Politics in Therapy

Contrary to what some believe, politics deeply affects our everyday lives. We’re constantly exposed to media that provides 24-hour coverage on political topics, and, consequently, we form opinions on what we think are the best outcomes for ourselves and our community. This opinion is also composed of our cultural background and belief system, which is why some fight tooth and nail to protect their own views.

Because of that, politics is a delicate affair, especially in this day and age, when many countries are heavily polarized and it seems like it takes only a simple statement to start a fight.

In this article, we’ll set to answer some of the most pressing questions regarding patients’ (and therapists’) political views and the best way to manage this controversial subject.

• What is the place of politics in therapy?
• What to do when the client comes up with this subject?
• Should you bring politics up yourself?
• How to help the client when they’ve been affected by politics?
• How can disclosing help with the minority clients’ experience?

What does APA’s Ethics Code say?

Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices. (Principle E: Respect for People’s Rights and Dignity

This means that no psychologist should let personal biases influence their work or condone a client’s practices, always considering the patient in a context. At first, it might sound like an easy task; however, sometimes our beliefs are so ingrained in ourselves that we may automatically disregard people’s opinions and experiences, especially when it comes to differing political views. One thing to have in mind is never to let these prejudices get the best of you, as imposing your own beliefs on your patients is deeply unethical, at best.

Know your Country/States Guidelines

Even though the American Psychological Association is often considered a global reference for psychology matters, it’s important to deeply comprehend your country’s or state’s Ethics Code, as it may diverge or expand on topics that don’t appear on APA’s guidelines. Being aware of your local mandates and recommendations is a way of keeping you and your client safe, maintaining an ethical and respectful environment.

Let’s talk politics

Now that we’ve discussed the ethical concerns regarding this issue, we can turn to more clouded matters. First, should you bring up political matters as a therapist?

Carolina Tirelli, a Brazilian therapist that has Human Rights as one of her areas of interest, says that according to the demands of the patient, it’s important to discuss political issues. She states: “I observe that the political climate of a country greatly influences the mental health of patients. For example, patients with irritability problems due to the president’s statements. In regards to the pandemic and economic issues, anxiety concerning financial uncertainty.” As mental health practitioners, it’s our duty to discuss factors that influence a person’s distress or suffering, and for many, they’re related to political conflicts.

In the current political environment, more and more clients are addressing this issue, and ignoring its importance won’t do anybody any good. Nonetheless, talking about it in therapy doesn’t necessarily mean disclosing your political view to your patient, but rather using this opportunity to work on their underlying values and subjectivity. As stated before, a person’s opinion appears in a context; there are different motives and implicit reasons why a client holds this particular set of beliefs.

Tirelli explains: “My political positioning in the face of these demands is to welcome it and discuss the current political and cultural crossings, without entering the merit of my political opinion, but linking the present context, respecting the patient’s speech.”

Nevertheless, therapists can never entirely be a blank slate, as we all have our own baggage and differing opinions. Therefore, understanding patients’ beliefs in a much larger context and recognizing your own triggers as therapists is a big part of the work. For example, is there a certain politician or topic that especially enrages you or makes you uncomfortable? Being aware of the matters that set you off is the first step to understanding your reaction to opposing views and not getting entangled in inappropriate discussions.

Things to consider when disclosing to your client

Disclosing information about yourself to your patient is always a tricky business because it’s difficult to know how it will affect the therapeutic alliance. And if you decide on disclosing, how much should you? When? Or how? At this moment of doubt, Irvin Yalom, in his book Gift of Therapy, urges us to ask the most important question: What is best for the patient?

As his/her therapist, only you will understand the patient’s and the particular session’s dynamic. Some patients might dead-on ask what are your political beliefs as a way to shock or corner you; others might try to know as a way to get support or feel safer. As the therapist, it’s always a matter of knowing your patient and his/her real intentions when asking these sensitive questions.

If you feel like sharing at this time (or at all) is beneficial, then you can go ahead and carefully answer the question, studying their reaction. If you judge that disclosing this sort of information will be prejudicial or not help the client, you can redirect the subject or ask why it’s important for them to know. The answer will rely on your interpretation of the situation.

Timing and therapeutic alliance

Other factors that impact your answer are timing and the therapeutic alliance. Yalom states that self-disclosure early in therapy might be prejudicial since a good working alliance might not have been established yet. Regarding that, you need to consider the current state of the therapist-patient relationship and if it’s compatible with self-disclosure at that time.

