The Therapist With a Placard

I’ve been thinking about activism lately, and about whether that word is supposed to sit comfortably alongside psychotherapist. There is still something deeply embedded in our profession about neutrality. The good therapist is careful, contained and measured. We don’t bring too much of ourselves into the room. We don’t impose our values. We make space rather than occupy it. All of which makes enormous sense to me, right up until neutrality starts being confused with having no position at all. Because I don’t know how you sit with people for more than fifteen years, listening to what happens when power is misused, and somehow emerge from that experience with fewer opinions about the world rather than more.

I’ve listened to people who learnt very young that keeping somebody else happy was the safest way to survive. People who have spent years believing there was something fundamentally wrong with them because they couldn’t function comfortably inside environments that weren’t built with them in mind. People carrying shame that never really belonged to them. Women frightened of their own anger. People exhausted from being good, compliant, useful, productive and undemanding. People who learnt, sometimes explicitly and sometimes through a thousand tiny interactions, that belonging required a particular version of themselves. I’ve also sat with people who have caused harm. People who avoid responsibility. People who can be selfish, cruel, defensive, frightened, manipulative, loving, generous and maddeningly contradictory, occasionally all before we’ve reached the end of the hour.

In other words, I’ve spent a large part of my adult life sitting with human beings.

And human beings are messy.

Perhaps that is why I’m wary of both political neutrality and political certainty in psychotherapy.

We talk a great deal in therapy about the internal world. Depending on our training, we might talk about schemas, attachment, defences, childhood, trauma, nervous systems or relationships. Whatever theoretical language we use, we are usually trying to understand how somebody came to experience themselves and other people in the way that they do. But none of us develops in a vacuum. A child learns whether anger is safe inside a family, certainly, but that family exists inside a culture. A woman learns what is expected of her not only from her parents but from everything surrounding them. A neurodivergent person may develop extraordinary strategies for surviving environments designed around somebody else’s nervous system. Someone living with poverty doesn’t leave financial insecurity in the waiting room when therapy begins. Neither do people leave racism, misogyny, homophobia, disability, class, religion, migration, privilege or social expectation outside with their coat.

The world gets into the therapy room whether we invite it or not.

So sometimes the therapeutic question isn’t simply what is happening inside this person? We also need to be curious about what has happened around them. Who was allowed to have needs? Who had to keep everybody happy? Who got to be angry? Who was believed? Who learnt to disappear? What happened when somebody said no? What was considered normal in this family, this workplace, this community or culture, and who benefited from that particular version of normal? Follow those questions far enough and eventually you bump into power.

That is where I think psychotherapy can become nervous, because once we acknowledge power we also have to consider the possibility that not everything we encounter in the therapy room belongs entirely to the person sitting opposite us. Sometimes distress is an internal struggle. Sometimes it is an old wound being repeatedly touched. Sometimes it is the consequence of choices somebody is making now and needs to take responsibility for. And sometimes a person is having an entirely understandable response to circumstances that are genuinely bloody difficult. If we aren’t careful, therapy can become another place where they are taught to tolerate those circumstances more effectively.

There is something that troubles me about helping somebody regulate themselves sufficiently to remain in an environment that is hurting them without ever becoming curious about the environment itself. Breathing exercises may help somebody survive Tuesday. Grounding might settle an overwhelmed nervous system. Reframing can create another way of understanding what is happening. I use these things and value them. But we still need to be able to ask whether Tuesday should look like this in the first place. There is, of course, an uncomfortable complication here. It is relatively easy to talk about power when it belongs to somebody else: parents, partners, employers, governments, institutions and systems. It becomes considerably less comfortable when we turn the same curiosity towards ourselves.

Therapists have power.

I don’t think acknowledging that undermines collaborative therapy. It simply recognises something real about the relationship. Somebody comes to us because they believe we may be able to help. They tell us things they may never have said aloud. They pay attention to our responses and notice our silences. Some will desperately want our approval. Some will expect our rejection long before we have given them any reason to. Others may argue with everything we say while quietly wondering whether we think they are a terrible person. Our words carry weight, and so do our values. Which is precisely why I don’t think being a socially conscious therapist gives us carte blanche to bring our activism into the consulting room. A client isn’t my audience. They aren’t there to be educated into my worldview. They don’t have to agree with my politics to deserve my curiosity, and they don’t have to vote the way I vote, care about the things I care about or arrive at conclusions I would personally choose.

There is a trap here for therapists who care deeply about social justice. We can become so certain that we are challenging oppressive power that we stop noticing when we are exercising our own. If my acceptance of a client becomes dependent upon them holding sufficiently acceptable views, I need to be curious about that. If I feel an overwhelming urge to correct them, I need to be curious about that too. If I’m sitting opposite somebody thinking, How can you possibly believe that?, I don’t need to pretend the reaction hasn’t happened. I’m human. But I do need somewhere to take it.

