The ideological Capture of Psychotherapy

[NotHavingIt]

A scray, and deeply concerning, piece by James Esses in which he recounts his attendance at a recent conference on Existential psychotherapy.

https://open.substack.com/pub/jamesesses/p/the-ideological-capture-of-psychotherapy?r=clsg2&utm_campaign=post&utm_medium=email

Those comments from Stella Duffy are crazy. I know she’s full gender woo, but she has always presented herself as savvy and a woman who is a feminist. She’s very “Labour TRA feminist” in vibe these last few years as she’s been marketing herself a queer therapist. She obviously can only make sense of her own cognitive dissonance regarding her work around menopause by the “trans and nonbinary” caveat. I had thought better of her; she’s a smart and brave woman.

“The world of trans activism has become one filled with threats, silencing, homophobia, misogyny, coerced language and belief policing.”

“........painfully othering”, “heteronormative essentialism predicated on gender binary essentialism”. “Menopause affects all bodies, including trans and non-binary bodies”.

Given that on Stella Duffy's practice website she states that she is interested "in embodied approaches to therapeutic work" the above statement surely contradicts that?

😔😔😔

Very pertinent words from the woman who invited him to speak:
“Who are we as therapists if we cannot tolerate and be open to divergent points of view? How can we truly attend to the Other in the therapy room if we need them to agree with us to feel ‘safe’? What does it mean to offer a therapeutic space where our clients can express their deepest, darkest thoughts and feelings if ‘words are literal violence’?

One thing for me (I accept that there are many who disagree with me) is that I won't use the word "ideology" to describe a belief in gender identity. In exactly the same way I wouldn't describe a belief in God as Christian ideology. It inherently has a negative and othering connotation IMO. So if I had a gender identity belief, and was experiencing gender dysphoria, I wouldn't want my therapist to have any implicit bias within their explorations with me. If a therapist calls it an ideology, this might be a red flag. It would be unethical for a therapist to bring any atheist bias in to their work with a Christian client (e.g. unpicking and challenging their beliefs), so the same would be true of a gender identity belief.

However, facts are facts. There are two sexes. Some people have a gender identity belief, some people don't. For those that do have a belief in gender identity, some will experience gender incongruence or the even more distressing end of gender dysphoria.

The fact that the author can't advocate for the delivery of therapy that assumes a neutral position on this belief is abhorrent. Gender dysphoria is a mental illness - regardless of belief, the idea that the physical body needs to be changed to match a belief must surely be a mental illness. In the most extreme of cases, after all therapy to accept the reality of the physical body is exhausted, medical transition may be the right answer. Anyone for whom this is the case deserves access to care and compassion without judgement throughout their mental health support. However, this will be the right outcome for an incredibly small number of people, from what would be an already incredibly small number of people.

Because gender identity is baked in to the psychotherapy world as fact, this important nuance is lost and patients will inevitably get poor, but well-meaning, care. If the profession was delivering therapy through a Christian belief lens I'm sure there would be uproar - imagine a therapist discussing a pregnant rape victim's trauma with them through a Christian affirmation lens that will "help" her see why it's so important that she allows the child a right to life, no matter how she herself feels about that. That would be considered coercion, surely. I can't see how this is any different.

I find it deeply concerning how mental and emotional fragility is being nurtured in people to the extent they have to be protected from any contradiction or challenge. It seems that rather than being counselled to become emotionally whole and resilient: to take responsibility for resolving one's issues internally, instead people are being encouraged to practice denial and evasion, and then to seek outward political or societal change instead.

This can only increase divisions in society and increase relationship break-ups and break-downs. If the source of all your suffering lies in other people, or in an uncaring, dangerous world then you have to try to avoid it, or shield yourself from it. Your world then becomes smaller and more isolated - as you seek to surround yourself only with that which re-affirms you; and the chasm between yourself and others seems unbridgeable - indeed your psychic structure and emotional well being now depends totally on distancing and separation from that/those which confronts or challenges you.

I've been witnessing this at first hand with my youngest son ( now almost 30). His mental health suffered during the lock-down ( I've long suspected he has Asperger's too) to the extent that he became paranoid and reclusive. Recently he's been seeing a variety of 'talk' therapists - but instead of helping him, he seems instead to have become even more entrenched and angry. And I feel, also far more vulnerable.

