Can individual therapy be a politically radical experience, given that it is generally also an economic transaction? What kind of escape from the world can we hope to get in a therapy session?
I have a few thoughts about this, speaking as a therapy patient. They start with a story.
I was pretty depressed and just starting a gender transition when I first started looking for therapy in Cleveland, Ohio. I was 36 years old and had never had an individual therapist before, but I had read some psychoanalysis in grad school, and I found a psychodynamic clinician whom I’ll call Alexis. She was decades older than me, working out of a dusty office in an old brick building, where wan daylight filtered through north-facing windows onto a few beloved office plants. I saw Alexis a couple of times, liked being in the room with her, and had gingerly started to tell her about my life and feelings.
But on the third session, I came to her office to find her on the edge of tears. I sat down in the usual place, but Alexis was visibly too upset to have a normal session. I said something like, You seem like you’re having a hard day; let’s just meet another day if this isn’t a good day for you. After a moment, she divulged that she was upset because her practice had just gotten a bad review on Google. I was a bit astonished — online reviews are always weird, spammy, unreliable; should one really take them so personally?
Alexis then asked me warily if I had written it.
Of course I didn’t, I wouldn’t do something like that, I said, taken aback by the undertone of mistrust.
We kept talking for a little while, and though I tried to help Alexis process her feelings, nothing I said got through her shell of despair. You’re not supposed to be comforting me, she protested eventually. I went home, feeling unsettled by the odd role reversal.
Alexis must have felt unsettled too. A few days later, she called me on the phone.
I wanted to tell you that after the bad review, I’m going to be closing my practice, it’s time to shut it down, she said.
But I just started seeing you, and I like seeing you, I don’t want you to close the practice, please can you keep it open a little longer? I said plaintively.
No, that won’t be possible, she responded.
Alexis proposed having a final session to transition me out of her practice. I declined, feeling hurt and betrayed, and thinking that I couldn’t see the point in paying for another session just to make her feel better.
As the therapeutic frame shattered, the scene filled up with things we don’t usually address in therapy: the therapist’s devastated anger and aggression, the enveloping forces of economic desperation, and the patient (me) pathetically trying to repair an irreparable clinical relationship. Alexis was emotionally undone, certainly, but I suspect the ego wound was worsened by underlying economic stress: as if she sensed her whole practice going under for want of clients. I can only imagine that running a private therapy practice requires a reliable clientele (what the MBAs crassly call a “sales funnel”), and that this demands a positive public reputation, which a hostile review would surely threaten. Alexis’s practice already seemed not to have a lot of remaining clients.
The incursion of the economy might seem like a rupture in treatment. It’s easy to long for a space apart, as if therapy could be somehow outside of an unsafe and dehumanizing world. It can’t be, though. There’s always an economic transaction underneath; there’s often turmoil that’s left unspoken. When the business stops working out, the therapy is apt to end. One of my other therapists used to advertise “individual psychotherpay” on their website. The Freudian slip is telling. There’s rarely any guarantee of what you get from therapy, as a patient. But there’s almost always a guarantee of what they get, the clinicians—they get paid. Until one day there’s no one still coming to pay them.
***
As a teenager, I loved confessing secrets until I went to college and read Michel Foucault. Foucault’s writing told us that therapy was a technology of power, one that makes us ritually “confess” our inner lives so that someone else (the analyst) could interpret them. “The obligation to confess is now relayed through so many different points, is so deeply ingrained in us,” Foucault wrote in History of Sexuality Vol. 1, “that we no longer perceive it as the effect of a power that constrains us.” Foucault explained that while confession was originally a church ritual, over time, “the obtaining of the confession and its effects were recodified as therapeutic operations.”
Having perceived therapy as a faintly theological “power that constrains us,” I was vehemently against it for years afterwards.
It was, in hindsight, a very self-defeating stance, which doesn’t mean that it was entirely wrong. (I’m certainly not saying that therapy should be exempt from political critique.) But on a personal level, I suffered for years without therapy, probably much more than I needed to.
I’ll spare you the rest of my life story. But eventually I married a critical psychology researcher, herself the daughter of two generations of social workers, and I did go to therapy (or was dragged). And it dawned on me that contemporary psychotherapy bore little resemblance to the confessional rituals that Foucault had described. The French radical critique of psychoanalytic therapy — their “Anti-Oedipus” moment — was basically a critique of a very different kind of therapeutic power than the one I see in 21st century Trumpian America.
The 1970s critiques of psychoanalysis were protests against the accumulated power of clinical elites. I can readily picture an analyst like Jacques Lacan abruptly ending sessions after a few minutes, just to assert dominance over the clients, and then leaving to spend a peaceful weekend at his fancy country home. “In France,” Foucault observed snarkily in 1975, “psychoanalysis… has always been and still is an elite, expensive form of medicine… When psychoanalysts talk about analytical practice, there are numerous things they never mention: the price of the session, the overall financial costs of treatment…”
This elitist therapy establishment is not altogether gone. I have encountered one or two of the bourgeois Manhattan psychiatrists over the years, old men with institutional authority, the heirs to Freudian prestige. Like Lacan, they tended to have fancy homes and a degree of economic capital. Elite clinicians aren’t all men, for that matter. My partner and I briefly saw a female psychoanalyst for couples counseling. She was at the height of her field, and her fancy office had its own wing at her $1.8-million-dollar home in Southern California. I felt a little bit intimidated by that office: a kind of class intimidation. We couldn’t really afford her fees; she certainly didn’t take our insurance.
