychopathology perspective (in which the sources of a woman’s unhappiness or mental illness reside within her) to a focus on understanding the pathological forces in the culture that damage and constrain women.

A profusion of research on gender bias emerged in the 1970s, which helped further feminist therapy ideas, and organizations began to foster the development of feminist therapy.  The 1980s were marked by efforts to define feminist therapy as an entity in its own right, and individual therapy was the most frequently practiced form of feminist therapy.

By the 1980s feminist group therapy had changed dramatically, becoming more diverse as it focused increasingly on specific problems and issues such as body image, abusive relationships, eating disorders, and incest and sexual abuse, and the feminist philosophies that guided the practice of therapy also became more diverse.  The second wave of feminism include liberal, cultural, radical, and socialist feminism.  These philosophies all advocate activism as a goal but have differing views on the soured of oppression and the most effective methods of effecting changes in society.  They are best seen as existing along a continuum rather than as completely separate philosophical stances.

Liberal feminists focus on helping individual women overcome the limits and constraints of their socialization patterns.  These feminists tend to believe the differences between women and men will be less problematic as work and social environments become more bias-free.  Personal empowerment of individual woman is the major goal of therapy.

Cultural feminists believe oppression stems from society’s devaluation of women’s strengths.  The solution to oppression lies in feminization of the culture so that society becomes more nurturing, intuitive, subjective, cooperative, and relational.  Social transformation through the infusion of feminine values is the major goal of therapy.

Radical feminists focus on the oppression of women that is embedded in patriarchy and seek to change society through activism.  Therapy is viewed as a political enterprise with the goal of transformation of society.  The major goals are to transform gender relationships, transform societal institutions, and increase women’s sexual and procreative self-determination.

Socialist feminists share with radical feminists the goal of societal change.  They focus on multiple oppressions and believe solutions to society’s problems must include considerations of class, race, economics, nationality, and history.  The major goal of therapy is to transform social relationships and institutions.

The third wave of feminism embraces diversity with its inclusion of women of color, lesbians, and the postmodern and constructivist viewpoints espoused by many in the most recent generation of women.  New developments in feminism also include global and international perspectives.

Postmodern feminists provide a model for critiquing the value of other traditional and feminist approaches, addressing the issue of what constitutes reality and proposing multiple truths as opposed to a single truth.  Polarities such as masculine-feminine are deconstructed, which involves analysis of how such constructs are created.

Women of color feminists believe it is essential that feminist theory be broadened and made more inclusive.  Women of color point out that they not only have to deal with gender discrimination but with oppression on the basis of race, ethnicity, and class.  They challenge feminist theory to include an analysis of multiple oppressions, an assessment of access to privilege and power, and to emphasize activism.

Lesbian feminists share commonalities with many aspects of radical feminism.  Both perspectives view women’s oppression as related to sexualized images of women.  Lesbians who define themselves as feminists sometimes feel excluded by heterosexual feminists who do not understand discrimination based on sexual orientation.  This perspective calls for feminist theory to include an analysis of multiple identities and their relationship to oppression and to recognize the diversity that exists among lesbians.

Global-international feminists take a worldwide perspective and seek to understand the ways in which racism, sexism, economics, and classism affect women in different countries.  Global feminists assume that each woman lives under unique systems of oppression.

Who is a feminist therapist?  Many therapists, both male and female, support the ideals of the feminist movement.  However, if they do not incorporate feminist methods of therapy in their practice, they are not feminist therapists.  Feminist therapists believe gender is central to therapeutic practice, that understanding a client’s problems requires adopting a socio-cultural perspective and that empowerment of the individual and societal changes are crucial goals in therapy.  Feminist therapists realize that ethnicity, sexual orientation, and class also may be more important factors in given situations and across situations for many women.

View of Human Nature:
The feminist view of human nature is one fundamental idea that differentiates feminist theory from most other therapeutic models.  Many of the traditional theories grew out of a historical period in which social arrangements were assumed to be rooted in one’s biologically based gender.  Women and men were viewed as possessing different personality characteristics.  It was assumed that because of biological gender differences women and men would pursue different directions in life.

