________ Sh'Niqua L. Alford, DSW, LCSW-S, Associate Professor of Professional Practice, Department of Social Work, Texas Christian University, Fort Worth, TX. Copyright © 2024 Authors, Vol. 24 No. 2 (Summer 2024), 304-320, DOI: 10.18060/27340 This work is licensed under a Creative Commons Attribution 4.0 International License. Implementation of Strength Reimagined: A Therapeutic Well-Being Framework for African American Women to Counteract the Strong Black Woman Stereotype Sh'Niqua L. Alford Abstract: The Strong Black Woman (SBW) stereotype has been consistently linked to poor mental health for African American women and its endorsement leads to anxiety, depression, and stress. African American women unknowingly subscribe to this stereotype through the exertion of strength and independence found necessary to combat oppression and gendered racism. This article explores existing literature on the SBW stereotype and suggests strategies for leveraging this stereotype to enhance mental health interventions for African American women. Utilizing an integrated conceptual framework that draws from the lens of Black Feminist Thought, Intersectionality, and Social Constructivism Theory, Strength Reimagined: A Therapeutic Well-Being Framework for African American Women is proposed. This treatment framework incorporates five key aspects: therapist awareness, psychoeducation, culturally responsive psychotherapy, trauma-informed complementary interventions, and mutual support to improve mental health outcomes among African American women. Keywords: Strong Black woman stereotype, African American women, mental health, psychotherapy interventions African American women, as a result of positionality in the United States, may exhibit behaviors and characteristics associated with the Strong Black Woman (SBW) stereotype. While deemed a response to societal pressures and a means of resilience, the SBW stereotype may hinder well-being as African African women strive to overcome societal detriments related to physical and mental health. Substantial literature explores the SBW stereotype and its association with anxiety, depression, and stress, however, limited research investigates how the schema impacts mental health help-seeking behaviors and treatment retention among African American women. The focus of this article is to provide an extensive review of the literature on the SBW stereotype while identifying gaps in the context of African American women engaging in psychotherapy treatment in the United States. Strength Reimagined: A Therapeutic Well- Being Framework for African American Women is proposed to improve mental health outcomes among African American women. This framework significantly contributes to scholarly literature, the social work profession, and the mental health treatment of African American women. Implementation of Strength Reimagined: A Therapeutic Well-Being Framework for African American Women contributes to optimal holistic mental health. about:blank Alford/STRONG BLACK WOMAN STEREOTYPE 305 Literature Review African American women in the United States must navigate the intersection of gendered racism, employing survival tactics to overcome this complex form of oppression. The strength of the African American woman is conceptualized as the SBW stereotype (Davis & Jones, 2021). The SBW stereotype will be defined, and a historical overview will shed light on its origins and perpetuation. While the resilience of African American women is widely acknowledged, it is important to recognize that this strength can also have detrimental effects. The negative consequences of the SBW stereotype will be examined, particularly its association with increased mental health issues and trauma-related symptoms. Additionally, this leads to a discussion of how the SBW stereotype influences help-seeking behaviors among African American women. The methodology employed for this literature review involved a search of scholarly databases, including PsycInfo, SocINDEX, Sage Premier, and PsycArticles, to retrieve relevant articles, books, and other academic sources. Keywords and search terms relevant to the topic were Strong Black Woman Stereotype, African American women, Black women, psychotherapy, social work, and mental health treatment. Inclusion criteria were established to ensure the selection of studies met the objectives of the review, publication in peer-reviewed journals, and availability of full text. The search was limited to English language publications and studies published within the past 15 years, except for seminal work, to capture the most current research in the field. Finally, the findings from the selected studies were synthesized and analyzed to identify key themes, trends, and gaps in the literature. This methodology aimed to ensure a comprehensive review of the existing literature, providing a solid foundation for developing the treatment framework. The Strong Black Woman Stereotype Within the African American community, the conceptualization of womanhood as a “Strong Black Woman” is perceived as an idealized representation that becomes a protective factor (Watson & Hunter, 2016). Similarly, Walker-Barnes (2009) identified “strong” as likely the most frequently used word to describe an African American woman. The SBW stereotype is defined as a set of cognitive beliefs coupled with behaviors depicting how African American women represent themselves, care for themselves, and provide care for others (Watson & Hunter, 2016). Research further suggested that African American women who subscribe to the SBW stereotype have an internalized belief that they must constantly possess qualities of strength and caregiving, often to their detriment (Donovan & West, 2015). Examples of these perceived characteristics include resiliency, the ability to handle adversity with ease, handling challenges with no assistance, independence, self-sufficiency, providing for the needs of others before their own, and