Abstract

Feminist therapy emerged from a collective effort by female therapists who believed that gender,

power, and social status were the main reason for understanding their client’s distress. Feminist

therapists have focused on women and their specific problems and issues, such as body image,

abusive relationships, eating disorders, incest, and other forms of sexual abuse. The therapy is

ideology driven and therapists utilizes techniques from other approaches, mixed with own

methods. Feminist therapy has been criticized for its lack of scientific support, although it can be

argued that if research outside of feminist therapy is taken into account, a wide body of empirical

literature supports central tenets of feminist therapy. In this paper, principles of feminist therapy

are reviewed along with its theoretical basis. It is examined which clients would benefit the most

from utilizing feminist therapy and strengths and weaknesses of the approach is addressed.

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Introduction

Most individuals who seek psychotherapy counseling are women. The majority of therapists in

psychotherapy counseling are also women. Yet almost all theories and treatment methods,

practiced in the field are created by white males from Western cultures. Feminist therapy is

different from other approaches to the extent that there is no single author of the theory. The

method emerged from a collective effort by women who believed that social, cultural, and

political context contributed to a person’s problems (Corey, 2017).

Feminist therapy is an integrative model in which the therapist’s philosophy strongly

affects the treatment process. Feminist therapists believe that gender, power, and social status are

the main reason for understanding the distress that trouble people who seek treatment.

Understanding and admitting that psychological oppression has a negative effect on physical and

mental health is therefore a central idea in feminist therapy (Brown & Bryan, 2007).

According to feminist theory all individuals use coping strategies to solve their problems

and survive. Some coping strategies are healthy, others are not. Overwork, high levels of

exercise, and moderate amounts of plastic surgery are all socially acceptable coping strategies.

However, overuse of alcohol, use of illegal drugs, or self-harm are unacceptable and the society

classifies the behavior as an illness (Brown & Bryan, 2007).

Principles of Feminist Therapy

The most important principle of feminist therapy is viewing problems in a sociopolitical and

cultural context rather than on an individual basis. The world is built on sexism and

understanding and acknowledging oppression is central in feminist therapy.

The six principles in feminist therapy are: 1) The personal is political and critical
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consciousness; 2) Commitment to social change; 3) Women’s and girls’ voices and ways of

knowing, as well as the voices of others who have experienced marginalization and oppression,

are valued and their experiences are honored; 4) The counseling relationship is egalitarian; 5) A

focus on strengths and a reformulated definition of psychological distress; 6) All types of

oppression are recognized along with the connections among them (Corey, 2017).

Feminist therapy has several key goals that can be found in most treatment approaches

but the assumption that victimization is damaging to emotional health is central to feminist

theory (Golding, 1999). In feminist therapy the term power is defined in relationship to self. One

of the most important goals of feminist therapy is empowerment of the client and to promote

changes in the client’s life – instead of teaching the client to adapt to expected gender role

behavior (Brown & Bryan, 2007).

Feminist therapy is value-driven, rather than technically driven and uses techniques from

other approaches to therapy (Negy & McKinney, 2006). Goals of feminist therapy other than

empowerment, include valuing and affirming diversity, striving for change rather than

adjustment, equality, balancing independence and interdependence, social change, and self-

nurturance. According to feminist therapy, women’s interpersonal qualities are seen as strengths

and as pathways for healthy growth and development, instead of being identified as weaknesses

or defects (Corey, 2017).

The famous feminist phrase the politics of the personal refers to the experiences of power

and powerlessness in people’s lives, that interact with the body and biology, to create distress,

resilience, dysfunction, and competence (Brown, 2006). Feminist therapy deals with the political

reality of their clients and feminist therapists have integrated social justice into their approach in

therapy – and into their lives. Social activism is therefore important in feminist therapy. The

therapists’ actions and beliefs in personal and professional lives are in harmony.

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 In the past, feminist therapy has been criticized for focusing on the experiences of white

middle-class women. Nevertheless, multiculturalism is essential part of modern feminist therapy.

