How Politics Pervade the Practice of Therapy

A new qualitative study explores how therapists engage with politics in therapy.

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1904

Despite mounting calls to integrate social justice into therapeutic work, much of the literature on psychotherapy falls short of directly addressing politics and political systems. New qualitative research by counseling psychologist Laura Anne Winter at the University of Manchester sheds light on the different ways therapists understand and experience politics and “the political” in their work, highlighting the complex connections between politics and therapy.

“The fact that the therapeutic relationship is viewed as political raises questions about whether or not therapy itself might be viewed as quiet activism,” Winter writes. “Nevertheless, therapy also has the potential to perpetuate oppressive systems and discourses around social justice in therapy might themselves be argued to constrain social change… This suggests, therefore, that training providers should shift their focus away from ‘diversity and difference’ and towards challenging oppression, discrimination and inequality, and explicit consideration of p/Politics and therapy.”

The intersections between politics and psychotherapy are numerous. Psychotherapy is represented in political discourse and whether it is prioritized within healthcare systems is often the result of public policy. In addition, the practice of psychotherapy is value-laden, and the values inherent in the field can come into conflict with the political forces in society. There is also a politics of mental health within the field, whereby different approaches and philosophies compete for power over discourse and resources.

There is also the engagement, or lack thereof, with political topics in the clinic itself. Since the Trump presidency, therapists have reported thinking more about the role politics plays in the therapeutic relationship. While all of these intersections are well worth teasing out, there is a gap between how mental health workers and advocates think about how politics show up in the course of therapeutic treatment (which may itself be considered political).

Winter’s study inquired into how therapeutic practitioners working in the U.K. understand and experience politics in their work. The research produced five major themes about the nature of therapeutic work and appropriateness of political topics, the importance of checking political baggage at the door, and the impact of a ‘culture of silence.’

A qualitative approach using reflexive thematic analysis was applied to an online survey of 32 open-ended responses to questions about the impact of politics on themselves, their clients, their practice, and how well equipped they felt to manage these aspects of their work.

The first theme constructed from the analysis was “swimming against the tide: working against p/Politics in therapy.” The analysis indicated that therapists view their clients’ difficulties as often rooted in political states of affairs, as in austerity policies and Brexit. A smaller thread in the accounts pointed out “the influence of social power and identity politics on their clients’ lives (small p politics), and the interlinking of such identities with Politics and Governmental policy (p/Politics).” For example, one therapist explained:

“Much of the suffering endured by my clients has a basis in politics. I worked as a therapist for two decades in a very poor area. I have seen the impact of neoliberal policy in thousands of ways… I have worked with many clients who have been impacted by policies which reduce their benefits, put them through humiliating assessments, or deny them benefits payments for months, which results in them being unable to pay their bills or feed their children.”

The impact of politics on well‐being, seen by therapists, was not only about Government and social policy but also about social identities and intersectional oppressions and how these two understandings of p/Politics come together.

The analysis also suggested that the political had an emotional impact on the therapist, with some expressing excitement and hope and its association with fear, despair, dread, and anger.

The next theme was “therapeutic work as p/Political,” denoting therapists’ political conceptualization of their work in sessions and the structure of the profession itself. The motivation and purpose of the work and accessing therapy as a practitioner or client were political in nature for many respondents. Participants note that politics is implicated in the way that different identities shape the therapeutic relationship:

“There is a power relationship between therapist and client with the therapist more powerful. Identity, cultural and economic issues (race, gender, sexuality, class) permeate and shape the therapeutic relationship.”

The notion of ‘parking our impressions of politics at the door’ arose too. Therapists rarely spoke with clients explicitly and overtly in sessions, noting that the client always broached it when this did happen. In this vein, many believed that the therapist should avoid political topics so that potential disagreements do not weaken the therapeutic relationship.

Related was the need to strike a balance between professional ethics and p/Politics. Therapists wrote of hoping that clients understand that their professional ethics come before their political opinions and that they felt great tension when considering the social impacts of their client’s political views. Some suggested that engaging with politics in therapy was itself an ethical requirement for them personally.

“… counselors often say we shouldn’t be political, but the act of going to therapy is political. The experience of depression or anxiety can be thought of as a reaction to political ideas, e.g., to remove someone’s benefits or to persecute or discriminate against them. We have to face these things and be able to hold all of them for our clients ‐ we are holding the political. It is scary and a burden, and an ethical requirement.”

