Abstract
Black American women are uniquely positioned to experience systemic racism and oppression due to their intersecting identities of gender, race, sexuality, and class. Black feminist therapy (BFT) provides empirically proven strategies to promote the psychological health and well-being of Black women and foster their empowerment, liberation, and radical healing. Through an examination of the principles and concepts of feminist theory, Black feminist theory, and BFT, a model of growth and healing is presented. A case example is provided as evidence of the process and effectiveness of BFT in working with Black women.
Psychological practitioners and researchers have continuously debated the efficacy of differing treatment modalities and interventions (Barkham & Lambert, 2021). Since the 1970s, therapy outcomes were linked with the Dodo Bird effect, which posits that psychotherapy outcomes are “broadly similar,” regardless of the type of therapy used (Barkham & Lambert, 2021, p. 144). More specifically, the Dodo Bird effect explains that specific and common factors contribute to positive client outcomes in any psychotherapy model (de Felice et al., 2019). However, there is research that suggests that the general effectiveness of psychotherapy varies depending on the treatment modality (Barkham & Lambert, 2021). To assess whether the Dodo Bird effect is attributable to providing therapy to Black women, this article examines Black feminist therapy (BFT) as a model for fostering change and healing through its therapeutic process. Furthermore, a case study that uses BFT is provided as an example of its efficacy and effectiveness.
Theory of Growth and Change
When human beings experience psychological distress, it is not uncommon for their lives to unravel. To cope with distress and alter maladaptive thinking, many individuals receive psychotherapy treatment and learn skills such as problem solving, developing supportive networks, self-care, self-control, mood regulation, self-monitoring, and perspective taking (Campbell & Ntobedzi, 2007; Guan et al., 2019). The therapeutic approaches and perspectives taken to teach these skills and the relationship between the client and therapist are what promote growth and change in clients (Bugental & Bugental, 1984; Watson et al., 2020). Many psychologists and researchers agree that there are six conditions that are sufficient and necessary to cultivate therapeutic change: (a) two people are in psychological contact; (b) the client is in a state of incongruence through vulnerability and anxiousness; (c) the therapist is integrated or congruent in the relationship; (d) the therapist provides the client with unconditional positive regard; (e) the client’s experiences or frame of reference are empathically understood by the therapist, whom communicates this empathy to the client; and (f) the therapist’s unconditional positive regard and empathic understanding is communicated to the client at a minimal degree (Elliott et al., 2019; Farber et al., 2019; Gelso et al., 2019; Kolden et al., 2019; Rogers, 2007).
The first condition, two people being in psychological contact, refers to the relationship between the therapist and client (Gelso et al., 2019; Rogers, 2007). The way in which the client perceives psychological contact with the therapist affects the client’s level of resistance to the therapy process, change (Bugental & Bugental, 1984; Gelso et al., 2019), and outcomes (Barrett-Lennard, 1962; Gelso et al., 2019; Rogers, 2007). The second condition, incongruence, is described as inconsistency between the experience that a client portrays as their experience and their actual experience (Kolden et al., 2019; Rogers, 2007). On the other hand, the therapist should be genuine, congruent, and integrated (Kolden et al., 2019; Rogers, 2007). Leijssen (1990) emphasizes that therapist congruence involves being an experiencing person who is self-aware and forthcoming of their experiences in the therapy room. Unconditional positive regard is the fourth condition and refers to the therapist being accepting of every facet of the client’s experience (Farber et al., 2019; Rogers, 2007). This regard should be constant, interpersonal, and related to the client (Barrett-Lennard, 1962; Farber et al., 2019). The therapist experiencing empathy toward their client, or empathic understanding (Rogers, 2007), provides active understanding of the client’s experiences and their meanings (Barrett-Lennard, 1962; Elliott et al., 2019). The final condition, the therapist communicating empathy and positive regard to the client (Rogers, 2007), leads to a deeper therapeutic alliance (Baldwin & Goldberg, 2021; Elliott et al., 2019; Farber et al., 2019). Research suggests that when these six conditions are implemented into a therapeutic process or model, clients will experience growth and change, which is evidenced in feminist therapies (Locher et al., 2019; Ort et al., 2022; Rogers, 1995).
