Responding to Therapist Activism: New Strategies for Change

Within the last several years, mental health treatment has taken a political turn, and activist approaches to therapy are being promoted across therapy institutions. These new treatment approaches have a different telos to classical therapy: The goal is more to change society rather than heal the individual. Though lacking empirical support, this change has been imposed on the field by therapy institutions, often bypassing critical debate. This paper identifies several strategies that professionals and academics can apply in five key domains—public outreach, knowledge production, therapy practice, therapy bureaucracies, and therapy training—to challenge these changes.

Keywords: Activism in psychotherapy, therapist training, professional organizations, critical theory, social justice, sociopolitical bias

Within the last several years, rapid and radical change has spread throughout the mental health treatment field. Therapy, which was once avowedly apolitical, is becoming politicized. This shift can be detected across therapy institutions, and these bodies use professional standards to impose political goals on therapy practice.

For example, see the American School Counselor Association’s 2022 ethical framework, which opens by stating: “School counselors are leaders, advocates, collaborators and consultants who create systemic change to ensure equitable educational outcomes through the school counseling program.”^1(p1) Therapy training programs exhibit similar tendencies. Note, for example, how the University of Vermont’s PhD program for counselor educators commits “to develop critically conscious scholar-activists in the counseling profession.”² This move is happening across the Anglophone world. An independent report on United Kingdom (UK) clinical psychology doctorate programs reveals the extent of the politicization of these trainings.³

One of the most concerning issues is the almost complete absence of critical debate within the academic and professional literature regarding these changes.⁴ It would appear that a radical transformation is being wrought in the therapy disciplines that is neither properly discussed nor researched. There is plenty of anecdotal support for the negative impacts of activist therapy (presented in op-eds, blogs, and podcasts^5,6 and in emerging research^9,22) but hardly any empirical evidence derived from substantive research programs.

A more robust response from clinicians and academics is needed to address these changes. Questions about the potential negative implications of activist therapy need to be posed and answered. However, it is also important to proceed in a cautious and considered way and to be open and charitable to opposing arguments. With this in mind, five key domains of action are presented here: public outreach, knowledge production, therapy practice, therapy bureaucracies, and therapy training.

A significant problem is caused by failing to label therapy services clearly. The terms therapist, counselor, psychotherapist, and clinical/counseling psychologist are used indistinguishably by classical/traditional practitioners and activist therapists. But there is a radical difference between these two approaches: Traditional therapy is client-centered, evidence-based, and politically neutral, whereas activist therapy views the client’s problems as created by an unjust society and so treatment involves a form of moral reeducation and political activism.

Activist approaches to therapy do not represent just another modality in a field. Instead, this new type of politicized mental health treatment is distinguished by characterizing all other modalities as merely products of a morally corrupt colonial Western psychology. (For a good example of this rhetoric see the introduction to a special issue on decolonial/liberation psychologies published in American Psychologist.⁷ See also the American Psychological Association’s formal apology for psychology’s role in promoting “human hierarchy.”⁴⁰) Taking this stance allows activist therapists to dispense with empirical evidence and well-established standards. For example, Lacerda-Vandenborn et al⁸ have asserted that therapists can have “multiple relationships” with their clients.

As the general public is unlikely to be aware of the big changes happening within the therapy professions, there is the potential for a mismatch between client and practitioner. One potential source of mismatch would be different political beliefs. In a recent survey of 8,000 therapy patients, 61% said that it was important that they and their therapist shared political views.⁹ This was confirmed by another study in which clients reported feeling more comfortable with and trusting of clinicians whom they perceived as sharing their values.¹⁰

Furthermore, there is strong evidence that sociopolitical attitudes and values are not only fundamental to people’s sense of self but that these beliefs are resistant to change.⁹ In order to reduce mismatches, we should focus on educating the general public so that the selection of a suitable therapist is better informed. This could be done through the following:

• A determined effort to provide information through accessible op-eds and podcast interviews: Good examples would be Lisa Selin Davis’ piece⁵ on how therapists became social justice warriors and Andrew Hartz’s essay¹¹ on therapists who are hostile to their clients’ beliefs.

• A campaign to differentiate established traditional/classical therapy from activist approaches in the marketplace: One strategy would be to encourage traditional/classical therapists to positively market themselves as such. Another strategy would be to characterize activist therapy more accurately as a different type of cultural practice altogether; one recent suggestion is to style activist therapists as “identity practitioners.”¹²

Due to the lack of viewpoint diversity within the academy and the academic/legacy publishing industry, knowledge production has become biased. Activist scholars are typically informed by critical social justice (CSJ), a postmodern ideological framework emphasizing identity-based power dynamics and systemic oppression.¹³ In this ideology, concepts such as intersectionality,¹⁴ white fragility,¹⁵ and microaggressions¹⁶ are accepted as axiomatic truths.