In the feminist view, therapy aims to empower clients through affirming diverse identities and

attending to social inequalities and stigmatization (Conlin, 2017). The emphasis is on wellness,

instead of disease, resilience instead of shortage, and diverse strengths instead of a dominant

culture (Corey, 2017).

Diagnosing Oppression

It has been known for a long time that sexual abuse is associated with an increased risk of a

diagnosis of multiple psychiatric disorders. Several systematic reviews have summarized data

from various studies and reported an association between sexual abuse and depression,

posttraumatic stress disorder (PTSD), eating disorders, and suicide attempts. One of these

reviews was conducted by Golding (1999) over two decades ago, who reviewed literature on the

prevalence of mental health problems among women with a history of intimate partner violence.

According to her findings, existing research is consistent with the hypothesis that intimate

partner violence increases risk for mental health problems (Golding, 1999). The feminist

theorists believe that the personal is political, or that unhealthy environmental factors such as

oppression and violence create distress, is based on scientific research.

Clen et al. (2010) conducted a comprehensive systematic review and meta-analysis to

evaluate the available evidence for an association between sexual abuse and psychiatric

disorders. The objective of the study was to systematically assess and summarize the best

available evidence of the association between a history of sexual abuse and a lifetime diagnosis

of psychiatric disorders. The research contained 37 eligible studies, 17 case-control and 20

cohort, with 3,162,318 participants. The findings showed a statistically significant association
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between sexual abuse and a lifetime diagnosis of anxiety disorder, depression, eating disorders,

posttraumatic stress disorder, sleep disorders and suicide attempts. There was no statistically

significant association between sexual abuse and a diagnosis of schizophrenia or somatoform

disorders (Chen et al., 2010).

Meyer (2003) reviewed evidence on the prevalence of mental disorders in lesbians, gay

men, and bisexuals by using meta-analyses. His findings proved that this group has a higher

prevalence of mental disorders than heterosexuals. Meyer explained that stigma, prejudice, and

discrimination created a hostile and stressful environment that causes mental health problems.

Meyer also offered a conceptual framework, the minority stress model, for understanding this

excess in prevalence of disorder in terms of minority stress. The model focuses on individuals

who are exposed to unique minority stressors (e.g., discrimination), which increased risk for

development of mental health concerns (Meyer, 2003).

Feminist therapists have challenged male-oriented ideas of what constitutes a mentally

healthy individual and traditional ways of assessing the mental health of women and other

oppressed groups. They have been especially critical of the DSM classification system and argue

that research show that gender, culture, and race can influence assessment of clients’ symptoms.

According to feminist therapy, diagnoses are based on what the dominant (male) culture consider

to be normal and therefore overlooks the complexity of cultural differences. Feminist therapists

consider external factors to be as important as internal factors in identifying the client’s

presenting problems. In this view many symptoms can be seen as coping or survival strategies

rather than as indication of pathology. Symptoms are results of coping skills to fight oppression.

The client is trying to survive (Corey, 2017).

According to Brown (2006) feminist diagnostic thinking is complex and requires that

therapists conceptualize clients’ distress. Brown argued that feminist therapists must “think

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diagnostically about a range of factors that include the parameters of distress and dysfunction as

currently subjectively experienced by our clients” (Brown, 2006, p. 19). However, unlike the

DSM, feminist therapists do not stop there:

After you describe the current distress, then you have got to stop and think about what informs

that distress, what are the developmental factors informing the distress and accompanying coping

strategies, what are the current and past issues of powerlessness and disempowerment, the current

and past factors of social location, the possible biological vulnerabilities, and the strengths and

competencies and talents that this person is bringing to the table. We diagnose the distress and

dysfunction of the context in which this person lives — is s/he surrounded by violence,

oppression, silencing? (Brown, 2006, p. 19).

Rather than assuming that pathology resides within the individual, feminist therapists recognizes

that many of the mental health disparities arise as a result of outside factors, such as violence and

oppression, which are known to have harmful effects on well-being (Ellis et al., 2020). Because

feminist therapy locates pathology outside of the individual, and not within, the concept of

psychopathology and diagnosing is generally avoided. Instead, feminist therapy describes

symptoms of distress and dysfunction. The behavior is seen as “resistance to experiences of

oppression” as an attempt to solve the problem of powerlessness (Brown & Bryan, 2007).

