Reimagining Psychotherapy

If I’m being gentle, I’ll say that I’m losing faith in the mental health industrial complex. If I'm being honest, I think that psychotherapists are cops and the revolution will not spare us. I’ve been meaning to write this essay for a long time, because I don’t want to be mistaken for someone who is under the illusion that our profession is noble and altruistic. So here’s my coming-out: I’m a psychotherapist, but I don't believe in psychotherapy as a long-term solution to community wellness. When I look into the future, I hope for one that doesn’t include carceral systems, like policing, military, nonprofits, predatory healthcare, or the mental health industrial complex. Imagine a world where people are able to get their basic needs met: food security, housing security, fair wages, accessible communities, healthcare, transportation, equitable workplaces (and while we’re dreaming, no billionaires…). I’d lose 90% of my caseload. Which would be great, because my capacity for being a bandaid on a broken system is rapidly diminishing. It’s not burnout, it’s a realistic reaction to exploitative expectations, but that’s a different essay.

The mental health industrial complex has always given power and authority to people with access to higher education. White researchers stole knowledge from community-minded cultures and then repackaged it to sell to predominantly white institutions, so white students could go to graduate school and teach Black, Brown and marginalized people how to assimilate into white dominant culture. Therapists don’t inherently have special skills that make us better at “healing” people. That probably made some of you mad, because you identify as a 3 on the enneagram, or an empath. Sorry. I’m an 8 so I don’t care. People come to therapy because they want to heal relationships with other people or heal the relationship with themselves. Therapists (who are also people) are tasked with the job of supporting folks in creating an internal environment that is a fertile ground for healing, which means you don’t have to be a special human, a highly sensitive person, or a Pisces. Anyone can learn this skill. 

To meet the requirement of assimilation as a means of survival, psychotherapy (at least in the United States) demands that we do one of two things: we fix people, or we hide them. If you disagree, think about the options you have in emergency situations: are you going to pick mobile crisis, hospitalization, or the police? This is not a sustainable solution. Maybe you, like me, have come up with a lot of creative ways to get around this demand. We create extensive safety plans, support development of community networks, and research all of the alternatives to calling law enforcement. This is wonderful, and it is also a bandaid. Our Codes of Ethics don’t help much with this, by the way, nor do our licensing boards, who would always rather see the ways we complied with carceral systems and documented it, to preserve the “integrity” of the profession. Yes, the integrity of the profession that was founded on colonialism and white supremacy. I offer a presentation called “The White (Supremacy) Elephant In The Room”, where I unpack the NASW Code of Ethics and highlight all of the places that white supremacy culture shows up. Heads up - the document is riddled with it. People with power and access have always been able to make the rules about what’s “right” and “wrong” for other people, even when they use pretty language like “injustice” and “equity” and “help”. I’ve said it before, and I’ll say it again: If your desire is to “help” a community with whom you have no relational connection, you are not helping them; you are colonizing them. 

A lot of psychotherapy modalities talk about “serving” clients, seeing them as equal partners in their treatment. This is a lie. As long as the therapist has the power to commit an individual to a carceral system against their will, the relationship will never be equal. Because of our access to higher education, and only because of our access to higher education, we’re given immense power. Remember, psychotherapists don’t have inherent special skills. We are people with diagnoses, reactions, countertransference, and trauma. Maybe we’ve learned to suspend our needs when our clients need us - but what kind of relationship is that, if we’re doing that in every single interaction? When our clients do it, we tell them they’re codependent, or have anxious attachment. Don’t even get me started on the DSM, which is a colonial oppressive tool that punishes people for valid reactions to their environment, and for not being “civilized” white men. Relationship is the most essential part of the healing journey, so the practice of offering a sanitized, wholly-accepting power-driven version of ourselves for our clients to become attached to feels…sus, right? And unconditional positive regard? Be serious. (I’ll write another essay about why I think that’s some feel-good bullshit that only serves a white-savior mindset but doesn’t actually support authentic connection and relationship). My friend Alison and I talk about the ethics of psychotherapy constantly, and she brought up that many people come to therapy to be reparented. This is why the expectation is that the therapist doesn’t make any mistakes, offers unwavering compassion, and responds to conflict the way you dream Michelle Obama would. Alison, who I think is brilliant, also offers this gem of a quote: “incomplete humanity is the most important ingredient for authentic connection.” Whew. I love her. She just drops quotes like that in casual conversation. Kai Cheng Thom, an author I love and want to be my best friend, wrote a tweet that I think addresses this exact problem: ‘Psychotherapy is weird because although there are some important ethical reasons for boundaries, the colonial paradigm of practice is like “let’s develop an extremely emotionally intimate relationship reminiscent of parent-child attachment and then NEVER SEE EACH OTHER AGAIN”’. 

I'm extremely attached to the idea that therapists don't have to sacrifice themselves in service of healing other people, and to do so is a perpetuation of white supremacy. I had a client who was unpacking some of their anti-fat bias in a way that was anti-Black and disparaging toward people who are my size. My client said, "if you can't support my weight loss, I can't talk about this with you." So we don't talk about their weight loss. They will continue on a long healing journey with me in lots of other amazing ways, but I do not allow harm to come to my being in service of someone else’s growth. Some therapists will read this and say, "wow, she really needs to get some supervision around her countertransference." Fine. I'm not afraid of countertransference. I think it's an awesome relational tool to help me reflect on how my clients (and I) approach relationships out in the world. I think it does a disservice to my client to pretend that their words have no impact on me, and that I’m too evolved to set boundaries or have a healing journey of my own. It is a healing practice for both of us to set boundaries, have conflict, and say, “I am still choosing to be in partnership with you, even though we have differences. I see you in your humanness, and you see me. We can move forward together.”  

We need to radically reimagine what healing can look like. It doesn’t have to look like a secret meeting in a room where you sit on a throne of stolen knowledge and charge people $150/hr to listen to you say “I’m on this journey with you”. It could look like authentic connections driven by the desire to explore our humanity through mutual relational messiness. I tell my clients constantly that they teach me as much as I teach them, but that’s easy for me to say. I’m on the throne. I want to burn down the system that empowers mental health professionals to believe that we know something about wellness that other people don’t. Therapeutic healing happens all of the time in communities without the gatekeepers of degrees and licensure. Many of the healers in these communities didn’t have to go to grad school to learn how to empathize, but they’ll never be recognized for the life-changing work they do because acknowledgement isn’t accessible. We don’t need therapists, I bet. We probably just need to clear the path for people who didn’t have to buy the knowledge of how to authentically relate to one another, and then pay them buckets of money to teach us. 

So, I don’t believe in psychotherapy. I believe in community, universal healthcare, mutual aid, and systems that don't involve carceral treatment or policing. We can’t “decolonize” psychotherapy because the mental health industrial complex was built on colonialism. So how do we get to this magical future with no psychotherapy? I have no idea. But I realized recently that it was possible that some of my ideas around what constitutes a "radical revolution" were influenced by white supremacy culture - the idea that the movement had to be big, unified, codified. But that might not be what radical change will look like. Maybe it will be small, revolutionary pockets of people changing each other in radical ways. I have pockets of people like that. Do you?