The 2016 Election Is Raising Ethical Concerns for Therapists

Is There a Place for Politics in Therapy?

Chris Lyford

In a profession that traditionally prizes neutrality, most therapists have considered presidential elections an issue outside their professional domain. After all, isn’t it almost a cardinal rule that therapy and politics don’t mix?

Recently, however, concerned about the stakes in this year’s election between Donald Trump and Hillary Clinton, some therapists have been wondering whether they have a professional, and even moral, obligation to bring politics into the consulting room. In June, University of Minnesota professor and couples therapist William Doherty launched Citizen Therapists, a grassroots campaign challenging what he calls Trumpism—an ideology he believes is “antithetical to everything we stand for as therapists,” including democratic values, upholding the rights of ethnic and religious minorities, and combating hypermasculinity and the denigration of women. Bold lettering on the Citizen Therapists’ home- page poses a central question: “Are you increasingly alarmed by Donald Trump? Do you recognize that he represents an ideology that won’t go away even if he loses in November? It’s time that we say these things publicly, as therapists, and not just behind closed doors.”

More than 2,200 therapists who support Doherty’s initiative have signed the anti-Trump manifesto on the Citizen Therapists’ website, including leading figures such as Salvador Minuchin, Susan Johnson, Mary Pipher, David Burns, and John and Julie Gottman. The campaign has an active Facebook group, which invites therapists across the country to dialogue about the clinical and ethical implications of discussing the election publicly as a profession and privately with clients. Obviously, this raises questions about whether it’s appropriate for therapists to speak out on political matters and the pitfalls of revealing their political views to clients.

For months, there’s been no lack of psychological analysis of Trump’s personality and its effects on the public. But Doherty says publicizing a psychological analysis of Trump doesn’t go far enough. He contends that therapists, as experts in emotional functioning and healthy relationships, are not only qualified to speak out on matters affecting public mental health, but have a duty to take a stand. Simply offering a diagnosis for Trump “seems to communicate that all we can do is talk our psychological language,” says Doherty. Instead, he insists clinicians have room to broach politics in and outside of therapy, provided that they do it in a noncoercive way that doesn’t come at the expense of the client’s autonomy and well-being. “I want to create a space where we see having these kinds of conversations as an option,” Doherty says. “This is an open-ended invitation that can actually deepen therapy.”

He insists Citizen Therapists isn’t about trying to influence clients to vote a particular way, which Doherty says would be tantamount to malpractice. Instead, asking open-ended questions at the start of sessions such as Are you following what’s going on in the world? or Are you being affected? allows clients to share as much or as little as they’d like, and doesn’t take clinical work off course.

If a client brings up concerns about Trumpism, for instance, therapists can explore specific issues further and validate the client’s reactions to them. At this point, Doherty notes, therapists might follow up with their own concerns about Trumpism that relate to mental health, such as hypermasculinity or demonizing those with differences. And if a client expresses support for Trumpist positions, he recommends trying to connect with their underlying concerns, such as a fear of terrorism or a sense of being displaced in today’s economy. At any point during this conversation, he adds, the therapist can choose to move on to other issues while acknowledging the client’s beliefs and modeling a respectful sharing of differences. “Sometimes we can start something big,” Doherty says, “and discover the sky isn’t going to fall.”

But getting therapists to take collective action—let alone sign a manifesto that some might interpret as biased or divisive—is a challenging task. Shortly after launching Citizen Therapists, Doherty started receiving concerned letters from therapists. “Suffice it to say, I simply don’t share your conviction that political idealism should frame our therapy work,” wrote one. “Political ideologies should inform our therapy work, but they should never autonomously ‘drive the bus.’” Others saw a lopsided focus on Trump. “Hillary Clinton and Donald Trump personify two sides of a similar coin—abuse of power and manipulation,” wrote another. A colleague from Kentucky drew a similar comparison. “I think that Hillary Clinton’s behavior rises to the level of pathology (entitlement, manipulation, lying) and sends a terrible message as well,” he wrote. “Are any of these people really models of emotional health?”