The Therapy Relationship

The main goal of the therapeutic relationship is empowering the client, enhance the client’s

power, authority, and autonomy. The client is the expert in his own life and knows what is best

(Brown & Bryan, 2007).

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 Feminist therapists view the therapy process as a collaboration between two equals. They

consider the therapeutic relationship to be a nonhierarchical, person-to-person partnership and

value being emotionally present for their clients. This approach includes being willing to disclose

their experience, participate in social activism, and being committed to their own ideology. An

important part of feminist therapy is to recognize that clients are experts on their own lives.

Informed consent and transparency are therefore crucial for the therapeutic process. But despite

this perspective, feminist therapists admit that there is an inherent power imbalance in the

therapeutic relationship, and they are aware of the risk of abusing their power. The solution is to

include the client as much as possible in the therapy process. According to feminist therapists

power abuse is for example: unnecessarily or inadequate diagnoses, interpreting or giving advice,

playing the “expert” role, or by discounting the impact the power imbalance between therapist

and client has on the relationship (Corey, 2017).

Rader & Gilbert (2005) conducted a quantitative study of 42 female therapists to explore

how they use power in the therapeutic relationship. The study showed that egalitarianism is a

central feature of practice with feminist therapists and participants who identified as such were

more likely to report engaging in power-sharing behaviors when compared to participating

therapists who did not. Additionally, clients of feminist therapists were more likely to report that

their therapists engaged in power-sharing behaviors (Rader & Gilbert, 2005).

How therapists and their clients deal with power is the most important variable in

feminist ideology. An egalitarian relationship is achieved when the therapist: a) views the client

as his/her own expert, b) informs the client of the therapy process and his/her role and rights in

that process, c) uses strategies that promotes the client’s autonomy and power, d) encourages the

expression of anger, and e) models’ appropriate behaviors for the client (Rader & Gilbert, 2005).

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Empirical research

It can be difficult to assess whether feminist therapy is supported by scientific evidence. Direct

evidence-based research on the efficacy of feminist therapy is lacking and in addition, no

credentialing organization confers official status as a qualified feminist therapist (Corey, 2017).

According to Brown (2006), feminist therapy is supported by evidence and diagnostic

strategy, “[t]hey are different sorts of evidence, and radically different ways of conceptualizing

pain and dysfunction, but they are not absent” (Brown, 2006, p. 17).

Feminist therapists value data from randomized controlled clinical trials, but also value evidence

arising from qualitative studies, from clinical case examples and single-participant designs, and

importantly, from the consumers of our services, more than a few of whom have had

opportunities to compare and contrast feminist and non-feminist practice during their forays into

psychotherapy. (Brown, 2006, p. 18).

According to Brown (2006) there is a great value in feminist practice because feminist therapy

has the framework that allows the therapist to show empathy. Brown mentions other methods of

feminist practice that are supported by scientific evidence, such as tailoring treatment to the

client, collaborating on goals of therapy, and the creation of a strong working alliance. Those

methods have all been empirically linked to the outcomes of therapy (Brown, 2006).

Feminist therapists utilizes techniques from other approaches and if research outside of

feminist therapy is taken into account, a wide body of empirical literature supports central tenets

of feminist therapy. Ellis et al. (2020) conducted a systematic review of the literature using

PsycINFO, PubMed, and Web of Science and included research that was published from 2009 –

2019. The review focused on empathy, alliance, genuineness, positive regard, and
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countertransference. The results showed that positive regard was associated with positive

experiences, strong therapeutic alliances and the “real” relationship (e.g., genuineness) predicted

psychological well-being. Both alliance and genuineness were related to strengthen the

therapeutic progress (Ellis et al., 2020).

Where do we need feminist therapy the most?

