How Psychotherapists Talk About Politics in the Trump Era

The Journal of Clinical Psychology recently published a piece on how therapists’ self-disclosure of political preference and perceived shared values with patients impacted the therapeutic alliance. They found that 87% of therapists said they discussed politics during sessions, 63% reported political self-disclosure and those who perceived political similarity with patients were more likely to have political discussions, self-disclosure, and a higher self-rated therapeutic alliance. At the time of the study, Clinton-supporting therapists reported their clients showing increased political discussion and negative emotions following the 2016 presidential election, with the opposite for Trump supporters.

“The results of our study suggest that therapists’ political views have a significant effect on their work with their patients,” wrote the researchers. “Our findings call for greater recognition of the potential impact of the sociopolitical context on in‐session therapeutic process and relationship. These findings suggest that as others have recently argued, the political discourse is an important aspect of clinical work.”

Recent research posits that the 2016 presidential election has had detrimental effects on the psychological well-being of youth and adults. This study is the first to investigate how Trump’s tenure has impacted the therapeutic relationship from the therapists’ point of view.

A 2018 study from the same authors showed that two-thirds of patients reported political engagement with therapists, half of the patients wanted to speak about politics more frequently and that two-thirds of patients reported their therapist disclosed their political views either implicitly or explicitly. Moreover, patients reported a better therapeutic alliance when they perceived their therapist as sharing their political views. There is, however, limited work on the effects of politics on the process of psychotherapy.

Previous studies have shown that political differences between therapists and patients negatively impacts therapists’ empathy to their patients. Others suggest that therapists report better outcomes for patients who show a change of values in line with their therapists’ values.

From back in the time of Freud, therapists have been told to avoid the dangers of self-disclosure, though significant shifts in this line of thinking have occurred recently, with studies reporting self-disclosure as a means to create a genuine connection to clients, as well as increasing therapist warmth and liking.

The current study aimed to understand therapists’ perspectives on how the current political climate has impacted therapy and patients’ and therapists’ experiences.

“[W]e predicted that at least two‐thirds of therapists will report political self‐disclosure, and that such disclosures would contribute to a stronger therapist‐reported alliance,” wrote the authors. “We also predicted that… therapists who perceive political similarity with their patients and experienced their in‐session political discussions as helpful would perceive their therapeutic alliance with their patients as stronger.”

“Finally, we hypothesized that… therapists who self‐identify as Hillary Clinton supporters would report a preelection/postelection increase in political discussions with their patients, whereas therapists supporting Donald Trump will not report such increase. Additionally, as patients who self‐identified as Clinton (but not Trump) supporters in our first study reported increased negative and decreased positive emotions expressed in session toward the Trump administration, we predicted therapists will report similar trends about their patients’ emotions during psychotherapy sessions.”

The authors solicited therapist responses to an online survey through listservs, websites, social media, community clinics, and by scouring Psychology Today. The authors aimed to recruit a diverse background of therapists and ultimately collected 268 verified responses. Of these 268, 62% self‐identified as Democrat, 7% as Republican, 23% as Independent, 4% as other, 3% indicated no political preference and 1% did not respond.

Therapists answered questions about the therapeutic alliance, their and their clients’ political orientation, political self-disclosure, the similarity of their political views to their clients, clients’ emotional expression before and after the election and on whether a number of political topics, such as distrust of the government, were discussed in their sessions.

Results showed that 87% of therapists reported having spoken to clients about politics in the last three weeks, that they spoke with about 44% of clients about politics, and that they agreed with 58% of their clients’ political views. Those who believed their clients shared their political orientation were more likely to discuss politics in-session and reported stronger therapeutic alliances.

Therapists who reported explicit disclosure of political stance, as compared to those who did not disclose and those who implicitly revealed, reported the highest levels of the therapeutic alliance. In-session political agreements had a mostly (69%) positive effect, while disagreements had a mostly neutral (68%) or negative (18%) effect.

“Therapists who indicated they voted for Clinton reported significant pre-post increases in political discussions in all the topics investigated in the study,” report the authors.

“In contrast, no significant differences were found for therapists who reportedly voted for Trump… Specifically, this group reported increased discussions on distrust of journalists and the media, policies that affect women, and social and health benefits. They also reported observing a decrease in their discussions with patients about the following topics: distrust of the government; education policies; immigration policies; environmental policies; foreign policies; government regulations; tax, military, and defense policies; and controversies regarding police behaviors.”

The authors conclude that, despite traditional views suggesting self-disclosure can be harmful, therapists who reported explicit disclosure of political views and who saw such discussions as positive had higher reported levels of the therapeutic alliance. Future studies, the authors suggest, should investigate therapists’ and patients’ perceived quality of the therapeutic alliance and political attitudes, examining whether divergence in the quality of alliance is related to the divergence of political views.

The study is limited by its small number of Trump-supporting therapists (9% of the sample), despite efforts to recruit in Republican-leaning counties. Additionally, the sample has a high degree of ethnical homogeneity (89% white), which is in line with the underrepresentation of people of color in psychology. Further, data were collected at only a single time point, which doesn’t allow for longitudinal analysis; this could be improved in future studies.

“[M]any therapists may be deeply affected by the current political climate, and thus may need support and guidance from peers and supervisors in navigating the complexities of political discussions and self‐disclosure in the therapeutic space,” the authors conclude.

“[W]e encourage psychotherapy researchers to consider the potential effects of the sociopolitical area on reports collected from therapists and patients in both controlled experimental and naturalistic settings.”

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Solomonov, N., & Barber, J. P., (2019). Conducting psychotherapy in the Trump era: Therapists’ perspectives on political self‐disclosure, the therapeutic alliance, and politics in the therapy room. Journal of Clinical Psychology, [Epub ahead of print]. (Link)