Do you know who your therapist voted for? Should you?

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Psychologist helping young man in a therapy session.

Psychologist helping young man in a therapy session.

This story is from The Pulse, a weekly health and science podcast.

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People go to therapy to talk about themselves mostly. But increasingly, politics is entering the therapist’s office as well. 

Politics and current events have become a huge part of more people’s emotional lives, a big part of what makes them feel anxious, unsafe, or angry. 

Minneapolis psychologist and trauma therapist Patrick Dougherty remembers a tense group therapy session in 2016. It was a men’s trauma therapy group, and the police killing of Philando Castile had just taken place a few miles from Dougherty’s practice. A white patient began to speak.

“And he went into a rage about the f— a— cops, and he was calling them like they were like Nazis, and he was just in this rage,” Dougherty said, “And everybody in the room was just like frozen, it’s like, `Holy shit, this guy is really big and he’s rageful.’”

Dougherty stopped him, asked him to reflect about his emotions — what the incident brought up for him specifically.

“He stopped for a minute, and his face changed and he dropped into his body. And then he started saying, ‘The f—- bullies, the f— bully a—. And tears came to his eyes and the whole room relaxed, because we knew he had been bullied. Severely bullied. It just slowed him down and opened up his heart, and then …  he was in the room with us,” Dougherty said.

The idea that therapists are supposed to be a blank slate, leave their personal opinions outside, and sit back and listen? Dougherty stopped believing that years ago.

“You know, that’s just bunk,” he said. “That’s just a fantasy.”

The first time he decided to take a stance was the day after the shooting at a gay nightclub in Florida in which 49 people were murdered.

“And that morning, I just sat at my table and just wept, and … it was so clear to me that I have to bring this up because it was so disturbing,” he said. 

Dougherty wrote an open letter and put it out in his waiting room. He doesn’t remember exactly what it said, but the gist of it was: We can talk about this. This shooting that happened to strangers in Florida may not seem relevant to why you’re coming into a therapist’s office in Minnesota, but it’s on the table for discussion.

“It was a clumsy attempt of saying, ‘You know, the world is in chaos, and it’s affecting most of us,” he said. 

Dougherty’s basic philosophy became this: If the world is affecting your nervous system, ignore it at your peril. 

Police shootings, the far right, terrorism, events in Washington or on the border, thousands of miles away, are affecting you in profound ways in your everyday life by way of affecting your emotional well-being.

“And so for most people, it’s just like, `Oh my gosh. Why hasn’t anybody told me this? Why isn’t this common dialogue?’” Dougherty said.

If the world is affecting us, he thinks we have to talk about it in the therapist’s office. That means diving into divisive issues. That means letting politics into the therapist’s office — an idea that was unthinkable for therapists only a generation ago.

These days, Dougherty is even upfront with clients about who he is politically. 

“I’m a passionate liberal. And very open about that,” he said. 

In fact, he believes therapists’ politics sometimes have to be obvious. 

“I think people need ethical and courageous therapists. I think it’s ethically … an imperative, you have to do it,” he said.

But what happens when a politically upfront therapist meets a client with opposing opinions?

Dougherty described one who had come to him reluctantly — Christian counselors had failed the client, and he was coming out of his third failed marriage. 

“So when it got hard with him, as when he came in and started really talking that demeaning stuff about immigrants or women or politics, this was the summer before Trump was elected,” Dougherty said. 

He recalled almost losing his cool during a session with the client, actually a few times, and this particular instance when the client said something about women belonging in kitchens, old school sexist stuff.

“This is where the ethical place comes in, because I’m watching my own nervous system and how pissed off I was getting at this guy,” Dougherty said. “And he knew what was going on, he was saying things when he got stuck in therapy, he could throw something out to get me going because he knew because I was so clear about where I stood.”

Dougherty ended up calling out his client: “Hey, you gotta cool it with that stuff or we’re not gonna work.” The client listened, and kept seeing Dougherty for quite some time.

But the episode illustrates a contradiction in the mental health codes of ethics. 

The therapy relationship

“We say in therapy all the time we want to accept who the client is,” said Mitchell Handelsman, a professor of psychology and ethics at the University of Colorado. “At the same time, we say you have to change the client, because that’s why they’re in therapy. There are all these inherent tensions in therapy, which is why therapy takes time to learn how to do.”

Handelsman said the point of ethical codes isn’t to tell you what to do, but instead how to think about problems. 

Therapy is at heart a relationship, not a lecture or a scolding. But at the same time, some therapists, like Dougherty, feel an increasing responsibility to correct their patients’ opinions on, say, women or immigrants.

The ethics code doesn’t actually spell out what to do there, Handelsman said.

The vast majority of therapists, studies show, tend to be on the left politically. Mental health issues don’t discriminate, with people of all political stripes dealing with things such as depression and anxiety. So how do blue therapists make that connection with red clients who are very different from themselves?

Handelsman said this kind of problem isn’t entirely new.

“This controversy has existed for a long time in terms of religion, because there are more atheists among psychotherapists than among the general population. And the question then becomes: Can somebody who does not believe in God do therapy with somebody who does?” he said. 

Nowadays, therapists are dealing with a political divide instead of a religious one.

