A recent Los Angeles Times article highlights how some therapists are responding to clients’ fears over Trump. Last summer 3,800 therapists signed a “manifesto” declaring Trump a “unique threat” to the nation’s mental health, and in the wake of the election many are reporting an increase in Trump-related patient concerns. Just a few weeks ago 33 mental health practitioners signed a letter to The New York Times charging his behavior is a sign of mental instability that makes him unfit to be president.
Apparently anxiety over Trump is not only filling therapists’ counseling sessions, it’s changing some of their practices, as well. Therapist Arlene Drake told the LA Times because President Trump is so evil she has “abandoned neutrality” on this issue in her practice.
— Mark Hemingway (@Heminator) February 24, 2017
It seems Drake has let her personal fears cloud her professional judgment. The election of President Trump is not an excuse for mental health therapists to throw out their professional training and evidence-based research to collude with their patients. Doing so conflicts with professional ethics because it has been shown to harm patients.
How Colluding Hurts Patients
Collusion in psychological profession is defined as “a resistance between therapist and patient in which the transference and countertransference become interlocked in a tacit agreement to avoid a mutually fantasized catastrophe. Collusions are possible because therapist and patient share an unconscious, fearful remembrance of the breakdown of the function of the primary object.”
In layman’s terms, collusion occurs when the therapist agrees with the client’s experience, as opposed to validating it. Agreement means expressing harmony or accordance of an opinion, belief, circumstance, etc. Validation means recognizing that what a person is experiencing is of value.
Agreement in itself is not harmful in therapy. Counselors will often use agreement as a way to affirm or encourage as part of the process. Agreement becomes collusion, and therefore harmful, when the therapist uses it as a form of solidarity.
Colluding with a client in solidarity is risky on many levels, but most obvious is that it can foment the client’s presenting problem. A client who comes in to get help handling anxiety over an election is likely to have more anxiety after seeing a therapist whose failure to remain impartial has only amplified the client’s mental anguish.
This posture also re-orients the therapist’s position in the relationship from that of professional expert to a co-conspirator in someone else’s suffering over Trump. Therapists who choose to commiserate with clients, rather than providing guidance on how to cope with the unpleasant feelings, are engaging in soothing, not healing, behavior. Soothing a client’s angst is a temporary event that, while it can be helpful in that moment, does not have lasting effect. Healing, however, is more likely to be effective long-term.
Therapists Need to Model Stable, Not Anxious, Behavior
“Abandoning neutrality,” as Drake suggests, also risks a breakdown in therapeutic alliance between client and therapist. Mutually confirming each other’s biases about Trump threatens the stability of the therapist’s clinical power, leaving her in a weakened position to promote healthy thinking later on. Clients need to believe their counselor has the expertise to help them move into a healthy space. That becomes a far more difficult a task if the therapist demonstrates the same elevated levels of anxiety.
How do therapists model strategies for dealing with distress if they themselves are not employing them? I’m not suggesting therapists behave as automatons. On the contrary, a counselor’s primary tool is empathy. Rather, I’m suggesting that if a therapist has concluded that she can no longer adhere to ethical standards about neutrality because half of America disagrees with her, she probably needs to take a break from seeing clients.
Shared outrage over the election results is not about providing empathy for one’s clients; it’s about certain mental health professionals using their client’s therapy to work out their own personal issues with President Trump.
Trump Is Not a Cataclysmic, Unprocessable Event
Let us also stop with the idea that Trump represents such a threat to mental health that desperate times call for desperate measures, so exceptions to professional appropriateness are allowable. Even if one conceded that Trump is such an extraordinary threat to mental health, it wouldn’t justify the kind of dramatic rejection of commonly held therapeutic practices the LA Times article portrays.
Trump’s election is not such a catastrophic event that there are simply no appropriate therapeutic models that can handle the fallout. The idea that the resulting mania from Trump’s election is, as therapist Randi Gottlieb suggests, “putting into flux and questioning how do we practice, what is the best way to support the people we care for” and “we don’t really have good answers,” is to literally disregard decades of evidenced-based research on how to care for individuals in existential crisis.
For therapists who truly believe the presidential election of 2016 is unprecedentedly unique, please re-read Viktor Frankl’s prodigious work on suffering. The distress some feel are feeling about the election is not so unique that it warrants a complete re-examination of how we conduct therapy.
It’s not as though Trump is inflicting some kind of “super trauma” hitherto unknown to our psychological community. After all, this is the same psychological community that developed incredibly helpful therapeutic techniques for handling the extreme trauma children have suffered in war-torn Syria, and post-traumatic stress disorder for our veterans returning from the Middle East.
Surely Gottlieb, Drake, and those who are like-minded do not mean to suggest Trump’s election is causing such emotional devastation that even our most intensive therapies fall short, making the only option that of conspiring with our clients in Trump-phobia? Forgive me, but that seems absurd.
This Is All an Egregious Violation of Professional Ethics
The real story here is not that some people are having a hard time handling the results of the recent election. There will always be those who are challenged by the events and circumstances of life. No, the real story is that a group of seasoned therapists would use this election as an excuse to completely disregard the ethical guidelines governing their practice, credentials, and licensing.
To announce that you can no longer remain impartial because in your opinion this election is “so evil” is to violate section A.1.a of the American Counseling Association’s (ACA) code of ethics, which states, “The primary responsibility of counselors is to respect the dignity and promote the welfare of clients.” Therapists cannot protect dignity or promote welfare if they are openly hostile about beliefs held by certain clients.
This is one of the reasons professional counseling organizations place such importance on objectivity in the therapeutic setting, because to do otherwise is to alienate and devalue the very person they purport to help. One has to wonder how counselors have managed their own self-care all these years if they too are unable to process their own emotions over the freely held election of an American president. (Just as an aside, the failure to continually monitor one’s effectiveness as a counselor through good self-care violates section C.2.d., of the ACA code of ethics.)
The way in which organizations like the ACA and the American Psychological Association (APA) decide to handle this small but important ethical dilemma among some therapists will be telling. In recent years, these institutions have been quick to reject the idea that therapists are allowed to act as independent agents when their conscience dictates. Will they continue to hold to this standard, or will they instead allow personal opinions to cloud objectivity and collude with these few therapists at the expense of those who really need their help?
My hope is that cooler heads will prevail, and mental health organizations like the ACA and APA will adhere to their own standards of care and put clients’ interests above the desires of a few activist counselors.