You’d think that the last places one would start treating individuals as embodying characteristics of their “tribe” are the offices of therapists. After all, both psychologists and psychiatrists are expected to deal with their patientS as people with unique problems, and not impute to the patient “group” characteristics based on stereotypes or political ideology. Nor should they impose their own political views on their patients, which is a real no-no for therapists. (They do, of course have ideas on how to treat patients, and make suggestions, but not of the genre, “hey, maybe you’d feel better if you wore a MAGA hat.”)
Well, the idea that therapy is ideology-free is, of course, dead wrong, especially now when there is no tent in the Universe where the Woke Camel won’t stick its nose. And so the nose goes onto the couch, as recounted in this Persuasion article by Sally Satel. Click on the screenshot to read:
Now activist therapists aren’t new; for years we’ve had specimens who impose their own views on patients rather than sussing out a patient’s problems from their own words. These activists include “recovered memory therapists”, who, it seems, already know what memories are supposed to be recovered, and try to convince the patient about the truth of things that might never have happened.
You’ve heard of the McMartin preschool case, in which recovered memory therapists dug up instances of sexual and even Satanic abuse of children that never happened. The accused people spent several years in jail, but were eventually acquitted. Right now Jerry Sandusky is sitting in prison for sexual abuse of young boys, with a lot of the testimony that put him there “recovered” by therapists digging around in the minds of young people. (Some said they weren’t abused but, after some bouts with the therapists, suddenly remembered that Sandusky committed sexual acts on them).
These therapists are clearly activists, and one would, based on their activities and the political leanings of therapists, expect them to often be on the Left.
Sally Satel, a psychiatrist who wrote this piece, is against activism, though she is affiliated with the Right-Wing American Enterprise Institute. Wikipedia says she’s a “political conservative” and has also written several books about the incursion of Left-wing doctrine into medicine, like this one (click to go to Amazon site):
Satel’s also identified as working at a methadone clinic in Washington D.C. and as a visiting professor at Columbia University’s Vagelos College of Physicians and Surgeons. If you’re one of those, you can ignore her views simply because she’s a conservative, but you might be missing some truths. And her claimed truth in this piece, which can be at least partly checked by following the links she gives, is that therapy is increasingly turning into the instillation of woke attitudes into patients as the world because woker. I doubt that, in these times, you’ll find that thesis inherently unlikely! But here’s what she says:
Until roughly five years ago, people seeking mental health care could expect their therapists to keep politics out of the office. But as counselor education programs and professional organizations across the country embrace a radical social justice agenda, that bedrock principle of neutrality is crumbling. Mental health professionals—mainly counselors and therapists—are increasingly replacing evidence-driven therapeutics with ideologically motivated practice and activism.
The Graduate Counseling Program at the University of Vermont, for example, intends to “structurally align” itself with the Black Lives Matter movement and begin “the work of undoing systemic white supremacy.” After George Floyd’s death, the Johns Hopkins University Counseling Center advised would-be students to “consider us one of many resources in the difficult but necessary work of engaging with internalized bias, recognizing privilege, and aligning values of anti-racism and allyship with embodied and sustained practice.”
Such sentiments are not limited to mission statements—they are playing out in the real world of clinical training. Some counseling programs encourage students to engage in social justice activism. Most troubling of all, trainees are being taught to see patients not as individuals with unique needs, but as avatars of their gender, race, and ethnic groups. Accordingly, more and more counselors encourage their patients to understand their problems as a consequence of an oppressive society. White patients, for instance, are told that their distress stems from their subjugation of others, while black and minority patients are told that their problems stem from being oppressed.
The stakes for patients are high. When therapists use patients as receptacles for their worldview, patients are not led to introspection, nor are they emboldened to experiment with new attitudes, perspectives, and actions. Patients labeled by their therapists as oppressors can feel alienated and confused; those branded as oppressed learn to see themselves as feeble victims. It is difficult to imagine how a healthy therapeutic alliance between counselor and patient—a core bond nurtured through a clinician’s posture of caring neutrality and compassionate detachment—could thrive under these conditions.
