The Politics of Psychotherapy

Richard Brouillette has raised an important issue for therapists. Most therapists are trained to avoid discussions of politics and the economy, thus leading their patients to believe that all problems can be solved by readjusting their minds.

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.

And he adds:

Unfortunately, many therapists, because they have been trained not to discuss political issues in the consulting room, are part of the problem, implicitly reinforcing false assumptions about personal responsibility, isolation and the social status quo.

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.

It’s convenient. Most therapists do not know enough about reality to have a serious discussion about it, anyway. They do not know how to help their patients to navigate difficult work-related dilemmas because they do not know how the world of work is structured. They do not know what can and cannot be done, and at what cost.

If you want to evaluate your own therapist by these criteria, try this: does your therapist keep asking you how you feel or how it makes you feel? If so, she is pointing away from a reality she does not understand into an emotional soup that she thinks she understands.

Here is a sure-fire way of seeing whether your therapist is intellectually unsophisticated: she analyzes everything in terms of “control.” Today’s therapists use the word as a fetish or a mantra. When they throw it into the mix it’s supposed to give you insight. In truth, it’s blinding you to reality.

Of course, Brouillette leans left politically-- so do nearly all therapists-- and he sees the world of business in terms of justice, fairness and even abuse. He identifies himself as a community organizer. Need I say more.

He wants his patients to rebel against injustice, the better to channel their righteous anger and to change the world. He claims to be in touch with reality, but he is seeing it through his own ideological blinders.

Psychotherapists have always leaned left. Some therapists are progressive and liberal. The rest are radical. It is extremely rare for a therapist to be centrist or even conservative. No one should be surprised that most patients, if they have done enough therapy, will end up leaning left.

One might conclude that most psychotherapy is a form of stealth indoctrination in an ideology. Hopefully, people have gotten over the idea that it is about mental health. See my book The Last Psychoanalyst for an extensive explanation of these points.

Brouillette shows his cards when he offers a clinical example of a patient. Not only has he not taught her how to work on real world problems. He has turned her into someone she is not. He has turned into a modern day Norma Rae… a textile worker become labor union activist.

In his words:

I once had a patient who had reached a breaking point with the situation in the startup where she was employed. In her therapy, she had been struggling for two years with the idea that it was possible to have authentic communication in relationships. Our therapy helped her hone her anger into a courageous, well-considered and pointed group email that resulted in nearly half of her co-workers supporting her and prompting direct labor negotiations with the chief executive.

Since Brouillette does not write very well, his thought is not very clear. It is not the business of business to foster “authentic communication in relationships.” One does not understand how he skipped from a vague relationship problem to a business issue.

More importantly, we would like to know whether the worker could have found a more constructive and discreet mode of expression. Sending an email to everyone is generally a very bad and self-defeating idea.

Normally, people who make their anger into a public spectacle damage their career prospects. Most business leaders value discretion. They prefer to hear about problems in private. They do not take kindly to public embarrassment. True courage would have been for this woman to make an appointment with a superior, even the CEO, and to voice her complaints directly, to his face.

Unfortunately, Brouillette does not understand the business world well enough to provide constructive advice. The woman divided the staff into those who supported her and those who did not. She embarrassed the CEO in public. I suspect that in the long run her actions will prove to be ineffective.

Based on Brouillette’s description, it’s difficult to know what the woman’s problem was. Happily enough, he offers another example where the problem is clearer:

“I’m meeting my boss later,” my patient said. “I’m worried she’s going to tell me I’m not pulling my weight, and that I should volunteer to work more hours to show my commitment.”

This tension had been building at her job for months, and she feared that there would be a tacit threat in this meeting: work longer hours, uncompensated, or we will push you out. She was already finding it hard to spend so much time away from home. But she couldn’t afford to risk unemployment.

“What am I supposed to tell my children?” she asked, breaking down.

Here, we do not know the nature of the job. We do not know whether the woman is married or not. We do know that she has chosen a job that requires her to put in so many hours that she is depriving her children of her presence.

Apparently, this woman is not pulling her weight at work or at home. Other people are putting in more hours and working harder. It sounds as though her friendly leftist therapist is going to tell her that her boss is being unfair and sexist. Perhaps he will tell her to send out an email blast to the entire staff, complaining about her boss’s wish that she spend as much time at work as everyone else.

She is not going to solve her problem by militating for paid family leave, or by asking to be paid as much as everyone else while working less. One suspects that however goodhearted her boss and however committed her boss is to feminism, company morale would suffer if this young mother is allowed to have a different schedule and to work less than others, while earning as much. After all, the other workers will be obliged to pick up the slack.

A brief glance at reality suggests that the problem is not political as much as it is economic. The woman is asking for a special dispensation on the grounds that she wants to spend more time with her children. If she does, she ought to be willing to accept less compensation and fewer promotions.

Beyond that, we do not have enough information to offer a solution or even to appreciate the problem fully. We do not know her financial situation, her salary, her benefits, the contribution made by her children’s father, the nature of the business where she is working. Perhaps she needs to find part-time work while her children need her at home and while she wants to be with them at home. Perhaps she needs a nanny to take care of her children.

Clearly, Brouillette sees it as a feminist issue, a moment where a woman should be imposing the conditions that pertain to her life on everyone else or should receive special consideration because she is a woman.

The woman has the right to make her own decisions and to fulfill her obligations to her family and her job as she sees fit. She does not have the right to force everyone to compensate for her dereliction at work. That, dare I say it, is reality.