Worell and Remer (2003) describe the constructs of feminist theory as being gender-fair, flexible-multicultural, interactionist, and life-span-oriented.  Gender-fair theories explain differences in the behavior of women and men in terms of socialization processes rather than on the basis of our “true” natures.  These theories avoid stereotypes in social roles and interpersonal behavior.  A flexible-multicultural theory uses concepts and strategies that apply equally to both individuals and groups regardless of age, race, culture, gender, ability, class, or sexual orientation.  Interactionist theories contain concepts specific to the thinking, feeling, and behaving dimensions of human experience and account for contextual and environmental factors.  A life-span perspective assumes that human development is a lifelong process and that personality patterns and behavioral changes can occur at any time rather than being fixed during early childhood.

Feminist Perspective on Personality Development:
Feminist therapists emphasize that societal gender-role expectations profoundly influence a person’s identity from the moment of birth and become deeply ingrained in adult personality.  Because gender politics are imbedded in the fabric of American society, they influence how we see ourselves as girls and boys and as women and men throughout the course of our lives.

Recognizing that theories of human development were based almost exclusively on research with boys and men, Gilligan (1977) undertook a series of studies on women’s moral and psychosocial development.  As a result of her work, Gilligan came to believe women’s sense of self and morality is based in issues of responsibility for and care of other people and is embedded in a cultural context.  She posited that the concepts of connectedness and interdependence – virtually ignored in male-dominated developmental theories – are central to women’s development.  According to Gilligan (1982), women tend toward relationship, whereas men tend toward separation.  She asserts that it is difficult for girls to maintain a strong sense of identity and inner voice when to do so would be to risk disconnection in a society that does not honor their relational needs and desires.  In feminist therapy women’s relational qualities are seen as strengths and as pathways for healthy growth and development instead of being identified as weaknesses or defects.

Feminist researchers have demonstrated that when all human development is seen through the lens of male gender, important qualities of both women and men are overlooked.  Through the work of Gilligan, Miller, and others, we have new models of development to understand women and a new perspective that recognizes that both women and men have been mislabeled and misunderstood.

Feminist therapists remind us that traditional gender stereotypes of women are still prevalent in our cultures.  They teach their clients that uncritical acceptance of traditional roles can greatly restrict their range of freedom to define the kind of person they want to be.  All of these approaches view women in a positive light, arise out of women’s experience, encompass the diversity and complexity of women’s lives, attend to the ways in which diversity influences self-structures, recognize the inextricable connection between internal and external worlds, and acknowledge the political and social oppression of women.  Each has made a unique contribution and has had an impact on the practice of feminist therapy.  These common characteristics enable practitioners to assess the adequacy of whatever personality theory they use.

Principles of Feminist Psychology:
1.  The personal is political.
Clients’ individual problems have societal and political roots.  Feminist therapy aims not only for individual change, but for social change.  If the environment is a major source of pathology in the lives of women and men, then the toxic aspects of the environment must be changed if individual change is to occur:  The goal is to advance a different vision of societal organization that frees both women and men from the constraints imposed by gender-role expectations.

2.  Personal and social identities are interdependent.
Interdependence between personal and social identities is a major vehicle for integrating diversity in feminist therapy.  Individuals have membership in interdependent social groups that are structured by cultural norms, and people occupy several different “social locations” such as gender, ethnicity, race, social class, sexual orientation, age, and physical abilities and characteristics within this matrix.  Feminist therapists work to help individuals make changes in their lives, but they are also committed to working toward social change that will liberate all members of society from stereotyping, marginalization, and oppression.

3.  Definitions of distress and “mental illness” are reformulated.
Feminist therapy rejects the “disease model” of mental illness.  Psychological distress is reframed, not as a disease but as a communication about unjust systems.  Pain is defined not as evidence of deficit or defect but as evidence of resistance and the skill and will to survive.  Resistance is seen as an indicator that the person is able to remain alive and powerful in the face of oppression.  By considering contextual variables, symptoms are reframed as survival strategies.  Women’s responses to pathological environmental forces are not viewed as symptoms but rather as creative strategies for coping with society’s oppression.  Enns (1993) suggests that learning to directly express this internalized pain (and anger, grief, and sorrow) represents a basic aspect of healing because it enables clients to productively redirect emotions they have introjected, or swallowed.