lack of reliance on others for emotional or financial support (Donovan & West, 2015; Jones et al., 2020; Walker-Barnes, 2009). These characteristics are a result of the SBW stereotype, as well as society's response to perceptions of African American womanhood as defined by this stereotype. Additional perceptions of this trait indicate that African American women should suppress feelings of fear and weakness and avoid vulnerability and dependence, depicting an unrealistic image that views African American women as ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 306 superhumans void of emotions and needs, thus the stereotype (Stanton et al., 2017). Similarly, Watson and Hunter (2016) identified this stereotype as a complex social construct that embodies strength and caregiving capabilities. Strength is depicted as perseverance despite obstacles, limited resources, and support (Watson & Hunter, 2016). Caregiving capabilities are understood by the frequent occurrence of African American women prioritizing the needs of others before their own (Watson & Hunter, 2016). Rooted in the history of enslavement, and the intersectionality of racism, sexism, and classism, the SBW stereotype contributes to poor, unmanaged self-care among African American women (Watson & Hunter, 2016). Historical Origination of the Stereotype The historical significance of the SBW stereotype must be explored to understand its prevalence in the African American community. Decades of unrealistic expectations for African American women have contributed to this stereotype. Researchers revealed that strength is an imperative aspect of the identity of African American women (Nelson et al., 2016; Walker-Barnes, 2009; West et al., 2016). It is not believed that African American women intentionally set out to overextend themselves and reject help because of the SBW stereotype, but it is more likely a subconscious response engrained in African American women from childhood due to generational trauma. Researchers suggested the SBW stereotype was developed during chattel slavery as a means of survival from violence and oppression and has been passed down through generations of women to young girls through socialization (Donovan & West, 2015). Nelson et al. (2016) offered similar insight. They elaborated on the historical significance of strength, referencing the strength of an African American woman as a coping mechanism in response to adversity during the enslavement of African American people during the 17th and 18th centuries. During these times, and arguably continuing today, it was falsely believed that African American women possessed greater physical and psychological strength than White women, implying that African American women could tolerate heightened pain and suffering (Anyiwo et al., 2018). In turn, African American women have historically adopted the need to demonstrate superior emotional strength, like the legacies of African American ancestors (Anyiwo et al., 2018). Nelson et al. (2016) corroborated this insight, offering that strength was seen as crucial for survival, forcing African American women to conceal negative emotions to avoid drawing attention and instead, facing the harsh consequences of the brutal mistreatment they endured. Donovan and West (2015) elaborated further that characteristics of strength and caregiving during chattel slavery were necessary for personal survival and to preserve family and community existence. Walker-Barnes (2009) noted the same, indicating the characteristics of strength among African American women as a cultural stipulation for survival. These experiences began the cycle that has resulted in African American women utilizing strength to lessen the detrimental effects of racism, oppression, and discrimination (Nelson et al., 2016). Liao et al. (2020) supported the same notion, stating that the SBW stereotype benefits African American women navigating an oppressive society. Walker- Barnes (2009) classified this further as strength evolving into resilience to combat suffering. Oshin and Milan (2019) took a deeper dive into the assessment of the SBW stereotype, highlighting specific attributes of self-reliance and emotional strength. Alford/STRONG BLACK WOMAN STEREOTYPE 307 Historically, due to the enslavement of African American people and the dismantling of the African American family through the separation of male partners, African American women assumed multiple roles to provide for their families (Oshin & Milan, 2019). As a result, African American women were expected to mask their emotions and develop a shield of resistance from these circumstances (Oshin & Milan, 2019). Other studies have found commonalities in how the SBW stereotype has developed in young African American girls. Socialization from parents, mimicked behaviors of ancestors, and the media are sources that explain the development of the SBW stereotype among African American girls (Anyiwo et al., 2018). Nelson et al. (2016) explained how commonly African American mothers focus on the socialization of their daughters to exhibit strength and resilience as a mechanism to exist in a society that will devalue and demean them and their culture. Nelson et al. (2016) further revealed differences in these practices among daughters and sons, with African American mothers demanding stricter rules and responsibilities for their daughters. According to Jones et al. (2020), this schema is developed through what is referred to as gendered-racial socialization. Through this process, young African American girls are given intentional messages of survival by their mothers and matriarchal figures to prepare them for life as African American women, essentially learning traits of the SBW stereotype. Epigenetics research further explains how environments influence genes, resulting in trauma being transmitted through generations (DeGruy, 2005). Through seminal research on the Post Traumatic Slave Syndrome, DeGruy (2005) discussed how African Americans enduring chattel slavery faced experiences of trauma and stress, which was stored in their genetic memory. Though chattel slavery does not exist today, Deoxyribonucleic Acid (DNA) contains biological memories of trauma and stress and this is passed down through generations (DeGruy, 2005). Kumsta (2019) corroborates these findings by explaining how mental health disorders have a substantial developmental origin and how epigenetics may explain the long-term effects of early adversity. Negative Consequences Associated With Stereotype Superficially, characteristics of the SBW stereotype are deemed positive and affirming because African American women are viewed as strong, independent, and self-sufficient. However, African American women who subscribe to the SBW stereotype are susceptible to negative consequences impacting their physical and mental health. Empirical findings demonstrate a correlation between the SBW stereotype and anxiety, depression, and stress. Additionally, the neurophysiologic effects of stress are explored, emphasizing the impact of stress on the brain and the negative ways the body responds to stress. Finally, the SBW stereotype adversely affects the mental health help-seeking behaviors of African American women. Anxiety, Depression, and Stress There is increasing evidence suggesting the SBW stereotype is not conducive to the wellness of African American women (Jones et al., 2020). Furthermore, the SBW ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 308 stereotype results in detrimental consequences on the mental health of African American women (Oshin & Milan, 2019). These consequences are exacerbated by the intersectional effects of racism, sexism, and classism. Researchers indicated through qualitative evidence that there is a correlation between the SBW stereotype and poor mental health outcomes, such as increased levels of stress, anxiety, and depression (Donovan & West, 2015; Stanton et al., 2017; Woods-Giscombé, 2010). Additionally, Abrams et al. (2018) found that women who subscribe to the SBW stereotype display increased anxiety and depressive symptoms. West et al. (2016) suggested a relationship between increased depression and a lack of help-seeking and self-care behaviors in women who internalize the SBW stereotype. As a result of the seemingly altruistic behaviors identified in the SBW stereotype, many African American women find themselves affected by negative physical health and mental health outcomes that include anxiety, depression, and stress (Donovan & West, 2015). Empirical research has shown that when African American women exhibit the strength and self-reliance behaviors characteristic of the stereotype, there is an increased risk of psychological distress (Watson & Hunter, 2015). Increased psychological distress leading to increased depression is of particular concern for African American women because depression is often undertreated (Nelson et al., 2022). Neurophysiologic Effects of Stress To effectively articulate the negative consequences of chronic stress on mental health, particularly toxic stress, it is essential to understand the effects of stress on the brain. Sporleder and Forbes (2016) described toxic stress as a constant state of hardship or prolonged exposure to stress in which the body’s physiological response is to stay in the fight, flight, or freeze mode. Continued exposure to stress is damaging and becomes toxic to the human body. Frequently, African American women are viewed as strong, tenacious, and capable of overcoming all obstacles encountered. While help may be sparingly available, if offered, African American women may find it challenging and even unreasonable to accept. This belief is exacerbated when African American women are praised for accomplishing difficult tasks without receiving help. African American women often internalize this superwoman identity as a badge of honor and may minimize or overlook the effects of stress, anxiety, and depression on the body. According to Bloom (2013), toxic stress weakens the architecture of the brain, resulting in damaging consequences on cognitive, emotional, and social functioning. When in a constant state of stress, the ability to think clearly and process the consequences of decisions and behaviors is affected (Bloom, 2013). Beyond its impact on cognitive processes, toxic stress has profound effects on the body’s overall health, particularly at the cellular level. One key area where this damage manifests is in the length and function of telomeres. Telomeres, which are protective caps found at the end of chromosomes, play a crucial role in maintaining cellular health by preventing the chromosomes from fraying. Their main function is to protect the genetic material in cells from damage during cell division. Each time a cell divides, telomeres shorten slightly. Over time, as telomeres become too short, the cell can no longer divide effectively, which contributes to premature aging and the gradual breakdown of cellular function (Bayly, 2013). Naturally, telomeres shorten as people age; however, stress accelerates the shortening of telomeres. Toxic stress rapidly Alford/STRONG BLACK WOMAN STEREOTYPE 309 shortens the telomeres, which may lead to the formation of cancerous tumors, an example of how stress detrimentally affects physical health (Bayly, 2013). Stressors, as defined by Osório et al. (2017) are challenging experiences that cause physiological and psychological reactions in the body. These stressors can contribute to a state of allostatic load, which refers to the cumulative physiological burden placed on the body due to chronic stress and the repeated activation of the body’s stress response systems (Guidi et al., 2020). Woods-Giscombé (2010) notes that excessive psychological stress increases allostatic load, resulting in dysregulation and impaired functioning. When the body’s stress response systems are overtaxed due to