A Handbook on Counseling African American Women

Psychological Symptoms, Treatments, and Case Studies 1st

Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/a-handbook-on-counseling-african-american-women-psyc
hological-symptoms-treatments-and-case-studies-1st-edition/

Click Download Now

Copyright © 2022 by ABC-CLIO, LLC
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, except for the inclusion
of brief quotations in a review, without prior permission in writing from the
publisher.
Library of Congress Cataloging-in-Publication Data
Names: Shelton, Kimber, editor. | King Lyn, Michelle M., editor. | Endale,
Mahlet, editor.
Title: A handbook on counseling African American women : psychological
symptoms, treatments, and case studies / Kimber Shelton, Michelle King
Lyn, and Mahlet Endale, editors ; foreword by Rosie Phillips Davis.
Description: First edition. | Santa Barbara, California : Praeger, 2022. |
Series: Race and ethnicity in psychology | Includes bibliographical
references and index.
Identifiers: LCCN 2021025303 (print) | LCCN 2021025304 (ebook) |
ISBN 9781440875953 (cloth) | ISBN 9781440875960 (ebook)
Subjects: LCSH: Mentoring—United States. | African American
women—Counseling of. | Cross-cultural counseling—United States. |
Social work with women—United States.
Classification: LCC BF637.M45 H363 2022 (print) | LCC BF637.M45 (ebook) |
DDC 305.48/896073—dc23
LC record available at https://lccn.loc.gov/2021025303
LC ebook record available at https://lccn.loc.gov/2021025304
ISBN: 978-1-4408-7595-3 (print)
978-1-4408-7596-0 (ebook)
26 25 24 23 22 1 2 3 4 5
This book is also available as an eBook.
Praeger
An Imprint of ABC-CLIO, LLC
ABC-CLIO, LLC
147 Castilian Drive
Santa Barbara, California 93117
www.abc-clio.com
This book is printed on acid-free paper
Manufactured in the United States of America
This book discusses treatments (including types of medication and mental health
therapies), diagnostic tests for various symptoms and mental health disorders,
and organizations. The authors have made every effort to present accurate and
up-to-date information. However, the information in this book is not intended
to recommend or endorse particular treatments or organizations, or substitute
for the care or medical advice of a qualified health professional, or used to alter
any medical therapy without a medical doctor’s advice. Specific situations may
require specific therapeutic approaches not included in this book. For those
reasons, we recommend that readers follow the advice of qualified health care
professionals directly involved in their care. Readers who suspect they may have
specific medical problems should consult a physician about any suggestions
made in this book.
 Contents

Foreword vii
Rosie Phillips Davis
Preface ix
Kimber Shelton, Michelle King Lyn, and Mahlet Endale
1 Intersectionality in Therapy for African American and
Black Women 1
Candice Nicole Hargons, Natalie Malone, and Chesmore Montique
2 Culturally Competent Counseling Practice with African
American Women 20
Kimber Shelton
3 Depression and Anxiety in African American Women 42
Lauren Simone Harper and Courtney Williams
4 Post-Traumatic Stress and Complex Trauma 55
Shavonne J. Moore-Lobban, Maria Espinola, and Karen Powdrill
5 African American Women and Chronic Mental Illnesses 78
Natalie D. Haslem
6 Substance Use and Dependence 101
Gemari Evans and Kimber Shelton
7 Eating Disorders 127
Judi-Lee Webb and Kimber Shelton
8 Individual Counseling 148
Tamara D’Anjou Turner, Mahlet Endale, and Michelle King Lyn
vi Contents

9 Couple and Family Therapy with African American Women 167

Ayanna Abrams and Ticily Medley
10 Group Therapy with Black and African American Women 189
Michelle King Lyn
11 Inpatient Treatment for African American Women 209
Stephanie N. Williams and Melissa G. Johnson
12 Sexual Orientation and Gender Identity Minorities 227
Danielle Simmons
13 African American Women with Disabilities 247
Anthea A. Gray, Ngozi Ndukwe, and Angela M. Kuemmel
14 The Mental Health Needs of African American Women
Enrolled in Higher Education 267
Mahlet Endale and Terrence Harper II
15 Culturally Competent Counseling with Clients
Identifying as Multiracial 287
Jasmine H. Winbush
About the Editors and Contributors 307
Index 315
 Foreword
Rosie Phillips Davis