Finally, the theme of ‘A culture of silence’ denotes therapists’ lack of training and support in dealing with political elements of their work. They described shortcomings of diversity training, such as the absence of political discussion within the profession.

“P/politics is both something that comes from the outside in and influences the process and something inherent to the process of therapy itself… This analysis, therefore, extends research that has considered only the impacts of big P, electoral politics in the therapeutic space.”

The author noted inevitable selection bias in that respondents are likely much more interested in the topic of social justice and psychotherapy than those who passed over the call for participation.

Together, these themes show that therapists have a multidimensional understanding of politics and its significant influence on their work. They draw on these dimensions variably in understanding different tensions and situations. Therapists’ experience of politics in therapy is also complex and full of ethical quandaries for which initial training and support is experienced as insufficient.

 

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Winter, L. A. (2021). Swimming against the tide: Therapists’ accounts of the relationship between p/Politics and therapy. Counseling and Psychotherapy Research https://doi.org/10.1002/capr.12401 (Link)

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Emaline Friedman, PhD
MIA Research News Team: Emaline Friedman received her doctorate in Psychology from the University of West Georgia in 2019. Her forthcoming book Internet Addiction: A Critical Psychology of Users argues that we are all implicated in Internet excesses as a function of social power under capitalism. Against pathologizing this, her work advocates for data ethics in tech. She is currently pursuing a Master's degree in Counseling.

12 COMMENTS

  1. No doubt, “Politics Pervade the Practice of Therapy.” Given the fact that all my so called “mental health” industry believed that distress caused by 9/11/2001, and the never ending wars that event brought about, was distress caused by a “chemical imbalance” in my brain alone.

    I had no idea the “mental health” workers harbored such an insane belief system, until I picked up my medical records from my former psychologist, and she confessed her insane “chemical imbalance” belief system to me.

    But the truth be told, psych drugs don’t make a person believe in the virtues of never ending wars, nor a government behaving in a completely fiscally irresponsible manner.

    And I’m not certain why anyone would want a relationship with someone who believed, “There is a power relationship between therapist and client with the therapist more powerful.”

    I believe all people are created as equal, thus I don’t want a relationship with someone who believes they should have power over me. And I’m quite certain an industry that believes they should have power over their clients, is a very anti-American industry.

    Plus when one can point out that the “therapists'” ADHD drugs and antidepressants can create the “bipolar” symptoms. And that their antipsychotics can create their “schizophrenia” symptoms, via anticholinergic toxidrome and neuroleptic induced deficit syndrome. And that none of the “therapists'” DSM disorders have any scientific validity. And that the psych drugs are killing “8 million” people every year. And that the vast majority of their clients are innocent child abuse survivors – NOT “dangerous” people, as the psychiatrists defame their clients to the world – meaning that the “therapists'” primary actual societal function is aiding, abetting, and empowering child abusers and pedophiles. And all this systemic child abuse covering up is by DSM design.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/
    https://en.wikipedia.org/wiki/Toxidrome
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders.shtml
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Well, information is power too. And when the truth about the psychiatric and psychological industries is pointed out, the “therapists” no longer look too classy. And our society should think twice about giving them any power whatsoever. Since, I hope and pray, the majority of people don’t really want to be living in the systemic child abuse cover uppers’ “pedophile empire.”

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

    We can, and should, work to bring about a better world instead.

  2. When you walk into any office and leave there thinking there is something wrong WITH you, a thing has been done to you, and it is illegal.
    The illegal thing being done to you is discrimination.

    It is no longer okay to make people think, or keep thinking that they are defective somehow.

    • What we see as a bug others see as a feature. Besides selling drugs and giving psychiatrists the mirage of being real doctors, blaming “chemical imbalances” provides a scapegoat. One where those pointing out the fabrication of chemical imbalances can be waved off as “shamming genetically/mentally/biologically ill people.” It’s a brave new world where labeling someone as inherently defective to get them to take deadly addicting drugs is considered supporting them.

    • “It is no longer okay to make people think, or keep thinking that they are defective somehow.”

      When, and why, was this unethical behavior ever declared “okay?”

      “It’s a brave new world where labeling someone as inherently defective to get them to take deadly addicting drugs is considered supporting them.”

      And now the pharmaceutical industry is fear mongering the entire world into believing they all need to be vaccinated, with untested “vaccines,” of which they have zero liability. It’s all just sick and wrong.

      • Got your “vaccine passport” yet?