Feminist Psychology
In 1848, the Seneca Falls Convention was organized and held in western New York by a group of women to address slavery in the United States and its abolishment (Chrisler & McHugh, 2011). This convention sparked the first wave of the feminist movement. During the first wave, despite their experienced oppression, women made many contributions to the field of psychology through faculty positions at women’s colleges, research assistantships, and by opening membership opportunities for women in scientific associations (Chrisler & McHugh, 2011).
The second wave of feminism, or the Women’s Liberation movement, was incited in 1963 by the publication of Betty Friedan’s The Feminine Mystique (Chrisler & McHugh, 2011). Friedan’s book transformed American society and culture, and had significant effects on the field of psychology. Critiques of Freud, Erikson, and other male psychoanalysts and behaviorists arose, which opposed the power imbalance that favored men (Abdullah & Zaid, 2022; Chrisler & McHugh, 2011).
In 1967, Karen Horney coined the term “feminist psychology” as she addressed previously held beliefs about relationships, women, and society’s effect on female psychology (Hitchcock, 2005; Horney, 1967). Prior to the 1970s, U.S. psychology was a White-male-dominated field (Abdullah & Zaid, 2022; Chrisler & McHugh, 2011), and Horney (2014) was instrumental in challenging the male perspective of understanding girls, women, and the feminine. In opposition to Sigmund Freud’s psychoanalysis, which pathologized girls, women, and sexuality, Horney (2014) centered her clients’ and students’ subjective experiences while considering social issues. In 1969, a group of women gathered during the American Psychological Association (APA) convention and began organizing feminist psychology (Chrisler & McHugh, 2011). Several years later, in 1975, Mary Parlee recorded the beginnings of feminist psychology in the journal, Signs, by analyzing the formation of the Psychology of Women and the formation of its American Psychological Association division (Stewart & Dottolo, 2006). Similarly, Reesa Vaughter discussed feminist researchers’ contributions to historical empirical psychological research in Signs in 1976 (Stewart & Dottolo).
The Girl Power movement, or the third wave of feminism, began forming in the 1990s (Abdullah & Zaid, 2022; Chrisler & McHugh, 2011). This movement was fueled to address the increasing objectification of women, consumer culture which led to emphasized body issues, and to support transgendered youth and young women. The third wave of feminism has influenced contemporary investigations of violence against women, self-objectification, the intersectionality of identity, and women’s health issues (Abdullah & Zaid, 2022; Chrisler & McHugh, 2011).
Feminist theory views human beings as biopsychosocial/spiritual-existential entities and psychotherapy as a tool for transformation (Brown, 2010; Mohajan, 2022). Client transformation during feminist therapy can be conceptualized through the four biopsychosocial/spiritual-existential axes of personal power: (a) somatic power, (b) intrapersonal/intrapsychic/inner power, (c) interpersonal/social-contextual power, and (d) spiritual/existential power (Brown, 2010; Ciurria, 2019).
Somatic power is considered the experience of the body (Brown, 2010; Ciurria, 2019). Individuals gain compassion regarding their body and learn to experience the body as a safe place, as acceptable (in size and shape), as a source of desire for food, rest, and pleasure, and as an object of love. One claims intrapersonal/intrapsychic power when they know their mind can think critically and is not suggestible. When an individual is interpersonally effective, they have desired impacts on others, are not preoccupied with control, experience close and meaningful engagement with others, can differentiate from others without being distant, are able to forgive self and others, and are able to resolve conflict in relationships when possible or end relationships when they become problematic or dangerous. When one can enter life roles such as a worker, partner, or parent from a position of choice and intention, they are demonstrating interpersonal/social-contextual power. Finally, individuals embody spiritual/existential power by responding to life’s existential challenges, fostering comfort and well-being, integrating heritage and culture into one’s sense of self, moving in awareness of social context (but not controlled by it), having a reason for being, and accessing their creative capacities without sacrificing the demands of realistic living (Brown, 2010; Ciurria, 2019).
