At the election polling place, you need to check your political paraphernalia at the door. No Obama buttons. No McCain magnets. What about in the therapy office? In a previous post, I wrote about some ways in which principles of psychology closely relate to the practice of politics. Here, let’s talk about ways in which politics sometimes gets injected into the practice of psychotherapy.
I was excited for Election Day, as many people were. Not the least of which reason was because it marked, believe it or not, my first trip to an actual voting booth following years of mailing-in absentee ballots. I confess that on Election Day I wore a blue shirt and tie to work. Not just any shade of blue, either. I call the outfit my "blue state" shirt and tie (in that statement is a full-disclosure of my general political leanings). It was a conscious choice, and a somewhat conflicted one because being a shrink, I nearly always vastly over-think things. On the one hand, I was raised with the value of sporting team colors on game day, cheering for my preferred candidate; on the other hand, I was sheepish about what I considered a brazen display (seriously, we really, really, really over-think things) of my political leanings in front of my patients. The next day, I was happy to learn that a colleague of mine had done the same thing.
Most of my patients asked me if I voted. This question was usually in the vain of the type of small talk that many use to settle in during those first few uncomfortable moments of starting a therapy session. Without broaching the specifics, I acknowledged that I had (therapist self-disclosure is a topic for another day) and pivoted the question back towards them. Some voted; some did not; some would have liked to, but were unable. Some patients floated out thoughts about specific local election initiatives almost as if hoping to see what I would say about them. By now, most of the people I see regularly are aware they’re not likely to get a whole lot of personal detail from me, and I encourage them to speak about their views instead.
Engaging people in a discussion of their values is a central part of the therapeutic endeavor. This is an argument that William Doherty makes in his book Soul Searching (an accessible and thought-provoking read for therapists and patients, alike). Similarly, in his recent post, Mark Sichel extols the values of ‘virtue therapy’. From that post:
"…we do all have the choice between acting correctly or incorrectly and there are ways to broach this issue without sounding critical."
and:
"Given the common human wish to believe they are virtuous human beings, dysfunction can be rapidly diminished by helping people reconcile their self-perception with their actions. Steering a person in the direction of right actions is not emphasized, or even mentioned, in most counseling or psychotherapy training programs. After many years of experience, however, I’m convinced that helping people get on the high road of virtue is a more direct and effective direction to achieving more satisfying and harmonious relationships."
Working with patients to articulate their values and look at behaving in ways consistent with those values is a noble endeavor. Yet, a major problem in this mode of relating becomes the question of who exactly is the arbiter of "right actions"? Sichel admirably notes that the authority in that matter lies with the patient, and it is the therapist’s job to facilitate identifying a patient’s morals and providing guidance towards the fulfillment of those moral imperatives. However, not all moral situations have such clear-cut distinctions of "right" and "wrong". It is exactly this kind of low-complexity, black-and-white thinking that I encourage my patients to steer away from. Think about a newly pregnant woman who comes in hoping to urge her husband to consider an abortion because their financial situation is too unstable to appropriately provide for a child? There is no "right action" that is going to lead to a "right feeling". Any of the choices she makes are likely to carry lasting and difficult emotions of the type that will always be a part of her life experience. Or how about an upright teenager with a bright future who is torn between upholding the law and maintaining his reputation versus helping out his grandmother by obtaining for her marijuana that eases her chronic pain?
Let me take an example from my recent experience. I work in Cambridge, Massachusetts, which promotes itself as ‘Boston’s Left Bank’ and not just because of its geographical locale. So in the days and even weeks following Election Day, I had a lot of patients express some election elation. Everyone talked about it in one form or another. Some discussions went past presidential politics and towards Prop 8, the passage of a ban on same-sex marriage in California, a staunch "blue state". Not only was there Prop 8, but there was also the passage of legislation in Arkansas banning adoption by any "unmarried couples" (you don’t need to be a rocket scientist, psychologist, or political philosopher to figure out who this legislation is targeting). I have a definite perspective on the issue, but what happens with this in therapy?
One of my gay male patients brought up this topic. He expressed sadness and disappointment about the newly instituted bans. He has lived with a steady partner for over a decade, and in our discussion, he revealed that he and his partner deeply long to raise a child. He felt humiliated by the popular vote insinuations that he would not be anything but a loving, capable parent. He was angered that with so many children needing stable homes, people would rather have them essentially sent out on the street than be placed in a functional family with homosexual parents. He praised his own parents for bringing him up in a tolerant, liberal, and accepting environment. His "right actions", developing love and affection through a lasting, mutual bond with another human being, tragically are not likely to sprout into the "right feelings" that come with raising a cherished child.
Immediately after he left my office, I met with another patient. This woman started the session by bringing up the election and discussing Prop 8 as well. She had the opposite reaction of my earlier patient, expressing satisfaction that the legislation had been passed. In treatment, this patient had previously spoken of the time her sister came out as a lesbian, only to be kicked out of the house and disowned by her parents. In reaction to the topic of Prop 8, she informed me that if her own son ever came out as a homosexual, she would follow her parents’ example and kick him out on the street. She praised her parents for bringing her up in a conservative, moral, religious environment. Were she ever to kick her son out on the street, she would view this as a "right action", but what kind of "right feelings" would it bring? She would have upheld her own sense of righteous morality, but at the cost of breaking up a family and surely causing intense emotional distress to her son.
As therapists, we balance a fine line between asserting our own values judgments and accepting the values judgments of our patients. I’ve often heard patients tell me that they’re not worried about what they say to me because they know I won’t judge them. They say that as a therapist, it’s my job not to have judgments. On the one hand, that’s great; I want patients to feel free enough to tell me whatever is on their minds. On the other hand, that belief is patently false. They are talking to another human being in the room. As a thinking and feeling person, I’m making judgments all the time. Having my own views, biases, and values informing the treatment I provide is inevitable.
As I see it, my job involves working towards awareness of my own perspectives in order not to act out on them in a thoughtless way. My job includes helping my patients explore and express their own thoughts and feelings in a way that they have greater understanding and control over the choices they make. Sometimes our values will not line up. This happens in therapy just as it happens in the world outside of therapy. We need to work together to work through these moments in adaptive ways. That practice is in the hope that patients can then take these experiences working through the therapeutic relationship into new ways of navigating other relationships in their lives.
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*NOTE: Here and in future postings, patient anecdotes will be disguised or composited to protect confidentiality.
