Politics and Religion: Revisiting Psychotherapy’s Third Rail

My clinical psychology trainees rarely have trouble asking their clients to explore problematic topics. The point of this exploration, explicitly stated or not, is to increase clients’ understanding of these topics and allow them to consider whether they might change their thinking or behavior. Such inquiry is not always welcome, because questioning can imply a judgment that a client’s beliefs or actions are questionable. Nonetheless, when therapy touches on politics or religion, trainees are often awkward and uncertain about what they can or should question. I suspect this holds true for many of my colleagues.

Politics and religion are, as I outlined in my original 2016 blog post on this topic (1), third rails of psychotherapy—difficult to approach, perhaps off-limits, taboo. Caution is suggested in order to maintain respect for differences. But under the guise of therapeutic neutrality, when does respect become unserviceable inhibition? In cosmopolitan, multicultural U.S. society, a therapeutic and ethical problem occurs when politics and religion mandate behaviors that violate the therapist’s personal integrity (2, 3). When these problems occur, therapist and client cannot cleanly sidestep conflict. Often, supervision and consultation are very good ideas in these situations.

Former President Trump’s ascendence valorized actions grounded in social grievance and affirmed the righteousness of these actions under a questionable banner of religion and patriotism. The following case study is a composite assembled from a supervision in 2016, when Trump’s candidacy was worrisome to many of my trainees. I think the dilemma this composite portrays is more entrenched today.

A White, lower-middle-class junior-college student, Bob, complained of bouts of depression and anxiety. He began treatment after a drunken brawl resulted in his arrest and mandated counseling. In reconstructing the day of the fight, Bob mentioned feeling “pissed” when observing an attractive classmate dropped off on campus by a man driving a BMW. Angry, Bob described her as someone he would like to date but would not ask out and as “a stick-in-the-[expletive] type” who would not give him the time of day. His therapist, “Dr. James,” heard Bob mutter a racial epithet when referring to the driver. Not knowing what to do, Dr. James let the comment pass. Near the end of the first hour of the session, when asked about family, Bob said that his father had a history of bar fights and usually ended up the worse for wear. This admission was not spoken with pride.

In the early weeks of treatment, Bob canceled an appointment so that he could attend a Trump rally. In the session that followed, he described elation during Trump’s speech, saying he felt “solid, strong” when yelling support in the packed arena. Dr. James wondered whether he was being baited when Bob used the terms “libtards” and “Gimmedat Party,” describing disdain for the “typical Boston” supporter of “Obummer.” Dr. James recognized he needed to sort out his own judgmental stance and not react to these remarks. He feared that inquiring too early into Bob’s words would undermine any positive treatment effects. I agreed, believing that he should let the relationship develop and establish an alliance before confronting this language, which could amount to taking sides at this early stage.

Dr. James wondered whether Bob’s ardent support for Trump was compensation for resentful feelings of sexual, social, and economic inadequacy. Dr. James saw Trump as an authoritarian populist and a neofascist demagogue who manipulates his crowds into celebrating racism, hypermasculinity, us-against-them nationalism, “might makes right,” and cathartic violence. He and I shared this appraisal.

We asked ourselves, Is this young man’s support of Trump essentially a grievance compensation for impotence, inadequacy, and envy? Are his politics essentially vicarious identification, an unconscious wish to merge with a strongman leader? When my supervisee asked Bob why he canceled his previous appointment, Bob responded that he had been hurt by affirmative action, that Obamacare would make it impossible for him to get a decent job, and that Trump “calls it like it is” about Muslims. Still, we asked, regardless of Bob’s compensations, identity politics, or wishes to merge with Trump, Was Bob’s conscious justification unreasonable for someone in his situation? Doesn’t one’s politics often address grievance? And when does a political stance become pathology?

We also asked, What could Dr. James do to help Bob and still maintain the integrity of his professional and personal values (values that Dr. James and I share in our supervisory community of two)? When is inquiry into the roots and significance of Bob’s politics appropriate? And when is the absence of inquiry collusion? Dr. James and I worried that silence would equate to assent to an aggrieved and violent movement, a step toward the consolidation of a dangerous political community whose specter would haunt the United States regardless of the 2016 presidential election’s outcome.

Participation and Satisfaction

People feel satisfaction when they are competently engaged in activities in ways that reflect their intrinsic values. Seeking help in understanding the dilemma Dr. James faced, I consulted the late Anthony Putman, a former colleague in the descriptive psychology community (4, 5). Putman thought that satisfaction becomes especially profound—what he called “ultimate satisfaction” (6)—when it involves the immediate experience of participating in activities in ways that reflect a person’s worldview. Naturally, this perspective includes one’s place in that world. At these moments of belonging, people feel cohesive, authentic, and sound. The corresponding elation and vitality become desire or, if appraised pejoratively, addiction. Once found, ultimate satisfaction is hard to relinquish.

This satisfaction requires a community that facilitates the expression of a person’s intrinsic values. Religions and political movements provide this space. Putman wrote (personal communication, March 14, 2016):

I think Putman captured the central dilemmas. Bob ordinarily lived in a world with no authentic, satisfying place for him and needed a world with such a space.

Can therapy provide space where participation is authentically satisfying? This space requires establishing a significantly valued relationship, which must happen before political or religious acts or beliefs can be examined.

