#76884: An Overview of Feminist Counseling

Knowledge of an individual's gender provides information that ultimately influences how people behave, think, and react to individuals [38]. Hoffman and Pasley assert there are five cognitive structures influenced by gender [38]:

All five of these cognitive structures are dynamic, interrelated, and influenced by gender as a social category.

Gender stereotypes are beliefs or assumptions about men's and women's roles and characteristics; however, they do not necessarily correspond to reality. They have strong prescriptive effects on individuals' responses [49]. Gender stereotypes can lead to prejudice and discrimination. For example, an employer might hold a belief that women are too emotional (a gender stereotype), leading to dislike and prejudice (a negative attitude) toward female employees. Ultimately, this could lead to discrimination (a biased behavior), as the employer will not hire women for a particular position based on this gender stereotype [49].

Although women have made strides in an array of social domains, gender stereotypes are still deeply embedded in society [111]. In one study, a total of 191 participants were recruited and asked to rate the likelihood that men and women had a set of traits, roles, behaviors, and attributes. Participants tended to ascribe certain gendered traits, roles, and behaviors to men and women, and this remained stable compared with data collected in 1983 [111]. When parents and teachers adhere to gender stereotypes this affects children's beliefs about their competencies. For example, the myth that boys are more skilled in math is a common gender stereotype that may be reinforced in families or classrooms [140]. However, a meta-analysis of 16 large-scale opinion polls conducted in the United States between 1946 and 2018 found that gender stereotypes shifted over time [76]. Perceptions of women's communion (e.g., compassionate, warm, expressive) increased over time, and perception of men's agency (e.g., assertive, competitive, ambitious) has remained stable. Confidence in women's competence compared to men's competence has also increased over time [76].

The feminist movement can be classified in three different waves. The first wave spanned the 19th century to the early 20th century. Middle-class women in the 1830s formed charitable and benevolent societies to help sex workers and the destitute. They later embraced the cause of slavery and put voice to the abolitionist movement [24]. Feminists during this time also advocated for the importance of bringing women's influence into men's spheres, such as for women's right to vote [112]. The Seneca Falls Declaration of 1848 rejected the prevailing doctrine of women's innate inferiority. After the Civil War, these first-wave feminists took up the temperance movement, which continued into the early part of the 20th century. During this time, they also focused on social welfare and labor reform, advocating for reform of working conditions in factories and for women and child laborers, specifically limiting women's working hours, developing minimum wage, and banning child labor [24]. Women's enfranchisement was also another key issue during this wave [90]. After women won the right to vote in 1920, this first wave of feminism waned and lost momentum [16]. In this first wave, issues of class and race can affect women's lives were largely ignored, as the recognized movement was largely co-opted by upper-class White women [90,112].

The second wave of feminism in the United States began in the 1960s and continued until the 1990s. The 1960s were a time of civil, social, and political discontent. The youth of this generation questioned the existing authority and government structures, the Vietnam War, and the marginalization and oppression of various minority groups (e.g., racial/ethnic minority groups, women, and gays and lesbians). In Betty Friedan's book The Feminine Mystique, she analyzed the time period after World War II and the social, cultural, and political forces that reinforced notions of women's bodies, domesticity, and femininity and how they impeded women's freedoms [144]. She later co-founded the National Organization for Women (NOW) [19].

Women's rights flourished in this social backdrop. Feminists advocated and argued for issues such as gender stereotypes in the media, reproductive rights, domestic violence, equal rights in the workplace, discrimination, day care, rape, domestic violence, sex work, and other issues relevant to women [112,144]. In 1963, President John F. Kennedy formed the Presidential Commission on the Status of Women to examine the issue of gender inequality. The report of this Commission highlighted the different forms of discrimination against women and outlined specific recommendations to rectify discriminatory practices, such as implementing fair hiring practices, paid maternity leave, and child care. In 1964, Title VII of the Civil Rights Act of 1964 was authorized and bars employment discrimination based on race and sex [170]. A main focus and slogan of the second wave of feminism was the belief that "the personal is political" [4,112].

During this period, women's groups began to establish health clinics that were run by women, advocating health policies that were sensitive to the power dynamics between individuals and institutional systems. In 1976, the National Women's Health Network was established, and the publication Our Bodies, Ourselves was one of the main mechanism for health education and advocacy [145].

Prior to the 1970s, when sex differences were discussed in the context of psychology, men were the normative baselines to which women were compared. However, by the late 1970s, most textbooks used to teach courses on the psychology of women focused on women as humans in their own right [82].

Within this social climate during the 1960s and 1970s, the mental health system became a focal point for feminist psychologists, counselors, and social workers. Feminist professionals focused on two predominant themes [27]. The first theme involved critiquing the existing mental health establishment and traditional psychotherapeutic ideologies. The second theme focused on grassroots advocacy and consciousness-raising efforts to combat social injustices. Today, the principles of feminist interventions can be traced to three efforts that came out of the 1960s and 1970s: consciousness-raising groups, shelters from domestic violence, and the anti-rape movement [29]. Consciousness-raising groups were non-hierarchal, informal groups composed of women who came together to talk about their experiences within the larger social context [27,146]. The goal of consciousness-raising groups was to learn from each other and ultimately challenge the status quo [146]. These groups were similar to the support groups that are now available in a variety of settings, including online. Second, domestic violence became a recognized social problem during this time. Feminists argued that violence against women was rooted in male patriarchy, as demonstrated in society's legal, political, and economic structures [21]. Feminists fought for principles of self-determination and ensuring domestic violence victims' protection and safety, which resulted in the creation of safe havens or shelters [58]. Finally, prior to the 1960s, rape and sexual assault were often invisible and were not conceptualized as a social problem. However, the feminist movement challenged traditional assumptions about rape victims' perceived culpability and causes [7]. In 1972, Ms. became the first national feminist magazine in the United States [88].