The image of the White policeman’s knee on George Floyd’s neck for
9 minutes and 29 seconds as he cried out, “I can’t breathe,” in May 2020
will live in my memory forever. I was so shaken that I could not talk. In
my predominantly White neighborhood, I walk about five days a week,
speak to all the neighbors, and encourage their walking. I am a member
of our neighborhood garden club. And yet when Floyd was killed, no one
said anything to me. No one called. When I finally mentioned it, people
seemed surprised by my feelings. I hardly heard from any of my White
friends and colleagues, even though I was serving as immediate past pres-
ident of the American Psychological Association. Interestingly, as I served
on a dissertation committee for an African American doctoral student,
part of her study included conversations about the strong Black woman.
The literature that she used questioned what such labeling did to Black/
African American women. Strangely, the discussion made me rediscover
the strong Black woman in me. I decided to stop waiting on someone to
save me. I began to find my voice.
I wonder what I would have done had I had women like Drs. Shelton,
Lyn, and Endale around or any of the women writers in this book? I sus-
pect the time it took to regain my voice may have been shorter. Oh, I have
seen therapists over the years, but the problems I took to them were so
definable. They were usually about my family and my relationships. But
what about the societal stressors that Black women face just because they
live in the United States of America? Throughout this book the authors call
that fact to the reader’s attention. They talk about the intersectionality of
viii Foreword

being Black and female. They talk about being poor; being LGBTQ/PAN/
nonconforming/nonbinary; having a disability; experiences in higher
education. They add all of the identities that make the Black/African
American woman the individual that she is in the context in which she
lives. Drs. Shelton, Lyn, Endale and their colleagues tell all of us that it is
perfect for that woman to be whom she is. Their book lets us know that
Black women are welcome in their offices and can be welcome in your
office too.
It was Kimberle Crenshaw (1989) who coined the term intersectionality,
and we began to understand gendered racism. But that was just the begin-
ning. Shelton et al. now tell the reader about the kinds of mental health
problems that are layered on the multiple identities of Black women. Afri-
can American women have depression, anxiety, bipolar, substance abuse
issues, eating disorders, suffer from partner violence, have loneliness, and
every other issue that the entire population deals with. These writers tell
us that there are those out there who can serve these Black women and
even more can serve if they just have enough training. In this book the
authors demonstrate numerous mental health challenges and add case
descriptions of African American women in order to help the practitio-
ner understand how to apply interventions with Black women who are
dealing with PTSD or alcoholism or whatever comes through the door.
Consistent throughout their descriptions is the call to create safe environ-
ments that empower and give permission to African American women to
be themselves and heal. In individual, couple and family, or group coun-
seling, or in residential treatment, this book will help the practitioner learn
how to intervene with African American women.

REFERENCE
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black
feminist critique of antidiscrimination doctrine, feminist theory and
antiracist politics. University of Chicago Legal Forum: Vol. 1989, Article 8.
http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8
 Preface
Kimber Shelton
Michelle King Lyn
Mahlet Endale

The intent of this book is to further mental health practitioners’ aware-

ness, understanding, and ability in providing competent mental health
care to Black and African American women. Post slavery, Jim Crow, Black
suffrage and civil rights, gendered racism, and other forms of oppression
continue to impact the mental wellness of African American women, their
relationships, and their families. Our hope is that readers will take away
conceptual knowledge, concrete skills and tools in affirmative practice,
and increased motivation to advocate and participate in systemic change
bettering the mental well-being of Black and African American women.
Black and African American women are deserving of mental health
services that empower and honor them, that invite challenge to internal-
ized and externalized forms of oppression, and that foster personal and
familial growth. However, practitioners are often ill prepared in creat-
ing therapeutic environments of safety, challenge, and respect for Black
and African American women. For one, mental health professionals con-
tinue to be undertrained in working with Black and African Americans.
Although there have been improvements in the number of diversity-
focused courses offered at the graduate level, mental health practitioners
continue to express being underprepared for work with ethnic minority
groups.
Two, mental health practitioners are not immune from internalizing
negative and dehumanizing societal messages targeting Black and African
American women. As all other Americans are, mental health professionals
x Preface

