Therapeutic Activism

The anomaly of 2020 is that we began to glimpse just how different our experiences are through the experiences we shared. Family therapists have long used anomalies in therapy as the sparkling moments to generate workable goals and lasting change. For systemic thinkers, the anomalies of 2020 can catalyze our collective change, away from political neutrality and into sincere and compassionate political activism.

The politics of therapy

One of the most significant barriers to therapeutic activism is therapists’ desire to be apolitical. However, family therapy is political, and acknowledging this, or not, is a political act (Jordan & Seponski, 2018a). Politics implicitly frames mental health in the U.S., and diagnoses and treatment are implicated in legacies of oppression (Gattuso, 2020). While we may see ourselves as agents of change, to many, we embody social control.

We also cannot distance ourselves from politics when our practices occur in tandem with overlapping policies (Jordan & Seponski, 2018a; 2018b). Social policies, such as healthcare and welfare programs, affect the clients we see and how we see them. Legislative principles and decisions influence our funding sources, the models of therapy we use, and how we access clients. Our codes of ethics are policies developed by our regulating bodies (to protect the public) and our professional organizations (to protect the profession). Finally, our personal policies, informed by our beliefs, biases, and morals, drive the clinical and professional decisions we make. In these personal policies, we decide whether we can be professional and political or remain therapeutically neutral.

Therapeutic neutrality

Therapeutic neutrality tells us to leave our politics at the door and not impose our values on our clients. This biomedical stance suggests that someone is ill, and we have an objective cure. We attempt to cleave the political from the professional to avoid overstepping boundaries, harming clients, interjecting self, and damaging reputations (Jordan & Seponski, 2018b). Yet, recognized or not, our ideologies are always in the room and in conversation with our clients’ beliefs. Presenting as an apolitical therapist ignores our clients’ political realities and identities while hiding our own; yet erasing neither. Just as early family therapists recognized the effects of the family system on the client, we need to seriously think about and discuss the effects of living in an unhealthy ecosystem.

The political world of our clients

Frequently, our clients describe problems that are really spillover effects of political disenfranchisement. The chronic stress experienced from politically-mediated phenomena such as poverty and racism can be internalized as shame, guilt, anger, and depression. For example, we see the internalization of living in a patriarchal and heterosexist system that does not believe survivors or hold perpetrators to account when our clients struggle with shame over a sexual assault. Political distress can also be relationally externalized. For example, when a couple will not separate, fearing racist stereotypes of unwed Black parents as deficient and negligent. If I were only to address symptoms or suggest parental training, I become complicit in clients’ disenfranchisement. Ignoring politics in therapy can reinforce social oppression, placing the responsibility for change (and thus the problem) solely on the clients.

We have also seen the rise of anxiety and depression, linked to the vicarious witnessing on social media. We continually witness and feel both hopeless and helpless to the pain of others as we doom-scroll (Paulsen & Fuller, 2020) through the unending display of politicized issues. We must be prepared to act when clients come into our office distraught over children’s caging and family disruption at the southern border. How do we respond when we hear about a client’s sleepless nights replaying images of over a million animals that died in Australia from climate-induced fires? What do we do when a young client asks if they can trust the police after learning that Breonna Taylor was murdered in her sleep? Do we turn our attention to symptomology, treating the news as a “fact of life,” or do we highlight and deconstruct the injustices witnessed?

Since the 2o16 election, families who previously appeared to “agree to disagree” are cutting-off and distancing from those with opposing beliefs. Even if our clients do not directly argue politics in front of us, we witness micro-exchanges that mirror the political divide.

While previously, we may have avoided overt political conversations, they have entered our practices with growing intensity over the past four years (Solomonov & Barber, 2019). Clients increasingly express politically-induced self-harm through binge eating, drinking, and suicidal thoughts. Political news, interactions, and stances have damaged friendships, family relationships, work, and overall psychological wellbeing. Since the 2016 election, families who previously appeared to “agree to disagree” are cutting-off and distancing from those with opposing beliefs. Even if our clients do not directly argue politics in front of us, we witness micro-exchanges that mirror the political divide. As families argue about Black Lives Matter yard signs, the use of face masks, or refuse to recognize a family member by their correct pronouns, do these moments slip past or do we use them in performative practice to foster growth?

Therapeutic activism

There are multiple levels of political involvement where family therapists can intervene. I and others have written about the need for policy-oriented therapists who work in the public sphere to sway opinion and legislation to promote our clients’ and the profession’s wellbeing (Jordan & Seponski, 2018a; Morgan, Jordan, & Goodman, 2019). Therapists can also engage in therapeutic activism through conversations with our clients and colleagues who call out and advocate against injustice. From Minuchin’s (1999) focus on political action and institutional disempowerment to White and Epston’s (1990) focus on the sociopolitical construction and deconstruction of problems, family therapy models have positioned the healer as a therapeutic activist.

Therapeutic activism occurs when we assist families in the therapeutic space to have politically-difficult conversations. As therapists, we hold multiple experiences of reality and encourage listening to understand differences. With these skills, we can discuss the social factors that perpetuate distress and harm to aid family growth and regeneration. We can also work in solidarity with clients grieving a family who does not accept them. Therapeutic activism also recognizes that family therapists are affected by many of the same stressors and disparities as our clients. It is a political act to orient towards confronting sociopolitical injustice to support our wellbeing and that of our colleagues.

From neutrality to advocacy: Overcoming barriers to political engagement

While the contexts and engagement-needs for therapeutic activism or advocacy in the public forum differ, the barriers remain similar. Several external barriers to political engagement, such as not having enough time (see Jordan & Seposnki, 2018b for a discussion), exist. Yet, it is the internal barriers that most challenge our genuine engagement. Therapists express feeling unknowledgeable (not knowing enough about an issue or legislative/political processes), feeling discomfort (being uncomfortable getting things wrong, being seen as political, or in representing others and issues), and a lack of agency (feeling unable to get things done). In a country that removed civic responsibility from the education system, and in a profession that does not typically engage our political-selves, it is natural we would feel uncertain, uncomfortable, and inefficacious. The barriers in this article are many, and we can lean on the available resources to help us confront them (e.g., www.thepraxislab.org/resources).

In the U.S., civic discussion has been reduced to polarized arguing and violence, and entering this landscape can be uncomfortable. Inviting political conversation into therapy clarifies what is already there: the potentially diverse beliefs between therapist and client. It is a vulnerable move, opening therapists to clients’ anger, pain, and mistrust. Conversely, if we avoid these conversations, we ask our clients to hold their political pains in check to prioritize our comfort over our clients’ healing. The ability to become comfortable in discomfort means that we must ‘do our work’ to do this work. Clients’ sociopolitical pain and anxieties may trigger our own. We must be aware of our hot-button issues to respond from a place of political-humility rather than anger, guilt, or fear. When we work with clients who hold perspectives contrary to our own, we must balance our responses to focus on their needs. However, if clients’ views are openly discriminatory, we must not complicitly condone bigotry. We can also do our work by moving in the public forum to work against injustice (see Jordan & Seponski, 2018a for a discussion). No matter the system in which we intervene, we must be committed to continued learning and growth about ourselves and social issues.

In a year where so many norms have been interrupted, 2020 was the year for deep reflection and considered action. More than ever, therapists can respond to society’s inequalities by becoming politically accountable to the communities in which we live and work. When so much has been lost in 2020, let us take this opportunity to improve our abilities to assist our clients. To disrupt the status quo of therapeutic neutrality, let us cultivate our political awareness, enter difficult conversations with our colleagues and our clients, and affirm the political responsibilities of our profession.

While we all experienced these things, we did not do so similarly.