During the 1980s, effort was spent in defining the principles, stages, and specific methods or interventions of feminist therapy. In other words, the focus was on defining feminist therapy [27]. In the academic circles, new peer-reviewed scholarly journals focused on feminism emerged, such as Women and Therapy, Feminism and Psychology, Journal of Feminist Family Therapy, and Affilia, a social work journal [27].

Despite the grounds gained by the women's movement during this second wave, there were also criticisms. Many felt that the movement reflected the experiences of heterosexual, middle-class, primarily white women. In addition, it created the myth of a superwoman, who had a successful career while balancing being a wife and mother [83].

The third wave of feminism started in 1990 and continued to around 2013 [112]. With roots in black feminist work, this wave is considered diverse, with no one philosophical stance; however, the third wave was viewed as a new feminist discourse for understanding gender relations that takes into account the inadequacies of the previous waves [48,82]. Third-wave feminists saw themselves as, "making right some of the second wave's wrongs. In many cases, feminists of the third wave perceived themselves as rebelling against their second-wave predecessors [88]. They posit many of their arguments in response to or in reaction to second-wave positions on sexuality, power, and culture" [57]. Third-wave feminists gave women the latitude to define feminism for themselves, and they strove to make the movement more inclusive and diverse [48]. This third wave has underpinnings in postmodernism, contending for individual choice and individualized feminism [112]. These feminists targeted young women who may believe in feminism but are concerned with the negative connotations [4]. Feminists of this period emphasized individual empowerment; however, critics assert that they did not adequately focus on collective activism to challenge systemic injustices and inequities perpetuated by structural forces [146]. While Ms. was the platform for many feminists in the second wave, the third wave took on utilizing homemade pamphlets (zines) and the Internet to disseminate their views using blogs, art, and music [88].

Third-wave feminists argued for intersectionality. The first and second waves of feminism downplayed the role of ethnicity and race and instead emphasized the unity of all women—the sisterhood of women and issues pertinent to all women [48]. Third-wave feminism argues that multiple, simultaneous oppressions exist, including oppression stemming from gender and race/ethnicity, and they are inseparable and intertwined [48]. In other words, women inhabit simultaneous conditions of marginality based on race, class, sexual orientation, age, and many more factors [82,144]. As a result, the third wave of feminism advocated for a more inclusive approach, embracing other social groups (e.g., racial/ethnic minority women, gay women, etc.) [4]. Queer theory, for example, emerged during this period [144]. There are three core tenets of intersectionality [84]:

Third-wave feminists also maintained that the macro unit of analysis be moved from the societal to the global level [48]. Women's lives are affected by the global economy, and women in developing countries are extremely diverse. The unique experiences and issues of these women are influenced by their social locations [48]. The emphasis is on heterogeneity, not homogeneity, of women's experiences [14].

There are some who posit that a fourth wave of feminism started around 2008–2012 and continues into today. Some of the issues of the second wave of feminism have emerged again, but the boundaries of what is considered "feminist" are not as clear [112]. This wave is woven with themes of spirituality and interconnectedness within a global community [85]. The theme of justice also prevails in this wave. Fourth-wave feminism questions "the limits of materialism; the need to turn from concerns about 'me' to concern for the planet and all its beings; and to put ourselves in the service of the world" [85].

With the pervasiveness of the Internet and digital technology, there is a sense of global connectivity that has challenged the need for the label "feminist" [86,146]. The use of hashtags in the #MeToo movement, for example, brought collective voices to the social problem of sexual assault and harassment [146]. Because the stories and voices of other cultures are witnessed on a global scale, there is a realization that gender is not necessarily the dominant force in marginalization and oppression. Instead, there is an awareness of power and privilege (or lack thereof) across multiple areas, as is touched on in third-wave feminism [86,146]. The use corporate social media (e.g., Twitter) as an activism tool has been criticized as shallow and potentially exclusionary [171].

Some people claim that we are now in the post-feminism era, arguing that the injustices that women have previously experienced have been conquered [87]. However, others assert that women's injustices and marginalization have not been overcome, despite the gains made. For example, violence against women is still a significant problem in today's society, and a significant wage gap persists [112]. This movement also continued the goals of reproductive justice, inclusion rights of marginalized groups, and global issues (e.g., women's poverty, education, health) [171]. Others argue that feminism needs to be rebranded for a new market (i.e., millennials and generation Z) [86]. Tension and conflict about what feminism is have resurfaced.

Liberal feminists argue that the differences between men and women are due to sex role socialization and patriarchal ideologies embedded in social institutions [52]. The fight for gender equality is at the heart of liberal feminists' work, with a goal to pave equal opportunities and access for men and women [175]. One of the solutions to remedy gender inequality proposed by liberal feminists is the implementation of laws to provide equal access [49; 175].