are exposed to political rhetoric that demoralizes Black women; legal prec-
edent that penalizes Blackness; misogynoir (anti-Black misogyny) mes-
sages that label Black women as dangerous, aggressive, angry, and ugly;
and the accepted violence against Black women and their bodies.
Third, White and male supremacy continue in psychological research.
With multiculturalism and social justice being adopted as the fourth and
fifth forces of psychology, the psychological community has far to go in
changing psychological narratives and translating research to practice.
Black women scholarship continues to be devalued and underutilized,
pushing the current movement of #citeblackwomen. Take, for example,
the fact that Black women scholars such as Drs. Beverly Green, Bev-
erly Tatum, and Janet Helms and emerging Black women scholars such
Drs. Jioni Lewis, Bryana French, Della Mosley, and Candice Hargons have
extensively written about anti-blackness and gendered racism, while one
of the top selling anti-racism books is written by a White woman, Robin
DiAngelo.
This book is written for all mental health professionals serving Black
and African American women. Shared ethnicity, race, and gender may
help Black and African American women mental health practitioners
better appreciate and connect with Black and African American women.
However, shared identity status does not automatically translate to com-
petent care. Black and African American mental health professionals
receive much of the same psychological training as their White and male
counterparts; thus, many must also develop awareness and skill in pro-
viding culturally competent practice.
Non-Black and African American women and men benefit from this
book by gaining clinical information, an insider’s view of the therapy room
with African American women clinicians working intimately with their
clients, and support for racial and gender justice advocacy. In recent years
as Black Lives Matter activism has forced the nation to face how it treats
Black and African American members of this society, many non-Black and
African American people, mental health clinicians included, have come to
understand and own their deficits in understanding and supporting the
Black experience in this country. Many have made a concerted effort to
increase their multicultural awareness and anti-racist approaches to their
clinical work. This text will serve as a great resource in these endeavors.

WHO ARE BLACK AND AFRICAN AMERICAN

WOMEN?
In this book, the terms African American, Black, and Black American
are used synonymously to represent women and gender-expansive folx
within the United States who are the descendants of the fourth African
diasporic stream. This book speaks specifically to the descendants of
individuals brought out of Africa to what is now the United States in the
Preface xi

Atlantic slave trade. Content is also relevant for people of African descent
who themselves or whose ancestors more recently immigrated volun-
tarily to the United States; however, this book does not fully explore the
experiences of more recently immigrated communities of African descent.
We use identity markers in shared solidity, while encouraging readers to
recognize the unique and diverse ethnic, cultural, and geographical differ-
ences between Black and African American women.
The book editors and the majority of the contributing chapter authors
identify as Black and/or African American women. The editors and
contributors are personally and professionally committed to improving
the therapy experience of Black and African American women. Having
attended psychotherapy themselves and with client caseloads comprised
primarily of African American women, the book editors understand both
the challenges African American women face in obtaining competent care,
and the healing and transformative benefits of quality care. Ideally, this
book supports readers’ investment in recognizing and challenging their
own beliefs and biases, reducing barriers to treatment, and demystifying
and decolonizing the therapy process.

ORGANIZATION
This book is organized in four parts. Part One introduces a general
contextualization of intersectionality and cultural competence related to
serving Black and African American women. Part Two examines clini-
cal considerations commonly experienced by Black and African American
women. Chapters detail symptoms and treatments related to depres-
sion, anxiety, trauma, severe and chronic mental health issues, alcohol
and drug addiction, and eating disorders. Part Three details treatment
approaches to working with Black and African American women. Indi-
vidual, couples and family, group therapy, inpatient and rehabilitation
treatment approaches, and cultural adaptations are explored. Finally, Part
Four addresses mental health and treatment needs of African American
sexual orientation and gender identity minorities, women with disabili-
ties, college students, and women with multiracial identities.

