Acknowledging Oppression as a Therapist

Today I am exploring the overlap between being a therapist and activism. There are certain theories of counseling that describe the therapist as someone who can and should acknowledge systems of oppression in their work, particularly when a client brings up presenting concerns that intersect with oppression or a marginalized identity. A couple of these theories are known as Feminist theory and Relational-Cultural theory.

My particular grounding theory is Gestalt, which in many ways is liberatory in its founding principles (at the same time, its most well-known contributer Fritz Perls warrants a fair share of criticism in a few respects). It was based in large part on Field Theory, which basically is the concept that everything is connected, and because of this it is arbitrary to pretend that one part of a system can be delineated and separated from the rest. The implication is to look at things holistically; to truly understand something, you must look to its connections and context. I think this certainly has implications for a therapist to be looking at the role of systems of oppression and injustice in their work with clients, understanding that the problem is rarely isolated just within a client.

It’s a nice historical fact that Gestalt has had many women contribute to its literature, but I think the majority of its foundational theorist writers and trainers were privileged White men. Still, I appreciate how there are many aspects of Gestalt theory that lend themselves well to a liberatory, activist therapy approach. I’ll save that for another post. But Feminist counseling theory, as it has developed over time, has put social justice and systems of oppression even more at the forefront of its theory, and while it originally focused on gender equality, it has become more encompassing of many issues of injustice.

Calling the Problem What It Is

One main way that therapists can be aligned with activism and social justice is by calling the client’s problem what it is. In my post about Insurance and Diagnosis, I talk about how diagnosis can be pathologizing if it is used to label a person as having a disorder, when they are actually responding to trauma, injustice, or any other kind of hardship in life. Therapists should be intentional about how they use the ability to diagnose, and always be transparent with the client about why they would or would not qualify for the diagnosis in their opinion. To me, being clear with the client when it isn’t a biology or mindset problem, but rather a problem of circumstances, is essential to a liberatory therapy practice. It’s important to validate the experience of people who are swimming against the tide to survive and find joy and ease in life. We can hold both of these truths at the same time: 1) people are able to have self-determination, within limits, and 2) they can be limited by their environment and the resources/support, or lack of support, that they have available to them.

I feel strongly about calling the problem what it is. I believe a disservice is being done when statistics represent widespread prevalence of certain DSM disorders that may in fact be radically different numbers when accounting for the impact of poverty, trauma, and all other forms of oppression. The skewing of these statistics means there is a misdirection: the true impact of oppression and trauma are not given their due spotlight. This is why we at least need to start with more comprehensive language about how complex trauma works, and how varied trauma is, in the DSM. Ideally we also need to have substantial language in the DSM about oppression, marginalized identities, the impact of poverty, lack of support. With the insurance system determining which diagnoses and codes are reimbursable, it wouldn’t mean much unless the insurance system also makes therapy accessible and reimbursable for clients with trauma and oppression-based presenting concerns. Accessible therapy regardless of diagnosis would be ideal, but this would require a huge shift in mindset from how insurance for mental health in the States is currently arranged. I hope we arrive there one day and I commit to doing what I can do advocate for these changes.

Another reason I think it’s important to be transparent about how we conceptualize a presenting problem is it also does a disservice to the client to ignore the role of oppression or trauma in their life. It can be pathologizing and invalidating on a personal level to say to the client that the problem is somehow within them. It can be fine to call out injustice or trauma and also offer them skills or techniques to help them adapt to their world if they want that, but I think a skills-based therapy alone that offers ways to adapt to injustice without calling it out, can at worst be a form of invalidation and misdirection to the client, who deserves the validation of knowing that their mindset or their biology is not the actual original problem.

But Nuance Is Required

There is a need for nuance for any therapist who tries to incorporate a liberatory approach to their therapy in these ways. We must strive to acknowledge injustice and systems of oppression without going so far as to impose our viewpoints onto the client, which is not ethical. It can be tricky to strike that balance. We therapists can never truly escape our own subjectivity. We see things through the lens of our own limited experience. At what point does our perspective begin to interfere with the client’s experience of their world? How far is too far to go in talking about these things? And, what is the best practice for working with clients who see things differently, in terms of human rights and social justice? I don’t have all the answers to these questions. Feminist theory of counseling suggests that therapists be upfront with clients about their views in order for the client to know clearly what the therapist thinks and they can decide to move forward or find another therapist. I agree that transparency is best, generally, but there must still be limits to how far you go in talking about your own viewpoint as a therapist.

Because no therapist is able to completely set aside their own lived experiences or worldviews, I do think it is best not to pretend that we are completely a blank slate. My goal is to discern when the occasion arises in counseling, the times when it is best to be transparent and when it is better to leave my perspective unspoken. I think there are going to be times when it’s best to disclose how our personal perspective influences how we practice or how we conceptualize our client, but we need to use our best judgement. At the end of the day, therapists are humans too, doing our best within our limitations.