Radical feminists link women's oppression to the sexism that permeates every dimension of day-to-day lives [49; 175]. They argue that gender differences are rooted in the notion of essentialism [52,148]. Essentialism propounds that women's identity is linked to a single trait, specifically that women are more caring and nurturing and less aggressive than men. Neither essential gender role is superior, but the existing social order is predominantly patriarchal and reinforces male attributes [52,148]. Sexism is so deeply ingrained that some radical feminists have argued for separatism, advocating for an exclusive "womanculture"—a female science, female religion, female arts, rejection of the nuclear family, etc. [17,115]. In other words, existing institutional structures should be recreated to be more woman-oriented [176]. These political tenets had underpinnings of destruction, and Valerie Solanas's SCUM Manifesto became the prominent symbol for radical feminists [115]. One of the major criticisms of radical feminism lies in their assertion for essentialism, focusing on the objectification of a woman's body and a reductionistic explanation linking women's roles to biology [148].

Marxist feminism is viewed as revolutionary. Although these feminists argue for structural change, they focus on class structure, as they believe women's oppression is rooted in capitalism [17; 149; 175]. Women's socioeconomic positions and classism are at the heart of this type of feminism. Marxist feminists trace patriarchy and women's oppression to women's roles being historically limited, meaning that patriarchy can only be eradicated if the separation of public and private work (i.e., housework) disappears [175]. Therefore, women are doubly oppressed as a result of their sex and class [149]. To Marxist feminists, domestic work is considered productive work, because although this work is "invisible," it is still important [116]. Therefore, Marxist feminists target women's work (both paid and unpaid) and focus on raising revolutionary consciousness of working women to instigate change [17]. They also posit that classism results in disparities in access to resources, manifested as, for example, healthcare disparities. However, beyond this, Zrenchik and McDowell assert that classism also results in the unequal distribution of respect and admiration [91]. Segments of the poor in society are therefore often labeled as "immoral," "criminal," or "dirty" [91]. Marxism feminism has resurfaced in recent years as globalization has increased poverty, migration, and violence around the world [150]. Marxist feminists attempt to understand these trends as the struggle within class, race, and gender.

Cultural feminism argues that certain qualities or characteristics (e.g., nurturing) are more prevalent in women. Cultural feminists believe these characteristics should be honored and valued as opposed to focusing on the similarities between men and women [49; 175]. According to this school of feminism, society should be restructured in such a way that emphasizes cooperation rather than aggression [49].

This type of feminism asserts that many of the other feminist perspectives do not take into account other factors of female diversity, such as race, ethnicity, social class, and sexual orientation, although these dimensions affect the lives of women as well [49]. Black feminism (also referred to as black standpoint) falls under this category and argues that black women's social realities, stories, and experiences are invisible, having been overshadowed by a focus on white women's experiences [92]. Social transformation occurs in the lives of African American women when their racial identities are intersected with economic and political consciousness [117]. In a study of African American women's experiences in the healthcare system, many of the women's "feminist" perspectives and emancipatory resistances were laced with their faith and religion [92].

Global feminists emphasize the issues of oppression, marginalization, and discrimination among all women globally. They maintain that other non-dominant and non-Western perspectives should be taken into account, focusing on oppression as it relates to neocolonialism (economic structures created by former colonial powers to maintain colonies' dependencies) and global capitalism [16,118]. Issues such as education, sex work, and access to health care are important topics for global feminists [16].

Postmodernism is an intellectual movement that argues against the traditional and universal ways of theorizing and reasoning and Western notions of science [56]. Postmodernist feminists emphasize the importance of the multiple and subjective experiences of women and other oppressed populations [148]. Knowledge is open-ended and relational, and each person will interpret and assimilate knowledge differently [175]. Postmodernists are also opposed to the language of binary opposites (e.g., male/female, white/black, etc.). Attention is paid to how language can reinforce social assumptions and hierarchies [175]. Postmodernist feminists emphasize the importance of deconstructing discourse to identify sexist and patriarchal tones and biases in the ideologies and practices of Western culture [56,119].

Post structural feminists focus on how language and text reinforce patriarchal ideologies. Specifically, they challenge the notion of women's shared experience and dichotomous thinking (i.e., male/female terminology) [151]. The goal is to respect differences in order to eliminate a "them/us" mentality and promote liquid thinking, or using metaphors to capture the experiences of the marginalized [93].

The focus of postcolonial feminism is on women in developing countries. Postcolonial feminists argue that Western and androcentric models of feminism are not appropriate for women born and living in developing countries, particularly those that experienced white/Western imperialism [149]. Their struggles and subjective experiences are uniquely different from white women in Western industrial countries [149].

Ecofeminism draws on the commonalities between exploitation of women and the exploitation of the environment [175]. From this perspective, the oppression of women and destruction of the environment can both be traced to patriarchy and capitalism. It supports of rights and empowerment of women and a sustainable environment [175].

The notion of abnormality is heavily influenced by social and cultural norms. Early philosophers have depicted women as irrational beings [16]. Harris and Lighter assert that, historically, when women were the focus of attention in the mental health fields, they were "in the role of patient or repository of psychopathology, not as exemplar of healthy personality development" [36]. In the 1700s and 1800s, women's mental illness was linked to sin and vice [152]. Later, women's mental illness was tied to the "weaker" female constitution due to menstruation, pregnancy, and menopause [71,152]. Some even argued that a woman's womb moved aimlessly throughout the body, causing insanity and draining life energy [71]. Hysteria, a disorder that involved the nervous system, was commonly diagnosed among women in the 18th and early 19th centuries, and many physicians believed this was a natural state for women (e.g., excitability, difficulty, egocentrism), but a "morbid state" for men [120].