ACKNOWLEDGMENTS
During the time this book was written and reviewed, Kobe Bryant,
Chadwick Boseman, and civil rights leader John Lewis died; Atatiana Jef-
ferson, Elijah McClain, Ahmaud Arbery, Breonna Taylor, George Floyd,
and Jacob Blake were murdered; and COVID-19 continues to kill a dispro-
portionate number of Black Americans, while subsequently amplifying
the burden of childcare and work Black women endure. Despite the his-
torical nomination of an African American and South Asian woman, Sen-
ator Kamala Harris, as vice president on a major party ticket, the political
xii Preface

climate has been oppressive and dismissive of the experiences of Black

and African American women.
This has been a year of perpetual mourning, rage, and frustration for
the Black community. It has also been a year of activism and social justice
momentum. We appreciate the authors’ dedication through this process,
as we know that the state of U.S. affairs has compromised our collective
mental well-being. This book is focused on counseling African American
women and improving the mental wellness of African American women;
however, note, many of our mental health needs will absolve when Black
Women Matter.
Black Women—We are you. We hear you. We see you. We honor you.
We do better for you.
 CHAPTER 1

Intersectionality in Therapy
for African American
and Black Women
Candice Nicole Hargons
Natalie Malone
Chesmore Montique*

Black women’s identities—the social groups they claim membership in

and the personal meaning they make from them—inform their lived expe-
rience. Beyond the two identities of Blackness and womanhood, other
social locations such as age, ethnicity, sexuality, and socioeconomic status
influence how Black women are treated, how they understand the world,
and how they act (Collins, 2000). Clinically, treatment that isolates their
identity to one defining identity, rather than the intersection of many,
misses the mark. This has been a long-standing critique of theory and
therapies applied to Black women.
During the second wave of feminism, women were striving for equal
rights. However, discussions continued to develop around the question
of which women were being considered. The origins of intersectionality
emerged from Black women realizing mainstream feminism was about
middle-class, educated, White women. In 1977, the Combahee River Col-
lective, a group of Black feminists, articulated the need for an interlocking
understanding of racism, sexism, and classism for Black women (Com-
bahee River Collective, 1995). They saw the need for a framework that

* All coauthors contributed equally to the writing of the manuscript; thus, the authorship
order reflects alphabetical organization by last name.
2 A Handbook on Counseling African American Women

incorporated the various experiences of diverse women, most notably,

women of different races (e.g., Black women). Black feminist scholars
began to challenge sociological research lacking examination of people’s
experiences with multiple forms of oppression. As we will comment, this
challenge extends to psychotherapy models and treatments related to
Black women’s mental health.

HISTORY OF INTERSECTIONALITY
Hancock (2015) notes that the origin of intersectional thought dates
back to 1823 in Maria Stewart’s criticism of the racial, gender, and eco-
nomic components of the U.S. system. Stewart, a free Black woman liv-
ing in Boston, was an activist whose impact on social movements was
minimal due to gendered backlash in the Black community and economic
oppression from White business owners. In her writings, Stewart repri-
manded those who complied with the U.S. systems of racial–economic
and racial–gendered apartheid. Predating Karl Marx’s (1843) ideas on
political emancipation, Stewart intended to illuminate the latent oppres-
sive systems using multiple axes of power (Hancock, 2015). Stewart serves
as early documented evidence for intersectional thought.
Leading critical race scholars Patricia Hill Collins and Kimberlé Cren-
shaw saw the need to replace single-axis frameworks with an orientation
that acknowledges the nuance of social identity interactions (Collins, 2000;
Crenshaw, 1989). Collins recognized the need for a model that integrates
social identities. This way of thinking removes the idea that identities
must be ranked by importance, recognizing that they all interact, inform-
ing what an individual does or does not experience. Likewise, Crenshaw
(1989) coined the construct intersectionality, which provides a framework
addressing how social identities are constitutive and undividable on both
individual and systemic levels. In short, the theory of intersectionality
provides the space to explore the interaction of social identities and how it
shapes experiences of oppression.

