Getting Out From Behind Closed Doors
In my NYC therapy practice, most patients expect to talk to me about their micro environment–their friends, family, co-workers or significant others. However, they often feel like the greater macrocosm of society and politics are off limits, as are the topics of race, gender, sexuality, and religion. In therapy, including all of these topics is imperative to get a full understanding of what the patient’s true experience of the world is.
These larger social and political conversations seem even more pressing in light of our current political climate. Recently, professor and family therapist William J. Doherty started a movement called “Citizen Therapists,” which centers around a manifesto asking fellow mental health professionals to publicly renounce what he calls “Trumpism”–an anti-democratic, strong man, discriminatory movement. While I tend to have a healthy skepticism with any type of absolute manifesto, his call that “it’s time that we say this things publicly, as therapists, and not just behind closed doors” made me reflect on the assumptions about what topics are and aren’t fair game to talk about in the therapy room.
The Therapist Agenda
In the past–perhaps naively, I was a bit timid around raising politics in the therapy room, mostly out of concern that I would inadvertently push an opinion on my patient. I am not a “blank slate” therapist–Sigmund Freud’s model, in which therapists remain totally opaque to their patients for the sake of the therapy. I certainly bring my personality into my relationships with patients and I have “politics,” in that I have a point of view. And I do often have an agenda–although it is generally a transparent, “I want what’s best for you” agenda.
I initially hesitated discussing these topics because I was fearful that if a patient did not raise these issues, then I would be taking up our time with something that did not feel important to them. As I progressed in my work with folks, I learned that it is part my job to lead around this topic. Many people did not realize we “could” talk about race, gender and politics in therapy. Others felt awkward raising it with me specifically, as someone who is a different gender, race, or religion than them.
Especially for those in the latter category, it is so imperative to consider how these issues impact our therapeutic relationship. Therapy can only flourish when there is trust between a therapist and patient and a feeling of understanding. I don’t know what it is like to walk around in any other body than my own, so learning the patient’s day-to-day experience in the world is a crucial part of how we get close.
It’s Hard to Talk About This Stuff
Even when the patient steers the conversation, I, as the therapist, must always be in charge. It is up to me to keep my patients safe and offer them what they need in whatever form that might be. If a therapist is not comfortable talking about race, politics, gender, or any topic, they may not feel competent to “lead.” Heck, even though I feel comfortable talking about these topics, conversations can still be very uncomfortable at points. Therefore, the therapist must really be comfortable with discomfort in order to cover all of the ground needed for the patient.
We are hardwired as humans to avoid pain and discomfort. When you touch a hot stove, your hand jerks away without you having to think twice about it. So in some ways therapy is a bit counterintuitive. Here at Tribeca Therapy, we often say to “move towards the pain” because that is the only way to really see, understand and eventually move through and away from the pain. Similarly with the awkwardness of talking about race, gender, sexuality and other difficult topics, even I may have a moment of wanting to “jerk away” from the topic as if it were a hot stove. However, I have learned to ignore that instinct and continue to move toward what feels important.
Furthermore, even though I am technically the expert in the room, my “expertise” looks different than one might think. Expertise does not necessarily mean “knowing”–in fact, some of my best sessions have come when I was able to acknowledge, “I don’t know what the right thing is now–this is messy.” Saying that, as the leader and “expert” in the room, validates how challenging the subject matter is and also models that it’s OK to not know.
The Political Environment Today
This latest political cycle has made the need to bring politics and current events into the therapy room even greater. And by current day politics, I am not referring to liberal vs. conservative or Democrat vs. Republican. The current day political arena is saturated with racism, xenophobia, and what feels like a threat to our pledge as Americans to support “liberty and justice for all.”
There is an incredible amount of fear in the atmosphere right now. As always, what is happening in politics impacts our society and the individuals within it, but in this election season, the amount of hate and racism that has been brought to the surface and, in some circles, celebrated, is abhorrent and scary.
So What Does This Have to do With Therapy?
Biases or assumptions that others make based on racism, misogyny, and xenophobia are all things that will absolutely impact a person’s experience in the world. When children are growing up and just beginning to form an identity, they will internalize what the world reflects back to them and integrate it into their sense of self. As adolescents and adults, the stakes are equally high when discrimination can lead them to miss school and job opportunities. In a June 2016 study by the Journal of Health and Social Behavior, we even learned that even therapists discriminate against potential patients. Working class African American men had to call 80 therapists before getting an appointment, compared with a white woman only have to call five.
Therapy should be a safe haven for people of all races, genders, sexualities, and religions. It is our responsibility as healthcare providers to not perpetuate discrimination or shaming of any kind. Just like in a family system with one parent who is harmful or abusive, if the other parent or caregiver stands idly by and allows the abuse to take place, they are a participant in it. In greater society, the same things rings true, especially if you are a person in power. Staying mute communicates that racism, xenophobia, and misogyny is allowable in our society. With my patients, it is my role to be curious and to hear how both their micro and macro systems impact them and to understand it as best I can. And it is also my role to not stay silent when they have been wronged.