In the early 1900s, when Sigmund Freud introduced the concept of psychoanalysis and the roles of the unconscious and drives in influencing behavior, many scholars, including feminists, were enthusiastic about his frank discussions about human sexuality [16]. However, Freud attributed much of women's behaviors to be the result of their inferior sexual genitalia, specifically developing the notion of penis envy. Freud maintained that a young girl's psychosexual development hinges on her realization that her genitals are not like her male counterparts (penis envy), leading to the conclusion that she has been castrated (castration anxiety). Ultimately, according to Freudian psychoanalysis, all girls feel inferior without a penis [22]. It has also been argued that the focus on the mother as the primary influence of personality development in Freud's theory can have negative repercussions for women [94].

Some have argued that the negative construction of women's bodies and behaviors essentially functioned as social control. Women's roles were maintained and perpetuated by labeling socially unacceptable behaviors as "hysterical," "insane," or "neurotic" [71]. Overall, a feminist approach to science minimizes a "masculine" approach to ensure it is not the predominant perspective [153]. Existing traditional personality theories are based on traditionally male values and benchmarks of normality; a feminist approach advocates for a shift to honoring women's values and experiences [177].

In counseling, the belief that the personal is political essentially means that women's personal problems are affected by social politics. Every client's personal experiences are unique and can be set within a larger sociopolitical context that is influenced by patriarchal tenets [94,158,182]. Therefore, a client's symptoms, feelings, and behaviors do not stem completely from within the individual but are influenced by external social and political forces [15]. Existing power structures and privilege that emanate from these systems impede women from achieving their goals [182]. This is not to say that feminist practitioners abandon all intrapsychic causes; instead, they also take into account the social context and assist female clients to examine how much their lives are shaped by societal norms [15,20]. According to this belief, women should not be labeled as "offenders, instigators, or willing participants" in damaging activities [3]. Overall, feminist therapy or intervention is characterized by a gender-free, interactionist approach that takes into account the fact that experiences are shaped by socialization processes, are contextual, and are not fixed at any point in the lifespan, such as childhood [96].

Another important aspect of feminist counseling is de-emphasizing hierarchal relationships. Patriarchal ideologies and power imbalances permeate society. As such, many relationships that women experience may be hierarchal and oppressive. In feminist counseling, the therapeutic relationship should minimize hierarchal relationships and reflect a more collaborate and egalitarian partnership between the client and the clinician [15,158]. One way to promote egalitarian relationships in the clinical process is for the practitioner to be transparent with the objectives of the therapy and to avoid the use of clinical and professional jargon that the client cannot understand [20,181]. Many women may have felt disempowered by the medical community [181]. Facilitating mutual goal-setting and providing information about therapy are also recommended [158].

Women's experiences have been traditionally underrepresented and devalued in the sciences and social sciences. In the feminist clinical context, clients should feel that their voices are heard and placed within the context of women's, not men's, experiences [15,182]. Furthermore, if women's experiences are understood and validated within the larger social and cultural context, this will reduce pathologizing symptoms and client blaming [123,158].

One of the predominant goals of traditional therapy is to reduce symptoms and bring the client back to a state of equilibrium. The goal of feminist therapy is not to simply reduce symptoms but to bring about long-lasting positive change. One aspect of this change is an engagement in skills development [60]. According to the APA, contemporary feminist counseling is conceptualized by "a shift from focusing the 'microscope' on individual change and responsibility to the more balanced focus on identifying and working to effect environmental and institutional change" [4]. Strategies employed involve promoting skills and decision-making in order to bring about egalitarian relationships, analyzing gender roles to help the client understand expectations that have been created by society, and evaluating how power is exhibited differently between men and women [124]. This would result in changes on the micro and macro levels.

Because gender stereotypes, discrimination, prejudice, and other forms of oppression are rooted and reinforced at institutional levels, social action is needed to bring about change [60]. The notion of empowerment is key when working with women in this feminist context. Empowerment results when individuals are assisted to develop skills and enhance their inner capabilities, thereby increasing their self-esteem and sense of self-efficacy [6; 158; 181]. The goal is to facilitate women's sense of control over their lives by raising awareness that men and women are equal [124,158]. This can be done on multiple levels—microsystem, exosystem, and macrosystem—with the ultimate goal of increasing empowerment on all levels [125].

In a survey study, 140 counselors and therapists who identified themselves as feminists were asked to define feminism and identify how feminism is translated into practice [8]. Three themes emerged: feminism as women-centeredness, feminism as a belief, and feminism as a critique against patriarchy. Women-centeredness was defined as placing a priority in analyzing and examining women's positions in society. Participants discussed the theme of feminism as a belief or a philosophical system that pervades the conscious and unconscious and that recognizes that women's position in society is affected by traditional gender role socializations. Finally, feminism as a critique against patriarchy was defined as contradicting the embedded ideologies in society in which women are devalued [8].