4.  Feminist therapists use an integrated analysis of oppression.
Gender is an essential consideration in feminist therapy, both in terms of oppression and in terms of differences that may influence one’s understanding.  Men who have learned that vulnerability is a weakness may have difficulty expressing emotions in and outside the therapeutic relationship.  Women who have learned to subordinate their own wishes to care for their families may have difficulty identifying and honoring what they want out of therapy.  Feminists challenge all forms of oppression (oppression on the basis of race, ethnicity, class, culture, religious beliefs, affectional or sexual orientation, age, and physical abilities and characteristics), not just oppression of women.

5.  The counseling relationship is egalitarian.
Attention to power is central in feminist therapy, and the therapeutic relationship is egalitarian.  Clients are assumed to be experts on themselves and the voices of the oppressed are acknowledged as authoritative and valuable sources of knowledge.  Feminist therapists believe all relationships should strive for equality, or better, mutuality (a condition of authentic connection between the client and the therapist).  Other elements essential to an egalitarian relationship are therapist self-disclosure when appropriate, therapists authenticity and presence with clients, and clients’ informed consent.

6.  Women’s perspectives are valued.
Women’s perspectives are considered central in understanding their distress.  Our society has tended to devalue subjective experience in favor of the objective.  A goal of feminist therapy is to replace patriarchal “objective truth” with feminist consciousness, which acknowledges a diversity of ways of knowing.

Therapeutic Goals:
Five goals for feminist therapy have been proposed by Enns (2004):  equality, balancing independence and interdependence, empowerment, self-nurturance, and valuing diversity.  But the ultimate goal of feminist therapy is to create the kind of society where sexism and other forms of discrimination and oppression are no longer a reality.  Feminist therapy strives for transformation for both the individual client and society as a whole.

Feminist therapy is a consciously political enterprise.  The aim is to replace the current patriarchy with a feminist consciousness, creating a society in which relationships are interdependent, cooperative, and mutually supportive.  The full meaning of “the person is political” is that women learn to free not only themselves but all people from the bonds of oppression and stereotypes.  Feminist therapists also work toward reinterpreting women’s mental health.  Their aim is to depathologize women’s experiencing and to change society so that women’s voices are honored and women’s relational qualities are valued.  Women’s experiences are examined without the bias of patriarchal alues, and women’s life skills and accomplishments are acknowledged.

Therapist’s Function and Role:
Feminist therapy rests on a set of philosophical assumptions that can be applied to various theoretical orientations.  Any theory can be evaluated against the criteria of being gender-fair, flexible-multicultural, interactionist, and life-span-oriented.

A therapist of another orientation who incorporates feminist principles and practices is not the same as a feminist therapist.  Feminist therapists have integrated feminism into their approach to therapy and into their lives.  Their actions and beliefs and their personal and professional lives are congruent.  Feminist therapists are also committed to understanding oppression in all its forms – sexism, racism, heterosexism – and they consider the impact of oppressions and discrimination on psychological well-being.  They value being emotionally present for their clients, being willing to share themselves during the therapy hour, modeling proactive behaviors, and being committed to their own consciousness-raising process.

Feminists share common ground with existential therapists who emphasize therapy as a shared journey – one that is life changing for both client and therapist.  Feminist therapists hold many beliefs in common with humanistic or person-centered therapists, trusting in the client’s ability to move forward in a positive and constructive manner.  They believe the therapeutic relationship should be a nonhierarchical, person-to-person relationship, and they aim to empower clients to live according to their own values and to rely on an internal (rather than external or societal) locus of control in determining what is right for them.  Like person-centered therapists, feminist therapists convey their genuineness and strive for mutual empathy between client and therapist.  Insight, introspection, and self-awareness are springboards to action, and feminist therapists work to free women (and men) of roles that have prohibited them from realizing their potential.
 

Client’s Experience in Therapy:
Clients are active participants in the therapeutic process.  It is important that clients tell their stories and give voice to their experiencing.