The gatekeepers (commissioning editors and reviewers) with these views often limit the publication and dissemination of critical perspectives. Meanwhile, other academics are wary of the likelihood that being associated with nonorthodox views could lead to cancellation and reputational damage. (See the dismissal of Klaus Fiedler from his post as editor of the prestigious Association for Psychological Science.¹⁷)

However, there are a few hopeful signs that some cracks are appearing in this wall; for example, recent papers have critiqued psychotherapy’s embrace of diversity initiatives¹⁸ and the taking up by psychoanalysis of a transgender-affirmative approach.¹⁹ In addition, an important academic book titled Ideological and Political Bias in Psychology: Nature, Scope, and Solutions lays out some of the arguments and evidence for taking different perspectives on the political turn in therapy.²⁰

One area of focus must be determined attempts to empirically investigate this new politicized therapy. Although it is difficult to operationalize activist therapy for research purposes, there are some other potential avenues. Researchers could do the following:

• Evaluate the mental health implications of holding particular CSJ-informed beliefs: One such recent study indicates a link between poor mental health in men and acceptance of the currently fashionable negative characterization of traditional masculinity.²¹

• Assess the challenges faced by classical/traditional therapists working in politically hostile environments: For example, a recent study explores strategies used by gender-critical therapists to guard against accusations of conversion therapy.²²

While activist clinicians focus on further consolidating critical consciousness²³ in their clients, it is important that traditional/classical therapists start to think about ways to help clients who present with harms caused by a politicized and polarized culture.⁴² In other words, a goal should be providing a therapeutic antidote. This could be supported through:

• developing informal professional consultation groups where practice issues can be shared (it is hoped that within supportive professional communities, classical/traditional practitioners can begin to pool ideas on how to work with these emerging challenges in practice);

• developing formulations informed by classical theories/modalities that can be adapted to clinical practice in an increasingly polarized environment—for example, understanding gender dysphoria from a psychodynamic perspective²⁴; and

• not allowing CSJ concepts (terms such as microaggressions, white supremacy, intersectionality, and inclusion) to go unchallenged within wider or more general therapy professional settings.

Professional organizations hold a great deal of power: They set standards for practice; issue guidelines; provide a stamp of official approval through accreditation systems; and, in jurisdictions such as the UK, operate as quasi-regulators. There are two possible routes forward:

• Begin the slow and difficult process of building new professional organizations: This is happening in higher education with the establishment of new universities.²⁵ This strategy of creating “parallel structures” to resist oppressive authoritarian regimes was pioneered by the Czech dissident Vaclav Havel.²⁶ We can see the beginning of this in new membership organizations, such as the avowedly apolitical International Association of Counseling and Psychology²⁷, the Open Therapy Institute²⁸ with its mission of addressing sociopolitical bias in mental health care, and Critical Therapy Antidote,⁶ which explicitly seeks to preserve therapy’s healing ethos.

• Attempt to reclaim legacy organizations by moving into positions of power within the bureaucracies themselves and attempt to reset the agenda along more balanced lines: This move will require determined individuals who are prepared for battles of attrition. A recent example from the UK demonstrates it is possible to break the activist stronghold. The UK Council for Psychotherapy (the UK’s second-largest membership body) recently withdrew its signature from the trans-activist Memorandum of Understanding on conversion therapy.²⁹ Subsequently, trans activists attempted to have the council’s board of trustees fired—a move that proved to be unsuccessful.

Possibly the most concerning of all the domains is the political capture of training institutions. New generations of professional therapists are being trained to view the client through an identitarian lens and diagnose the client’s difficulties as being solely determined by their membership of oppressed or oppressor groups. These ideas are being instilled with the help of unsuitable anti-relational training methods³⁰ and radical changes to the curricula. A recent independent inquiry into UK clinical psychology doctoral training programs has exposed the extent to which these courses are being “decolonized.”³ One published account by a former counseling professor described recruitment processes in which candidates were more likely to be admitted if they were sympathetic to “social justice activism.”³¹ What can be done?

• Provide informal facilitated peer groups for affected trainees where they can be supported in navigating politicized training programs.

• Provide online seminars and short courses in traditional theories and methods to supplement an increasingly narrow curriculum.

• Use legal means to challenge aggressive and discriminatory actions of training institutions that try to impose political viewpoints. For example, see Leslie Elliott’s case against Antioch University³² and James Esses, who successfully fought a high profile case against his UK training institute, Metanoia,³³ after he was expelled for publicly expressing his gender-critical views that a person’s sex is based in biology. A current legal case is being prepared by a student on a counseling master’s course at the Catholic university Santa Clara: Naomi Epps Best objected to both the curriculum with its focus on “kink” and a mandatory assignment for which she was required to write a personal “sexual biography.”³⁴

• Initiate more debate about the demographics of the therapy profession. Over the last 10 years, the female-to-male ratio has remained fairly consistent among therapists in the U.S.; currently, this data source indicates about 70.4% are women, while about 24.7% are men, and the remaining 4.9% are unknown.³⁵ This is part of a broader feminization of the helping professions.⁴¹ Because CSJ attitudes are more prevalent among women³⁶ and large cohort studies indicate younger women are more likely to sympathize with social justice activism than their male counterparts,^37,38 this means an increasing bias might entrench itself further over time.

A schism has emerged between traditional/classical approaches to therapy and new activist approaches, even though both operate under the same name: psychotherapy. practitioners and clients are increasingly confounded, and the therapy professions are in danger of falling into disrepute.

However, there are ways in which bad practices can be corrected. As Kaufmann³⁹ argues, the social sciences as a whole need to move beyond relativist theories and an anti-positivist philosophy of science and return to realism and the scientific method. Similarly, professionals have a duty to deliver evidence-based therapies. By implementing the strategies outlined in this paper—educating potential clients, developing research, informing practice, reforming therapy bureaucracies, and improving training—professionals working together can start to correct course. Clients need therapists who respect them as individuals and are committed to helping them become more agentic, insightful, and realistic. These strategies are essential steps toward restoring the profession to these ideals.