Is it hard to imagine that therapists might engage in this form of indoctrination when secondary-school and college teacher do it all the time? Satel goes on:
The American Counseling Association, “the world’s largest association exclusively representing professional counselors,” has a Code of Ethics that explicitly cautions against such boundary violations: “Counselors are [to be] aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors.” Yet the association has said nothing about the overt ideological stance of some programs, or blatant instances of imposition.
It’s hard to argue with that paragraph’s advice. Nor is it hard to believe that any form of propagandizing patients will be aimed at moving them toward the left because, at least according to Five Thirty Eight, social and personality psychologists are about as liberal as college professors:
When New York University psychologist Jonathan Haidt asked about a thousand attendees at the annual meeting of the Society for Personality and Social Psychology in 2011 to identify their political views with a show of hands, only three hands went up for “conservative or on the right.” Separately, a survey of more than 500 social and personality psychologists published in 2012 found that only 6 percent identified as conservative overall, though there was more diversity on economic and foreign policy issues.1 The survey also found that 37.5 percent of respondents expressed a willingness to discriminate against conservative colleagues when making hiring decisions. Psychologists, it appears, tend to fall on the liberal end of the political spectrum.
I expect therapists will line up pretty much the same way.
Now it’s okay if a patient’s problems involve politics. Perhaps he was driven to fury by Trump, and it’s upsetting his life. Or he can’t live in a world in which race seems to be the main driver of everything. Then the therapist can draw out the patients and suggest ways to improve their lives. But I don’t think it’s ever valid to impose your own politics on a patient, nor to treat them as a member of a political or ethnic group rather than an individual, like trying to urge them to be “more black or Hispanic” or “less white”. Satel has a couple of anecdotes about this, but remember, they are anecdotes.
Central to the ideology that’s creeping into the field of mental health care is a growing aversion to recognizing personal responsibility and agency. One colleague of mine who works in a prominent psychiatry department told me that during a group discussion of the growing problem of stress and suicide in black youth, her colleagues were unwilling to discuss explanations that pointed to factors coming from within beleaguered communities. Thus, participants who pointed to fear of police aggression and societal discrimination were greeted with nods, but when she suggested they also consider bullying by classmates, chaos in the home, or neighborhood violence, she was ignored.
I have had my own encounter with this growing illiberal strain. Following a lecture I gave earlier this year to a group of psychiatrists and trainees, I was castigated by several attendees for drawing attention to personal agency in overcoming drug addiction. My transgression, as they saw it, was to “blame the victim” and take focus away from factors such as racism, poor education, and poverty—which, as I had noted in my presentation, also predispose people to heavy drug use. But I was not “blaming the victim,” I explained in an icy Q-and-A; rather, I was drawing attention to the patients’ capacities to improve their lives and, therefore, to hope.
As a palliative, she touts an organization, The International Association of Psychology and Counseling, dedicated to promoting “critical thinking over indoctrination” and to an organization called FAIR in Medicine, a group designed to combat the incursion of ideology into medicine as a whole. As Satel says at the end (her emphasis):
Though I am worried for my profession, for colleagues who feel pressure to conform, and for the patients who depend on them, I take heart from these flares of resistance. I am confident that there is a silenced majority of clinicians who see the need to resist the ideological encroachment into the field of mental health care and the health sector more broadly. These new organizations are in their early stages but have the potential to attract the critical mass needed to rebuff politicized narratives and re-assert the primacy of individual patients in all their complexity.
Sally Patel or Sally Satel?
The book cover says Satel.
My typos, which are fixed. Thanks.
It is strange that the moderate left is completely missing from the discussion. From the cited excerpts’ especially concerning the survey results, it can be learned that a small minority of the therapists are right-wing, while the rest are liberals that are, in the context of this discussion, the same as the Woke Left. But where is the center-left or the moderate left?
I think that in fact most therapists, like most Democrats, are moderate left or center left. We are hearing from the loudest voices: extreme cases and educational organizations.
The moderate left is cowed into silence by the woke-left tactic of yelling “-phobe”, “-ist” and “literal violence” at any dissent.
