Political Therapy or Open Therapy?
Guest Post by Nina Silander and Eddie Waldrep
Dr. Waldrep is a Veteran of the War in Iraq, Purple Heart recipient, and is currently a clinical psychologist for the Department of Veteran Affairs specializing in PTSD. Views expressed here are those of the author and are not the views of the Department of Veteran Affairs. He has previously published this essay at Unsafe Science
https://unsafescience.substack.com/p/the-anti-american-psychological-association
Another essay of his can be found here.
Nina Silander, PsyD is a licensed health psychologist practicing in the Veteran Affairs system. Outside of work, she devotes time to challenging the ideological hegemony and promoting viewpoint diversity in psychology including academic and blog articles, contributions to books, presentations, and interviews on Youtube and in the media.
Political Therapy or Open Therapy
Eddie Waldrep and Nina Silander
The ‘safest space’ should be that found in therapy. We meet an unfamiliar professional, divulge our histories, and often reveal intimate parts of ourselves that we may be reluctant, even unwilling, to share with anyone else. Frequently, going to therapy happens as a last resort–when one has exhausted other means of self-help and social support.
The Politicization of Therapy
Unfortunately, the politicization of mental health professions jeopardizes the safe space of psychotherapy. This politicization is also bringing about the beginning of implicit and explicit partisan therapy services, which are fundamentally antithetical to universal professional values. Yet, the mental health needs of the politically disenfranchised must also be met. Let’s consider mental health professions’ ethical underpinnings, and then the benefits and problems associated with partisan services, before suggesting a way forward.
Each professional mental health organization has a code of ethics calling for professionals to be aware of potential biases and mitigate their possible influence (APA), to be aware of, and avoid imposing, their own values, attitudes, beliefs, and behaviors (ACA), and to not practice, condone, facilitate, or collaborate with any form of discrimination (NASW), and to prevent discrimination based on any protected categories (e.g., race, religion, sexual orientation, etc.). Psychologists have long deliberated about the incorporation of values in the therapeutic space, such that if therapists could not remain value-neutral, the degree to which their personal values (and biases) influence the therapeutic relationship and work should be minimized. This goal was to avoid causing harm to clients and to preserve client autonomy.
Mental health professions esteem ‘cultural diversity’ and, in turn, promote development of cultural humility, sensitivity, and competency. Graduate education, supervision, and training focus frequently on developing such expertise and knowledge–related to many aspects of cultural diversity, typically based on immutable or other physical characteristics (e.g., gender/sex, disability), and for many demographic groups (e.g., immigrants, native/indigenous, the elderly, etc.). Yet, at this time, sociopolitical diversity is not formally, nor even informally, recognized as a component of cultural diversity, which is striking given the extent to which sociopolitical values are a “deep culture” component of diversity.
This would not be so concerning were it not for the fact that professional mental health services, have become increasingly politically left-wing (a modest ratio being 10:1, liberal to conservative, amongst psychologists), in stark contrast to a typically even split, left-wing to right-wing, general population. Many training programs and professional organizations have shifted to encourage, and often enforce, application of and adherence to particular ideological values and beliefs popular in politically progressive circles (e.g., critical social justice or CSJ, critical theory, antiracism, DEI initiatives). This is also reflected in a 532 percent increase in politically slanted press releases from the American Psychological Association over the period 2000–2002, compared with 2017–2019. Almost 80% of those political statements leaned left, and only 3.9% leaned right.
Similarly, therapists are prompted to treat their clinical roles as (quasi-religious) activist enterprises–for example, advising clients on their privileged or oppressed statuses based solely on superficial, visible characteristics and irrespective of the clients’ concerns or reasons for seeking therapy. To some clients who share this worldview, the focus may seem incidental or empowering. But to others, it is alarmingly prejudicial and alienating. But since as much as half, if not more, of the general population do not subscribe to this belief system, then roughly half of therapy clients may feel ostracized and judged by their therapists’ approach. Additionally, some unknowing mental health professionals may adopt trending phrases (e.g., equity, privilege, allyship) without awareness of their ideological salience, thus unintentionally putting off prospective or current clients.