DeVoe argues that feminist therapy is nonsexist, but nonsexist therapy is not necessarily feminist [20]. The principle of the personal as political is the foundation of feminist therapy; this is not necessarily true of nonsexist therapy. Clients who find feminism threatening or who do not subscribe to feminist ideals may be more amenable to nonsexist therapy [20].

Feminist practitioners advocate for social change in order to eradicate injustices and oppression. On the other hand, a nonsexist clinician focuses on assisting women to minimize the distress they experience due to traditional gender role socializations and to adjust to discrimination and gender role inequalities. Feminist counseling/therapy emphasizes change at the macro level, to cultural, social, and political forces, that will help to eliminate women's problems and result in social justice. Nonsexist counseling/therapy focuses more on a client's intrapsychic state rather than the environment in which the client exists [20].

The goal of gender role analysis is to assist clients to identify the specific gender role expectations and messages that influence their behaviors as well as behaviors that they engage that might reflect specific gender role expectations that ultimately impede them from achieving their goals [124,177]. Five steps are necessary in true gender role analysis. First, the clinician helps the client to identify various gender role beliefs and expectations experienced from early childhood [60]. Second, the clinician and the client discuss how these expectations have affected the client's life negatively and positively. Third, the client works to identify internalized beliefs based on these gender role expectations. Fourth, with the help of the clinician, the client will decide which of the internalized beliefs he/she would like to address. Finally, a specific plan is developed to implement and monitor changes [60]. It is important for clients to understand the sources of gender role messages and to identify what reinforcers and punishments exist for adhering to these messages [159]. Clients should be encouraged to evaluate the costs and benefits if they were to eliminate certain messages.

Bibliotherapy involves the use of literature as part of the therapeutic process. Clients are provided readings (fiction and/or non-fiction) on topics that are relevant to the issues that the client is experiencing [15,160]. It can transfer the client to a safe space, exploring what it might be like to make various decisions in this world [183]. The goals of bibliotherapy are several-fold. It can educate clients about problems, create awareness of how others cope and solve problems, and help identify problem-solving solutions [40; 183]. Chrisler and Ulsh conducted a survey study with 249 members of the Association for Women in Psychology [11]. The vast majority (94%) of respondents indicated they identified as feminist therapists, and 93% utilized bibliotherapy. Interestingly, locating the appropriate books was not the predominant barrier in employing bibliotherapy; rather, respondents indicated that the major barrier was that their clients were not readers or simply could not afford to purchase books.

Again, feminist therapy is not limited to women. For example, men who are diagnosed with body image dissatisfaction can use bibliotherapy within a feminist framework to educate themselves on healthy body image, nutrition, and self-esteem [97]. Any intervention aiming to ultimately empower clients to move out of socially learned scripts may be feminist.

Assertiveness has been defined as behaviors that involve standing up for one's rights without violating the rights of others [60,161]. Assertive skills training frequently involves cognitive-behavioral strategies to assist clients in verbalizing their needs/desires, developing social skills, and reducing anxiety that arises when executing assertive behaviors [161]. Many feminist practitioners argue that women may need to be taught assertiveness skills due to the fact that assertiveness is not usually considered a desirable female attribute. The underlying assumption of assertiveness training is that after women are educated about their personal rights and taught skills to overcome perceived barriers, other positive outcomes (e.g., enhanced self-esteem) will follow [25].

Looking within oneself as the root of the deficit is the norm in many traditional therapies. However, feminist counseling/therapy encourages clients to understand how societal forces impact deficits or problems [60]. Reframing tends to focus on relabeling three areas: symptoms as a manifestation of role conflict, behaviors as coping strategies to handle oppression and discrimination, and distress as a manifestation of socialization in traditional gender roles [29].

Feminist practitioners work with clients to promote awareness of the differences in power relations between men and women in society (also known as power analysis) [60,124]. The first step is to explore definitions of power with the client and to assist clients to identify which definition of power best fits within the client's value orientation. Subsequent steps involve helping the client to recognize internalized messages about power and to alter them [15]. In order to model egalitarian relationships, the therapeutic environment becomes crucial. As discussed, in feminist counseling and therapy the clinician/client relationship is collaborative. Instead of the clinician simply diagnosing the client's distress, the therapist and client dialogue and work collaboratively to discuss potential reasons and meanings of the symptoms [29]. Clients are given the position of the expert and control what occurs in therapy. They also have the freedom to voice disagreements with the practitioner [18].

It is important to remember that the heart of feminist counseling/therapy is changing the larger community in which the client exists [28]. In other words, it is not enough to simply work with a couple in conducting a gender-role analysis in how traditional gender role socializations have influenced their domestic decisions. Working in an advocacy and consultant capacity in the community to educate and raise awareness about gender issues in order to promote change in areas such as child care, education, and occupational policies is equally as important.

Feminist practitioners utilize a range of interventions; they do not rely on one modality. When infusing feminist tenets with other clinical theoretical orientations, feminist practitioners shift the focus from intrapsychic processes to the larger social context [12]. In addition, sources of gender bias should be identified within the existing theoretical frameworks [60,152].

Lawrence Kohlberg was a pre-eminent moral-development theorist. According to Kohlberg's theory, there are six stages of moral development that people go through in much the same way that infants learn first to roll over, sit up, crawl, stand, and finally walk [42]. Kohlberg characterized these stages in a number of ways, but perhaps the easiest to remember them is by the differing kinds of moral justification employed in each stage. Regarding any decision, the following replies demonstrate the rationale made within each stage.

