Monthly Archives: May 2010

Combining Cognitive Behavioral Therapy (CBT) and Feminist Theory

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Cognitive-behavioral and Feminist approaches share many common factors. These factors include a belief that a solid therapeutic relationship is necessary when working with clients from marginalized groups, techniques can be individualized to fit the needs of each client, and differences between and within marginalized groups are considered. Both cognitive-behavioral and feminist theories emphasize education and awareness, as well as external causes of issues. Cognitive-behavioral approaches differ from feminist approaches in that they are empirically supported.  Feminist approaches focus on experiences as relating to a patriarchy and the empowerment of women and other individuals from marginalized groups, and considers advocacy an essential element.

Strengthening CBT using Feminist Techniques

Although cognitive and behavioral approaches to therapy may be more consistent with how African Americans approach problems than other therapies, there is a need for improvement (Carter, Sbrocco, Gore, Marin, & Lewis, 2003).   A study by Carter, Sbrocco, Gore, Marin, and Lewis (2003) on Panic Disorder in African American Women differed from previous studies in several ways. Treatment was conducted in a group format; a sense of community is believed to be important in African American culture.  The groups contained only African Americans, and were conducted by a leading African American author with expertise in cultural sensitivity.   Issues of emotional control and race pertaining to any aspect of treatment were discussed and managed as they arose during therapy.   When issues of race arose in the context of treatment, they were subjected to cognitive restructuring when appropriate.   In this study, CBT protocol was extended to address other issues relative to African Americans.   Being an African American was associated with additional pressures that lead to anxiety and panic symptoms, and complicated exposure therapy (Carter, Sbrocco, Gore, Marin, & Lewis, 2003).   The ethnically specific changes made in the context of CBT, although in an unsystematic method, are thought to have improved treatment compliance and effectively reduce panic symptoms in a relatively short duration of time. According to Cohen (2008), feminist and multicultural approaches to therapy may be applied to enhance cognitive-behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse.  With girls and women representing over 90% of victims, sexual violence is a gendered issue (U.S. Department of Justice, 2006).  Addressing themes of betrayal, self-blame, power, and stigma in CBT helps clients develop a feminist consciousness. Consistent with feminist theories, there should be an emphasis on a client’s strengths, resilience, and ability to accomplish her life goals. The therapists’ modeling of a belief in the client’s inherent worth and abilities is especially important so that the client may gradually learn to validate herself and internalize these values.  Awareness of the systematic devaluation and sexualization of girls and women, and the overemphasis on violence in popular culture is likely to assist the survivor in externalizing responsibility of the abuse. A feminist analysis focuses on the fact that not only does the abuse itself create suffering, but also the way in which society responds to and depicts abused women also creates suffering. A feminist analysis acknowledges that individual change is difficult when it is not accompanied by social change (Brown, 2004).  When working with women with posttraumatic stress disorder symptoms resulting from childhood sexual abuse, CBT treatments need to be adapted accordingly. Addressing themes of self-blame, betrayal, stigma, power, and sex-related cognitions and emotions assist clients to develop a feminist consciousness (Cohen, 2008).   What often seems to be a personal issue is actually an external political or social issue (Gilbert, 1980; Wyche & Rice, 1997).   The shift from internal to external causes of issues alleviates clients’ self-blame and self-insufficiency, and is a major source of empowerment (Remer, 2008).   The counselor must assess how the patriarchal society that privileges male beliefs, experiences, and insights affects the experience of each client. Empowerment of women and other minorities is an important theme in feminist theory (Vasquez, 2008).

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