excessive or chronic stress, allostatic overload can occur, resulting in a range of negative health consequences (Arden, 2010). Health implications of allostatic overload include increased risk of cardiovascular disease, mental health disorders such as anxiety and depression, metabolic disorders such as obesity and diabetes, and impaired immune function (Guidi et al., 2020). One may argue that women from all races experience challenges due to allostatic load/overload; however, Thomas et al. (2019) highlighted disproportionately higher levels of allostatic load among African Americans when compared to other racial and ethnic groups, and it was found to be significantly higher for African American women. Osório et al. (2017) further explained the fight, flight, or freeze response, also referred to as acute stress response, as our body’s reaction to stressors. When we perceive danger or experience challenging or stressful situations, our body responds with a specific set of protective capabilities (Bloom, 2013). When enduring chronic stress, these systems become hyper-aroused, resulting in less effectiveness when necessary (Bloom, 2013). Demanding career responsibilities, unreasonable caregiving expectations, and lack of self- care are common experiences of African American women subscribing to the SBW stereotype. These factors may contribute to chronic stress. Bloom (2013) identified a correlation between chronic stress and poor health outcomes. This predictor is concerning, as the primary causes of death among African American women include heart disease, cancer, stroke, and diabetes (Centers for Disease Control and Prevention, National Center for Health Statistics, 2024). Chronic stress on the body leads to a constant state of activation in the autonomic nervous system, contributing to negative health outcomes such as hypertension, asthma, headaches, and ulcers (Bloom, 2013). Likewise, endorsers of this stereotype experience heightened rates of obesity and disproportionate rates of cardiovascular disease (Stanton et al., 2017). The literature strongly suggests chronic stress leads to physical and mental health disorders among African American women and a linkage between the stereotype and poor mental health outcomes (Donovan & West, 2015). As African American women subscribe to this stereotype, chronic stress can ensue, resulting in increased physical and mental health symptoms and disorders. Influence of the Stereotype on Help-Seeking Behaviors Historically, stigma exists in the African American community surrounding mental wellness and mental health treatment, hindering African American women in their quest for mental health care. In turn, these barriers affect the mental health help-seeking behaviors of African American women (Ward et al., 2009). Studies dating back to the ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 310 1980s reflect that African American people in the United States hold more negative beliefs and attitudes towards people with mental illness than other racial and ethnic groups. Ward et al. (2009) revealed that when compared to White people, African American people exhibit feelings of shame toward friends or family who seek mental health treatment; thus, the associated shame surrounding mental illness results in avoidance of mental health treatment. Events of historical significance, such as the Tuskegee Experiment, also shaped the negative beliefs that African American people hold regarding health and mental health care (Ward et al., 2009). Other historical factors to note include the Eugenics Movement, segregation in healthcare, misdiagnosis, and disparities in treatment. Cultural mistrust is a contributing factor to the stigma of mental health treatment in the African American community (Shelton, 2022; Ward et al., 2009). Despite 60% of African American women reporting depressive symptoms, African American women utilized outpatient mental health services less than White women and African American men (Ward et al., 2009). More recently, 10.3 percent of African American women utilize mental health services, which remains considerably less than the 25 percent of White women receiving mental health treatment (Shelton, 2022). Borum (2012) suggested African American women are distrusting of psychiatry and the medical system, resulting in less frequent treatment of depression when compared to White women. Additionally, the pattern of mental health treatment in the African American community reveals lower rates of outpatient treatment and higher rates of emergency room care (Ward, 2005). This demonstrates how many African American women wait until their needs are dire before seeking care. African American women commonly relied on other coping methods, such as confiding in friends, family, and the church, while upholding deeply rooted convictions within the African American community that familial issues should not be disclosed to outsiders (Ward et al., 2009). These cultural beliefs, coping mechanisms, and the portrayal of the SBW stereotype may serve as barriers, reducing the likelihood that African American women seek mental health care (Ward et al., 2009). Internalization of the SBW stereotype resulted in some women upholding the image of the stereotype (Davis & Jones, 2021). Stanton et al. (2017) suggested that the SBW stereotype may prevent African American women from seeking and engaging in mental health treatment due to the beliefs of the stereotype. Additionally, a qualitative study revealed that some African American women admitted that the SBW stereotype prevented them from acknowledging depressive symptoms, diagnosis, and treatment (West et al., 2016). Watson and Hunter (2015) also explained that African American women might not disclose somatic symptoms often indicative of anxiety, such as headaches, digestive issues, or pain, due to the stereotype’s expectation to hide emotional discomfort. West et al. (2016) mentioned that race, racialization, and