Stage 1: When a person making a stage 1 decision is asked why the decision made is the right one, he or she would reply, "Because if I do not make that decision, I will be punished."

Stage 2: When a person making a stage 2 decision is asked why the decision made is the right one, he or she would reply, "Because if I make that decision, I will be rewarded and other people will help me."

Stage 3: A stage 3 decision maker would reply, "Others whom I care about will be pleased if I do this because they have taught me that this is what a good person does."

Stage 4: At this stage, the decision maker offers explanations that demonstrate his or her role in society and how decisions further the social order (for example, obeying the law makes life more orderly).

Stage 5: Here, the decision maker justifies decisions by explaining that acts will contribute to social well-being and that each member of society has an obligation to every other member.

Stage 6: At this final stage decisions are justified by appeals to personal conscience and universal ethical principles.

Kohlberg's theory of moral development has been criticized for being androcentric, meaning the dilemmas capture male moral development and do not apply to women. Furthermore, some experts argue that Western conceptualizations of ethics are based on the premise that there are a set of universal, rational, neutral, objective, and impartial rules that are applied to everyone [53]. For example, the concept of justice is based on the assumption that the individual is autonomous and independent, with a rational ability to exercise control [46]. Carol Gilligan, a leading critic of Kohlberg's work, asserted that men and women have different ways of conceptualizing morality, and therefore, the decisions made will be different [35]. In her study, for example, girls did not want to make a moral decision without considering the social context; they wanted to avoid conflict, and their thinking reflected a need to take into account interpersonal relationships using principles of care (e.g., empathy, awareness of others and their feelings) [186]. In a cross-cultural study in Turkey, women managers scored higher on reproductive moral imagination (i.e., taking on the perspectives of another individual) than men [101]. The authors argued that women tend to take interpersonal relationships into account in their moral decision making.

Skoe reconceptualized the levels of ethics of care in six levels [130]:

These gender differences do not mean women's moral reasoning is deficient; rather, women represent "different voices." Nor does this necessarily mean that one way of thinking is better or that women are irrational or dependent. Humans are comprised of both rational and emotional dimensions, and to focus only on one element provides only a partial view of human nature [46]. Some have maintained that men have a morality of justice while women have a morality of care [5]. The feminist ethics of care is rooted in the notion of the "relational self," in which the moral compass is inextricably connected and embedded in social relationships [53]. This longing for relatedness and connectedness results in a "feminine" ethic of care, and it is this that guides the majority of women's ethical decision making [31]. Noddings asserts that care ethics is a relational ethic [102]. In other words, the decision-making process includes both a rationale-cognitive component as well as a personal-emotive one. The "feminine ethic of care" involves a dynamic process of balancing objectivity, systematization, and rationality to reflect upon the moral dilemma without forsaking the affective component [31]. It can also be a political activity—standing up for what is right in order to recalibrate power inequities and ensure justice [186]. As such, the ethics of care can help to redefine power relationships/dynamics and promote more egalitarian relationships and a more equal environment, focusing on human interdependency [164]. The goal is not to elevate one form of moral development as the scientific standard; rather, it is crucial to view female ethics of care complementing the "standard" theories of moral development. Furthermore, an ethic of justice must be balanced with an ethic of care [46].

The ethics of care theoretical framework should be moved from the private to the public sphere [131]. Professionals should consider how it be extended to the larger political, social, and global contexts and applied to social problems such as poverty and human rights violations [131].

The Feminist Therapy Institute developed a Feminist Therapy Code of Ethics, which offers a set of guidelines to supplement rather than replace the code of ethics of the field in which a practitioner practices (Table 1). The Feminist Code of Ethics covers five areas that direct practice, training, and research [30]:

Cultural diversity and oppressions

Power differentials

Overlapping relationships

Therapist accountability

Social change

Frequently, practitioners will confront an ethical dilemma that has no clear right or wrong answer or a simple solution. In such cases, the practitioner uses a host of resources, including the code of ethics and discussion with supervisors and colleagues, to make a decision. In the context of feminist therapy/counseling, an ethical decision-making model that adheres to feminist principles has been established [37]. This model involves several dimensions: (1) the practitioner's emotional-intuitive responses, which involves examining how the practitioner affects the process, (2) contextual factors, such as gender, race, socioeconomic status, religious orientation, and sexual orientation, that affect the parties involved, (3) recognition of the power dynamics inherent in the practitioner and client relationship, and (4) collaboration with the client.

The feminist ethical decision-making model involves seven steps. Although it is presented in a linear manner, the practitioner frequently moves back and forth through the steps [37].

Step 1 involves recognizing the problem. The recognition of the problem is influenced by a range of factors, including the practitioner's level of experience and his/her values system. Often, a feeling of discomfort might arise for the practitioner, and it will be crucial to identify feelings and reactions that might influence understanding of the problem.

Defining the problem is step 2. This consists of identifying the nature of the conflict and whether it stems from potential discrepancies between the code of ethics, laws, clinical issues, and agency guidelines. To the extent possible, the client should assist in defining the nature of the problem. Defining the problem also involves evaluating how the practitioner's and client's contextual factors (e.g., gender, race/ethnicity, age, and other social variables) affect the situation. On the emotional-intuitive side, the practitioner should begin to examine his/her feelings of potential discomfort.