Sexual assault affects a significant portion of women in the world. The prevalence of sexual

assault among women is approximately 1 in 3 (Pemberton & Loeb, 2020). Women who have

been attacked have an increased risk of numerous mental health symptoms and disorders,

including depression, anxiety, posttraumatic stress disorder, substance use disorder, low self-

esteem, eating disorder, suicide attempts and more. Feminist therapists have focused on women

and their specific problems and issues, such as body image, abusive relationships, eating

disorders, incest, and other forms of sexual abuse.

The feminist approach to eating disorder does not reject psychological or biological

factors, but feminist therapists assumes that sociocultural dynamics, especially gender

ideologies, are primary factors. Holmes et al (2017) evaluated a 10-week closed group

intervention based on feminist approaches to eating disorders at a residential eating disorder

clinic in the East of England. The results of the study were mixed and complex but suggested

that the participants found the approach helpful in enabling them to place their problem within a

broader social/cultural and group context (Holmes et al., 2017). Another study, conducted by

Maier (2015) reviewed a case example were feminist informed emotionally focused couples

therapy was used as treatment for eating disorders. In this case the female partner had an eating

disorder, and the approach gave the opportunity to address with the couple, the fear, shame, and

secrecy often associated with eating disorders (Maier, 2015).

face higher rates of stigmatization and violence, childhood sexual abuse, homelessness,

discrimination, unemployment, and poverty as compared to cisgender and/or heterosexual

individuals (Ellis et al., 2020). Negy & McKinney (2006) presented a case study were feminist

therapy was used as a means to validate, strengthen, and promote resiliency among the family

members of a lesbian couple who had entered treatment (Negy & McKinney, 2006).

Seponski (2016) provided an example of the integration of emotionally focused and

solution-focused therapies through a feminist family therapy lens. This approach can be used to

strengthen traditional family therapy models by addressing gender, ethnic, racial, and social

inequities in the family and therapeutic relationships. Seponski’s example is not evidence

supported, however it provides a starting point for integrating models with a feminist ideology

(Seponski, 2016).

SAMSHA’s principles of empowerment, voice and choice have similarities with the basic

tenets of feminist theory. According to Pemberton & Loeb (2020) therapists can better

conceptualize the impact of trauma and the healing journey for survivors by utilizing SAMSHA’s

trauma-informed framework and feminist perspective. They described the physical, sexual, and

mental health impact of traumas for women and the parallels between feminist theory and

SAMSHA’s six principles for trauma-informed care: 1) Safety; 2) Trustworthiness and

Transparency; 3) Peer Support; 4) Collaboration and Mutuality; 5) Empowerment, Voice and

Choice; and 6) Cultural, Historical, and Gender Issues (Pemberton & Loeb, 2020).

Feminist therapy is for diverse groups, both men and women but, like every other theory,

it is not suitable for everyone. It can cause problems when working with individuals who do not

share feminist worldview. Feminist therapists must understand and respect the cultural values of

clients from diverse groups. To minimize the risk of forcing feminist values on a client, it is

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essential for therapists to understand that their own cultural perspectives can impact their work.

Feminist therapy’s primary tenet, the personal is political, is embraced by the multicultural and

social justice perspectives, and feminist therapy has been used with individuals belonging to

minorities (Corey, 2017).

Conclusions

One of the greatest gifts of feminist therapy to the counseling field was to provide gender-

sensitive practice and awareness of the impact of oppression. Feminist therapists caught our

attention to the amount of child abuse, incest, rape, sexual harassment, and domestic violence.

They showed us the consequences of physical, sexual, and psychological abuse. Feminist

therapist drew our attention to the fact that therapy should address oppressive factors in society

rather than expecting individuals to adapt to distorted reality (Corey, 2017).

Therapeutic relationship variables, for example thoughts, feelings, and attitudes, have

been shown to predict significant variance in treatment outcome for a range of disorders or

problems. Positive regard, strong therapeutic alliances, genuineness, and empathy were all

associated with improvements in treatment engagement and treatment outcome (Ellis et al.,

2020).

The world is not a safe place. Many of the values associated with feminist therapy can be

applied to clients who have experienced historical or ongoing oppression. Feminist practice

affirms client’s reality and demands therapists to acknowledge what it is like to live with the

consequences of violence.

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