“What Trump stands for,” Doherty responded to the Kentucky therapist, “is qualitatively different from the policies that Hillary Clinton stands for and represents. I see a big difference between personal pathology that sends a bad message (even if that pathology is equal on both sides) and the deliberate stirring of dark forces of xenophobia. I do respect you and your careful reflections on this. My goal is to get us therapists into conversation about the connection between the public and the personal—both in our offices and in society.”

In the weeks following the launch of Doherty’s Facebook group, Doherty created a customizable agenda: focus on expressing concerns about Trumpism to fellow therapists and clients with connections in swing states, such as Colorado, Florida, and Iowa. Reach out to colleagues and friends through social media with focused messages—not rants—explaining the dangers of Trumpism. Share your motivation for signing the Citizen Therapists manifesto and send along a link so other clinicians can sign it too. Write letters to news editors, op-eds, and talk-show hosts who cover politics, mental health, or relationships. And if you decide to discuss the election with clients, look for connections between Trumpism and what they might be working on in therapy. Follow your clients’ leads, and emphasize their agency in supporting or opposing political positions.

In contrast with Doherty’s campaign, the major credentialing organizations for mental health professionals have adopted a stance of studied neutrality, mindful of restrictions imposed by their 501(c) nonprofit status. According to Jim Sliwa, director of public affairs at the American Psychological Association (APA), “We can take a stance on issues,” like the APA’s 2015 condemnation of enhanced interrogation techniques, “but not on candidates.” Likewise, the National Association of Social Workers (NASW) contains a political action committee known as Political Action for Candidate Election, which endorses and financially supports particular candidates, but candidates’ identities are privy only to members with NASW website login credentials. “Because of our tax status,” says NASW senior field organizer Dina Kastner, “we’re required by law to talk only to our members about whom we endorse.”

The clinicians who support Citizen Therapists have embraced Doherty’s agenda to varying degrees. Couples therapist Julie Gottman says the unprecedented level of vitriol expressed by the Trump campaign persuaded her to sign Citizen Therapists’ manifesto. “The venom that’s been spouted by Trump, the xenophobia, and the dehumanizing of different races and classes have been painful to watch,” she says, adding that several of her Middle Eastern clients have expressed anxiety about how Americans now treat them. “Whatever we therapists feel politically, we need to use our networks and our profession to voice our beliefs,” Gottman adds. But she rejects the notion of discussing Trumpism in the consulting room. “I don’t tend to mix my social activism with my therapy,” she says. “I’m not here to influence my clients’ value systems.”

Others, like couples therapist Terry Real, believe therapists have room to be more open with clients about their political beliefs, especially in the case of Trump, who he says exhibits the aggressive, self-aggrandizing behavior he sees in many of his struggling male clients. “Can we stand by and be neutral in the face of political movements that are adversarial to the human vision that underlies therapy?” asks Real. “I believe that we therapists are moralists, whether we believe it or not.”

For Real, the remedy for Trumpism lies in calling out abusiveness when clinicians see it, even at the expense of therapeutic neutrality. Although clinicians shouldn’t necessarily argue politics with their clients, Real says, it’s unreasonable to expect them to be the blank slates of traditional psychotherapy. “That’s not the therapy most of us do any more,” he says. “What’s so terrible about putting a bumper sticker for a particular candidate on your car and having a client see it in the parking lot? My clients can know where I stand. We can agree to disagree.”

Some, like Minneapolis therapist Patrick Dougherty, believe that clinicians need to take their willingness to speak about political issues a step further. After the Orlando nightclub shooting in June, Dougherty says he felt an urge to address the despair he saw in the world around him. He put a personal letter in his waiting room, asking clients if current events were taking a toll on their mental health. After nearly two-thirds of his clients responded, the tactic was added to Citizen Therapists’ list of ways to broach Trumpism in the consulting room. “I’ve always tried to protect the sacred container of therapy from the outside world,” he says. “But this doesn’t work any more. I know these events are affecting the vast majority of people. Right now, we have to be the kind of therapist our clients need.”