Step 3 of the feminist ethical decision-making model is generating solutions. As various potential solutions are brainstormed, a cost-benefit analysis should also be conducted for each option. The risks and benefits should also be considered. The client should be involved to the fullest extent possible in the brainstorming and cost-benefit analysis. The emotional-intuitive component continues in this step, as the practitioner should reflect on initial reactions that arise with each option.

The next step is selecting a solution. Practitioners should determine the solution that is the best fit both emotionally and rationally for both the client and him or herself. It should be a solution that meets everyone's needs, can be implemented, and is acceptable to both parties [37,165].

Reviewing the process is step 5. In the review process, the practitioner should carefully consider how a solution was reached. Questions that may be helpful to this process include:

Implementing and evaluating the solution should be undertaken next. The plan will be implemented, and the consequences can be observed and noted. In some cases, new information comes to light and the problem will be redefined.

The final step in the process is continuing reflection. The lessons learned from the experience should be reflected upon in order to be applied to future situations. Practitioners should determine what they would do differently, what they have learned, and how they have changed as a result of the decision [165].

Overall, Brabeck identified five main themes of feminist ethics [187]:

Feminism and multiculturalism share many commonalities and roots. Both concepts grew out of social movements in the 1960s that challenged the established norms. Both recognize the marginalization and discrimination experienced by women and racial/ethnic minority groups and how this is reinforced and perpetuated by societal infrastructures, and both emphasize strength, human growth, and potential instead of pathology [55]. The client, rather than the clinician, is considered the expert in telling his/her story [103]. Because of their concerns with oppression and marginalization, counselors from both perspectives are entrenched in social advocacy work, fighting for justice and equality, and reducing disparities [103]. Despite sharing similar values and coming out of a shared history, these two philosophies have remained in their distinct spheres [55].

Feminism in general has been criticized for neglecting other factors that contribute to the marginalization and oppression of women, such as race/ethnicity, sexual orientation, ability, religion, socioeconomic status, and age. In their call for a unifying sisterhood, some argue that feminists have failed to recognize the heterogeneity within the broader category of women. Women from racial and ethnic minority groups may not connect or identify with feminism for several reasons. First, they may feel that feminism is rooted in and reflects white women's experiences, particularly those from privileged backgrounds [49]. The issues of racism and discrimination are vital concerns to many ethnic minority communities, and women of color may be concerned that their communities will feel that they are divesting themselves of one group's advocacy movements by focusing on women in general [49].

Many feminist values originated from Western European traditions [16]. Feminist principles of autonomy, for example, are not consistent with collectivistic principles espoused by other cultural groups. For instance, the traditional therapeutic model consists of talking about problems, believing that this cathartic experience will cure the problem. The emphasis on disclosing private and intimate information to a nonfamily member is primarily a Euro-American value [44]. Goals for self-improvement, empowerment, and self-actualization are Western tenets; these same concepts are dissonant to collectivistic orientations that emphasize the primacy of the collective groups' needs and desires over the individual needs [61].

A collaborative alliance between feminism and multiculturalism is the ultimate goal. Discussions of egalitarianism should be rooted in how diversity intersects with power and how this shapes human behavior and social problems [132,166]. Reynolds and Constantine note [55]:

Multiculturalism and feminism have a joint goal of empowering individuals on the micro and macro levels. Social justice and social action are vital components of both [132].

Another controversy involves the suitability of feminist therapy for male clients. Some have argued that feminist therapy cannot be employed with men because, simply put, they are not women. But many feminist practitioners believe the principles and practices of feminist therapy are not exclusive to female clients. Heterosexual and homosexual male clients can benefit from learning how traditional gender role socializations and norms impact their relationships and identity [16,188]. Some argue that the loss of power can trigger psychologic distress (e.g., acute anxiety), so men can also benefit from feminist multicultural therapy [167,188]. Those who are opposed to feminist therapy for men argue that the goal may be to make men more like women [104].

Those who advocate for men participating in feminist therapy maintain that all cultures have norms about manliness and masculinity [104]. In Western culture, these norms include being a risk-taker, emotionally in control, independent, dominant (including being in control over women), an achiever, a "playboy," and a provider. Conformity and nonconformity to these norms could trigger stress, which could then result in mental health and health issues, and challenging dominant gender roles is part of feminist therapy [104,167]. Furthermore, feminist therapy may be helpful for men dealing with issues such as anger, expressing distress and psychologic pain, and excessive focus on performance and achievement [60,133,167]. The use of gender role analysis can be beneficial in assisting male clients to understand how society reinforces and rewards men for performance and how their sense of identity is tied to these gender stereotypes [60,133]. For relationship issues, feminist therapy could help male clients to work on listening skills and to learn how to work collaboratively with women. In these cases, the goal is to break out of traditional gendered notions of masculinity [60]. When working with men, feminist counselors should reflect on their own notions of what it is to be a man and what a man should be like [104].

There is a divide among feminist practitioners regarding whether it is possible for men to be feminist clinicians. Some argue it is not possible, while others assert that men should not be excluded in fighting against oppression. According to Enns, a feminist practitioner is an individual who self-identifies as a feminist, one whose value systems and clinical approach align with feminist tenets and values [26]. Men who have reflected and developed an awareness of how gender roles and embedded patriarchal ideologies in social institutions impact their upbringing and socialization, how androcentric views contribute to women's oppression, and who champion and advocate on women's issues can be effective feminist clinicians [25]. While some men can relate to marginalization and oppression due to class, race, or sexuality, they should be willing to admit that their experiences are limited and that they cannot completely align themselves with women's experiences [105].