This dynamic of ideologically-motivated clinical practice is further worsened in consideration of the bleak attitude changes within today’s society at large. In a recent Wall Street Journal poll, people’s self-reported valuing of tolerance declined from 80% to 58% over the last 4 years. While mental health professionals ought to be especially tolerant, dispositionally and professionally, they are not ubiquitously so. Moreover, according to a 2017 Cato poll, many more conservatives than liberals experience the need to self-censor.
How Clients Cope with Politicized Therapy
Understandably, many prospective therapy clients, and/or their loved ones, have begun to seek out ideologically ‘friendly’ therapists. Concerns include not wanting to be unfairly judged by their therapists during a time of vulnerability or wanting to avoid services that may catalyze loved ones’ mental health decline (e.g., parents seeking therapists for their minor children).
Professional organizations offer little to assuage these concerns, and an unknown number of professionals are uncomfortable with and even opposed to treating clients whose political values run counter to their own. They don’t even seem aware of the problem, as Lisa Selin Davis reports:
When I told Dr. Mitch Prinstein, chief science officer of the APA, about the patients being damaged by CSJ [critical social justice], he said he had never heard of the problem. The bigger issue, he said, is therapists whose religious or ideological beliefs spur them to deny care to sexual and gender minorities. He pointed me toward the APA’s Code of Ethics, which states that psychologists should be “aware of and respect cultural, individual, and role differences” and “try to eliminate the effect on their work of biases.”
Given the extent to which progressive therapists outnumber conservatives, this seems quite extraordinary. Clients don’t want to be unfairly judged for their politics at a time when they are feeling particularly vulnerable.
How Some Clinicians Have Responded to the Politicization of Therapy
In response, some therapists, such as those listed on conservativetherapists.com (several dozen around the country, in fact) and other individual practitioners, have begun to market partisan therapy services in an effort to cater to the needs of these displaced clients. This development, albeit small, merits significant consideration on the part of individual mental health professionals, as well as their professional organizations. Should mental health professionals market sociopolitically partisan services? Consider the advantages and disadvantages:
Advantages:
Satisfies an immediate need – As described above, professional psychology, for instance, faces a number of concerns related to ideological and political bias, and mental health needs among the general population are continuous, even growing. We also know of clients actively seeking non-judgmental/ non-woke therapists.
Preserves the therapeutic relationship – Ideological congruence between therapist and client results in a stronger therapeutic relationship; whereas incongruence may weaken it. Prospective therapy clients electing services from therapists who share their values may promote eventual treatment success.
Ensures a ‘safe space’ – Relatedly, prospective therapy clients can anticipate a level of psychological security in knowing that they are unlikely to be chastised or rejected for their personal sociopolitical values. For conservative therapist-client pairs, clients’ visible characteristics are unlikely to be politicized (e.g., ‘whiteness,’ ‘maleness’), and they may feel that their stated goals actually guide their care.
Disadvantages:
Authorizes (sociopolitical) discrimination – Therapists seeking to provide politically partisan services can set sociopolitical values as a criterion of eligibility when fielding prospective clients. Additionally, immutable characteristics can become proxies for sociopolitical values when, for instance, a left-wing (progressive) belief may equate ‘whiteness’ with patriarchy and racial supremacy, thus resulting in racial discrimination.
Undermines universal professional skills and characteristics – Mental health professionals are purported to treat a relatively wide array of demographically and clinically diverse client populations. They must do so within their scope of competency, which may at times require referring clients to better-suited providers (e.g., specialized treatment for those with eating disorders). But referring based on sociopolitical diversity could result in referring out 1 in 3, to 1 in 2 clients presenting for services, regardless of other more relevant variables (e.g., mental health specific needs).
Siloes professional members and institutions – One or two primary organizations exist already for each primary mental health discipline (e.g., psychology, social work). These organizations provide a ‘locale’ for professionals to share research, review changes within the profession, exchange resources, and attend skills-based workshops. Should mental health professionals provide ideologically partisan services and pursue more explicitly and ideologically divergent research interests, it may result in schisms within the professions. Of note, some may not view this development as a disadvantage at all…
Impedes access to mental healthcare – Partisan mental health services may serve to impede access for prospective clients if sociopolitical diversity must be added to a list of other criteria for therapist characteristics and expertise (e.g., female, CBT-oriented, takes BCBS).