Therapy orientation

Another aspect to be conscious about is what your therapy approach says regarding self-disclosure. For example, a psychoanalyst would probably be way less inclined to answer that question since he’s supposed to reflect the patient. In contrast, a Gestalt therapist would likely respond, having in mind the power of a sincere and authentic therapy relation.

When disclosing becomes a necessity

When approaching clients from minority groups, such as POC or LGBTQ+, discussing political topics and self-disclosing might take on a different meaning.

As part of oppressed groups, these clients’ lives are greatly impacted by politics, as they have to fight for their rights every day, keeping up with current events and taking part in protests. While non-minority therapists and counselors will never experience this kind of hardship, they need to approach political topics, which heavily influences a person’s well-being and mental health.

To illustrate, LGBTQ+ people are more than twice as likely to have a mental health disorder in their lifetime as compared to heterosexual men and women; additionally, many of these individuals reported experiencing stigma and discrimination when accessing health services, leading some to delay necessary health care or forego it altogether (APA, 2017. That’s why it’s so essential for therapists and counselors to express their acceptance and support!

What is the therapist’s role in this?

Sofí Paz- Rutherford, an American counselor based in Iowa, weighs in on the matter: “I do check up with clients on how protests/riots, the upcoming election, and the pandemic has been impacting them. Even simply asking a political client when there will be another protest shows the client your interest and willingness to advocate for them and their movement. Maybe attend a protest sometime and discuss it with your client. Discuss maintaining their safety and reflecting on their experience”.

She states that it’s the counselor or therapist’s responsibility to bring up broaching topics with minority clients because when being attended by a non-minority counselor, it’s common for them to have the preconceived notion that the professional wouldn’t understand or care. As a way of creating a non-judgemental and open space, Paz suggests, for example, building rapport with LGBTQ+ clients by asking for their pronouns or by identifying and exploring past experiences of oppression with clients OC.

Bear in mind that, while you might not be part of your client’s minority group, they must recognize your respect for their culture, experiences, and sheer existence, leading to a constructive experience for them and strengthening the therapeutic alliance for you both.

What happens to the therapeutic alliance when you decide to disclose (or not)?

Many concerns arise upon considering sharing your political views, and one of the main ones is the impact on the therapeutic alliance.

The study ‘Patients’ perspectives on political self-disclosure, the therapeutic alliance, and the infiltration of politics into the therapy room in the Trump era‘ (2018), by Solomonov and Barber, offers some insight into what are the outcomes of the therapist’s disclosure of their political stance, and to what extent it affects patients’ perceptions of the therapeutic alliance and their experience in therapy. Even though it’s an American study focused on the 2016 elections, its context strongly resembles many others worldwide.

Solomonov and Barber conducted an online survey with 604 patients, composed of questions concerning their therapists’ political orientation and self-disclosure, their own political views, and their perceived experience and therapeutic alliance.

Results from the Study

The results showed that two-thirds of the participants held political discussions in therapy, with almost half of the sample wishing to speak more about it.

Regarding the therapists’ self-disclosure, it was found that 30% explicitly shared their political orientation, 38% did not explicitly disclose, but the patient could easily guess, and 32% didn’t disclose their political stance at all. When correlated with the perceived therapeutic alliance, it was discovered that patients whose therapists demonstrated their political stance, especially implicitly, had the best perceived therapeutic alliances.

On the other hand, patients who believed their therapist had the same political orientation as they reported the highest therapeutic alliance levels, suggesting that those who perceived their therapist’s opinion as opposing theirs didn’t share such a strong relationship.

As remarkable as these findings are, every study has its limitations. For one, this was conducted with a specific event in mind, including an all-American sample, at that; further, the data was collected at a single point in time, so it’s hard to establish causalities. However, it’s undeniable that these results point to an answer that most therapists long to know.

What can we gather from this study?

It became clear that patients desire to bring up politics in therapy, especially during a heavily charged political moment. Thus, it’s a therapist’s job to understand political events’ influence on a person’s mental health. Besides, investigating what a patient’s stance is on such topics relates to their experiences, relationships, and functioning.

Furthermore, the fact that the highest therapeutic alliance levels were found to belong to therapists who implicitly shared their political views indicates that appropriately and carefully sharing your thoughts with the client’s well-being in mind is the best course of action. Of course, it all depends on the several factors that we’ve discussed above, but it’s a start!

