Submission to The Social Lens: A Social Work Action Blog by Catiyana Adam, an incoming BSW student
‘By themselves, neither psychological nor political explanations suffice in accounting for the sources of suffering and human welfare. By the same token, neither political nor psychological interventions alone can improve human welfare. It is only when we achieve an integrated political and psychological understanding of power, wellness, and oppression that we can effectively change the world around us (Prilleltensky 2008, p. 129)’.
The therapy room is a space of acceptance, compassion, and healing. In therapy, you are wholly accepted and supported without fear of judgement or rejection. No person, whether their politics, views, or opinions conflict with their therapist, should feel rejection based on what they believe.
This does not mean therapy is a neutral force. By its very nature, therapy is political. Therapy in a social work context, especially, has its roots in social justice work, and is in constant consideration of clients’ social location and experiences of society. While the therapy room can be a refuge from destructive or oppressive forces, it can never entirely remove itself from the social reality in which it operates.
Therapy has not always been progressive or helpful for certain groups. A lack of culturally competent care and the continuation of power dynamics often jeopardizes clients’ healing. At times, therapy has been directly harmful to marginalized groups, such as in the case of conversion therapy for queer, trans, and other 2SILBGTQ+ youth.
However, as therapists with a social work foundation, the goal should be to facilitate healing, which often means subverting harmful political forces. At the very least, it requires an understanding of how they shape therapy practice on an individual and large scale. The following is a series of ideas on how to integrate social justice into therapy practice.
Begin with Education and Understanding
Understanding how politics plays into therapy is an undeniably important step in furthering social justice within therapy work. Education, including reading and research, but also self-reflection and discussion, can help therapists understand the basic historical, social, and political climate in which they are operating. A social work education already provides much of this background, but social workers and therapists should seek out continuous learning.
Beyond simply understanding how forces such as racial dynamics, misogyny, patriarchy, and capitalism work in a societal context, it is also important to understand how these forces influence psychotherapy specifically. Psychotherapy and other ‘psy’-iences (professions or disciplines based on the field of psychology) carry traits of the society from which they emerged and have often been criticized for neglecting to confront their political undercurrents (Rose, 1998, p.16 in Rossiter, 2000, p.151). Winter (2021) points to how psychotherapeutic goals such as the “thriving selfhood” are grounded in a capitalistic understanding of what constitutes a successful, functional person. The diagnostic criteria for many mental disorders rest upon significant interruption to life functioning, often interpreted as attending and completing work or school. If a condition is not severe enough to impact one’s participation in a capitalistic-oriented society, it may not qualify as a legitimate disorder. What is missed here are the aspects of a successful life that are outside of the capitalist definition of “functional”. When a person’s well-being is reduced to how well they perform within a harmful economic macrosystem, at what point does it stop being about a person’s health?
Questions such as this can help refine or shift a therapist’s individual practice if approached with openness and curiosity. Understanding how our economic, social, and societal structures affect individual problems, including mental health, is key to providing effective holistic mental healthcare. While it often leads to realizations about the difficulty of overcoming such barriers, it can also point to new solutions outside of the traditional therapeutic relationship. For example, a client may become involved in a cause close to their heart, which may facilitate connection with individuals who share similar values and hopes. This can build community and companionship for the client, as well as expand networks of connection. It can increase motivation and a sense of control over seemingly insurmountable barriers. Thus, in facing difficult social forces, the therapist and client can discover new ways of creating healing, as well as acknowledging the effects of oppression on the client’s health.
Create Culturally Competent and Considerate Care
Attention to cultural diversity and the differing needs of various cultural groups has risen in the past few decades as the world has globalized and countries have recognized the need to diversify services and resources. Positive steps have been made to address differences in needs, such as businesses and schools offering services in other languages or providing translators free of charge. Similarly, therapy needs to continue to adapt in order to meet the needs of their changing client base.
There is a growing need for services for immigrants and new residents, who may benefit from therapy. The move to a new country, as a refugee or otherwise, is difficult, as immigrants face new cultural practices, languages, post-traumatic stress, and culture shock. Often, therapy is inaccessible due to cost, a lack of provincial or private insurance, or language barriers. One suggestion for private practices is to actively hire therapists who can address specific cultural needs, such as therapists with additional language skills or specific experience working with immigrants. Sliding scales and pro bono services are also an excellent way to increase the accessibility of therapy to equity-deserving groups.
Other diversity training programs, such as education around cultural differences and needs can increase awareness for therapists. In obtaining these services, therapists should be mindful that educators are adequately compensated for their work, as education is often an extra burden taken on by marginalized people. Tracking demographic information, including that of therapists, can help identify gaps in services. Practices could consider adjusting hiring procedures to provide more comprehensive culturally competent care.
Culture, like politics, has a huge influence on our daily life and health. Understanding and accounting for this aspect of a client’s life can positively benefit their recovery, as well as improve services as a whole.
De-Centre the Self and Deconstruct Power Dynamics
While much of the work incorporating social justice into therapy involves examining work at the organizational level, an analysis at the individual level is just as important. Power dynamics make their way into therapeutic relationships, as with all relationships, and require an examination in order to maintain a balanced, mutually beneficial relationship.