I gained a counselling qualification myself, many years ago ( psycho-dynamic - even though I suspect I may have been more suited to humanistic). I understand that social justice activism has been infiltrating counselling and psychtoherapy services - with counsellors viewing themselves as activists.

I was watching a programme about Recep Tayyip Erdogan the other day ( ahead of the Turkish election) and what struck me was the way that you ensure your ideology succeeds is for young people to be trained and educated in its precepts and to then enter into occupations in every avenue of civil society in order to shape and influence them. You then ban or imprison your opponents ( including academics, journalists, politicians). Autocracy and totalitarianism is then achieved - with no effective challenge permitted.

Any total world view which has articles of faith which must not be questioned is an ideology.

All therapists are working from a basic conception of what therapy is there to do.

No therapists would use the word 'ideology' in the course of a therapeutic relationship - even though they would likely be seeking to explore or test out the psychic structure of the client - to see where the conflicts and dissonances that might be caiusing distress, are located.

It seems as if there is no agreement on the basic premises of psychotherapy then it just becomesa marketplace of competing ideologies, and the client just chooses the one that is least likley to challenge the existing structure.

It seems that rather than being counselled to become emotionally whole and resilient: to take responsibility for resolving one's issues internally, instead people are being encouraged to practice denial and evasion, and then to seek outward political or societal change instead.

This can only increase divisions in society and increase relationship break-ups and break-downs. If the source of all your suffering lies in other people, or in an uncaring, dangerous world then you have to try to avoid it, or shield yourself from it. Your world then becomes smaller and more isolated - as you seek to surround yourself only with that which re-affirms you; and the chasm between yourself and others seems unbridgeable

Absolutely. I see this in the autism world with my daughter too. At home and via her EHCP (school support plan) reasonable adjustments are made to accommodate her differences so that she can partake on an equal footing with others as much as possible. However, it's very easy for "reasonable" to creep further and further in to such a special accommodation that it is now unfair on others. We watch out for this constantly but that can only be achieved by helping our daughter to build resilience to the twists, turns and general unfairness at times of life. However, in the autism parent support groups that I'm in, "resilience" is becoming a dirty word. I'm told that my daughter shouldn't need to build her resilience at all, it's the world that needs to change and be more understanding. I'm all for a world where autism is better understood but equally, it's my role as a parent to equip her for the reality of the world. Something seems to have gone very wrong on this point in general and we're creating permanent victims.

My son has has also been seing a Christian counsellor ( as everyone knows the waiting list for NHS mental health services is very long and so people are taking what is available) - and I had assumed that would be better than the other organisation he has been receiveing counselling from - which I assume is politicised and social justice based; because from my own experience with Christianity there would be a focus on inner resolution and letting go, which to my mind is far healthier than clinging on to a unhealthy pattern of thought or response, and then separating oneself from all challenge to it.

No therapists would use the word 'ideology' in the course of a therapeutic relationship - even though they would likely be seeking to explore or test out the psychic structure of the client - to see where the conflicts and dissonances that might be caiusing distress, are located.

Understood. I'm just offering a counter argument that a therapist that uses this word in general (not in the sessions) will need to keep their own gender identity belief bias in check.

Any total world view which has articles of faith which must not be questioned is an ideology.

Agreed. But it's all or nothing. If people are happy talking to a Muslim using the phrase "Islamic ideology" in the conversation, or "Christian ideology" to a Christian etc, fair enough. "Gender ideology" it is. I personally wouldn't use any of these terms as I think it sounds disrespectful. I don't hold any of those beliefs myself, including a belief in gender identity, but I would still want to show that I respected their belief.

When you encourage someone to identify themselves as a victim of an oppressive system (or person) of any kind - you embed fragility and vulnerability, and this makes emotional resillience almost impossible to achieve.

It is not you who has an issue - it is the uncaring world that has the issue - and so you are encouraged to surround yourself with only allies and supporters.You are encouraged to believe you are unique or special and that the purpose of therapy is to be able to express your best or most true self. You embed yourself further into the community that embraces you for who you are and they become your family.