Also, consider the number of implicit ways a patient can tell what your opinions are. For example, if you have a business social media account where you share your thoughts or articles relating to politics or have certain kinds of books or posters in your setting. All of this can indicate what your views are and even be part of your niche. In these cases, it’s most likely that the clients begin treatment with you already inferring your political inclinations.

What if the patient’s views oppose yours?

When your political opinions are opposite to the patient’s, it takes even more consideration upon self-disclosing, as it might take a toll on the therapeutic alliance. This goes in compliance with a second study conducted by Solomonov and Barber, named ‘Conducting psychotherapy in the Trump era: Therapists’ perspectives on political self‐disclosure, the therapeutic alliance, and politics in the therapy room,’ which investigated the therapists’ side on this matter. The results showed that therapists whose patients shared their political views perceived a better therapeutic alliance than those who didn’t.

There are many sides to this situation, but it’s possible to think of a few basic rules of conduct and tips for therapists who find themselves in them. The starting point for all should be identifying those triggers we’ve mentioned earlier, working through preconceived notions, stereotypes, and personally distressing subjects, because, as counselor Sophia Paz- Rutherford puts it, “This is an ethical obligation and part of increasing your professional development.” This means that being a therapist or counselor, it’s your duty to work towards increasing your cultural competence. You can do this by attending training, continuing education, advocating for clients, and by simply keeping a listening, non-judgmental ear. Be aware that this is a constant exercise and, inherently, part of your betterment as a professional.

From there, it’ll be easier to recognize that just because someone has opposing views to yours doesn’t mean they’re bad people, nor that it’s safe to make assumptions about them. And even though you might feel the urge, trying to change the patient’s opinions is problematic. In the article ‘I’m Ruber, You’re Glue,’ psychotherapist Catherine Ambrose recounts her own experience with a politically divergent patient, stating that trying to convince clients through argument doesn’t bring any therapeutic gain.

Paz- Rutherford shares some pro tips to use during sessions in these complicated circumstances, them being:

• Reflect on the content the patient’s bringing, and what their feeling towards that is; **
• Normalize their experiences (this doesn’t mean legitimization of harmful behavior, but rather explaining its impact without imposing personal opinions or encouraging the behavior);
• Validate their experiences, showing them they’re being heard;
• Create a safe space where they feel comfortable expressing their opinions, even if you disagree with them.

Paz- Rutherford remarks that by reflecting on the content and feelings attached, it’s also possible to deepen the meaning of their emotion, always exercising empathy and understanding. Address these matters without antagonizing your patient. It’s possible to comprehend where a person’s opinion is coming from without agreeing with them or discuss the patient’s opinions without disclosing yours, elaborating on their own experience. This comes back to linking the client’s political views to other areas of their life.

To sum up

From all of these thoughts and opinions, one thing we can say for certain: know thy patient!

Regarding the therapist’s actions, few things are set in stone. This offers marvelous opportunities to exercise creativity and put your knowledge to good use. Simultaneously, it can be frustrating and stressful to come across ethical and theoretical dilemmas such as this one.

Because of that, there is no one right way to navigate politics in therapy; as a capable professional, you must consider you and your patient’s particularities, as well as your relationship, and decide accordingly.

However, I hope that by reading this article, you’ve gained a little more direction on this issue, or, at least, reflected upon the endless possibilities of how to approach politics in therapy.

If you wish to learn more about this matter, we’ve gathered this list of great resources:

• Books: Psychotherapy and Politics, by Nick Totton and What Do I Say?: The Therapist’s Guide to Answering Client Questions
• Free course: When Client/Therapist Values Clash: The Diversity Training EVERY Clinician Needs Right Now (Ep. 106)
• Group: Psychotherapists and Counsellors for Social Responsibility
• Article: Therapists as Allies: Helping Clients Navigate Political Stress
• Facebook group: Therapists in Private Practice
• Subreddit: /psychotherapy

Lastly, we’d like to give a huge thanks to professionals Sophia Paz- Rutherford and Carolina Tirelli, as well as to Facebook’s Therapists in Private Practice and Thriving Therapists groups, and Reddit’s psychotherapy sub.

If you like our content and would like to read more please check out PsychFeed.cc or send us an email if you want something written about at chris@couchandclient.com