Power dynamics show up in therapeutic relationships in a variety of ways. Communication and language can replicate power dynamics; the terminology used by the therapist can create the illusion of a ‘knowing expert’ or simply be illegible to the client. Therapists should focus on utilizing the language used by the client and refrain from imposing their own frameworks of understanding upon the client’s experience.
While critiques of the biomedical model of health have gained traction, and attention has shifted to biopsychosocial models of health, the vestiges of the biomedical model still find root in mental healthcare. A common conceptualization of therapeutic relationships within the biomedical model is of the client as a “sick patient” and the healthcare provider as the “knowing expert” with the tools to “treat” the client’s “problems”. Combine this with the moral deservingness groundwork of social work, and you have a dangerous mentality of clients as sick individuals who have accrued problems due to problematic decision-making or inherent failings, who can only be fixed by an all-knowing healthcare provider. While hopefully most therapists do not think this way, these fundamental assumptions can infiltrate their practices, through an over-reliance on medical understandings of mental health (rather than the client’s own experience), disbelief or invalidation of clients’ conditions, under-emphasis on client autonomy, or general therapeutic dynamics (knowing expert/sick patient). To address these power differentials, both an understanding of this particular history, as well as an ability to challenge and self-reflect, are key.
Examining power dynamics within therapeutic relationships is important to providing genuine and effective care to clients, especially where differences in privilege and oppression are present. Once again, approaching one’s own approach with curiosity, non-judgement, and openness to change can refine a therapist’s practice.
Break Down Barriers for Clients and Employees
Barriers to mental healthcare, such as cost, have been previously discussed in this article. The cost of therapy sessions can be addressed through the provision of sliding scales or pro bono services. For example, I have encountered private practices that require therapists to take on a certain number of pro bono clients at a time.
Session fees are not the only barrier to therapy for low-income clients. Other hidden costs, such as transportation, parking, loss of income due to working hours, even food and drink, can create barriers for clients. Often, therapy practices will offer complimentary tea, coffee, or snacks, which is an excellent initiative. Providing free menstrual products, such as pads, tampons, and liners, also create more comfortable care. Adjusting practice hours to include evenings and weekends, or providing virtual care, can also reduce the financial burden incurred from attending therapy.
Creating partnerships with other community programs can also expand access to care. While practices do not have to offer explicitly cost-reduced care if partnering with another organization, it can help extend the range of awareness and interconnectedness of services. For private practices, this also increases awareness of their community’s specific needs. Being aware of other community resources is essential for referring out clients who receive better care from another service, but can also be a base for creating partnerships with local organizations and interconnected care.
Go Beyond the Therapy Office
Finally, we must acknowledge that social justice can not be fought for solely from the office. Advocacy, community work, and similar efforts must be found outside individual practice. Therapists are intimately aware of their clients’ challenges, which can provide an important starting point for change. Like all people invested in social justice, choosing an issue we care about often produces the best results. Passion and knowledge create a powerful impetus for change, and even if your advocacy doesn’t involve protest or lobbying, lending a skill can be just as effective. For example, many communities have crochet or knitting initiatives, where volunteers make socks or blankets for those in need. Baking, art, graphic design, or writing can all be useful skills for fundraising, awareness-raising, or education.
Social workers and therapists all have a role to play in furthering social justice – both inside and outside the office. Therapy offers social workers a unique look into the effects of oppression and politics on individual lives, as well as a powerful launching pad for change. With curiosity, passion, and a willingness to learn, therapists can shift the tide of mental healthcare towards a comprehensive, caring, and just system.
References
Prilleltensky, I. (2008). The role of power in wellness, oppression, and liberation: The promise of psychopolitical validity. Journal of Community Psychology, 36(2), 116–136. https://doi.org/10.1002/jcop.20225
Winter, L.A. (2021). Swimming against the tide: Therapists’ accounts of the relationship between p/Politics and therapy. Counselling and Psychotherapy Research 21(2). https://doi.org/10.1002/capr.12401
Rossiter, A. (2000). The professional is political: An interpretation of the problem of the past in solution-focused therapy. American Journal of Orthopsychiatry 70(2), 150–161. DOI 10.1037/h0087656
Based on an original article written by Catiyana Adam: Adam, C. (19 October 2021). Revolution from the couch: Integrating social justice into therapy practices. The Bliss Blog. Bliss Counselling and Psychotherapy. https://www.blisscounselling.ca/revolution-from-the-couch-integrating-social-justice-into-therapy-practices/
Catiyana Adam is an incoming BSW student. She previously studied sociology at McMaster University in Hamilton, Ontario, with a focus on feminist, family, and disability studies. She is passionate about social justice, music, writing, and art.
THE SOCIAL LENS: A SOCIAL WORK ACTION BLOG - The views and opinions expressed in this blog are solely those of the original author(s) and do not express the views of the UBC School of Social Work and/or the other contributors to the blog. The blog aims to uphold the School's values and mission.