But the vestigial remains of psychoanalysis don’t now seem very representative of therapy in general. Therapeutic power has changed forms, becoming more atmospheric in ways that resonate with consumerist ideology. Anxiety and depression meds get more ubiquitous than ever, patients get trained to “self-manage” their own symptoms (as my partner Talia Rose Weiner documents), and “wellness” has exploded into a huge part of the economy. The psychotherapy workforce itself is far from elite, on the whole. Sociologically, it is currently mostly female and professionally intermediate, being paid on average just a bit above the median annual income. Therapy is less prestigious and less well compensated than medicine and psychiatry, and it remains vulnerable to swings in the capitalist economy.
My current therapist does not have a million dollar home. She works over Zoom from a little spare room, and seems like she’s getting by, but it’s hard to tell. Meanwhile, her predecessor asked me outright to pay more than my standard copay, saying bluntly that she really needed the money. It seems clear that private therapists are under lots of economic pressures — whether to repay their student loans, to satisfy insurance company requirements, to market their own practices and garner good online reviews, or just to survive the growing competition from for-profit teletherapy companies and AI therapy bots. We’re all Alexis, these days, if by that we mean precarious.
***
In an economically precarious environment, it’s hardly shocking that therapy is not for the most part a politically radical experience. In my experience it rarely encourages social activism, political analysis, community organizing, or broader historical consciousness. As feminists like Carol Brown observed decades ago, therapy can be seen as female labor extracted from the household and made into a commercial service. This, in turn, can lead to dark places. Jennifer Tolleson puts it perhaps too starkly: “Like a mother who comforts her child after he has endured a beating by his father, we help our patients feel better but stop short of confrontation with the system.” A sweet, maternal male therapist once told me to stop stressing about the political situation under Trump and just focus on what I could control in my own life. Which is why we also need to question psychotherapists’ attachments to idealized white bourgeois mothering norms, as Tolleson has also insisted.
Perhaps then “Is therapy a politically radical practice?” is the wrong question. We do not normally expect other forms of late capitalist labor, including emotional or care labor, to be politically radical by their nature. We might at most hope that they meet some of our needs at a given moment. Personally, I expect capitalist care labor to be a mixed bag, whether we’re talking about psychotherapy, a primary care clinic, a classroom, or really anywhere caretaking is part of the transaction. I find such encounters to be heavily scripted, often slightly awkward, often full of unexamined social norms and unspoken assumptions. Sometimes it’s transformative, sometimes not; sometimes it’s touching and very human—because empathy and recognition do happen—but often it’s pretty unmagical and routine. I usually adjust my expectations downward for such situations. Nothing is more disappointing than expecting too much from emotional capitalism.
And yet I do find still that therapy can be a little bit magical, because I do still love the confession sometimes, and I love how therapy can become a repository of dirty secrets about the self and the society, about unspeakable things, cravings, taboo wishes, hatreds, unavowable fantasies, traumas and everything else that’s difficult about living. Sometimes therapy can be an escape hatch, a pressure release, for everything that is unlivable about a bad world. As such, therapy is a holding environment, in Donald Winnicott’s famous image. Holding environments aren’t necessarily revolutionary spaces; they are often spaces of gradual adjustment, absorption, and adaptation.
But while my therapists have typically eschewed radical social critique during the session, in a way, therapy’s very existence is already a critique of society. After all, the very existence of therapy isn’t natural; it is historical, it’s a symptom of other problems with our way of living. We’re bombarded with marketing campaigns telling us that the world is great and a radiant future awaits us, and yet we live in a world that endemically produces misery, inner disorders, helplessness, anxiety, social abandonment, trauma, isolation, vulnerability, and so on. It’s a messed up world where people and their networks suffer great violence and are often undone, where people might need therapeutic help just to get through their lives or somehow cope.
In such a world, what would it even mean to have a politically radical holding environment? Is there anything radical about care, or in particular psychological care, in and of itself? I honestly don’t know anymore — some people think so? Sometimes I wish there were?
It reminds me of the end of Nikki Giovanni’s poem, “When I Die”:
and if ever i touched a life i hope that life knows
that i know that touching was and still is and will always
be the true
revolution
Surely this remains a radical potential of therapy: to touch someone’s life, or at least create space for their feelings or mitigate their unraveling in some way that matters. But whatever that might mean, it seems like it crumples easily under the paradoxes of making therapy into a viable business. When therapy becomes a numbing routine, maybe it becomes radical to end therapy, to break the therapeutic frame.
When I first started writing this, I felt that Alexis had done me some kind of harm by ending therapy with me, by dumping her feelings on me and refusing any consolation. But now I wonder if that was her own revolutionary moment, as if she was saying: I’ve had it, I’m done doing thankless emotional labor for my patients, I’m out of here. Get out of my office. My practice is closed. Let’s not repress the political economy of therapy, but rather try to learn from it, even as patients: I’m sure Alexis was teaching me something in her outbursts about the real economic stress and instability of her work. If therapy is an extension of women’s care work, then to suddenly refuse it, as Alexis did, might be a radical gesture. An incipient women’s strike, as Liz Mason-Deese has theorized, or a moment of “feminist snap,” in Sara Ahmed’s image. Maybe what we need from therapy isn’t an escape from the world, but a new camaraderie, with new ways of seeing each other struggling with an impossible world.
