Mental health training and practice has been increasingly co-opted by the corrosive hyper-partisan regime of social justice ideology. Titles of conferences, talks, and continuing education (CE) offerings reproduce a basic formula:
How to treat/evaluate/work with [chain of identity signifiers: (trans-male queer sex-workers, for instance)].
How to eradicate/recognize/work through the whiteness/patriarchy/sexism that is affecting your therapeutic dyad.
The epistemic dominance of manualized treatment—intervention performed according to predetermined administrative guidelines—has begun to reformulate itself into the rise of the manualized patient. Unfortunately, rather than bucking this trend, social justice ideology participates in this depreciation of psychotherapy.
This trend is “political,” but it is also straightforwardly economic: the industry requires constant compression of treatment to increase profit. The focus on identity, diversity, and representation has been developed as a means of simplifying and manualizing treatment to make it more “efficient,” in line with the broader trends in the field toward acclimation to narrow reimbursement categories. The intertwining demands of industry and politicization on the field have created an economy in which ever-more specific identities require ever-more specific training, which in turn reduces therapeutic acumen to accordance with identitarian norms.
It should come as no surprise that a credentialed field like mental health would be a vehicle for disseminating the ideology that legitimizes the class interests of its PMC practitioners, but the ways that this dynamic has impacted clinical practice recently is troubling. As a new generation of therapists vies for dominance of the field, the function of the identity-based training industrial complex as a disciplinary battering ram for their own legitimacy becomes clear. New practitioners, as members of the PMC with aspirations towards roles in consultation, program development, and management, generally do not see themselves benefitting from redistributive politics. Instead, the politics of representation and diversity are circulated through the field of mental health to secure consultative and managerial roles for the elites of industry and academia.
Any well-meaning clinician would, of course, want to make sure not to replicate or re-enact biases that patients face outside of the consulting room. But a hyper-focus on a taxonomical model of patients being like this because they look or act like that, in addition to cynically serving career goals, begins to reproduce exactly the race- and gender-based classifications of people that social justice ideology ostensibly aims to transcend. Mapping prescriptive ideology onto our patients is inherently dehumanizing. The depravity of programming a patient is masked by a facade of social justice. Ambiguity or nuance is minimized and the patient becomes a product to be interacted with based on ascriptive attributes. The clinician listens only to what they would imagine the patient is speaking about in terms of their ascribed social position. Is this patient of color talking about her overbearing mother, or is she unconsciously referring to how my whiteness dominates the space we share? In embracing the all-importance of a patient’s identity signifiers, a pernicious veneer of “fragility” permeates the dyad, obscuring the patient’s speech behind their appearance.
One of the many screeds touting anti-racist therapy contains the following self-satisfied example of clinical practice:
Sitting with my white clients, I ponder, sometimes aloud with them, how race has shaped their lives, how it enters our therapy relationship, and notice how frequently when these reflections happen they move toward externalizing racial identity in people of color versus an exploration and understanding of white racial selves.
New trainings re-situate the therapeutic relationship: practitioners and patients alike suffer from the neurotic intangible symptom of “whiteness” (or “maleness” or “cisness”). Although you will never be free from the original sin of your privilege, you will be able to buy more of the correct books, CE credits, and attend identitarian conferences to attenuate it. You will never be free from the stain of your status, but you are able to assuage this guilt through making your patients aware of theirs. This identification matrix is precisely what Lacan railed against over 50 years ago when he warned against the goal of treatment being the patient’s identification with the analyst.
A treatment based on identity validation and social justice can also leave certain questions out. Competence in working with the LGBT+ population, as one example of the identity/therapy merge, is conceptualized with some of the following interventions: “encouraging positive subjective experiences” (or being nice), “giving handouts listing character strengths,” and (of course) “self-disclosure of same-sex attraction.” A non-identity-indoctrinated therapist might work to analyze patterns in the patient’s relationships regardless of the gender or sexuality of their love object, and maximize space for the patient to relate to their own projections instead of foreclosing on such understandings through too-quick self-disclosure. Therapy is work, and therapists should have the space to work free of the political injunction to validate and unconsciously condescend to people with marginalized identities. Asking what dynamics are being repeated and looking for what is being repressed conveys a level of respect that few of our patients, regardless of identity, have experienced before.
Of course, marginalized and vulnerable patients of any group may need validation and warmth to develop trust. But treatment dominated by a reductive and formulaic architecture may be in effect more “structurally homophobic” than an open-ended mode. A woke script deprives the LGBT+ patient of a relationship with a live other and substitutes the presence of a potentially flawed therapist with an oversaturated script that the therapist and patient must collude to call “comforting.” People often come to therapy because they are having problems with behaviors or identity. To have the potentiality of articulating the complexity of these issues literally papered over by handouts is, for the therapist, to take the easy, phobic, and ultimately harmful way out.
