On the couch
Black Women Don’t Cry
Black Women Don’t Cry
I have always prided myself on being driven and resilient, but what does resilience mean and how does it relate to race and identity?
My own burnout experience has led me to reflect on my understating of resilience and coping on a personal and professional level. During certain times in my life, I may not have practiced the self-care strategies that I have modelled to the clients I have been working with. I currently have a private therapy practice and work with some fabulous inspirational women; whilst private practice is rewarding, it can be challenging.
Within my own personal therapy, I have explored how the Black Women Schema might contribute to managing emotional stress and the importance of me demonstrating positive wellbeing to the clients I work with.
The Black Woman Schema amalgamates cultural beliefs and expectations of independence, strength and cognitions related to Black womanhood. The schema results in a conjuring of resilience in response to stress and hardships; many Black Women maintain a complex balancing act of portraying strength whilst concealing their trauma.
Biopsychosocial Models of Health
Biopsychosocial approaches to health are beneficial as they provide a holistic perspective, considering culture, spiritual beliefs, social factors, and environment. It is crucial to be aware of these social factors to promote better health outcomes in clinical practice and increase awareness when working cross-culturally. Behavioural characteristics and social conditions that may influence health outcomes in Black Women.
“Researchers have suggested that health disparities in Black Women, including adverse birth outcomes, lupus, obesity and untreated depression, can be explained by stress and coping. The Strong Black Woman role has been highlighted as a phenomenon influencing Black women’s experiences and reports of stress.” (Woods-Giscombé, 2010).
Applying biopsychosocial models of disease can improve outcomes in the physical and mental health of Black Women.
The biopsychosocial model was first developed by George Engel in 1977 and suggested that thoughts, feelings, and behaviour may influence a physical state, which is also implied in Cognitive Behavioural Therapeutic Interventions.
Piaget (1926) first proposed the notion of schemas as a stage within cognitive development. Schemas relate to a framework, pattern, and way we organise and interpret our environment. Schemas help us to develop a perception of self and others. The concept of the SBW framework provides an overview of the defining factors, roles, beliefs, and cost-benefit analysis regarding how this schema may affect physical and mental health amongst black women.
Schema modes are states of mind that everyone experiences from time to time. A schema mode usually presents during stress responses and activates a person’s schemas, or coping styles. In a healthy person, these schema modes can generally be calmed and are adaptable. In individuals who may be struggling with their mental health, these schema modes may be less flexible and lead to rigidity.
The Strong Black Woman Schema
The Strong Black Woman Schema is characterised by three components: emotional restraint, independence and caretaking. Liao, Wei and Yin (2020) make valuable contributions to understanding cultural psychology and personality by reviewing the Strong Black Women Schema and mental health outcomes amongst Women of Colour.
Previous research within this area has identified an association between ineffective coping strategies, maladaptive perfectionism, and increased psychological distress amongst Black Women (Dunkley et al., 2000). In their article, Liao, Wei, and Yin (2020) precisely analyse the correlation between the SBW schema and psychological outcomes such as depression, anxiety, and loneliness.
Their study identified four mediators between the Strong Black Women Schema and psychological health outcomes; these included maladaptive perfectionism, self-compassion, and two agricultural coping strategies – collective and spiritual coping. The study explores the affective processes of Black women, their responses to stress and implications of this on mental health within this demographic.
Micro-aggressions and Mental Health
Any minority can experience can experience micro aggressions based on gender, ethnicity, age, disability, religion or socioeconomic status. While micro aggressions may seem harmless, a lifetime of micro aggressions can be detrimental to mental health. Existing research has explored the link between micro aggressions and their impact on Black women (Lewis, Williams, Pepper and Gadson 2017).
Biopsychosocial approaches to health can provide helpful insight into how environmental factors can influence self-perception, identity, and psychological wellbeing. Biopsychosocial models of health can also be used to link ethnicity and gendered micro aggressions and racism to coping strategies.
Ethnicity, Chronic Stress and Health Outcomes
Stress as a bio psychological causal mechanism has been the focus of extensive research in the past. Chronic stress has been identified as a key mechanism leading to stress-related biological reactions, negative immune responses, and increased risk of developing various health conditions such as depression, cardiovascular disease, and obesity. (Steptoe, 2005; Slavich and Irwin, 2014).
The authors developed a mediation model based on Clark et al.’s (1999) biopsychosocial model exploring racism as a stressor amongst Persons of Colour. Clark et al. (1999) investigated the bio psychological effects of perceived racism within the stress and coping models. Clark et al. (1999) identified that the perception of racism resulted in psychological and physiological stress responses.
The study also highlighted that to people of colour utilised various coping strategies to mediate against racism. These strategies identified were associated with physiological reactivity and included avoidance, denial, aggression, passivity, helplessness, and assertiveness.