Casts off the sociopolitically-homeless – In the provision of partisan mental health services, self-identifying left-wing and right-wing clients may readily find services. However, because mental health is overwhelmingly left-wing, there would likely be a dearth of right-wing professionals, as well as potentially few apolitical therapists for the sociopolitically-homeless population.
Reinforces the ideological echo-chambers – Partisan therapists may inadvertently reaffirm not only their clients’ mainstream political views but those that are also maladaptive since their sociopolitical values will be shared. In sacrificing objectivity and a values-neutral (or values-filtered) approach, therapists may further promote in-group/out-group political polarization in themselves and their clients.
Limits the potential for clients’ growth – Clients may seek out therapists who share their values in part due to ‘confirmation bias’—wanting to work with someone who reinforces, and not challenges, their own deep-seated views. Similarly, research suggests that ‘selective exposure’ (i.e., focusing on information that matches one’s worldview) further cements political polarization.
Seeking out a therapist who shares one’s belief system ultimately reinforces the sense of ‘safety.’ Yet safety is a means to an end: from the foundation of a secure relationship, therapists partner with clients to explore and, as needed, therapeutically and thoughtfully challenge potentially harmful presuppositions, values, and schemas for clients’ growth and personal betterment–not because therapists have bigger political agendas in doing so.
Potential to worsen mental health symptoms – ‘Iatrogenic effects’ occur when symptoms or illness are created by the clinical assessment or intervention. For example, therapists adhering to a CSJ orientation may inadvertently reinforce an ‘external locus of control’ in clients, which can undermine self-efficacy, in turn contributing to increased anxiety and depression.
Where Do We Go From Here?
We recommend that 1) professional organizations return to distinctively ideological-neutrality and non-partisanship and 2) mental health professionals seek to advance their competency in sociopolitical diversity.
Indeed, groups of mental health professionals are seeking a return to greater sociopolitical neutrality in the professional context. Examples include the International Association for Psychology and Counseling (IAPC), which aspires to promote critical thinking over indoctrination in research, education, and clinical practice; the Society for the Open Inquiry of Behavioral Science (SOIBS), which is committed to freedom within behavioral science research; and the Critical Therapy Antidote Network (CTA Network), which seeks to protect psychotherapy from antithetical ideological values-imposition. Some practitioners are seeking to provide non-partisan, hospitable clinical services to those ideologically-disenfranchised by most current mental health professionals (e.g., Open Therapy Institute).
And for those seeking psychotherapy and other clinical services, consider interviewing mental health professionals for their openness to ideological differences. Having a good fit with your therapist is important, so take time before investing time and resources. Look for evidence of ideological partisanship, as well as cultural humility. This may be apparent from noting key words, such as a focus on social/structural explanations for health outcomes vs. a focus on the individual or individual factors.
Ideally, mental health professionals and training programs will soon return to neutrality and maintain professional boundaries when it comes to sociopolitical competencies. In the meantime, one may consider contacting networks of mental health professionals committed to universal values or even those who may advertise as open to, or are, conservative leaning. There are also many great mental health professionals who have completed their training and supervision prior to the radical shift in the orientation toward activism in the field. Your mental health is important and dedicated, compassionate professionals exist, and there will surely be more as awareness grows regarding this recent trend.
The politicization of psychotherapy is a disgraceful development. It is not only morally repugnant it is also at variance with every empirical finding on effective therapies and therapists. This is one, among many, of the reasons I am no longer a member of APA after almost 20 years of membership. The institutional rot goes deep, and as long as ideologues like Prinstein, run the show, it is highly unlikely that anything will change.
Outside psychology, we are mortified. Leaders of psychoanalytic societies routinely accuse each other of racism and sexism, declaring "Whiteness is a condition" and rampant "toxic masculinity". Among themselves! For us outside, what chance do we have?