ethnic disparities further impact the role of stress related to physical health and mental health outcomes. African American women who identify with the tenets of the SBW stereotype show increased symptomology of stress, namely due to the belief that they must abide by the societal pressures of self-reliance, emotional suppression, and enhanced strength. West et al. (2016) also identify additional findings from anecdotal and empirical research that support the SBW stereotype as a method of ineffective coping, in turn generating poor mental health outcomes. Woods- Giscombé (2010) noted that the “legacy of strength in the face of stress among African Alford/STRONG BLACK WOMAN STEREOTYPE 311 American women might have something to do with the current health disparities that African American women face” (p. 669). Literature Gaps Wojtalik (2018) noted social workers deliver the majority of mental health care in the United States and play a key role in integrating cognitive neuroscience and mental health interventions. Wojtalik further suggests that social workers have the ability and responsibility to educate clients about the neurobiology of mental illness to reduce the stigma surrounding diagnosis and symptoms. While there is substantial literature identifying effective strategies for social workers providing mental health treatment, there is limited knowledge or awareness of implementing these strategies with African American women susceptible to the ideals of the SBW stereotype. Additionally, while there is significant research identifying various components of the SBW stereotype and its impact on help-seeking behaviors, there is limited research on the SBW stereotype in the context of psychotherapy (West et al., 2016). African American women experience challenges identifying the need for mental health treatment or therapy due to an internal belief that it is necessary to always demonstrate strength (Nelson et al., 2016). Additionally, there remains a gap in the literature for identifying ways to counteract the SBW stereotype to increase mental health treatment retention. Due to the SBW stereotype, African American women frequently encounter obstacles when it comes to participating in and sustaining psychotherapy sessions. These challenges are often linked to struggles in recognizing the necessity of support and prioritizing self-care (West et al., 2016). Additional barriers to psychotherapy treatment include culturally incompetent therapy and a lack of accessible and affordable therapy. Furthermore, substantial research exists identifying the harmful effects of the SBW stereotype on the physical and mental health of African American women (Nelson et al., 2016) yet there is a lack of scholarly literature identifying specific strategies to overcome this barrier for African American women. The Rationale to Address Literature Gap There are compelling reasons to further explore this issue and address the existing gaps in the literature. The SBW stereotype is deeply embedded into the existence of many African American women and as a result, must be understood and incorporated into aspects of psychotherapy treatment. In doing so, physical and mental health risks and impairments may be mitigated and decreased among African American women. African American women should be educated on the importance of prioritizing healthy stress management strategies and establishing a self-care regimen to effectively cope with the challenges of daily life. This may look like establishing healthy boundaries, cultivating self-compassion, prioritizing physical activity, nourishing the body with quality food, and fostering supportive relationships. It is crucial to communicate to African American women that wellness is not solely an attitude or belief, but encompasses a series of behaviors and actions that necessitate a strategic approach to follow. ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 312 African American women have witnessed generations of women as pillars of strength and perseverance in the face of challenging obstacles. Consequently, failure to provide and adequately perform is seen as a weakness (Stanton et al., 2017). Mirror neurons are brain cells possessing multiple functions, including imitative learning of social behavior and social interaction (Farmer, 2014). These neurons play a crucial role in how individuals learn and internalize social norms and expectations by observing others, which may influence the propagation of social behaviors and stereotypes. Abrams et al. (2014) identified the transmission of the SBW stereotype through verbal communication, modeling, and direct and indirect conditioning. It is deemed a desirable quality to be revered as an African American woman who is strong, goal-oriented, and capable of meeting her needs independently (Watson & Hunter, 2015). Stress is heightened when one feels or perceives that their environment cannot be controlled. To mitigate the transmission of the SBW stereotype ideals as it passes through generations, psychotherapy interventions must strategically educate African American women about the effects of the SBW stereotype. By raising awareness of the detrimental impact of the SBW stereotype, effective psychotherapy may help African American women overcome the need to constantly present themselves as strong and resilient to manage the adversities they face in their environments. Treatment Framework In psychotherapy treatment with African American women, the SBW stereotype is rarely discussed or addressed. Alternatively, if the SBW stereotype is discussed in psychotherapy, the approach generally insists that women relinquish these beliefs and inherent behaviors without the skills or strategies to do so effectively. This presents a challenge due to how the stereotype is embedded in the very existence of many African American women. Liao et al. (2020) stated the SBW schema does not need to be discredited among African American women due