Applications of Intersectionality
An intersectional framework recognizes the distinctions within
oppressed groups, emphasizing the qualitative differences among social
positionings. For example, the experience of a particular gender may be
dissimilar for different racial identities (e.g., Black women and White
women). With intersectionality, we emphasize that it is not as valuable to
talk about identities separately, because it omits the multiplicative expe-
rience of identities. Intersectional theory is useful for interrogating the
interaction of various social locations such as ability, ethnicity, religion,
class, and sexual orientation. Previous single-axis theories do not appreci-
ate the interaction of social identities that integrate into one’s experience.
Intersectionality in Therapy for African American and Black Women 3

Intersectional theory recognizes the compounding feature of identities,

rather than exclusive characteristics that do not interact.
Intersectional theory has become a central tenet to feminist theory and
transformed the way we conceptualize gender (Shields, 2008). Moreover,
intersectionality is utilized by policy makers, human rights activists, and
political figures around the world. Yet, despite recognition of the impor-
tance of intersectionality, many fields that value rigorous methodologies
have lagged on the practical implementation of this perspective (Shields,
2008)—its application to therapy has been limited.

The Misuse of Intersectionality

The reach of intersectionality’s application is undeniable. However, as
the theory attracts a broader audience, concerns of how the core tenets are
being utilized exist (Shields, 2008). Bilge (2013) discusses how current cul-
tures of neoliberalism neutralize the political potential of the framework.
“Commonplace discourses assume that western societies have largely
overcome problems of racism, sexism, and heterosexism/homophobia”
(Bilge, 2013, 407). This culture leads individuals to employ a “language of
diversity” to acknowledge social locations (Bilge, 2011), without the imple-
mentation of intersectional interventions. Intersectionality then becomes
a buzzword to validate one’s level of awareness of diverse experiences.
People overlook the systemic work necessary to accomplish social equity.
Bilge (2011) refers to this as ornamental intersectionality, utilizing it oppor-
tunistically to gain intellectual, moral, and political capital. Consequently,
ornamental intersectionality neutralizes radical social justice politics.
Therapy is a site where intersectionality can be reclaimed for healing.
For therapy to be intersectional, it must address structural inequalities
and the complicated relationship between marginalized and privileged
identities. When therapists lack comprehension of the core features of
intersectionality, the therapeutic impact can be minimal and superficial.
This mishap leaves intersectionality only to be addressed as “multiple
identities” (Grzanka & Miles, 2016), diminishing the theory back to the
predated single-axis model. This shallow understanding negates the inter-
active component, where facets of self cannot be considered exclusively. It
is crucial we transcend superficial identity politics, moving from viewing
diversity as a demographic to an intersectional orientation (Grzanka &
Miles, 2016). For Black women, the intersectional construct of gendered
racism is an important starting point in therapy.

GENDERED RACISM
Sociologist Philomena Essed (1991) defined gendered racism as forms of
oppression due to the inextricable nature of racism and sexism embedded
in Black women’s experiences. Black women may share racial oppression
4 A Handbook on Counseling African American Women

with other racial or ethnically marginalized groups. However, the process

of racism alone does not account for potential gender oppression Black
women encounter. Both forms of oppression independent of one another
insufficiently capture experiences of power struggle and silencing for
Black women. Thus, gendered racism accounts for the “double burden”
of racism and sexism (Essed, 1991). Understanding how gendered racism
operates and informs Black women’s coping styles is critical for therapists
working with this population.

Recognizing Gendered Racism

Some forms of gendered racism are more recognizable than others. For
example, the #SayHerName campaign highlights the pervasive, yet over-
looked, police victimization of Black girls and women and calls for a more
gender-inclusive interpretation of race-based violence. These overt expe-
riences of gendered racism brim into therapeutic work in the form of cul-
tural mistrust, stigma, and underutilization of services by Black women
(Curtis-Boles, 2019), and require therapists to navigate Black women’s
experiences with gendered racism.
Still, gendered racism manifests in subtle ways such as gendered
racial microaggressions, stereotypes, and racialized sexual objectification
(Lewis & Neville, 2015; Szymanski & Lewis, 2016). These experiences are
rooted in the historical dehumanization and attenuated devaluing of Black
women (Collins, 2000). It is critical that therapists, particularly those con-
ducting cross-racial therapy, understand the conditions for Black women.
A therapist’s ability to navigate overt and covert gendered racism with
Black female clients will ultimately inform the therapeutic relationship
and level of satisfaction experienced by the client.