To foster achievement of the four axes of personal power and transformation through feminist therapy, feminist psychologists seek the empowerment of clients through egalitarian relationships, and the undermining of patriarchal influences through an analysis of power, gender, and social location (Brown, 2010; Bryant-Davis & Moore-Lobban, 2019). Empowerment is viewed as self-control as opposed to control over others and is promoted by an egalitarian therapeutic relationship (Brown, 2010; Roca et al., 2022). The egalitarian relationship is defined as equality of power in social and political relationships (Tomlin, 2014). As Carl Rogers posited, the client–therapist relationship is necessary and essential to the process of growth and change (Joseph, 2021; Rogers, 2007; Woodward, 2020). In feminist therapy, the egalitarian relationship is characterized by Rogers’ conditions of therapeutic personality change—empathy, unconditional positive regard, congruency, psychological contact, and the client’s perception of the therapeutic experience (Brown, 2010; Bryant-Davis & Moore-Lobban, 2019; Joseph, 2021; Rogers, 2007). In addition, feminist therapy emphasizes the use of self-disclosure to strengthen the therapeutic alliance, foster equality of power, and advance growth and change (Brown & Walker, 1990; Bryant-Davis & Moore-Lobban, 2019).
Along with encompassing the overarching goals of feminist therapy, feminist psychologists may ascribe to a number of different theoretical or political positions (Chrisler & McHugh, 2011; Ciurria, 2019). The various forms of feminism include liberal feminism, cultural feminism, socialist feminism, radical feminism, and most recently formed, Black feminist thought (Chrisler & McHugh, 2011). Liberal feminists fight for the rights and inclusion of women in society, and their equality to men. Cultural feminists visualize the unique strengths of women transforming society and perceive women’s experiences as separate from men. Socialists suggest that women’s subordinate status is a result of inequalities, exploitation, and competition in the economic system. Furthermore, they seek to modify, undermine, and eliminate the social class system and capitalism to liberate women. Radical feminists propose that to eradicate the oppression of women, fundamental political and social change is necessary (Chrisler & McHugh, 2011; Hutchinson, 2020). Finally, Black feminist thought recognizes the distinct oppression that is experienced by Black women (Chrisler & McHugh, 2011; Hutchinson, 2020).
Black Feminist Thought
Maria W. Stewart, regarded as America’s first Black feminist (Collins, 2009; Shorter-Bourhanou, 2022), gave an address at the African Masonic Hall in 1833 and stated, “We have pursued the shadow, they have obtained the substance; we have performed the labor, they have received the profits; we have planted the vines, they have eaten the fruits of them” (Richardson, 1987, p. 59). Stewart pointed out that the poverty of Black women was a result of race, class, and gender oppression, and challenged Black women to reject the negative portrayal of Black womanhood (Collins, 2009; Shorter-Bourhanou, 2022). Majority of Black women arrived in the United States forcibly via the Transatlantic Slave Trade and were enslaved to work in a situation of oppression. American women of African descent’s relationship with the United States are defined by U.S. slavery and oppression, which encompasses three interdependent dimensions: (a) Black women’s exploitation for labor as necessary to U.S. capitalism; (b) the denial of Black women’s rights and privileges; and (c) controlled narratives of Black women as jezebels, mammies, and breeders. These dimensions create a system of social control that is intended to perpetuate the oppression of Black women, suppress their ideas, inhibit their intellect, and protect the worldviews and interests of the White elite (Collins, 2009).
Given that Black American women are historically oppressed, Black feminist thought is intended to oppose intersecting oppressions of gender, race, and class (Collins, 2009; Shorter-Bourhanou, 2022). From the Black feminist lens, institutionalized racism is analyzed to resist it, contradictions between Black women’s devalued status and the dominant groups ideology of womanhood in America is questioned, and empowerment, emancipation, and liberation are at the forefront of advocacy (Bryant-Davis & Moore-Lobban, 2019; Collins, 2009). Black women reclaim their ideas, discover Black American women who have been silenced, reinterpret works using new frameworks, and search for alternative institutions to express intellectual thought (Collins, 2009).