According to Developmental Psychology, stress and other adverse experience can contribute to the development of maladaptive coping strategies, which can develop into schemas that form part of our identity and personality. (Clark and Beck, 1999). Wood-Giscombé (2010) observed that explored biopsychosocial factors to health and identified that the Strong Black Woman Schema may lead to chronic stress, obesity, inflammation, and metabolic diseases.
Developments in Research on Strong Black Woman Schema
In their study, Liao, Wei, and Yin (2020) used existing research (Dunkley et al., 2000; Dunkley et al., 2003) to develop their hypothesis and explore mediation effects to be considered within the study, which included coping responses of self-compassion, collective coping and spiritual coping. The authors clearly reviewed existing research relating to SBW schema, Maladaptive Perfectionism, and coping responses.
They identified a need for quantitative analysis to affirm the existing body of qualitative research in this field. In summary, the authors provide a useful contextual overview relating to the attributing factors linked to the development of the SBW schema amongst Black Women. “The SBW schema consists of emotion regulation, caretaking with Black families, and being economically independent, which are traits that may counteract the negative stereotypical images of African American women.” (Nelson, Cardemil and Adeoye, 2016)
Recent studies in this area sought to determine direct associations between the SBW schema and depression, anxiety, and loneliness in a sample of African American women. An existing body of research relating to the SBW schema is primarily qualitative in nature.
Research focus into the SBW has developed over the last ten years. Liao, Wei and Yin (2020) have expanded on relevant research within with field, such as Allen et al. (2019). The study aimed to test the empirical findings of Dunkley et al., 2000; Fleet et al. (1998) to evaluate how schemas related to maladaptive perfectionism and coping styles many impact influences on psychological outcomes.
Implications for Black Women’s Mental Health
The results identified that Black women who support the SBW are likely to be more susceptible to adverse mental health outcomes. The findings highlighted that self-compassion is a significant mediator between the SBW schema and depression, anxiety symptoms, and loneliness. In addition, it is suggested that maladaptive perfectionism, beliefs are associated with low use of collective coping and increased symptoms of depression and anxiety symptoms and loneliness.
The research is consistent with existing findings (Donavan and West, 2015) relating to the SBW schema to increased depression and anxiety symptoms. The Strong Black Woman Schema is often shrouded in secrecy and Black Women might have an internalised experience of this schema that they may not share with others.
Intersectionality in Clinical Practice
Previous research has highlighted the stigma in Black communities in terms of accessing mental health intervention. (Ward, 2013). It is critical to consider the therapeutic alliance within clinical practice and for the therapists to explore with women of colour how they experience their identity, coping, and available resources to develop a more effective treatment plan.
Biopsychosocial approaches to understanding health can be effective in exploring coping strategies, resilience, and self-care. However, there are limitations and caution is required as it is necessary not to generalise the experiences of Black Women. Existing research in this phenomenon mainly uses research samples with university students in America; it would be beneficial to explore the experiences of Black Women in other geographical locations to explore if the schema is present in different populations. Possible limitations in applying cultural perspectives to health psychology involve ‘cultural assumptions of uniformity or homogeneity within sample groups.’ (Hatala, 2012).
Criticisms of the existing research are that it focuses on the negative psychological implications of the Strong Black Women Schema and fails to explore positive mediators such as resilience, drive and self-efficacy.
Further exploration of the development of Strong Black Woman Schema over a lifespan is crucial. Existing research has considered how SBW schema can act as a protective mechanism in early development. Still, in middle age, it can be a mediator to psychological distress such as burnout.
In summary, research about the Strong Black Woman Schema supports a need for increased reflexivity as a practitioner. As part of continued professional development and cross-cultural awareness, Counsellors and Clinical practitioners need to reflect and understand the experiences of Black women psychological health from a unique perspective.
When working with the Strong Black Woman Schema in therapeutic practice, I found compassion-focused therapeutic techniques beneficial in challenging this type of schema. Being compassionate relates to “a sensitivity to suffering in the self and others with a commitment to try and alleviate and prevent this suffering.”
The importance of practicing compassion lies in the willingness to explore the causes of suffering within others and ourselves. In my own journey, a challenge has been to understand and reflect on my own suffering so I can support other Black Women to feel comfortable and feel safe enough to explore their own suffering alongside me in therapy.
Clark, D.M and Beck, A.T. (1999) Scientific Foundations of Cognition Theory and Therapy for Depression.
Donovan, R. A., & West, L. M. (2015). Stress and Mental Health: Moderating Role of the Strong Black Woman Stereotype. Journal of Black Psychology, 41(4), 384–396.
Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth, G. (2000). The relation between perfectionism and distress: Hassles, coping and perceived social support as mediators and moderators. Journal of Counselling Psychology, 47(4), 437–453. https://doi.org/10.1037/0022-0188.8.131.527
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Ward, E (2013) African American Men and Women’s Attitude Toward Mental Illness, Perceptions of Stigma, and Preferred Coping Behaviours
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