“Part of what I think happened is that politics has become part of identity in a way that things like religion were,” said Bill Doherty, a family therapist in Minnesota and co-founder of Better Angels, a nonprofit that aims to bridge the left-right divide. 

Doherty does a very specific type of therapy: He deals with family breakups and estrangements, “I’m never speaking to you again” sort of stuff.

In his field, there’s pre-Trump and post-Trump. Pre-Trump, these breaks were usually caused by some kind of interpersonal conflict —disparaging a partner, cheating, an argument that went too far. But, he said, after Donald Trump came into the political picture, it was different.

“I was confronted with people who had been married for a long time … where somebody was threatening divorce if their spouse voted for Trump. And so this, and then with family members cutting each other off, getting into Facebook wars and then defending not just on Facebook, but refusing to go to a Thanksgiving dinner,” Doherty said. 

All of this boils down to one process, he said: polarization. The other guys aren’t just wrong about this issue or that, they’re 110% wrong — and they’re evil.

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It’s a force against which the therapy world itself isn’t immune. Doherty described a recent psychological conference at which a speaker made the case that any acknowledgment of progress or improvement in race relations in the United States was a betrayal to progressive causes. A pretty bold statement reasonable people might find controversial in many circles, but not in Doherty’s.

“I think there’s a kind of evangelistic fervor that’s going on in the therapy world, the therapy professions, where you can’t even debate a topic like that,” he said. 

That kind of polarization that shuts down conversation and debate makes therapy difficult. He offered an example: Let’s say a white client comes in and starts throwing around racial slurs during a session. Doherty said most therapists can and should address it, and draw a line saying that kind of talk is not acceptable. 

Increasingly though, Doherty said, he sees mere political positions carrying the same weight as open slurs in the minds of some therapists.

“Let’s say [there’s] a white guy who part of his problem is job stress. And maybe he’s lost a job, and he’s having trouble getting another one. And he says something like, you know, I’m a white male and, you know, they want to hire people, you know, Black people and people of color, and I don’t think it’s fair,” Doherty said. “There are some people in my field who would view that as a racist statement. And then could, if they don’t have a way to address it with this person, they would be kind of repulsed by it. And I think there is a big ground in between somebody’s attitude towards affirmative action and their kind of hateful, dehumanizing speech that they would do in front of me. But that distinction is lost in some of the kind of more left-wing literature in therapy.”

Doherty is worried that too much political passion on the side of therapists could lead to lots of people shying away from seeking or getting help. It’s why Doherty doesn’t share his politics with anyone. (He went to great lengths never to show his cards, even in an interview, about where his political leanings lay.)

He said it’s easier to find common ground that way. When politics comes up in his office, instead of fighting or trying to shut down a client’s political position, Doherty’s strategy is to burrow underneath it with the client: What is it about you personally, your life and firsthand experiences, that make you feel this way?

“I interviewed a woman who was alienated from her parents because of her politics. Her parents were strong Trump supporters, actually, distributed leaflets for him and so on him. She is a strong, liberal blue,” Doherty said. “And one of the commonalities I helped her see is that her parents cared deeply about politics and trying to make a difference for the country and she does too. And that she got some of her passion for making larger contributions from them.”

The potential risk

Without more common ground, Doherty said, there’s a real risk that therapy, mental health care, will be considered something that’s done by lefties for lefties.

And that may already be the case now. In interviews for this story, researchers who surveyed patients and therapists to get a handle on their politics said they had tremendous difficulty even finding conservative patients to survey.

Does that mean that conservatives just have better mental health, or that the right is being left out?

“I have certainly had in my practice, people have said to me, `I am a Trump supporter. I hope you don’t hate me.’ That’s horrible. Right?” said Randy Freeman, a clinical social worker and psychotherapist in New Jersey. She’s a kind of old school Republican.

“I liked Ronald Reagan. I liked George Bush,” Freeman said. “I would have loved to have seen Mitt Romney win the election in 2012 and the one that Trump won.”

She noticed even before Trump that she was the odd one out as a conservative during the Obama years. It started on a listserv for therapists.

“And I noticed people writing things that were assumptions that leaned very far left or lean left. And the assumption was that everybody was going to just think this is just the right thing,” she said. “And a couple of times, they wrote some kind of comment about something. I don’t remember what it was, and I was told it was too political.” 

Like Doherty though, she thinks Trump supercharged things. Disdain increasingly went alongside simple disagreement. 

“I have found a lot of my friends, colleagues and friends, are very, very liberal and very judgmental of people who are conservative. So I can’t imagine that that doesn’t come across in a therapy session,” she said. “That’s what I find disturbing, is that you’re sitting in therapy and you hear that one of your patients is a Trump supporter. What feelings go on inside of you?”

Left, right, or in the middle, the therapists interviewed for this article were asked what they thought was on the horizon: Would things get hotter or cool down? They all said the other side needs to change, or at least has to do most of the changing.

But, Freeman said, she recently held a workshop for colleagues aimed at depolarization, at having therapists look at themselves and their own reactions to clients. You can’t treat someone when you’re judging them.  

She said the sizable turnout was good, which was promising: People want a way out of the current political moment even if that means giving a little ground.

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