I don’t think it’s a case of moderate left or far left, or of Classical Liberalism vs. far left per se. I think it’s an issue of the “Old” class/materialist based left as opposed to the “cultural” left. There’s no good simple dichotomy to describe it but that’s the basic division, IMO. The sociologist Anthony Giddens, himself in some ways part of the “cultural” left noted the negative implications of social theory in general moving from Marx to Nietszche as its progenitor. There’s been a long trend where a lot of people on the left became what i would call “therapized”-by which they began to associate being active in left wing causes with self help, moral improvement and self actualization. I also think there is a division in the Profession between those who do psychological research and approach it as a hard science (rightly or wrongly) based in the cognitive and Ev Psych programs and the therapy wing of it as well as Social Work/Counseling vs. Psychology per se.
Recommended reading:
* Therapy and the Hermeneutics of Oppression: https://newdiscourses.com/2020/08/therapy-hermeneutics-oppression/
* How Critical Social Justice Theory Cuts the Heart out of Therapy: https://newdiscourses.com/2020/08/critical-social-justice-theory-cuts-heart-out-therapy/
On a less serious note, I just ran across this Tracey Ullman bit about a therapy group for the Woke. It’s quite funny.
https://twitter.com/bbccomedy/status/1010189882503950336
Tracey Breaks the News was great – especially her Angela Merkel, Brigitte Macron, and Jeremy Corbyn sketches…
This gambit is called “psychologizing.” It is a weapon.
It falls back on the post-modern metaphysical axiom “reality is socially constructed.” That, in turn, falls back on a long uninterrupted chain of philosophy back to Plato (and from there to Eastern religion) which claims the phenomenal world is illusion and true reality exists in the supernatural realm. The supernatural (noumenal realm) can only be grasped by initiates, who then instruct and govern the masses. As in: telling a person in pain what to think and do, per an agenda.
In other words, there is no such thing as objective truth know by human cognition from evidence of the senses. Foucault and an army of like-minded Platonists then say that Power to control is constantly in play, and the fool tries to ‘prove’ or ‘discover’ objective reality. Better to gain Knowlege of the power play and construct human society.
So, these termites are not isolated aberrant insects. They are logical soldiers following orders.
Satel describes a very worrying trend and while some of it is anecdotal I see no reason to disbelieve her. In her piece she notes that
so it seems that the creep towards wokeness/political correctness is taking place in medicine more broadly construed than her own field of mental health care, and she isn’t the only one making the assertion.
Incidentally, the statement in the Wikipedia article that “[Satel] is considered a political conservative” wasn’t supported by a citation. Elsewhere, Wikipedia notes “Her articles have been published in The New Republic, The Wall Street Journal, The New York Times, and in scholarly publications like Policy Review on topics including psychiatry and addiction” which strikes me as a list of titles from across the political spectrum? It also says that “Satel supports legally recognizing same-sex marriages”, again not a stance I associate with the conservative position in the US (but I freely admit my ignorance on this point).
For those with the time, Dr Tara Gustilo’s EEOC discrimination claim makes an interesting read: https://www.fairforall.org/profiles-in-courage/gustilo-v-hennepin-healthcare-system/
After I flagged up the lack of a citation for the “politically conservative” claim in the Wikipedia article about Sally Satel it has been amended to include a source plus the additional statement “which she denies”. The latter assertion cites an interview in which Satel says:
https://www.aei.org/articles/thebestschools-interviews-dr-sally-satel/
(Apologies to PCC(E) for yet another comment in this thread.)
While I accept that there are gifted people who can help restore the mental health of those who for various reasons are deeply unhappy, they are rarer than the presence of a psychotherapy industry might suggest. I wouldn’t go as far as to suggest that psychology/psychiatry/psychotherapy are voodoo sciences but the lack of an evidence base for their treatments would surely make them vulnerable to extreme wokeness
Have you read the literature on the evidence for the usefulness of therapy. It’s not as strong as people think, and sometimes studies show no effect, but there are plenty of other studies that do, so you simply cannot make the unconditional assertion that there is “the lack of an evidence base for their treatments.” See here for a start: https://aeon.co/ideas/the-evidence-for-evidence-based-therapy-is-not-as-clear-as-we-thought
I agree. And a lot of the help that people get from talking to therapists is really due to just the “talking” part. I suspect everyone has experienced the effect of describing a problem to someone else in order to spark one’s own thinking. As a software engineer working on, say, a difficult bug, I have often taken a break to talk to a fellow programmer about my problem. The act of describing the bug forces one to think differently about it, filling in gaps and fleshing out assumptions. I would think that therapy often works that way too. All that is needed in a good therapist is someone who can get the patient to talk and is a good listener who can occasionally throw in a few ideas as to which direction to go. This was demonstrated many years ago with the ELIZA artificial intelligence program which acted a primitive therapist. Even after being told that they were communicating with a computer rather than a human, some patients still wanted to continue their session.