Black Feminist Therapy
Black feminist thought posits that traditional feminist theory lacks the necessary tenants to address the issues of Black women (Evans et al., 2017). Thus, BFT was derived from Black feminist thought as a psychotherapy that is inclusive of race, gender, class, and sexual orientation to address all forms of marginalization and discrimination. BFT integrates an analysis of race, gender, sexual orientation, and class, and places an emphasis on Black women’s psychological well-being being affected by social pressures at the micro, mezzo, and macro levels. BFT prioritizes fostering safe, authentic spaces (F. Jones, 2019), cultivating empowerment through egalitarian therapeutic relationships (Evans et al., 2017), and promoting Black women’s innate growth tendencies (Bryant-Davis & Moore-Lobban, 2019). Black women’s ability to function among external forces that exacerbate psychological distress empowers liberation from internal distress and promotes skills to self-actualize goals (Evans et al., 2017).
BFT as an Agent of Growth and Healing
When Black women seek mental health services, more than likely, they have reached crisis point (L. V. Jones & Guy-Sheftall, 2017). Black women’s experiences of oppression may have significant impacts on their psychological well-being (or distress) and necessitates a process that focuses on cyclical and continuous restoration and healing. Many psychotherapy models are culturally inadequate or ineffective when working with Black American women; however, BFT is uniquely situated to meet the specific needs of Black women (Bryant-Davis & Moore-Lobban, 2019; L. V. Jones & Guy-Sheftall, 2017). To treat and prevent Black women’s psychological distress, promote transformation, and foster Black women’s innate growth potentialities, it is necessary for practitioners to implement culturally relevant strategies such as BFT (Bryant-Davis & Moore-Lobban, 2019; L. V. Jones & Guy-Sheftall, 2017; Shorter-Bourhanou, 2022).
Black American women experience simultaneous oppressions from the multiplicity of gender, race, class, and sexual orientation (Bryant-Davis & Moore-Lobban, 2019; L. V. Jones & Guy-Sheftall, 2017). BFT reflects the integration of analyzing those identities to assist Black women with understanding the structural constraints of identity effects on personal and emotional struggles (see Figure 1). BFT emphasizes empowerment, social action, exploration of power imbalances, and consciousness raising (Williams, 1993), but includes building skills to negate negative cultural messages as a part of minimizing psychological symptoms and maladaptive coping strategies (Greene, 1994; L. V. Jones & Guy-Sheftall, 2017).

Race, Gender, Sexual Orientation, Class: Oppression’s Effect on Black Women’s Mental Health.
When working with Black American women, interventions should be strength-based (L. V. Jones & Guy-Sheftall, 2017). Interventions that are often successful in promoting growth and change in Black women from BFT include cultural mind/body practices (Bryant-Davis & Moore-Lobban, 2019; L. V. Jones & Guy-Sheftall, 2017), cognitive-behavior strategies, expressive arts, alternative therapeutic spaces, critical affirmations, and consciousness raising (Oliphant et al., 2022). There is empirical research that supports the use of these practices for working with Black women through BFT (Oliphant et al., 2022).
Empirical research suggests that mind/body interventions, cognitive-behavioral interventions, the use of expressive arts, and alternative healing therapeutic spaces promote growth, change, and healing in Black American women. Woods-Giscombe and Black (2010) conducted a study on culturally derived mind/body interventions. They suggested that mindfulness interventions that emphasize awareness of the socially ingrained strong Black woman role and are grounded in African-centered culture promote the reframing of the concept of strength. These interventions were found to promote awareness of and cultivate inner strength, self-defined authenticity, wellness, and wholeness and fostered rejection of workaholism, self-sacrifice, excessive caregiving, or self-silencing (Woods-Giscombe & Black, 2010). Similarly, Phillips (1990) found that relaxation exercises and self-awareness exercises promoted growth and change.
In a study on cognitive-behavior interventions through the practice of critical affirmations, it was found that Black women’s mental health improved (West, 1999). West (1999) explained that Black women constantly receive messages of inferiority, and their internal voices are often harsh and critical. By responding to those messages with compassion and love, Black women were able to prevent the continuation of self-blaming, the internalization of the lie of White Supremacy, and change their automatic thought patterns (West, 1999).