The female therapist may share some of her own struggles with gender-role oppression, and as an analysis of gender-role stereotyping is conducted, the client’s consciousness is raised.  She will move from the safe environment of individual therapy sessions out into the larger support system of women.

Feminist therapists do not restrict their practice to women clients; they also work with men, couples, families, and children.  The therapeutic relationship is a partnership, and the client will be the expert in determining what he needs and wants from therapy.  He will explore ways in which he has been limited by his gender-role socialization.  He may become more aware of how he is constrained in his ability to express a range of emotions, and in the safe environment of the therapeutic sessions he may be able to fully experience such feelings as sadness, tenderness, uncertainty, and empathy.  As he transfers these ideas to daily living, he may find that relationships change in his family, his social world, and at work.  Clients can expect more than adjustment or simple problem-solving strategies; they need to be prepared for major shifts in their way of viewing the world around them, changes in the way they perceive themselves, and transformed interpersonal relationships.

Relationship Between Therapist and Client:
The very structure of the client-therapist relationship models how to identify and use power responsibility.  Feminist therapists clearly state their values to reduce the chance of value imposition.  This allows clients to make a choice regarding whether or not to work with the therapist.

Although there is an inherent power differential in the therapy relationship, feminist therapists work to equalize the power base in the relationship by employing a number of strategies.  First, they are acutely sensitive to ways they might abuse their own power in the relationship, such as by diagnosing unnecessarily, by interpreting or giving advice, by staying aloof behind an “expert” role, or by discounting the impact the power imbalance between therapist and client has on the relationship.

Second, therapists actively focus on the power clients have in the therapeutic relationship.  Third, feminist therapists work to demystify the counseling relationship.  They do this by sharing with the client their own perceptions about what is going on in the relationship, by making the client an active partner in determining any diagnosis, and by making use of appropriate self-disclosure.  The counselor is not the all-knowing expert but rather is a “relational expert,” who strives to develop a collaborative relationship in which clients can become experts on themselves.

The Role of Assessment and Diagnosis:
Feminist therapists have been sharply critical of the DSM classification system, and research indicates that gender and race may influence assessment of clients’ symptoms.  Sources of bias include disregarding or minimizing the effect of environmental factors on behavior; providing different treatments to various groups of individuals who display similar symptoms; inappropriately selecting diagnostic labels due to stereotypical beliefs; and operating from a gender-biased theoretical orientation.

Feminist therapists believe diagnostic labels are severely limiting for these reasons: (a) they focus on the individual’s symptoms and not the social factors that cause dysfunctional behavior; (b) as part of a system developed mainly by White male psychiatrists, they may represent an instrument of oppression; (c) they (especially the personality disorders) may reinforce gender-role stereotypes and encourage adjustment to the norms of the status quo; (d) they may reflect the inappropriate application of power in the therapeutic relationship; (e) they can lead to an overemphasis on individual solutions rather than social change; and (f) they have the potential to reduce one’s respect for clients.

Reframing symptoms as coping skills or strategies for survival and shifting the etiology of the problem to the environment avoids “blaming the victim” for her problems.  Assessment is viewed as an ongoing process between client and therapist and is connected to treatment interventions.  In the feminist therapy process, diagnosis of distress becomes secondary to identification and assessment of strengths, skills, and resources.  Diagnostic categories used to label individuals who have experienced violence are another area of controversy for feminist therapists.

According to the DSM-IV-TR, depression is twice as common among women (APA, 2000).  Feminist therapists believe women have many more reasons to experience depression than do men, and they often frame depression as a normative experience for women.  Women are often financially disadvantaged or dependent, relationally submissive, and strive to please others by anticipating their needs.  Thus, depression may result from women’s internalized perception, belief, and experience of not being in control of their lives or bodies and feeling less valuable than men.  Similarly, with eating disorders feminist therapists focus on messages given by society, and by the mass media in particular, about women’s bodies and the importance of being thin.  The therapist uses a gender-role analysis to help clients who suffer from anorexia or bulimia examine these societal injunctions and how they have come to accept them.  Therapist and client work together on ways to challenge and change these messages.  