        Many are saying that to call this a “vaccine” is a misuse of the term, and that what it actually amounts to is experimental “gene therapy” being tested on a global scale. Apparently there are too many “side” effects being reported to keep track of — curiously, more in younger than older people. Maybe because the old people COVID has passed over have stronger immune systems?

  3. As Fredric Jamison brilliantly laid out in his book “The Political Unconscious”, every last area of our lives is political. My experience with psychotherapist is that they will defend or remain silent to whatever their client is unconscious of “and to”, nevermore so than when that unconsciousness is a violence (betrayal or egregious constitutive injustice from which undeniable psycho-social and emotional injury occurs) that is in direct or indirect opposition to the cultural, social, economic, et al., interest of the psychotherapist personal and professional interest, all the way to the “power’ end point. When I look back at my psychotherapy from the mid-nineties, and factor the difference in my education and overall awareness-and their lived experiences, including significant reclaimed “political unconsciousness” (i.e., childhood violence and betrayal I suppressed from recognizing beyond internalized personalization’s, etc.), I now realize my psychotherapist breathtaking complicity to that violence. I suspect that my psychotherapist, like most mental health “professionals”, viewed their professional success as getting me back out into the bewildered herd (society) with renewed vigor, and ever the more personally and politically unconscious vis a vis “our psychotherapy”.

  4. One psychiatrist I saw for six years, once a week for 50 minutes and who I paid out of pocket (I was a secretary and a single mother), was Yale educated, still Yale affiliated, lived in a rich suburb of New Haven, was the Commodore of the New Haven Yacht Club, prescribed a ridiculous amount of drugs over that six year period, beginning with Prozac and ending with Adderall, everything from Klonopin to Wellbutrin to Paxil in between, kept no records of the treatment, not even of the drugs he had prescribed, then passed me on for “a consultation” with a psychiatrist who recommended ECT (I was already well on my way to hell, this was just the beginning).
    When I found out the psychiatrist had kept no records for 6 years, I spoke up. I contacted the American Psychiatric Association and tried to file a complaint. They claim to you done nothing wrong. The psychiatrist to suggested the ECT claimed that the first psychiatrist and not keeping any records “was trying to protect you”. No one was trying to protect me. No one made any effort to protect me. But plenty of people protected him Mr Commodore of the yacht club who was too busy commodoring the yachts to bother writing down what drugs he was prescribing. And speaking up earned me a new diagnosis:. Borderline personality disorder.
    It’s all political.

    • It used to be called Treason. Even if you did not speak up, if they sensed any ability to be able to speak up, in a person, or if the people or person disagreed, you went back to poordom, the castle lockup, or off with the head.
      When you speak or resist power, or do not subscribe to simplistic moronic splaining, in women, still now, it is not desirable.

  5. I have no problem with people discussing how psychology, or the “mental health” system, relate to politics. But my perception is that most people don’t understand the various aspects of politics or the various aspects of spiritual existence well enough to bring much clarity to this issue.

    One meaning of “politics” concerns governance, policy and control. Here we see the interplay between those who see freedom as the more workable principle and those who see slavery as the more workable principle. One of our biggest problems with “mental health” currently is that it appears to be firmly in the slavery camp, even when it gives lip service to the contrary. Blaming it all on the brain is not liberating. Validating the role of Spirit could be liberating.

    Another meaning of “politics” concerns one’s personal sense of power in various situations, whether or not they are overtly competitive. Can one stand up for what one believes is right or best or workable at work or at home? I believe that a central goal of “mental health” should be to increase one’s sense of personal power, or certainty; self control. The current trend seems more geared to “helping” people fit in.

    And then we have the meaning of “politics” involving political parties, social justice issues, and events that come up and affect us in various ways. The amount of deception involved in many of these activities is seldom fully recognized. Here, I think the ideal goal for “mental health” would be to help each individual get up to the point where they can freely make up their own mind about each issue that presents itself, fully cognizant of the likely underlying power plays that result in distorted information (“fake news”) and similar attempts to influence public perception and opinion. Here the actual emotional state of the individual is very important. Someone who is fearful will react very differently than someone who is cheerful, when presented with the exact same event or set of facts.

    All these aspects of politics interact and they are all relevant to the subject of mental health and Spirit. But where discussions of mental health or psychology don’t even take Spirit into account, the likelihood that those discussions will result in any conclusions that are useful or workable is small. We might as well be talking about sports or the weather.

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