to it being seen as a source of resilience. Instead of working with African American women to dispel the SBW stereotype, it is more important to utilize the stereotype as a source of resilience and empowerment. Created as a holistic therapeutic approach, Strength Reimagined: A Therapeutic Well-Being Framework for African American Women utilizes an understanding of the SBW stereotype and transforms the negative connotation of its key aspect of strength to improve mental well-being. Strength Reimagined offers specific strategies for psychotherapists working with African American women to improve psychotherapy treatment outcomes. Utilizing an integrated conceptual framework that draws from the lens of Black Feminist Thought, Intersectionality, and Social Constructivism Theory, Strength Reimagined: A Therapeutic Well-Being Framework for African American Women is proposed. Strength Reimagined incorporates five key aspects: therapist awareness, psychoeducation, culturally responsive psychotherapy, trauma-informed complementary interventions, and mutual support to improve mental health outcomes for African American women. The emergence of Black Feminist Thought arose during a time when mainstream feminism, while advocating for gender equality, often overlooked the unique experiences, struggles, and perspectives of African American women. Black feminists argued that traditional feminist theories and movements failed to adequately address the intersecting Alford/STRONG BLACK WOMAN STEREOTYPE 313 oppressions of race, gender, and class faced by historically marginalized African American women, leading to a need for a distinct and intersectional feminist framework (Borum, 2012; Collins, 2009). Black feminism emphasizes the importance of centering African American women's voices, perspectives, and experiences in feminist discourse and activism, and argues that the liberation of all women requires addressing the unique forms of oppression faced by African American women (Bryson & Lawrence-Webb, 2000). Key figures associated with the Black feminist movement include Sojourner Truth, Anna Julia Cooper, Patricia Hill Collins, Audre Lorde, and Kimberlé Crenshaw. Intersectionality is a concept developed within feminist theory to describe how various aspects of social identity, such as race, class, gender, sexuality, ability, and other factors, intersect and overlap, creating unique experiences of oppression and privilege for individuals who hold multiple marginalized identities (Collins & Bilge, 2020). Coined in 1989 by legal scholar Kimberlé Crenshaw, intersectionality recognizes that individuals are shaped by multiple social identities that interact with one another and cannot be understood in isolation. For example, the experiences of an African American woman are not solely shaped by race or gender individually, but when viewed through the lens of intersectionality, are influenced by the intersection of race and gender, as well as other factors such as class, sexuality, and ability (Collins & Bilge, 2020). The SBW stereotype can also be analyzed through the lens of Social Constructivism Theory, which posits that a person’s perceptions of reality are influenced by social and cultural contexts, rather than being determined by objective facts or innate characteristics (Nelson et al., 2016). Social Constructivism Theory provides a framework for understanding how the SBW stereotype is socially constructed and maintained, which is critical in offering effective mental health treatment for African American women. Therapist Knowledge and Awareness Although the United States is becoming increasingly diverse, African American women continue to face significantly higher rates of adverse mental health outcomes and obstacles to accessing care. However, the mental health workforce remains predominantly White. Shelton (2022) reported only two percent of psychiatrists and four percent of active psychologists in the United States are African American. Similarly, the Bureau of Labor Statistics reported in 2023 that approximately 70% of social workers and 76% of mental health counselors were White (U.S. Bureau of Labor Statistics, 2024). This strongly suggests that African American women who seek mental health treatment may encounter difficulties in finding a mental health clinician who shares their racial background. Many African American women desire a connection with a therapist who shares their racial and gender identity, thus meeting these preferences may improve therapy outcomes (Shelton, 2022). Before working with African American women in treatment, psychotherapists must seek to understand and recognize the complexities of the SBW stereotype, its ideals, and its beliefs. Failure to do so is detrimental to the success of mental health treatment for African American women. Nelson et al. (2016) emphasized the importance of mental health professionals seeking to understand how African American women endorsing the ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 314 SBW stereotype may conceptualize mental health treatment. This is especially important due to its impact on depression, mental health help-seeking behaviors, and overall mental health treatment (Nelson et al., 2016). Stanton et al. (2017) recommended therapists and counselors acknowledge that African American women who identify with the SBW stereotype may experience adverse mental health effects. It is crucial not to generalize or assume that all African American women will exhibit mental health symptoms. However, these findings underscore the importance of thoroughly assessing African American women in psychotherapy for negative beliefs associated with the SBW stereotype. Instead of perpetuating harmful stereotypes, therapists should assist them in understanding the drawbacks of the stereotype and in developing effective coping mechanisms. To provide effective mental health support to African American women, psychotherapists of all races and genders