While the psychiatric survivor’s movement has problematized the mental health field since the Civil Rights Movement—particularly its penchant for pathology, paternalism, and carcerality—waning social stigma has mainstreamed critiques in recent years, normalizing the expression of dissent.
Some folks question the validity of the DSM, others strongly oppose involuntary commitment, many more see solitary confinement as inhumane, and a large segment stands against any involvement whatsoever of [armed] police in mental health crises. Among social workers, lobbying against the criminalization of addiction and homelessness has taken off.
The momentum of such critiques has coincided with intense debate about whether myriad other industries/institutions—academia, Hollywood (e.g., #MeToo), organized religion, prisons, and Wall Street—are living up to their social responsibility, and if not, whether they are still useful.
When folks turn this scrutiny on therapy, many are surprised that their critiques don’t offend me, that I don’t invalidate their experience or perspective, that I can see the merit of their arguments, and that I’m curious about how their innovative recommendations might look in praxis.
Most expect me to step out of character defending the field in which I have invested much time and energy. Yet, not even the harshest critiques of therapists could ever bait me into defending or promoting therapy as a panacea for healing—especially pertaining to structural trauma.
Here are a few reasons why I have come to appreciate the harshest critiques.
First, some of these critiques serve to humanize us therapists and remind us of certain safe spaces in graduate school, where therapists needing help was not taboo. A fair amount of therapy students are psychiatric survivors and/or individuals with mental health challenges, which they effectively manage. During graduate programs, their perspectives are able to open minds and hearts, and leave an indelible impact.
Many of their stories remind us that therapy is not the only tool for growth, healing, and recovery, and other paths are just as legitimate/valid. Their experiences with avenues besides therapy prove that therapists aren’t exclusively qualified to assist in crisis or with trauma, and that it’s wise to keep an open mind about which helpers are assets, regardless of pedigree (e.g., peer support specialists, facilitators, or elders without degrees or licensure).
Moreover, their presence in education and training spaces reminds colleagues that there is no "us v. them" binary. In some classes, for example, braver students may share about a suicide attempt, a negative experience with a crisis line, a hospitalization, or their own therapy session.
Considering the potential for re-traumatization or vicarious trauma, many faculty make a concerted effort to normalize therapists seeking therapy, and also encourage students to attend AA meetings and other support groups as a form of prevention and self-care.
To onlookers, this may seem unusual.
One study, for instance, found that clients felt anxious about their therapist's well-being and professionalism following therapist self-disclosures of illness. Failing to live up to the myth that therapists are always perfectly "put together" resulted in judgment. Relatedly, it's not uncommon for folks to express implicit bias toward therapists with tattoos, piercings, long nails, or unconventional hairstyles.
Another study found that the media perpetuates conservative stereotypes and that "in cartoons, psychotherapists or psychiatrists are described as upper-middle-class professional men, with a balding pate (92%), spectacles (77%), and beard (74%), often carefully and formally dressed."
Conversely, most degree/training programs are de-conditioning these assumptions about therapy/therapists, which lends itself to openness and listening to critiques.
Second, bridging the theory-praxis gap—specifically as it relates to structural barriers, systemic bias, and supremacy culture—requires confrontation with critique. Off-the-clock concern about clients often compels therapists to seek out critiques of status quo practices, as an ethical obligation.
In fact, for many therapists, there’s no greater burden than the insider-perspective that therapy isn’t a cure-all for structural trauma. It can be unsettling to know that anyone who’s not avoidant, escapist, or spiritually-bypassing will have to confront oppressive pitfalls head-on after session—and what we offered may be helpful to some degree, but ultimately inadequate.
On the upside, this awareness spurs many therapists to become more critically conscious, to explore the professional implications of capitalism, carcerality, and other hegemonic structures, and to listen attentively to critiques of therapy’s complicity.
The critiques that therapists discover—of “normed” assessments, evidence-based treatments, and diagnostic constructs—all enable therapists to better serve clients. So do accounts of Western psychology's "forefathers" that challenge historical revisionism and expose their dehumanization of and cultural appropriation from non-White cultures. Debunking these myths about the alleged authority and purity of the field validates our hunches that there is no one-size-fits-all intervention or "typical" client, and that even the most established and proven interventions have yet to be adapted for minoritized clients.
Last, but not least, tapping into our own resistance to pointed critiques of therapy can yield valuable insight about the potential defensiveness of willfully ignorant colleagues whose minds we try to change.
Even today, there’s still not unanimous support for analytical frames/lenses like Black feminism, harm reduction, liberation theology, and prison abolition. Some therapists who've advocated for these perspectives have faced severe backlash or had their careers derailed.
As James Baldwin said, “The price one pays for pursuing any profession or calling is an intimate knowledge of its ugly side.”
This ugly side rears its head in classrooms, group supervision, performance reviews, the elections of professional organizations, the crafting of public statements in response to current events and, most crucially, the DSM.
Yet, if critically conscious therapists can pinpoint where in our bodies resistance to new information emerges—and name the corresponding feeling—we can access the cheat code for how to best introduce our more traditionalist colleagues to new ways of thinking, perceiving, and being. Our own defensiveness can serve as a map.
My two biggest takeaways from the harshest critics of therapy are, first, that it’s possible and necessary to be critical of the field from within the field, and, second, that good-faith critiques which further innovation and social responsibility are more valuable than an appeal to tradition ("this is right because we've always done it this way").
At the end of the day, our labor is indeed important and much-needed, but also merely one of many gears in the capitalist grind. Letting our egos convince us that it's too sacred to be critiqued sets us all back. We have an ethical obligation to get out of our own way.
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