This is one of the places supervision earns its keep. Not as somewhere another professional gives me the approved answer, but as a place where I can bring the material that is uncomfortable precisely because it belongs partly to me: the judgement, anger, irritation, the client who gets under my skin, the thing somebody said that collided spectacularly with something I care about, or the moment I desperately wanted to tell them what I thought. Those moments don’t make us bad therapists. They make us therapists with histories, values and nervous systems of our own. What matters is what we do with them.

There is a question I return to often around therapist self-disclosure: Who is this for? I find it annoyingly useful.

If I’m considering telling a client something about myself, why? Does it open something useful for them? Does it reduce shame, deepen the work or allow us to acknowledge a difference sitting very obviously between us? Or do I simply really, really want to say it?

I think the same question belongs in conversations about therapist activism. If I speak publicly about something, am I comfortable with clients knowing that position? If I campaign for something, what happens when a client strongly disagrees? If I speak with the authority of being a psychotherapist, am I actually speaking from psychological evidence and professional experience, or am I borrowing my professional title to lend additional weight to a personal political belief? Being a psychotherapist doesn’t make my opinion about everything more important.

God help us if it did.

And yet the answer cannot be that therapists never speak, because silence isn’t an empty space either.

There are things I don’t want to be neutral about. Abuse. Coercion. Conversion practices. Discrimination. The deliberate stripping away of somebody’s humanity. Systems that repeatedly cause harm and then locate the problem entirely within the people struggling to survive them. I don’t believe my professional identity requires me to look at those things and shrug politely. Outside the therapy room, I’m a citizen as well as a psychotherapist. I can write, protest, campaign, question, challenge and occasionally make a nuisance of myself when making a nuisance of myself seems warranted.

I can also challenge my own profession, and perhaps this is one of the places therapist activism matters most.

We can ask who gets to train and who can afford to train. Who can afford therapy once we have trained. Whose theories become foundational and whose research gets taken seriously. Whose communication is described as disordered. Which behaviours we understand as pathology and which we recognise as adaptation. We can ask how much of what psychotherapy calls psychological health reflects a culturally specific idea of how a successful human being ought to behave, and what happens when somebody has no particular desire to become that person. I love psychotherapy. That is precisely why I think we should be prepared to poke it occasionally with a stick. What worries me just as much as neutrality, though, is certainty. Activism can give people language for experiences they have felt but couldn't name. It creates communities, challenges power and unsettles systems that rely upon everybody quietly accepting that this is simply how things are. But certainty can become intoxicating. Once we are absolutely convinced we are standing on the right side, curiosity becomes surprisingly easy to abandon.

And curiosity is rather fundamental to psychotherapy.

Human beings stubbornly refuse to organise themselves into morally convenient categories. Someone can experience oppression and behave appallingly. Somebody can hold considerable privilege and carry profound pain. People remain fiercely loyal to families that harmed them. They defend systems that disadvantage them. They can love somebody and be frightened of them. They can desperately want change and resist every opportunity for it. They can hold two apparently contradictory truths about themselves at once.

So can therapists.

I want psychotherapy to be spacious enough for all of that. I don’t want a profession so frightened of politics that it becomes blind to power, but neither do I want a therapy room in which the therapist already knows the morally correct destination and quietly steers the client towards it. Neither feels particularly liberating to me. Perhaps neutrality was never quite the right aim. Perhaps what we need is openness: enough openness to recognise injustice without assuming we understand somebody simply because we recognise the category their experience belongs to; enough to acknowledge our own values without requiring agreement; enough to hear something we dislike without immediately reaching for correction; enough to notice power outside the therapy room and inside it. And enough humility to change our minds.

I’m increasingly comfortable, then, with the idea that activism and psychotherapy can belong in the same life. Not because I want activism to colonise the therapy room. Quite the opposite. I want the therapy room to remain somewhere another person has enough space to work out who they are, including when the answer isn’t one I expected and wouldn't be the answer I would choose.

But I also don’t want to spend my working life witnessing what power, silence, shame and exclusion can do to people and pretend that witnessing none of it has changed me. More than fifteen years of this work has made me less interested in telling people how to live. It has also made me considerably less willing to accept some of the things we ask human beings to live with.

Those two things no longer feel contradictory to me.

Perhaps they belong together.

And when I’m unsure where that boundary sits, there is a question worth carrying into supervision, into professional life and occasionally beyond the therapy-room door:

Am I using the power I have to make more room for somebody else’s humanity, or am I trying to make them more like me?

I suspect I’ll be asking myself that one for a long time.

And yes, I reserve the right to own a placard.