This, on the contrary, can make for a very lonely and isolated place - and it also increases the risk of suicide ideation: as you cannot effectively shield yourself from the world, from your family, friends or from any challenge at all. Feelings of powerlessness and inability to cope only grow.

To my mind, any organisation or group which engenders the above is a cult - or it certainly operates as a cult.

I've briefly out-lined my experiences with evanagelical Christanity before - for it to work and to offer healing, you have to totally embrace it with no caveats ( hence the evangelism). The world does then become black and white. That which is in-line, and that which is out-with. the needs for greater and greater purity increase, as one totally dedicates onself to the path.

In order to achieve purity one must cast out all that hinders, or that challenges; and in that you tend to separate yourself from people, including former friends and family, that don't align or that distract you. but because human beings are social creatures and naturally seek companionship you fall back on the group/the church/the community that shares your belief/vision/ideology.

Taken to extremes you end up with the Branch Davidians, or like any number of isolated cults that you can see documentaries about on Netflix.

Falling out, or leaving the group is difficult because you are now on your own, and have to start to develop some emotional resillience and some inner toughness of spirit. Freedom can be very difficult to handle and is not for the faint hearted - which is why people often prioritise group belonging over individual inner integrity.

I don't hold any of those beliefs myself, including a belief in gender identity, but I would still want to show that I respected their belief.

For me the difference lies in the client needing me to validate and uphold their belief system, the requirement that I recite the catechism if you like. I can respect a client's beliefs without sharing them, but with gender that isn't enough. I've worked with clients who hold completely different views to me, and made great working relationships with them. But none of them ever needed me to believe the same as them, in order to make use of therapy. I've never had a Christian client require me to declare I believe in God, or an antivaxxer need me to refuse to have the covid vaccine, though I've worked with clients with those beliefs. But I've had adherents to gender ideology want me to state I believe TWAW, TMAM, NBIAV, and decline to work with me because I won't do that.

For me the problem with embracing someone's belief in gender identity is where it can lead. It can lead to the taking of hormones not suited to one's natural biological make-up, and/or to mutilating surgery.

Also, the embrace of gender identity theory can also lead to the trampling of other people's rights and as we continually see, to the suppression of anyone who doesn't share in that belief.

One thing for me (I accept that there are many who disagree with me) is that I won't use the word "ideology" to describe a belief in gender identity. In exactly the same way I wouldn't describe a belief in God as Christian ideology. It inherently has a negative and othering connotation IMO. So if I had a gender identity belief, and was experiencing gender dysphoria, I wouldn't want my therapist to have any implicit bias within their explorations with me. If a therapist calls it an ideology, this might be a red flag. It would be unethical for a therapist to bring any atheist bias in to their work with a Christian client (e.g. unpicking and challenging their beliefs), so the same would be true of a gender identity belief.

This is a good point and, although I can certainly see calling it an ideology in a therapeutic situation harmful, I am not sure I entirely agree. Christians would totally agree that Christianity is a belief system; the creed includes the words “I believe”, it is supernatural, other worldly. ‘Ideology’ suggests it is based on ideas about the nature of the world rather than the nature of God (theology). A Christian is unlikely to object to you calling their believe a type of theology. Those who follow gender identity ideology/belief do not consider it a belief, so calling it gender identity belief would not be considered any less biased by them. Instead it they do base it on a set of ideas about the world so calling it an ideology is more correct.

Another difference between mainstream Christianity, as opposed to fundamentalist Christianity or any other fundamentalist belief system such as gender identity belief, is that Christianity went through a reformation and has since then adapted itself to an evolving society that embraces a multitude of beliefs and practices.

Gradually, many of the edicts and expectations that had formerly been placed upon everybody have dissolved, leaving only those who wish to practice to do so.Yes, we still have an established church and the King is the head of that church - but nobody was forced to watch the cornonation nor to pledge an oath of loyalty.

You cannot say that with radical genderists. We are all expected to pay lip service at the very least; to use pronouns even against the truth of our eyes; and to accept males who believe they are women in women's spaces and sports, and so on.....

