As a long- time therapist whose career has spanned four decades, I’ve sat with people of varying ages, physical and psychological conditions, life circumstances, histories, cognitive capacities, and communication styles as they shared their concerns and unpacked sometimes unbearably heavy baggage. Often, I have been astounded and deeply moved by the courage it has taken for them to remain vertical.
I like to think that I offer a safe, neutral space for them, so that they can feel fully empowered to make positive change. Feedback from most indicate that it works. I adapt my style depending on their individual needs. I am what I call a ‘seat of the pants counselor,’ often ordering off the menu, no cookie cutter counseling here. I do my best to withhold judgment as we work together to sort through their limiting thoughts.
Lately, I have been challenged to meet that standard, courtesy of the present political climate. Unless they tell me, I don’t know my patients’affiliations or beliefs. Some come right out and inform me that what has been going on in the world has upped the amps on their anxiety and depression and that they either feel helpless to do anything about it or that they are actively engaged in social action.
I support them in finding ways to take steps in the direction of making the world a more peaceful, kind and safe place for themselves and for the next generations.
Recently in a session, a client who had never before revealed his alliances, had been speaking about the erroneous link between mental illness and mass shootings and that while he didn’t agree that those with mental health diagnoses were more likely to commit violent crimes he did support the president, who made statements connecting the two, praising him for who he is and what he perceived he is doing for our country.
He said he had voted for him and intended to do so again in the next election. I took a deep breath and put on my best game face as I did a quick assessment of how to proceed from here. Admittedly, I wanted to challenge him or at least question why he held the beliefs that he did. What amazed me was that he is in a demographic demonized by the man he admired.
I wanted to remind him about losing his rights if the current administration had its way. He is a man of faith and I wanted to ask him how the current occupant of the Oval Office reflects his own deeply held spiritual beliefs that lead him to be of service to the people around him, since the president’s statements fly in the face of what Jesus was said to have taught.
Re-Directing the Conversation
I did my best to re-direct the conversation to his other issues, as I felt myself adding an extra layer of compassion for both of us and self -restraint for myself. I wanted to be of service to my client despite what I perceive as the pro-social values I hold and some of the misinformed and detrimental statements he made.
He was my last patient the evening and fortunately, a colleague was still there as I asked to sit with her for a bit and process my experience. She understood my dilemma as she has faced similar challenges. We agreed that while we can attempt to steer conversations in a particular direction with our well- honed communication skills, we need, first and foremost to see the world through the lenses of our clients.
I wasn’t sure what shaped this person’s values, and it felt as if it would be leading into dangerous professional territory to pursue that thread of conversation.
It reminded me of an experience I had a few years back.
This case study was presented at a seminar for therapists: A 10-year-old boy was in mandated treatment. Both his parents were incarcerated, and he lived with his maternal grandmother, who was described as loving and attentive. She also cared for many of his cousins, their parents being behind bars as well.
Many generations of the family had arrests for non-violent crimes, and the grandmother reinforced these behaviors. The 10-year-old was incredibly intelligent; he’d read auto manuals to learn how to remove car alarms. In a therapy session, a counselor told the boy his family was bad. His reaction was to set a fire at his school and steal a school bus, and then abandon it, leaving it to roll down the street in neutral.
Exploring Motivations for Behaviors
The seminar facilitator asked the class to consider what any reasonable person with the boy’s background would come to believe about himself, relationships and the world. Then the seminar leader asked about his possible motivations for his behaviors.
The group offered input, suggesting the boy might believe that he could do whatever he wanted without consequence, that he might believe about relationships that family is good and the legal system is bad, and that he might believe about the world that everyone outside his family was an enemy, or a “mark” to be exploited or tricked.
His fears, they said, might be getting caught, being separated from his family by child protective services, or disgracing his family by succeeding in ways that broke with their tradition.
The facilitator, who’d become the boy’s therapist, revealed that because the family believed the attorneys who’d defended his parents had failed them, the boy felt the family needed its own attorney — him. He spent years preparing to fill that role.
He avoided trouble with the police, studied for and passed the bar, and became a defense attorney. Someone in the class characterized him as “a productive member of society.” But as the facilitator pointed out, his world view might not have changed, and he still had potential to pass the values he grew up with on to the next generation.
A class participant asked if, in the course of treatment, there was ever a mention of empathy for the crime victims. The answer was no, because it would have been a foreign concept for the client. In his world view, his family’s needs came first, to the exclusion of the needs and rights of others. The participant asked further whether the therapist brought up accountability and consequences. Again, the answer was no.
Because the patient’s outcome was deemed positive, the other issues were considered less therapeutic. They also would have reflected the therapist’s judgments of right and wrong, going against the tenet that treatment should meet clients where they are, respecting their views as valid for them.
Questions to Consider
The case study raises important questions for therapists to consider — questions that unfortunately don’t have definitive answers:
- What responsibility do we have to introduce pro-social values and actions to clients?
- Should we encourage changes that will help clients break unhealthy patterns?
- Is it possible to teach empathy in patients whose world views tell them it’s unnecessary?
- Is it our right to try to help clients break the cycle of family behaviors if they see nothing wrong with them? For example, part of the family culture might involve drinking together, then driving home. Should we remind clients those decisions could have deadly consequence?
- How can we support our clients, knowing that they’ll make choices based on value systems that might not be in harmony with ours?
- What can we do to acknowledge our own biases and beliefs and not permit them to infiltrate our therapeutic interactions and interventions?