What feminist therapy taught me about living with anxiety and depression

A Golden Retriever jumps to take a ball from a woman on Recreio dos Bandeirantes beach in Rio de Janeiro, Brazil, August 30, 2015.
A Golden Retriever jumps to take a ball from a woman on Recreio dos Bandeirantes beach in Rio de Janeiro, Brazil, August 30, 2015.
Image: Reuters/Sergio Moraes
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When I was 18, I moved to Chicago to start my freshman year of college. I was thrilled to be in a big city and full of optimism about my classes. But as the year unwound, I began dealing with anxiety and depression—and found myself in the midst of an emotionally and psychologically abusive relationship. The relationship, and my mental illness, would go on for years before I got help.

One day in my early 20s, after yet another painful argument with my boyfriend that sent my anxiety skyrocketing, I called a local women’s health collective. I left a message on the counseling department’s answering machine. “I shouldn’t have waited so long to ask for help,” I said, “but I don’t know what else to do.”

I’d tried therapy before, without much success. But the women’s health collective introduced me to a new form of treatment: feminist therapy. As one of the millions of American women who struggle with anxiety and depression, I came to understand that my mental health struggles did not exist in a vacuum. Living in a sexist society necessarily impacts the way that I, and many other women, process our experiences and emotions. The therapeutic work that arose from this simple premise saved my life.

Sexism isn’t always the root cause of the mental health problems that women face. But there’s no doubt that it adds mental anguish to women’s lives in a number of ways—from the gender pay gap to rape culture to shouldering a disproportionate amount of household and caregiving responsibilities. Women of color have it even worse, as Morgan Parker writes in a 2016 op-ed for the New York Times. “Every time I tell myself that I am worthless,” she writes, “how do I know whether it’s me thinking it, or the white voices I’ve internalized?”

It makes sense that over time, these forces can wear a person down, as well as exacerbate existing clinical mental health issues. Today, women are twice as likely to be diagnosed with an anxiety disorder than men. The same is true of depression. Ignoring sexism when treating these issues is dangerous, according to Abigail Conley, who teaches counseling and special education at Virginia Commonwealth University. “If you don’t take into account the barriers that folks face, then you’re not really looking at the full story,” Conley says. “So for women, of course, sexism absolutely is going to impact their experience.”

Unfortunately, mainstream psychology frequently neglects to consider the ways in which women’s mental health issues may be responses to a patriarchal culture. In a 2016 New York Times op-ed, “Why Do Girls Tend To Have More Anxiety Than Boys?,” psychologist Leonard Sax acknowledged that girls’ higher rates of anxiety may be tied to specific experiences that are the products of sexism—for example, girls are more likely to learn to hate their bodies, obsess over their looks, and have an unhealthy relationship to social media. Yet Sax never directly identifies a sexist culture as the root cause of stress for girls, despite the fact that the crux of his argument tap-dances around that very point.

By contrast, feminist therapy—an approach that first arose during the women’s movement of the 1960s—attempts to put these experiences into context. The psychological practice, informed by relational-cultural theory as well as several others schools of thought, aims to help patients understand how biases like racism, sexism, and homophobia can contribute to their mental distress. It also accepts that specific iterations of misogyny—such as sexual assault or emotional abuse—are part and parcel of a broader system of sexism.

“Patriarchy hurts everyone,” says Rhea St. Julien, a practicing feminist therapist. “But for women and nonbinary folks, it is particularly harmful psychologically, because we have been taught to gaslight ourselves when we suspect sexism is at work. So a big part of my work is pointing out, ‘Hey, you’re not crazy, it’s the patriarchy! This is sexism at work, in your life.’”

For example, many of St. Julien’s female and non-binary patients suffer from imposter syndrome—the overwhelming feeling that they are inadequate and less intelligent or deserving than their peers. “This is intimately linked to the patriarchy, and the ways our system is set up to disbelieve women,” she says. When St. Julien treats patients with imposter syndrome, she puts a focus on “pointing out the ways the greater society implants these ideas that they are not good enough.” Once her patients understand the culture that has shaped their feelings of inadequacy, they are in a better position to address those feelings.

Feminist therapy also places an emphasis on the emotional effects of living as a woman within a rape culture. “When you’re looking at an adult woman and her experiences with anxiety and depression,” Conley says, “it’s hard not to think about trauma, because that’s a part of it. Once you’ve experienced trauma, is it that you have a diagnosis, or are you healing from things that happen to you?” Even for women who never experience sexual abuse or rape, the looming threat of sexual assault—and consistent exposure to degrading images of, and language about, women—can be exhausting and depressing, resulting in both mental and physical distress.

For me, this idea was life-changing. Feminist therapy prompted me to examine my relationships with others—and my relationship with myself—through a new lens. While I had embraced a feminist worldview long before I sought therapy, I clearly needed a professional to help me connect the dots between what I knew to be true intellectually and what was happening to me in my relationships.

Most therapy offers patients a space to discuss their personal experiences. As it turned out, I also needed help contextualizing them. With the help of a therapist who accepted my feelings as valid and encouraged me to find ways to advocate for myself and my humanity, I was able to see my situation more clearly. In time, I came to admit that I was being abused and manipulated by my partner. And I was able to eventually cultivate the confidence I needed to end the relationship and begin to heal.

Today, I still struggle with anxiety and depression. But I’ve learned to recognize and manage my triggers in healthy ways. I know now how to identify patriarchal behaviors that make me feel demeaned or devalued—and I have both the will and the desire to keep toxic relationships out of my life.