Yes, and again as a former therapist, I can say that I very rarely had the slightest idea whether my clients gained anything from the experience. Some would come to the end of a course of therapy and thank me profusely for doing such a good job. Others would tell me quite bluntly that the whole experience had been pointless. Most commonly, people fell somewhere in the middle. I taught myself not to believe any of them, not because they were lying but because the nature of the process is so indefinable: most people at one time or another experience some kind of emotional/psychological illness, and very many emerge on the other side without any help. It is usually very hard for the therapist to know whether a client has got “better” through the therapy or simply in the natural course of events. And because there is so much variation and imprecision in both the practice and experience of therapy, the evidence base is very hard to pin down.
Perhaps it is relevant as to who ends the therapy. How often does the therapist say, “I think we’re done here” or “I think we’ve gone about as far as we can go”? Or does the client just end it? If the relationship went on for some time, then perhaps it is reasonable to conclude that the client was helped, at least for a while.
I am a licensed professional counselor with compassion fatigue because indeed, there seems to be the 1/3 rule…a third of my clients “got better,” a third stayed basically the same, and a third got worse. I used CBT, which is the most popular therapeutic approach used by mental health practitioners and it aligns well with cognitive neuroscience, but 2/3 did not want to do the hard work of applying introspection and honest self-analysis to their situations. It is a tough profession but wokeness has made it impossible to speak truth without fallout. And telehealth makes it even more difficult!
In the old days, I used to bring my developmentally disabled son into my lab to play computer games. One time, I set him loose on the ELIZA game. His responses to ELIZA’s programmed questions were so goofy that ELIZA broke down, dropped the “therapist” mask, and started
issuing computer-type error messages like SYNTAX ERROR and FILE NOT FOUND!
Hah! Your son obviously found a bug in ELIZA!
ELIZA is a very crude program. I’ve always wondered how well a modern version would do. ELIZA often has to fall back to a default response when it doesn’t understand its input. A modern version could be made to be much more sophisticated in handling such a case. For example, it could use GPT-3 to generate a new response. ELIZA-2 still wouldn’t know what it was talking about but that was never its point anyway. It only needs to maintain the illusion that it understands for as long as possible, letting the user be the source of most of its “knowledge”.
Christ on a bike, if I may begin by simultaneously offending believers and annoying atheists, what’s going on? As a lapsed therapist (I went to live in a country where I didn’t speak the language well enough to practise), I find this astonishing. It seems to undermine the whole purpose of therapy, which is to identify possible causes of suffering (causes which may be relatively minor or truly traumatic), and help the client work through or around them and discover resources within himself or herself to do so. In some cases, this may mean accepting “micro-aggressions” as simply an inevitable fact of life, and usually unintentional. In other cases, it might mean finding ways to live with the consequences of truly appalling experiences, such as severe abuse. But whatever the nature and source of the psychological suffering, the whole purpose of therapy is to restore a sense of agency in the face of life’s vicissitudes, to acknowledge a degree of “victimhood” but together to find a way past it. And the whole method is to listen and wait and help the client arrive at his or her own understanding, not to impose a framework based on the therapist’s ideology. To me, this is abuse, a form of malpractice.
+1.
L
Let me second comment #6. In at least one School of Medicine I am familiar with, the termites have been very active, imposing general worship of the holy trinity of Diversity, Equity, and Inclusion. The rites of worship are supervised by the new clerisy of DEI deans, officers, and committees. I would guess that other medical schools and associated medical organizations follow the same trend.
The worst aspect of woke clichés in the mental health profession is the assault on personal agency. After all, personal agency is the reason that psychiatry and psychological counseling exist.