Techniques and Strategies:
Feminist therapists have developed several techniques, and others have been borrowed from traditional approaches and adapted to the feminist therapy model.  Particularly important are consciousness-raising techniques that help women differentiate between what they have been taught is socially acceptable or desirable and what is actually healthy for them.

Empowerment:  Informed consent issues are paid close attention to as a way of discussing ways of getting the most from the therapy session, clarifying expectations, identifying goals, and working toward a contract that will guide the therapeutic process.

Self-disclosure:  Self-disclosure shows the client that the therapist is a real person with her own struggles, and through this common connection the client begins to understand that the “personal is political.”  Self-disclosure is not just sharing information and experiences.  It also involves a certain quality of presence the therapist brings to the therapeutic sessions.  Feminist therapists, like counselors who have other theoretical orientations, are ethically committed to using self-disclosure to enhance the therapeutic process.

Gender-role Analysis:  A hallmark of feminist therapy, gender-role analysis explores the impact of gender-role expectations on the client’s well-being or distress and draws upon this information to make decisions about future gender-role behaviors.

Gender-role Intervention:  Using this technique the therapist responds to the client’s concern by placing it in the context of society’s role expectations for women.

Power Analysis and Power Intervention:  These techniques are similar to the analysis and intervention with gender roles.  The emphasis here, however, is on helping the client become aware of the power difference between men and women in our society and empower the client to take charge of herself and her life.  Power analysis includes recognizing different kinds of power that clients possess or to which they have access.

Bibliotherapy:  Nonfiction books, psychology and counseling textbooks, autobiographies, self-help books, educational videos, and films can all be used as bibliotherapy resources.  At times, a novel may be extremely therapeutic and provide rich material for discussion in therapy sessions.  Reading can supplement what is learned in the therapy sessions, and the client can enhance her therapy by exploring her reactions to what she is reading.

Reframing and Relabeling:  Reframing is applied differently in feminist therapy.  Reframing implies a shift from “blaming the victim” to a consideration of social factors in the environment that contribute to a client’s problem.  In reframing, rather than dwelling on intrapsychic factors, the focus is on examining societal or political dimensions.

Group work:  An important adjunct to individual feminist therapy, group work alone is often the preferred modality for some issues that women experience in our culture.  Women’s groups, including self-help groups and advocacy groups, help women experience their connectedness and unity with other women.

Social action:  Feminist therapist may suggest to clients that they become involved in activities such as volunteering at a rape crisis center, writing letters to lawmakers, or providing community education about gender issues.

The role of men in Feminist Therapy:
Can a man be a feminist therapist?  It seems to us that men can be pro-feminist therapists when they embrace the principles and incorporate the practices of feminism in their work.  This entails being willing to confront sexist behavior in themselves and others, redefining masculinity and femininity according to other than traditional values, working toward establishing egalitarian relationships, and actively supporting women’s efforts to create a just society.

Feminist therapists routinely work with men, especially with abusive men and in battering groups.  Issues that men can deal with productively in feminist therapy include learning how to increase their capacity for intimacy, expressing their emotions and learning self-disclosure, balancing achievement and relationship needs, accepting their vulnerabilities, and creating collaborative relationships at work and with significant others that are not based on a “power-over” model of relating.

Contributions to Multicultural Counseling:
Of all the theoretical approaches to counseling and psychotherapy in this book, feminist therapy and multicultural perspective of therapy practice have the most in common.  Culturally competent feminist therapist look for ways to work within the client’s culture by exploring consequences and alternatives.  They appreciate the complexities involved in changing within one’s culture but do not view culture as sacrosanct.  It is important to understand and respect diverse cultures, but most cultural contexts have both positive and toxic aspects.  Feminist therapists are committed to challenging cultural beliefs and practices that discriminate against, subordinate, and restrict the potential of groups of individuals.

Limitations for Multicultural Counseling:
The core of equality in feminist therapy may limit the effectiveness of the therapist in working with clients from culturally different backgrounds.

Contributions of Feminist Therapy:
One of the major contributions feminists have made to the field of counseling and psychotherapy is paving the way for gender-sensitive practice and an awareness of the impact of the cultural context and multiple oppressions.

Limitations and Criticisms:
Some feminist therapists may become overzealous and in subtle ways impose their values on clients.