In one survey study, the attitudes and practices of 81 self-identified feminist and non-feminist male therapists were examined [62]. Approximately one-quarter of the participants identified themselves as feminists. Men who self-identified as feminist therapists scored significantly higher on their attitudes toward feminism and the women's movement, had more liberal gender role attitudes, and engaged in practice behaviors that were more aligned with feminist therapy compared to the non-feminist male therapists. In a similar vein, a qualitative study of 12 male feminist therapists explored how their feminist identity developed [2]. The researchers found their feminist identity developed over time through a series of events that made them realize how sexism and traditional gender roles were in ingrained in society [2]. The therapists also identified a sense of connectedness with women and with the feminist community. Three of the participants were also gay, and these men discussed how they identified with the issue of marginalization.

In the 1970s, the men's movement emerged alongside the women's movement to examine masculine gender roles and how they impact men's lives [49]. There appear to be three schools within the men's movement, one of which is profeminism [49,134]. Profeminist men argue that they want to eliminate the negative effects of gender oppression and inequality, gain a better understanding of how gender and traditional images of masculinity shape men's behaviors and experiences, assist men to realize their full potential, and commit their energies and efforts to other oppressed groups, such as women, gays/lesbians, people of color, the disabled, and the elderly [49]. Most feminists agree that men who adhere to profeminist tenets should be viewed as allies to the women's movement.

A second wave of the men's movement emphasized paternal rights, with a focus on custody rights and child support [135]. Participants in this movement maintain that there is gender bias and discrimination family law, but some have criticized this agenda as focusing more on equality and rights versus the actual care of children [106].

Another type of movement is the mythopoetic men's movement, which is a blend of a quasi-religious and self-help approaches [107]. Members of this group maintain that men are the victims of oppression by the feminist movement's removal of their masculinity. Spiritual journeys are believed to help men revive and reclaim their identities [134]. The mythopoetic men's movement was made popular in the 1990s by Robert Bly's book Iron John: A Book about Men. The message is that men are losing their manhood and should rediscover it alongside other men; this may involve taking part in "wildman retreats" [107].

In many cases, men's movements are antifeminist and pro-men. These individuals tend to argue that feminism oppresses men and unfairly privileges women [189].

The terms "feminism" and "feminist" have many associations, including negative stereotypes. Throughout history, feminists have been called "manly," "man haters," "femi-Nazis," and "child haters" [190]. This first emerged with the suffrage movement and the first wave of feminism [16]. In the 1970s, these negative images resurfaced, and terms like "Amazons," "lesbians," and "extremists" were used [16,135]. In the 1980s, the media casted feminism as outdated. During this period, media generally indicated that gender equality had been achieved, and the outcome was a host of negative effects, such as the breakdown of the nuclear family [16].

Porter observed that although women in general have more freedom today in various economic, educational, and political arenas, many gender inequality issues remain. Problems such as violence against women, pornography, blatant sexualization of women's bodies (e.g., on the Internet and in the media), increasing eating disorder rates among women, and the wage gap seem to indicate that oppression continues to be an issue for women [54].

Labeling oneself as a feminist generally involves being willing to endorse the statement "I am a feminist" and adhering to feminist tenets [108]. A small percentage of Americans identify themselves as feminists today, and surprisingly, college students show lower levels of identification with the feminist movement despite the fact they state they agree with feminist tenets [69]. There may be several reasons for this trend. Some scholars maintain that the principles of feminism are more ingrained in our day-to-day lives, making the issue of gender inequality seem less pressing than in earlier decades. Others believe that the negative images of feminism are still rampant, causing young women to reject these negative stereotypes [39,168]. In one study of college students, 44% associated feminists with negative characteristics, describing them with such words as ''femi-Nazi,'' ''bitch,'' ''fat,'' ''militant,'' ''aggressive,'' ''whiny,'' ''raging,'' and ''crazy'' [39]. More than one-quarter of study participants also associated the term feminist with "lesbians" or "butch" [39]. The students in this study were also generally confused about the definition of feminism and were not able to identify the goals of the feminist movement.

In a study of 233 female university students in the Midwest, participants who stated that they identified as feminists were more likely to engage in feminist activism, regardless of beliefs [108]. It would appear that, in this study, activism was at the core of identifying as a feminist [108]. In one study, a feminist man was viewed more positively than a feminist woman; however, a feminist man was perceived as less powerful and less heterosexual than a non-feminist man [169].

There appears to be an understanding that there are different types of feminists, and stereotypical perceptions vary. In one study, college students rated radical feminists lower on warmth compared to their liberal feminist counterparts. Radical feminists were perceived to be less hireable and not as suited for a job compared to their liberal or general feminist counterparts [176].

In a 2015 online survey with 332 students, 49.7% were neutral, reporting no strong feelings of identifying as a feminist/pro-feminist. In comparison, 45.8% described themselves as feminist/pro-feminist [135]. The meanings of feminism varied widely among participants. For some, it was described as a set of ideologies, while others described feminism as action-based. Some linked feminism to women, but others believed it applied to both genders [135]. Today, many tend to espouse feminist values but reject a feminist identity or label [190].