should acquire essential knowledge about the SBW stereotype. Enhancing this knowledge is critical to meet clients where they are in their experiences. Social workers, guided by the value of competence in the profession, can demonstrate this by engaging in a comprehensive review of scholarly literature on the SBW stereotype and concepts of intersectionality. Psychoeducation African American women participating in psychotherapy may find it beneficial to explore and comprehend the SBW stereotype. Although many African American women may conform to this stereotype, they often do so unconsciously and without knowledge of its consequences. Those who adhere to the SBW stereotype may find value in receiving psychoeducational insights into the compounded effects of stress, anxiety, and depression. Additionally, psychoeducation must encompass an understanding of the adverse effects of the SBW stereotype on both physical and mental well-being. From a social constructivist lens, psychoeducation about the SBW stereotype acknowledges the diversity of African American women’s experiences and can be used to deconstruct the socially constructed meanings and beliefs surrounding strength and resilience. This encourages African American women to question and challenge the dominant narratives and stereotypes that are inherited. Culturally Responsive Psychotherapy Interventions Within the African American community, women are frequently portrayed as symbols of strength, determination, perseverance, and resilience. While these characteristics may initially seem positive, embodying them often leads to a reluctance to accept help, ultimately fostering feelings of shame and stigma. Research has indicated that African American women who subscribe to this trope experience increased symptoms of stress, anxiety, and depression. Unfortunately, many African American women fail to recognize the correlation between their symptoms and this belief system. As a result, many African American women find themselves overwhelmed, experiencing mental anguish, and grappling with psychological distress. When these individuals seek psychotherapy with a readiness to confront issues such as anxiety, depression, and longstanding unresolved Alford/STRONG BLACK WOMAN STEREOTYPE 315 trauma, psychotherapists must employ culturally sensitive interventions for optimal treatment outcomes. Knowledge gleaned from the literature identifies ethical treatment practices that enhance mental health services for African American women. Psychotherapy interventions identified for use with African American women generally emphasize the importance of mental health professionals possessing cultural competency skills, which leads to culturally sensitive therapy (Cardemil, 2008). Social work, psychology, and counseling professional organizations require mental health professionals to engage in cultural competency knowledge and practice (Shelton, 2022). Cardemil (2008) defines cultural competence as a learned or taught skill encompassing an awareness of different cultural and ethnic backgrounds and an understanding of power, privilege, and oppression. Cultural competency improves outcomes for diverse client populations (Cardemil, 2008). Cultural competency involves knowledge about different cultures, awareness of one's own cultural biases and assumptions, and the skills to adapt interventions and services to be culturally appropriate. Cultural humility is a lifelong process of self-reflection, critical self- awareness, and acknowledgment of one’s limitations, biases, and assumptions (Shelton, 2022). As a result of the pervasiveness of strength among African American women, research further indicates that psychotherapists providing mental health services to African American women must specifically exhibit competence and sensitivity to the cultural aspects of the SBW stereotype (Nelson et al., 2016). Scholarly literature identifies interventions that are culturally responsive or trauma- informed, but it is challenging to find interventions that incorporate components of both. Culturally responsive, trauma-informed therapy acknowledges that individuals hold multiple intersecting identities that interact to shape an individual's experiences of privilege and oppression. By recognizing and validating the complexity of client identities, therapists can better understand their lived experiences and tailor interventions to meet their diverse needs. African American women would benefit from psychotherapy interventions such as mindfulness-based cognitive behavioral therapy (MB-CBT) and culturally responsive cognitive behavioral therapy (CR-CBT). Cognitive behavioral therapy (CBT) is a well- researched evidence-based treatment that is highly effective in the treatment of anxiety, depression, bipolar disorder, and other mental health diagnoses (Zigarelli et al., 2016). By learning to restructure negative thought patterns, clients can change how they feel. Historically, much of the research and clinical trials for psychotherapy interventions have focused on samples of White participants, resulting in a lack of racial and ethnic representation. CR-CBT aims to resolve this, by integrating ethnic and cultural values, beliefs, and considerations into treatment delivery (Zigarelli et al., 2016). Mindfulness- based interventions promote stress regulation, increase overall health symptoms, and improve coping skills (Watson-Singleton et al., 2019). Therefore, MB-CBT further expands traditional CBT by incorporating mindfulness meditation practices such as body scan, mindful breathing, and mindful movement. The positive benefits of culturally responsive psychotherapy options are well documented and show that therapy is most effective for racially and ethnically diverse clients when individualized to their specific needs (Zigarelli et al., 2016). In addition, psychotherapists working with African American ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 316 women must