“After all, personal agency is the reason that psychiatry and psychological counseling exist.”
1) Is that true when the majority of a given practitioner’s solution is a prescription for a mind/mood altering medication?
2) do the Wokes’ assaults consist of saying the patient (and everyone) has no free will, and therefore no actual agency?
The injection of therapists’ views, political, religious, and personal, has been going on for a whole lot longer than five years. Freud talked about girls’ and women’s sexual “fantasies” about molestation. He couldn’t, or wouldn’t, face the fact that a lot of those reports were NOT fantasies, but real experiences. “Pastoral” counseling, which incorporates some actual therapeutic techniques, is largely a method for pressuring women to accept religion’s misogyny, and it’s been going on for a long time.
And, every technique has its biases, and if you should bump up against them, you’re likely to face pushback from its adherents. When I was in grad school, I once attended a training seminar in Gestalt therapy, where the group leaders asserted that people’s experiences were the result of their own behavior. When I asked how far they would take that, they both said, “For everything”, to which I asked, “Even, say, myopia?” When I asked that question, I didn’t know that there was an ophthalmologist in the group, and he proceeded to spent the next hour and a half arguing with the group leaders about the physical origins of myopia (including heredity). I was fascinated by their defensiveness, and their absolutism, in the face of expertise that wasn’t their own.
One time during a job interview I was asked what my theoretical viewpoint was. When I answered, “I believe in whatever works”, I got a bunch of blowback from the interview panel. They couldn’t imagine a therapist borrowing from different theoretical systems based on the needs of the client/patient.
And then, I did a postdoc with head injuries, and I learned how therapy had to be adjusted according to the nature of the injury, since the behavioral deficits had a physiogenic origin rather than a psychogenic one, and you couldn’t count on perceptual abilities to function fully.
Wokeness has no business in the therapeutic relationship. We are right to point that out. Jesus has no business there, either, but you will never hear anyone say that out loud.
L
If you’re a woman who has been raped and go to this rape crisis center in Scotland and ask to talk to another woman, you’ll be told to “reframe your trauma”.
‘Bigoted people may be challenged’: Comments by trans head of Edinburgh Rape Crisis sparks controversy
Pretty shocking. The Guilty Feminist episode is here and the “Sexual violence happens to bigoted people as well…” segment starts at about 1hr 14 mins in: https://guiltyfeminist.com/episode/?episode=323
The vast majority of psychotherapists are not psychiatrists, nor do they need to be. Most will have a background in psychology or social work, and, well, you know social science grads… They aren’t quite as bad as teachers in terms of following fads rather than evidence-based changes in practice, but no one ought to be surprised by the above. My experience of working in the public health care systems of the UK and Canada has shown me they try hard, mean well, and do their best for their ‘clients’ (they do not like to call their charges ‘patients’). Most of them are well aware of the limitations of what they can do, and can be hard-nosed about offering only effective modalities like CBT and brief interventions. The really wishy-washy types are in private practice, and don’t practice as part of a team. They actively prefer to have a small collection of clients seen frequently and for the long term. The aim is to milk the herd, rather than cure anyone of anything.
Sally Satel, though, speaks to a more worrying issue, which is the increasing uniformity of the medical profession. Recent years have seen us become driven by algorithms and protocols more than ever, which isn’t all bad if they replace guesswork. I worry about the amount of industry input into the formulation of these protocols; it’s always the latest and most expensive drugs that we are told to use first, while the cheaper, old generics with decades of proven worth are denigrated, and using them leaves you open to complaint. And it’s not just drugs, but attitudes in general that are policed. If I were still in practice and wanted to preserve my license, I don’t think I’d stand up and say ‘there are two biological sexes’ – unless I enjoy defending myself at a hearing in front of the licensing body, that will require an abject apology, some corrective training at my expense, and a period of supervision to ensure I have been successfully reformed. I rather liked the time when medicine was an art as well as a science, the art part allowing for some wiggle room in different approaches and styles. These days I’m a consumer rather than a deliverer of medical care, and it comes home to me frequently how strongly I can like or dislike a consultation based on the smallest things, even as I do my best to be an obedient, and well-behaved patient!