Having had the grave misfortune of doing a case involving numerous psychologists, psychiatrists, therapists and the American Psychiatric Association, one thing became painfully clear: there is no profession more squishy, full of shit and taken with the importance of their own empty rhetoric. They make lawyers look good.
So it came as no surprise to find an op-ed by Richard Brouillette, “a former community organizer,” and now a “psychotherapist,” (which, it turns out, means he’s a licensed clinical social worker) contending that therapists should treat their patients’ mental issues with . . . politics.
As a psychotherapist with a private practice in Manhattan, I see a lot of early- and mid-career professionals coping with relentless email and social media obligations, the erasing of work/life boundaries, starting salaries that remain unchanged since the late 1990s. I see “aging” employees (30 and up) anxiously trying to adjust to a job market in which people have to change jobs repeatedly and cultivate their “personal brand.” No one uses all her vacation days. Everyone works longer hours than he would have a generation ago.
Damn, the “coping with relentless email and social media obligations” is a tough one. There is always the “shut off the computer” solution, but that would be victim blaming. It’s not the only issue, but by putting it first, does Brouillette mean to suggest this is the more severe problem his patients face?
Aside from that, they suffer the burden of working for a living. Life is hard. Work is hard. That’s kinda true for most people. Some can’t handle it, which raises questions about whether they’re too fragile or nobody ever told them to toughen up. Some might suggest that the problem is that we now indulge the infantalization of anything hard and unpleasant. Don’t we have a right to a world that makes us happy?
More to the point, don’t patients go to therapy to help them deal with the world, to adjust their attitude, expectations, mindset so that they can function successfully in the world in which they exist? Not any more.
Typically, therapists avoid discussing social and political issues in sessions. If the patient raises them, the therapist will direct the conversation toward a discussion of symptoms, coping skills, the relevant issues in a patient’s childhood and family life. But I am growing more and more convinced that this is inadequate. Psychotherapy, as a field, is not prepared to respond to the major social issues affecting our patients’ lives.
There is a reason “psychotherapy, as a field, is not prepared to respond to major social issues.” That’s not its purpose. The psychotherapist can either look to help the patient adjust to the world or the world adjust to the patient. The former is what therapists are there to do. The latter is the province of others.
When people can’t live up to the increasingly taxing demands of the economy, they often blame themselves and then struggle to live with the guilt.
This is no different at the social level. When an economic system or government is responsible for personal harm, those affected can feel profoundly helpless, and cover that helplessness with self-criticism. Today, if you can’t become what the market wants, it can feel as if you are flawed and have no recourse except to be depressed.
And thus comes the test of the therapist. Should he help his patient move beyond the guilt so they don’t feel “profoundly helpless”? Is the patient suffering from some mental inability to deal? Not according to Brouillette. The problem is injustice.
If the patient describes a nearly unbearable work situation, the therapist will tend to focus on the nature of the patient’s response to the situation, implicitly treating the situation itself as unchangeable, a fact of life. But an untenable or unjust environment is not always just a fact of life, and therapists need to consider how to talk about that explicitly.
There is a creep occurring here, where Brouillette conflates the therapy provided the patient with the therapists becoming “complicit” in rationalizing “an untenable or unjust environment.” Not only does he presuppose that the therapist has magic powers to change an “unjust” world, but a duty not to become its enabler.
Too often, when the world is messed up for political reasons, therapists are silent. Instead, the therapist should acknowledge that fact, be supportive of the patient, and discuss the problem. It is inherently therapeutic to help a person understand the injustice of his predicament, reflect on the question of his own agency, and take whatever action he sees fit.
Injustice? You mean, like an employer expecting his employee to, ya know, work when the employee would rather not?
When I am in this situation with a patient, I will introduce into our dialogue the idea that what is happening is unfair. This opens an opportunity for us to explore how my patient reacts to the notion that he is being mistreated, which can be revelatory and vital to the therapy.
Are they now offering “Mistreatment 101” in therapy school, providing the therapist with the authority to “explore” (I told you they talk nonsense) what’s unfair, like the demands of social media obligations?
You would be surprised how seldom it occurs to people that their problems are not their fault. By focusing on fairness and justice, a patient may have a chance to find what has so frequently been lost: an ability to care for and stand up for herself. Guilt can be replaced with a clarifying anger, one that liberates a desire — and a demand — to thrive, to turn outward toward others rather than inward, one that draws her forward to make change.
So the problem isn’t that patients suffer from any psychological inability to function in society, but society? And it’s the therapist’s job to get them angry? And what? Vote Bernie? Live on a commune? Read Marx? Or Debs? Or listen to Pete Seeger songs?
Like lawyers, psychotherapists work with people who are vulnerable, unable to “cure” themselves, and so need the guidance of someone trained to help. The idea that a therapist would impose his vision of “justice” on a vulnerable patient, manipulate a person who came to them for help to indoctrinate them to their politics, is an abuse of the relationship of trust.
Not to make too sharp a point of it, but by what delusion does Brouillette suppose his mad social worker skillz make him a political guru? His flavor of politics is so irrefutably right that he should be entitled to bet his patients’ mental health on it? Or are all social workers the doyennes of politics?
At a time when fragility and victimhood have become sexy, desirable statuses, infusing vulnerable patients with the notion that the problem isn’t their ability to cope, but telling them that their cure is to fight injustice isn’t merely irresponsible, but flagrant malpractice.
Granted, psychotherapy is squishy at its finest, but to get space in the New York Times to promote the notion that therapists should be entitled to abuse their patients to serve their politics is outrageous. It might be a good time to mention the admonition of the ancient Greek Hippocratic oath, “first, do no harm,” except you’re not physicians, and they left that part out of the modern oath anyway. You’re just friggin’ therapists. Still, do no harm.