Although the cognitive-behavioral approach has often been cited to be more efficacious and effective than other treatment models and interventions (Lutz et al., 2021), it is important to note that altering maladaptive cognitions is a western perspective (Oliphant et al., 2022). Taking this into consideration, it is important to acknowledge that cognitive-behavioral techniques do not always capture Black women’s unique experiences, and other healing practices may be more effective in certain circumstances. In addition, when using cognitive-behavioral strategies with Black women through the BFT model, affirming Black womanhood, liberation, and Black women’s authentic healing power should be centered (Oliphant et al., 2022). Phillips (1990) indicated and provided evidence that relabeling, reframing, and humor are effective tools to developing trust in the inner self.
Research has also shown the efficacy and effectiveness of expressive arts in BFT. Phillips (1990) and Bryant-Davis and Moore-Lobban (2019) provided evidence of positive mental health outcomes when implementing guided imagery, creative visualization, prayer, libations, Afro-drama, role-play, and engaging with nature. Their research suggested that incorporating culturally sensitive, African-centered expressive arts promoted a healthy view of Black race and culture, increased feelings of connectedness, sense of self and worth, and nourished internal wound healing (Bryant-Davis & Moore-Lobban, 2019; Phillips, 1990).
Grills et al. (2016) presented research on the efficacy and effectiveness of emotional emancipation circles in promoting growth and change in Black American women. Emotional emancipation circles provide safe healing spaces for Black people to collaboratively overturn and overcome the lie of Black inferiority. In these healing spaces, Black people share their stories, find deep understanding of the impact of history and oppression in their lives, engage in community, and establish strong, healthy, emotional foundations. Grills et al. (2016) found that these sacred healing spaces provided Black women with a chance to “breathe” and cultivate restorative healing (p. 340). Similarly, Sawubona Healing Circles have been cited to foster grounding and healing in Black women (Gardner, 2023). Sawubona Healing Circles offer safe spaces for the Black community to strengthen their cultural and ethnic identities and learn healing strategies (Gardner, 2023).
ML: A Case Example of BFT
BFT is uniquely situated to address psychological distress experienced by Black women (L. V. Jones & Guy-Sheftall, 2017). The case of ML, a Black American woman, is shared as an example of the implementation of BFT and its effectiveness.
ML was a 19-year-old, Black American female. She identified as bisexual and was single. ML identified as spiritual, but not religious, and was an undergraduate student at a large, predominantly White public university. ML presented with feelings of misplaced guilt, difficulty sleeping, extreme fatigue, low self-esteem, a lack of self-worth, a lack of motivation, negative body image, depressed mood, loss of pleasure in activities, frequent panic attacks, irritability, difficulty concentrating, difficulty trusting and connecting with others, and excessive worry.
ML attended weekly psychotherapy sessions. She always presented to sessions well-groomed, wearing neat and clean clothing. She was oriented to person, place, and time, with an anxious mood. ML’s speech and affect were generally normal, and her short- and long-term memory were intact. There was no evidence of visual or auditory hallucinations, or delusions. She denied suicidal ideation, plan or intent, and denied homicidal plan or intent. ML had good insight and fair judgment.
ML and her family lived in a predominantly White neighborhood and she attended all predominantly White schools. ML was the youngest of her married parents’ three biological children. She had two elder brothers—both of whom were high functioning on the Autism spectrum. ML’s parents were always extremely critical of her and held her to high and unrelenting standards. She did not tell her family that she was bisexual because she believed they would reject her due to their religious beliefs and values. In middle school, ML was rejected and isolated by her friends, who told her that her emotions and mental health difficulties were “too much.” ML had experiences with microaggressions, discrimination, and racism at schools and in her community since early childhood.
ML had perfectionistic tendencies and felt that she could not make mistakes. She had trouble establishing and maintaining interpersonal relationships out of fear of rejection. She experienced significant distress related to her continuous experiences of racism and oppression. She had low self-esteem and lacked a sense of self-worth. ML did not receive psychotherapy treatment until turning 18, because her parents would not allow her to seek treatment.
ML and her therapist had a strong therapeutic alliance that could be characterized as egalitarian. ML received empathic understanding, unconditional positive regard, and congruence from her Black, female therapist. ML and her therapist collaboratively developed treatment goals and objectives. Most recently, ML and her therapist set goals to increase self-esteem and self-worth, establish and maintain an interpersonal relationship, and decrease the frequency and intensity of panic attacks and symptoms related to anxiety (see Figure 2). In addition, ML and her therapist collaboratively developed objectives to meet the goals of treatment.