Gender dysphoria is a mental illness - regardless of belief, the idea that the physical body needs to be changed to match a belief must surely be a mental illness.

Stonewall et al have lobbied very hard against that view, and to have it removed from the DSM.

But that doesn’t mean it isn’t. DSM is a political document as well as a medical one.

No disagreement from me!

Agreed! But the problem is that now it has been de-clasified as a mental health issue, any insistence that it is will lead to accusations of transphobia and all the rest of it - such as that which happened to James Esses.

Legitimisation techniques are one way that totalitarian regimes ensure compliance; as they cannot totally rely on active suppression forever.
Dysphoria ( the very word implies dysfunction) has now been legitimised by removing the stigma of mental health issues associated with it. So, dysphoria is no longer a mental health condition but a sign that you are transgender.

"According to an old joke, while in a liberal democracy everything that is not forbidden is allowed, in a totalitarian system everything that has not been banned is compulsory"

A very thought provoking thread. I had to take some time to read through all the comments.

For me the problem with embracing someone's belief in gender identity is where it can lead. It can lead to the taking of hormones not suited to one's natural biological make-up, and/or to mutilating surgery.

Absolutely. Striking a balance between respecting without judgment and not embracing, encouraging or embedding would be the key skill here. I suspect that many (all?) gender dysphoric people would refuse to engage at all if their pronouns and preffered name (if different) weren't used. Which is fair enough... but this:

For me the difference lies in the client needing me to validate and uphold their belief system, the requirement that I recite the catechism if you like. I can respect a client's beliefs without sharing them, but with gender that isn't enough...But I've had adherents to gender ideology want me to state I believe TWAW, TMAM, NBIAV, and decline to work with me because I won't do that.

....adds the extra dimension that also comes through in the fundamentalist religion examples. I'm sure there are some gender dysphoric people who much be aware and accept that not everyone believes in gender identity (so by extension, not everyone believes that TWAW) but it sounds like many (most?) will want the affirmation of the belief as a condition of engagement. At this point, the only logical conclusion is that an affirming therapist is needed.

For children and young adolescents, I don't imagine many will have deep beliefs in gender identity to the same degree. They may well have a firm belief in their own gender identity and a firm belief that they are dysphoric (which makes both real at that point as a net effect). However, if gender identity can be taken out of the conversation entirely after pronouns and preffered names are accommodated, it could then be possible for the therapy to move on to the other presentations. There may also be some adults for whom this is true too.

this is interesting for me: I am a gender critical lesbian and will be going to UK to do a grad course (on a career break, I am not young). I wonder if it would be possible to easily find a GC therapist who would allow me to speak of gender critical concerns (I am receiving therapy for past homophobic violence, which therapy I would hope to continue in UK).

I'm sure it would. When I was creating a safeguarding approach for my daughter (in education and mental health) I included some respectful and clear guidelines. Such as the impact of the question "what are your pronouns?" on her autistic processing - it effectively asks her if she was happy being a girl. I didn't say "Don't ask her her pronouns", instead I asked professionals that were working with her to be mindful of unconscious bias and consider different ways of understanding how she would like to be addressed e.g. "what would you like me to call you? Is there anything else that's important to you about how I address you?"

I've found it to be a real conversation opener and it has been very easy to quickly ascertain whether any professional that is working with my daughter has a belief in gender identity or not. Equally, it would uncover if they did have a belief but were happy to keep it out of the conversation - I personally would be fine with that as long as I was confident from my exploratory conversations that I understood how their belief would or wouldn't impact the delivery of their therapy. As has been said above, it's possible for therapy to be successfully delivered even if the therapist and client have different beliefs. It just sounds like a gender identity belief needs a lot more scrutiny to unpick a "fundamentalist" from someone that simply wants to support those who are distressed in their gender identity. The GP that I worked with to support my daughter fell in to the latter category - he believes that gender identity is real. But he was an integral part in helping to build a balanced safeguarding document with firm boundaries that stop unconcious bias.

Perhaps you could do something similar in an email about your own "safeguarding" needs in relation to your trauma when you approach some potential therapists? To open up the conversation and find the right person.