The Role of Politics in Therapy

What role should politics play, if any?

Part I: The Politics of Individual Therapists

The way I was trained, a therapist should not allow their political beliefs to seep into their work with clients. If a therapist cannot do this in a given case, they should refer the client elsewhere. This is but one example of a much broader ethic, with a long history, that therapists ought to defer to how their clients engage with the world. The therapeutic task is about helping people process their own situation—not processing or solving it for them—and although there are many schools of thought about how this is best done, the clinical community agrees that preserving autonomy is essential.¹ Among other things, this means respecting the client’s beliefs, political or otherwise. (This is particularly true for Carl Rogers’ client-centered therapy, which makes empathy, respecting client autonomy, and unconditional positive regard the primary goals of therapy.)

I haven’t found this too difficult in my own practice, although I do get irritated once in a while when (mostly younger) clients endorse what I see as either nonsensical or unrealistic ideas. For example, one client was convinced that her boyfriend couldn’t understand her experience as a non-White person because he is White. When I asked if she would consider explaining it to him, it was clear by her reaction that the thought had never occurred to her.² Another client told me that he had been excused from school that day for a dress rehearsal at a local theater. I was shocked by this, but he saw nothing wrong with it. In fact, he thought students should be allowed to have a job instead of going to school, since, after all, a job was just another “educational experience.” Unable to help myself, I asked him how colleges might respond to that policy…which stumped him.

So, I will occasionally indulge myself, but for the most part I’m comfortable with a wide range of client beliefs. My job is to understand those beliefs and how they interact with other dimensions of the client’s life. Other people in society, and other people in a client’s life, have different responsibilities. Some judge and punish, others support, and still others persuade. Therapy is, and ought to remain, a place where clients can pause and process—that’s it. If a therapist injects too much of themselves, or has too much of an agenda, therapy ceases to be special in this very important way.

In fact, if we think about the fundamental difference between a therapeutic conversation and a political one, it might be the very presence of an agenda. In political conversations, each person shows up with a bundle of talking points and an entrenched position. Each knows what the other will say. There’s really no point to the ensuing debate except to demonstrate prowess to one’s allies.³ Perhaps this is why, whenever I am witness to one of these discussions, I have the overwhelming impression that the conversation could finish itself. Nothing new or unexpected is going to occur.

Two figures sticking it to each other.

Therapists, on the other hand, try to remain in a position of “not-knowing.” Oftentimes, they just listen, without having a solution or even reply. Of course they have opinions about what their clients should do—and quietly hope for certain outcomes—but this is ideally weighed against both the ethic of client autonomy and the power of conversations without agenda. Indeed, this absence of outside priorities might be why therapy, if conducted well, is characterized by what political conversations lack: receptivity.

Part II: The Politics of the Average Therapist

My guess is that most therapists would agree with the ideal sketched above—that political beliefs should remain separate from clinical work—even if they did not always practice that way.⁴ But even if they did, there would still be the issue that most psychologists hold liberal views.⁵ Why does that matter? Because political beliefs aren’t confined to the relationship between client and therapist; they can also can seep into and influence the field’s core beliefs and assumptions. A high level of implicit agreement is bound to manifest in various and subtle ways, from the language therapists use, to the research they conduct, to the social issues they weigh in on. Most importantly, there is bound to be groupthink at the level of clinical culture, a major factor in what the broader culture believes about issues surrounding mental health.

Think about it this way. Therapists using Cognitive Behavioral Therapy (CBT) often try to uncover “core beliefs”—the assumptions a client has about the world or themselves that influence their behavior—and assess if there is any evidence supporting those beliefs. For example, a client might not cook because she was told in 4th grade that her fine motor skills were subpar, so she’s afraid of chopping a finger off. A CBT therapist might ask if there is any evidence that her motor skills have improved, at least enough to make basic meals. The idea is to help the client form a tighter fit between behavior and reality.

Every day, therapists perform this “reality check” for their clients—but who is doing it for the field itself? In other words, who is asking what therapy’s core assumptions are and what evidence it has for holding them? As far as I can tell, the answer is: not many.⁶

So, what are therapy’s core beliefs? One example is: The more you share, the better. Another is: The more vulnerable you are, the stronger you are. These are common narratives—principles virtually every therapist would agree on—and yet there is little evidence (that I am aware of) to support them.⁷ The same therapist who would never impose their political beliefs on a client might happily tell them that “the truth shall set you free,” blind to the possibility that some truths are, in fact, better left unsaid. (Or that some things are better left alone.) The same therapist might also claim that “vulnerability is a sign of strength,” without recognizing that many people in the world interpret vulnerability as a sign of weakness, as something to be exploited.

Dwight on the dangers of vulnerability.