ML’s Treatment Goals and Objectives.
Treatment Interventions
When working with ML through the Black feminist lens, the therapist used various culturally appropriate interventions including cognitive-behavior strategies, critical affirmations, mind/body practices, consciousness raising, expressive arts, and alternative therapeutic spaces.
Through a multiculturally focused client-centered approach, the therapist spent time building rapport and the therapeutic alliance. Once a solid relationship was established, the therapist moved into consciousness raising. The therapist worked with ML on resisting the stigma and bias of receiving mental health services and becoming aware and acknowledging the role that her oppressive experiences due to race, gender, sexual orientation, and class played in her psychological distress.
After raising ML’s consciousness, the therapist slowly implemented cognitive-behaviors strategies. ML learned skills such as reframing thoughts from negative or self-disparaging to neutral or positive. ML practiced critical affirmations to promote the self-healing process. Critical affirmations involved using affirmative statements to respond to negative internal voices related to oppressive systems (Oliphant et al., 2022). The therapist implemented various forms of expressive arts into her treatment with ML, including journaling, writing poetry, singing, and acting. These modes of expressive art were used based on ML’s interests.
The therapist also taught ML culturally grounded mind/body techniques. People from African backgrounds often benefit from healing strategies that connect the body, mind, and spirit (Oliphant et al., 2022). By engaging body movement with interventions of the mind, therapists can foster balance between the spirit, mind, and body. Specifically, the therapist and ML engaged in ritualistic dance therapy and grounding mindfulness techniques. Finally, ML was referred to Black cultural healing groups that tapped into the community aspect of healing. ML and the therapist also implemented strategies to engage in self-care and reject the oppressive notion of overworking to achieve. ML attended emancipation healing circles, which focused on the empowerment, liberation, and emancipation of Black people. These culturally healing community spaces train Black women to reject the lies of Black inferiority and White superiority (Grills et al., 2016). These circles emphasize acquiring power and identity and the healing of historical trauma (Grills et al., 2016).
Assessing Growth and Change
To assess the growth and change occurring in ML through BFT and the therapeutic relationship, weekly check-ins were conducted. Each week, the therapist engaged ML in a self-report of her level of psychological distress and symptomatology. The therapist tracked ML’s movement and progress by noting when distress levels decreased. The therapist also noted changes that she personally saw in ML in the therapeutic session such as decreases in self-disparaging or negative statements, increases in positive statements or use of critical affirmations in the moment, or increased interpersonal involvement. The therapist also queried ML’s perception of the usefulness of different techniques, and they adjusted treatment accordingly based on ML’s reports. Finally, Sellers et al. (1997) Multidimensional Inventory of Black Identity was used with ML monthly, to assess how the relationship between her Black identity, racial discrimination, and psychological functioning was changing over time. According to ML’s reports and the therapists’ observations, BFT was effective in promoting growth and change in ML.
Limitations of BFT
BFT is designed specifically for Black women and their healing (Bryant-Davis & Moore-Labbon, 2019; Collins, 2009). This makes BFT limited in its applicability to other populations. In addition, in some instances, Black women struggle with consciousness raising (L. V. Jones & Guy-Sheftall, 2017). Therapists’ lack of awareness of the role that societal pressures and oppressions due to intersecting identities of race, gender, class, and sexual orientation can interfere with BFT’s goal of radical transformation and healing. This suggests that there is a need for researchers to address ways in which this therapeutic model may be used with other populations, and ways to move past resistance to consciousness raising.
Summary
BFT is an efficacious and effective treatment process model to promote innate growth potentialites and change in Black American women. For Black women, BFT fosters empowerment and liberation from the social pressures and oppressive acts that affect psychological well-being and functioning in Black women. BFT analyzes the intersection of race, gender, sexual orientation, and class in Black women and promotes skills to self-actualize. In conjunction with the six common factors of therapeutic change, BFT is a powerful tool to assist Black women with healing and restoration. Although BFT is a successful model for working with Black women, it is limited in population applicability. Future research should address ways to adapt this model and develop versions for other cultures, races, and populations.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
