The structural influences on cognitive-behavioral therapy (CBT) with Black individuals may vary by gender, geographic location, and historical context. This chapter discusses the use of CBT and the RESPPECTUS principles with Black American men, women, and Black diasporic groups in several continents and countries. Regarding Black men and women, key components of the RESPPECTUS principles are viewed in the context of sex and implications for CBT are described. The importance of respect and dignity for maintaining empathy with Black men is discussed. Structurally determined Black male health disparities, barriers to accessing social support, and other CBT-relevant factors are discussed. The Strong Black Woman Schema is explained with regard to identifying and mobilizing Black women’s strength and resilience. Cognitive-behavioral coping skills for challenging the Strong Black Woman Schema are described. The RESPPECTUS principles and their implications for Black diasporic individuals in Canada, South Africa, and South America are described.