How can therapy be authentically satisfying? When I asked this question in my supervision seminar, maintaining empathy was the first answer. Some trainees wondered whether it would be proper to ask, How do you imagine I am feeling about what you are saying? However, because this question might provoke troublesome defensiveness, a safer route might involve asking Bob how other significant figures in his life might feel about his words.

Psychotherapy requires tolerant and uncertain negotiation, with the therapist empathically attending the unfolding improvisation. One way or another, therapy will involve the therapist’s professional and personal values. This happens silently and out loud. With their careful attention, kindness, and appreciation, therapists demonstrate and model their deeply held values. But something also needs to change in ways that help the client progress. That is why clients attend treatment. They need acceptance, but something about them or something they are doing also needs to be addressed. Redescription, interpretation, and tactful confrontation serve this purpose, which is where the question, How do you imagine I [or significant others] feel …? might be useful. Appropriate functioning requires understanding that everyone stands at the center of their own world. Too often, clients do not adequately keep this in mind.

Therapists who acquire trust, show fair-mindedness, and demonstrate an accurate appreciation of their client’s experience are in a position to employ redescription, interpretation, and empathic confrontation. Still, how does a therapist handle Bob’s racist epithet and his joy of participating in fascism? This question boils down to whether Bob can find an authentic place for himself as a participant in the tiny community he has with Dr. James. Here, the size of the community does not matter, but significance does. For this approach to work, Dr. James must be able to accredit and maintain Bob’s good standing within the dyad. They both must value belonging before their participation in negotiation and improvisation can allow the possibility of an alternative ultimate satisfaction.

Therapeutic improvisation requires openness and acceptance between the therapist and the client in order to tolerate the assimilation and accommodation that take people somewhere new and, likely, unanticipated. But consider the dilemma that occurs when one party brings to the improvisation an idea or behavior that is unacceptable to accommodate. Rather than immediately challenge, the therapist should pause, hold the idea a bit longer, look closely at it, and somehow indicate to the client, What do I do with this? I am reminded of the annoying but sometimes wise parental approach of indicating that a child’s behavior is bad without attributing essential badness to the child. This works when the child’s trust in being loved is securely intact. I sometimes remind students of the similarities between parenting and psychotherapy.

Dr. James was smart to recognize he needed a firm alliance with Bob before exploring Bob’s politics (assuming Dr. James had sufficient reason to do so). The outcome of such an exploration will always be uncertain, but if the relationship is significant and trusting, Bob can at least hear and consider Dr. James’s questions. Change can occur only when a client can safely consider another’s view and when the relationship with that person provides reason enough to do so.

Why touch the third rail in the first place? Why not stop with the principle that, to the extent that people can effectively engage in their communities, it is not the therapist’s job to judge? This principle, of course, is complicated by the overlaps and conflicts that naturally attend communities. All people are members of multiple communities: professional, ethnic, religious, recreational, and so on. Some people get along, and some are in intractable conflict.

Intractable Values: When Worlds Collide

A culture is an umbrella term that encompasses a multitude of communities. As a collective of communities, cultures have a stand-alone viability that covers the life spans of all members. Cultures differ regarding worldview, core values, and social practices (5). National societies often house a variety of cultures. Certain institutions, religion being a prime example, function as cultures when they provide a complete guide to proper and improper behavior—prescribing and prohibiting. Fundamentalist strains of Judaism, Christianity, and Islam offer and demand such total worldviews (8). Religion and authoritarian/totalitarian politics become sources of intractable conflict when their core values and practices are hostile toward other communities within shared cultures—people who otherwise appear to be neighbors. As Putman put it, “Participants in such disputes literally live in significantly different worlds. What ultimately keeps these worlds apart is what ultimately holds each one together” (6).

I suspect that many therapists are becoming uncomfortably acquainted with clients wedded to cultural communities whose values threaten cosmopolitan society. It is reasonable to think that we are living in a period of culture wars. Therapist-citizens who value diversity and are devoted to their client and to their community struggle here, but those struggles must be discussed to be overcome.

In the 1950s, the psychiatric anthropologist George Devereaux (9) wondered how to distinguish the normal from the abnormal in cultures and religions different from his own (6). He explored this question by observing the lives and spiritual practices of Mojave shamans. He noted that no ordinary Mojave would choose a shaman’s liminal and difficult path. Nonetheless, shamans occupy an important role in Mojave culture.

Devereux observed a pattern common in the developmental history of shamans: they offered shamanism as a cure. The Mojave recognized that it is unfortunate to “be disturbed,” but some people with certain disorders could enter the ranks of healers. Some forms of disorder can be shaped by ritual.

Devereux contrasted the shaman’s culturally syncretic disturbance, common in Mojave culture and guidable by the culture’s ritual options, with idiosyncratic disturbances that rendered an individual pathological, without a valued place in society. Likewise, politics and religion might provide a place to find satisfaction even for those who are disturbed, but only if the disturbance is sufficiently shared, valued, and addressed by the community. In such a situation, otherwise troubled people can engage in some of the valued practices of the community. However, what is valued in one community can be anathema to another.

In a cosmopolitan multicultural society, communities exist side by side, overlap, share, compete, and clash. Sometimes the values of one community require action against another. Ideally, these disagreements should be a matter for politics, not therapy. Not living in that ideal, people need to sort out disagreements the best way they can. I doubt that there is a fully satisfying solution. Because conflict comes with the therapeutic territory, it needs to be thought through and carefully addressed without knowing whether, when outside of the consulting room, Dr. James and Bob will act with indifference toward each other, forge an alliance, or go at each other’s throats.