Of course, taking up the mantle of political activism can have ramifications beyond rubbing a client or colleague the wrong way, says Mitchell Handelsman, an ethics specialist and psychology professor at the University of Colorado Denver. The distinction, he says, is the degree to which therapists’ politics detract from clients’ well-being, as it would if a therapist tried to indoctrinate clients to follow their political position. Whether there’s an ethical breach depends on how much taking a stand wrongfully invokes the legitimacy of psychotherapy. For example, if a therapist lobbies for a neighborhood to be rezoned so as to benefit financially but says rezoning is a mental health issue, that would be a misuse of professional identity.

Undoubtedly, the ethos of Donald Trump’s campaign, the voices of those who bristle at it, and the ethical dilemmas facing politically active therapists will persist beyond the election. Questioning what it means to reconcile obligations as both a citizen and a therapist is likely to continue. As for Doherty, he says he does want to thank Donald Trump for one thing: “He’s helped me see more clearly the connection between therapy and democracy. We therapists have taken for granted how much our work relies on a democratic tradition that gives people a sense of personal agency—the ability to create new narratives and take personal and collective responsibility for themselves, their families, and their communities.”

This blog is excerpted from "The 2016 Election is Raising Ethical Questions for Therapists" by Chris Lyford. The full version is available in the September/October 2016 issue, Courage in Everyday Life: An Interview with Brené Brown.

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Topic: Cultural, Social & Racial Issues | Ethics

Tags: activism | bill doherty | chris lyford | code of ethics | Cultural, Social & Racial Issues | culture | ethical | ethical and legal issues | ethical boundaries | ethical issues | ethical therapist | Ethics | John Gottman | Julie Schwartz Gottman | Patrick Dougherty | politics | race | Terry Real | therapy ethics

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2 Comments

Monday, December 3, 2018 4:22:37 PM | posted by daisy swadesh
Cont.--A group of mental health professionals has formed, written a book with 27 viewpoints--the dangerous case of DT. They have challenged the Goldwater rule gag order and put forward that a responsibility to warn of danger overrides it. And the powerbrokers in the APA (psychiatrists) have refused it and insisted on the gag order. Most MH professionals have capitulated into silence and denial. I have encountered numerous times previously when psychiatrists threatened people into silence by using various methods including ethics claims. The first was Freud himself who presented a paper--The Aetiology of Hysteria--he was warned not to publish, but did. He was ostracized until he capitulated and invented the Oedipus Complex with which he was welcomed back. We have now heard from thousands of survivors of sexual abuse in childhood, the overwhelming majority expressing their ongoing distress. I first encountered the Oedipus Complex when I was struggling to cope with incest in my family. And because I didn't get raped, but was terrified I soon realized it was the perfect cover up for what my father did--and for any perpetrator. Not until 1984 did I come across Jeffrey M Masson's the Assault on Truth. APA hierarchy has also tried to discredit--John Bowlby, D L Rosenhan, ,misled the Catholic Church, refused to recognize 30 years of growing, decisive evidence for Developmental Trauma and has now intimidated most mental health professionals into silence. If all of you remain silent and abet mr. trump the whole mental health field will be discredited beyond repair. Or we can take this crisis--a world crisis of overpopulation, environmental and social breakdown (into which mr. trump inserted himself) and rebuild our understanding of healthy communities.

Monday, December 3, 2018 4:00:46 PM | posted by daisy swadesh
This article urgently needs an answer and since it's still posted I'm going to do so. The issue is not about politics--but about extremely abusive behavior that would disqualify anyone running for president. trump has been described with malignant narcissism, sociopathy and antisocial personality disorder. All of these involve behavior seriously harmful to relationships at every level--between individuals, community, national and international. He is disrupting and undermining healthy social patterns of behavior--of reciprocity, honesty and fair play necessary for us to live together. He is setting a gravely immoral example, encouraging bullies. bigots, perpetrators and abusers in general--demonstrating how to get away with it. Survivors of domestic violence and psychological abuse were the first to pick up on this. Like canaries in a coal mine we responded with distress--we had lived through something similar and knew the long-term consequences. We were the first #MeToo. And mental health professionals didn't quite understand this. We are now 2 years into this presidency. Even people without trauma in their past are in distress or shutting down in denial. The promises were too-good-to-be-true. A con man's deception. And people who trusted him and were fooled will become violent or the suicide rate will go up dramatically.