A conservative therapist recently addressed this point in a New York times article— that it’s possible to overshare and that boundaries (such as keeping some things to onself) can be healthy. Perhaps in part because we cannot stipulate “a healthy range” of sharing in the same way we can for blood pressure or body temperature, how much to share is largely influenced by the opinion of clinical professionals, which, historically, has been: The more the better. But even I, as someone trained in the art of saying everything, and sold on the narrative of being emotionally open, recognize this as oversimplified. The right amount of sharing and vulnerability is much more complicated.

With this in mind, my view is that therapy should be a place where people can share whatever they like, but not one where they have to. Yet many of my clients initially assume that unless they bare all, they won’t get better. It sometimes takes me a while to figure out where this comes from, but the answer is usually the same: it’s in the drinking water. In other words, therapeutic professionals and the culture at-large co-create the dominant narratives of mental health, which are suspectible to all kinds of influences. It’s hard for me to believe that the liberal views of most clinicians and researchers aren’t among those influences. And while it is impossible to predict how this shared bias might show up, the basic message is that when everyone drinks the same Kool-Aid, problems are going to arise. What’s the solution? Clinical psychology should undergo some of the same reality-testing it provides for its clients, so it can achieve a tighter belief-reality fit.

By the way, probably the most obvious core belief regarding therapy—one so obvious that, like the purloined letter, it is hard to spot—is that “everyone should go to therapy.” This has infiltrated our public thought to such an extent that some of my clients are refusing to date someone who has not “worked on themselves” with a therapist. I’ve also noticed an impasse between many clients of my generation (Millennials) and their parents. Clients are asking their parents to go to therapy as a precondition for having important conversations with them. When their parents balk, gridlock ensues. These conflicts represent some of the drawbacks to the idea that therapy is something everyone should undergo.

A final downside to political homogeneity among therapists is that conservative clients will be reluctant to reach out. Case in point, the therapist from the Times piece advertises on conservativetherapists.com. What is the equivalent for liberals? Literally any other therapist directory.

Part III: The Political Life of Clients

That last point brings the politics of clients front-and-center. Obviously, the average American is more distressed by politics—and the condition of the country in general—than they’ve been in a while. Although there is plenty to say here, I want to confine our discussion to what I see as the two biggest factors for the average citizen’s mental health: polarization and politicization.

The U.S. is currently in the midst of one of the most polarized periods in its history, with levels surpassing the peaks of other democracies and apparently growing faster than them, too. High levels of polarization mean, broadly, that both citizens and politicians are less likely to compromise with, or have sympathy for, the other side. Although polarization itself has a corrosive effect on society, its effect is amplified when combined with high levels of politicization, or the process of making what was previously unpolitical, political.⁸ In effect, when polarization interacts with politicization, the result is that more things get discussed less authentically.

To me, this argues even more strongly for the therapist’s office remaining insulated. In fact, the intensity of our political divide is why I’m writing this article in the first place. In a calmer era, this sort of piece would be unnecessary, and the practice of weaving politics into therapy would be dismissed from the get-go. In our hectic area, it bears repeating that some things must not become politicized so that we can continue to have productive dialogue about them. At Living Fossils, we believe this applies both to the practice of therapy and the topic of mental health.

1. For example, the American Counseling Association’s code of ethics lists autonomy as one of six “fundamental principles of professional ethical behavior.” Autonomy is defined as “the right to control the direction of one’s life.”

2. In one sense, I was being a bit simplistic with my question. Philosophers continue to debate which of our experiences (if any) are relatable. In fact, it’s likely that my client cannot share her experience of being non-White perfectly. Still, perfect understanding is not the standard we apply elsewhere. If I am late in meeting a friend, and try to describe the comedy of errors that prevented me from being on time, I am not looking for complete or exact understanding of my experience. “Good enough” will do. So, what I was reacting to in this client’s attitude was the assumption that identity differences cannot be bridged enough, an assumption I think is counter-productive.

3. “People who have an opinion to defend don’t really evaluate the arguments of their interlocutors in a search for genuine information but rather consider them from the start as counterarguments to be rebutted.” Mercier, H., & Sperber, D. (2011). Why do humans reason? Arguments for an argumentative theory. Behavioral and brain sciences, 34(2), 57-74.

4. That said, this article from the WSJ argues that political ideology has already infiltrated a large portion of clinical psychology, so perhaps I am behind the times.

5. Silander, N. C., Geczy Jr, B., Marks, O., & Mather, R. D. (2020). Implications of ideological bias in social psychology on clinical practice. Clinical Psychology: Science and Practice, 27(2), e12312.

6. For two examples, see: 1) Shedler, J. (2018). Where is the evidence for “evidence-based” therapy?. Psychiatric Clinics, 41(2), 319-329. 2) The Psychotherapy Myth.

7. My education certainly did nothing to dispel these narratives; if anything, it was the opposite.

8. Recent examples include vaccines, masks, and voting by mail.