In analyzing the trends in mental health education, it can be inferred that anyone practicing therapy in any capacity must be positioned as unquestionably subservient to social justice ideology. The dictums of anti-racism and other woke philosophies are seamlessly inculcated into the curricula of higher education in psychology PhDs, MSW programs, and even analytic institutes. Courses regarding internal racism, implicit bias, and the all-encompassing demonology of whiteness take the forefront in academic and post-graduate trainings and organizations (despite shoddy evidence of efficacy) at the expense of more traditional clinical skills. Regardless of modality or approach, the therapeutic relationship is the most curative factor in treatment. If practitioners are instrumentalized to be patronizing scolds to their patients, this could jeopardize precisely what helps patients change.
And there are straightforward material reasons for therapists to embrace a reductive approach. An LGBT+ graduate student interested in learning family therapy (for instance) at a family therapy institute placement may be pushed to intern at an LGBT+ therapy center instead, despite not having any drive to work with that population. The implicit message underlined by this phenomenon is that your success in the field will be contingent upon working with others who share your lived experience of oppression. The fantasy that competence is ensured or made more likely by shared identity markers serves a political function, moving therapy from being potentially curative to therapy becoming a space of recursive validation.
The mental health field is diverse, but the practitioner is always in a position of power in their relationship with the patient. The already-present guilt in practitioners caused by this power dynamic has enabled PROP (Power, Race, and Oppression Privilege) discourses to flourish. But the pedagogy of identity also undermines a therapist’s confidence in working with difference. A black trans clinician may not have the right skillset to work with black trans patients who have the lived experience of being fat-bodied or working in the sex industry, for instance. This is an important recurrence in the social justice therapy industry: under the guise of justice, the actual complexity of “lived experience” is reduced to a set of reified identity characteristics whose “treatment” is manualized.
The trainings meant to address therapists’ “lack of skill” should not be seen as addressing a therapeutic blindspot but as a kind of automation of personal interactions to accord with the official doctrines of an obscene societal superego. Their function is not to tangibly improve clinical practice; they are a form of top-down discourse that forcefully demands the therapeutic space become a reductive, and thus untherapeutic, one.
I do not mean to imply that progressive values are bad, or that white supremacy and sexism do not exist. But these concepts are being used to legitimize precisely what they attempt to decry. The more the mental health field has become aligned with counterproductive “progressive trends,” the more it increases alienation and resentment.
Social justice ideology’s expropriation of the field of mental health through its pervasive control on the academic sphere has created two new economies that practitioners are subsumed by: one psychological and discrete, the second politicized and ostentatious. In the first, the currently dominant cultural relations of shame, guilt, and identity fetishism are imparted onto the practitioner, transforming them into an agent compelled by anxiety to “do the work” whether or not the patient sitting in front of them has any interest in it. In the second, a scaffolding of diversity cartels and committees has circumscribed our institutions, diverting funding and attention to ever-more arcane trainings, talks, and an entire set of non-clinical consultation careers. The manifest purpose is (of course) to save face, while the latent purpose is to prevent lawsuit or liability. The unconscious consequence of both these trends is that the field loses further touch with its roots: direct therapeutic work.
Scrolling through Psychology Today, you will find the majority of profiles riddled with therapeutic progressive-identitarian jargon. It’s important to remember the source of this trend: mental health workers have increasingly been deskilled and are eager to abide by the new professional standards of success for plainly material reasons. They have abandoned analytic neutrality for a kind of condescension at a moment when they feel themselves condescended to.
But what does the radlib echo chamber of Psychology Today profiles indicate to potential patients? In short, that we therapists only want to be available to those who think a certain way. As a result, only subjects already inclined to trust the ruling woke orthodoxy are provided mental health care services. There is a reason that working people have long had a distrust of therapists and social workers for imposing bourgeois lifestyle norms and criminalizing poverty. Despite the progressive language in education, mental health workers are still liable to fall into the trap of reproducing and transposing oppression onto their patients under the guise of altruism. Now, in addition to time, money, insurance, and all the other hazards of getting help, the identity polarization of the field of mental health is yet another barrier that working-class people (or those who distrust the PMC political project) may face when seeking services.
Patients I work with have admitted that they are afraid to tell me things as banal as the fact that they may have skeptical thoughts on the new COVID vaccines simply because I am in this line of work. If fear of a vaccine is something almost unbearably difficult to share with your therapist, what else is being censored and hidden from view in a field that has been made irremediably partisan? If there is any social justice victory to be had in mental health, shouldn’t it be through unconditionally prioritizing the importance of therapy for all? For therapy to be in any way “radical,” it must not become a hectoring chamber in which the legitimizing ideology of the imperialist neoliberal state is reproduced. What can really help patients from marginalized groups better their lives are competent and confident clinicians, not dithering therapists compulsively self-flagellating over alterity.
Evan Dunn is a psychotherapist in Los Angeles chasing the bourgeois dream.