Gendered Racial Microaggressions. Sue (2010) refers to racial micro-

aggressions as subtle slights and insults, verbal and nonverbal, delivered
by members of dominant groups. Racial microaggressions become gen-
dered at the intersection of race and gender (Lewis et al., 2013). Gendered
racial microaggressions in professional settings include microinsults (e.g.,
assuming a lack of intelligence; questioning a Black woman’s position of
authority, being held to higher standards, and exclusion [Lewis & Neville,
2015; Sue, 2010]). Often therapists are unaware of their microaggressive
behavior and may be anxious to address their actions with clients. For
example, a therapist attempting to encourage a Black woman about her
professional role may inadvertently microaggress the client by insinuat-
ing it is remarkable for her to have her position. A comment such as “your
job is impressive” may be interpreted as a microinsult by the client. Lewis
and Neville’s (2015) Gendered Racial Microaggressions Scale (GRMS) pro-
vides a useful measure for researchers and clinicians interested in assess-
ing Black women’s experiences with gendered racial microaggressions.
Intersectionality in Therapy for African American and Black Women 5

Based on the development of the GRMS, Black women experience silenc-

ing and marginalization, controlling imagery or stereotypes, and a reduc-
tion to physical qualities (Lewis & Neville, 2015).

Silencing and Marginalization. Black women are often rendered insig-

nificant and invisible, which complicates their workplace and professional
experiences. Therapists should be aware of marginalizing behavior occur-
ring during therapeutic interventions with Black women. For example,
silencing may occur in therapy when a therapist minimizes a Black female
client’s emotional reaction to a sexist experience tied to race by referencing
all women’s experiences with gender discrimination. Instead, therapists
may empower Black female clients to name experiences of silencing or
marginalization during therapy, as a means of establishing voice and an
egalitarian relationship. In the example above, using process comments
or inviting interpersonal feedback from the client could mend the thera-
peutic relationship and allow the therapist to process potential anxiety or
discomfort arising in the present moment.

Stereotypes. Therapists working with Black women may increase cul-

tural competence and treatment outcomes with Black female clients by
understanding the sociopolitical context of Black women’s stereotypes
(Watson-Singleton, 2017). Collins’s (2000) Black Feminist Thought high-
lighted sociohistorical images of Black women. These controlling images
include Mammy, Jezebel, and Welfare Mother. Other imagery includes
the Superwoman schema and Angry Black Woman stereotype (Collins,
2000; Woods-Giscombé, 2010). Black women’s endorsement of these ste-
reotypes reveals some benefits. For example, enacting the Superwoman
schema (e.g., displaying strength, being independent) helps some Black
women survive despite barriers and limited resources (Woods-Giscombé,
2010). However, the benefits associated with endorsing stereotypes are
at the expense of Black women’s mental health. Black women’s stereo-
types are associated with increased psychological distress, increased
anxiety, and depressive symptoms (Watson-Singleton, 2017). Moreover,
Black women’s stereotypes may negatively impact help-seeking behav-
iors. Despite being at risk for physical and mental health concerns, Black
women underutilize treatment services (Ward, Clark, & Heidrich, 2009).
In addition to stigma and cultural mistrust, characteristics of Black wom-
en’s stereotypes, such as displaying strength, serve as barriers to treat-
ment therapists should be aware of.

Racialized Sexual Objectification. Sexual objectification refers to a pro-

cess of dehumanization that reduces people to sexual objects (Szymanski,
Carr, & Moffitt, 2011). Black women are often reduced to their physical
attributes, receiving undesired and uninvited sexualized comments, cat-
calls, body viewing and touching, and sexual advances (Lewis et al., 2013).