take extreme caution to avoid therapeutic ruptures related to a lack of cultural competency, such as possessing racist attitudes, clients feeling misunderstood, clients being misdiagnosed, and lack of connection (Turner et al., 2022). Trauma-Informed Complementary Interventions Meditation and yoga practices are specific interventions to reduce allostatic load and engage the parasympathetic nervous system, ultimately calming the amygdala (Lazar, 2017). These strategies relieve stress by turning off the body’s stress response and offering the benefit of calmness, increased well-being, decreased depression, and improved mood and cognition (Lazar, 2017). The use of these techniques empowers clients to enhance their self-care practices and achieve balance, thereby averting the risk of reaching allostatic overload and experiencing adrenal exhaustion or depletion. Though psychotherapists are not commonly trained in complementary interventions, these recommendations for African American women may improve engagement in psychotherapy and reduce symptoms of anxiety, depression, and stress, highlighting the need for investment in these interventions. As stated, the use of yoga and meditation as complementary interventions is a fundamental aspect of psychotherapy. Yoga poses are a form of alternative medicine that promotes a connection between the mind and body (Javnbakht et al., 2009). Furthermore, yoga effectively reduces and manages stress-related symptoms (Javnbakht et al., 2009). Trauma-sensitive yoga may be helpful for use with African American women to eliminate skepticism of yoga. This form of yoga does not include physical assistance or touch without permission, does not use Sanskrit words, which is the ancient language of India used in yoga practice, and does not use words like relax or play to avoid re-traumatization of traumatic experiences. Trauma-sensitive yoga emphasizes empowerment and cultivates a sense of agency within the healing process, offering tools and practices that empower individuals to reclaim control over their bodies, minds, and narratives. Examples of such are the trauma-conscious yoga method and the trauma center trauma-sensitive yoga (TCTSY). TCTSY has foundations in trauma theory, attachment theory, neuroscience, and hatha yoga, emphasizing body-based yoga forms and breathing practices. Mutual Support The concept of mutual support involves individuals using their own lived experiences to offer assistance, encouragement, and solidarity to one another. Social relationships represent important aspects of support among African American women and are viewed as a vital stress-coping mechanism (Nguyen et al., 2019). Furthermore, research indicates that social relationships, family, and church support protect against depressive symptoms (Nguyen et al., 2019). Examples of support include emotional support, which demonstrates empathy, compassion, and concern for others. Information support includes offering advice and guidance. Appraisal support involves sharing information helpful for self-reflection, and instrumental support is administering tangible aid, such as financial assistance, childcare, or transportation (Nguyen et al., 2019). Mutual support through a social constructivist lens involves recognizing the role of social interactions, shared meanings, cultural contexts, and building community. Therapeutic examples of mutual support may Alford/STRONG BLACK WOMAN STEREOTYPE 317 include group counseling and peer support groups or may involve African American women seeking and developing affinity support groups of choice with a focus on offering and receiving support from one another. Conclusion The SBW stereotype is characterized by a model of strength, and while initially perceived favorably, results in increased symptoms of anxiety, depression, and stress among African American women. Psychotherapy treatment with African American women requires a comprehensive understanding of the social, cultural, and systemic factors that shape their mental health experiences. Thus, psychotherapists are charged with identifying these complex needs and utilizing the most effective interventions. Strength Reimagined: A Therapeutic Well-Being Framework for African American Women leverages the concept of strength woven into the SBW stereotype and enhances resilience and empowerment among African American women. Utilizing Strength Reimagined can enhance the scope of psychotherapy treatment available to African American women, addressing detrimental help-seeking patterns and enhancing treatment continuity and effectiveness. By embracing a holistic approach to mental health, encompassing physical, mental, emotional, and social dimensions, Strength Reimagined empowers psychotherapists with the necessary tools and insights to foster holistic well-being among African American women. Implications for social work practice include adopting a client-centered approach by prioritizing the needs, preferences, and strengths of African American women. Social workers must acknowledge the intersecting identities and experiences of African American women and how they may influence their mental health and well-being. Social workers should advocate for systemic changes to address the structural inequalities and injustices that contribute to mental health disparities among African American women. This could involve advocating for policy change, community resources, and increased use of culturally responsive services. Social workers should also prioritize their knowledge of cultural competence, cultural sensitivity, and cultural humility. As the largest group of mental health providers in the United States, clinical social workers play a critical role in implementing culturally responsive and empowering approaches to therapy that promote the mental health and well-being of African American women. References Abrams, J. A., Hill, A., & Maxwell, M. (2018). 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