Radical Therapy

I was taught that as a counselor, I should never let my personal values enter into therapy. To maintain a veil of neutrality. The idea behind this approach is, for the most part, sound. We don’t want our own personal beliefs to compromise the agenda or to guide the client away from determining for themselves what they feel and how it should inform their actions. I was also taught never to adorn my office with idols that might give away said leanings: a cross on the wall, a buddha on the desk, a symbol representing a political leaning. A counselor ought not to alienate a client or appear biased.

"Frankie's Wedding Ring" by Nancy MarksI have written before about the near impossibility of being this “blank slate.” A wedding ring on my finger implicates me as someone who believes in marriage and is, more likely than not, heterosexual, though this is (thank goodness) changing. If I am wearing leather shoes, I am most likely not vegan. If I allow my tattoos to be visible, I most likely convey the idea that I am in some way counter-culture or at the very least, appreciate alternative forms of self-expression. I have written before about my belief that to remain unchangeably neutral as a counselor is to be ineffective and disingenuous. This by no means suggests that I think it is appropriate or ethical for my personal views and leanings to guide a client’s process. It just means that I am a person, and that a client is choosing to see me instead of another counselor because of who I am. I state on my website that I am a feminist and that most of the clients I work with are left-of-center. I use terms such as “progressive” and “radical.” I feel that this empowers clients to make an informed choice about whether I am the right fit for them.

As such, many of my clients share my belief system. I would describe them as being, in varying ways, “radical.” For now, I am using the term loosely to describe an individual who seeks to change the status quo, including members of communities such as: feminist, queer, punk, anarchist, vegan, poly, and many more. To me, radicals are farmers trying to grow all their own food and fight against capitalism and the use of GMOs and pesticides in our food. Radicals are gender nonconforming folks. Radicals are members of communities who try to utilize the power of community-accountability processes rather than more traditionally punitive and authoritarian networks of the legal system that often contribute to institutional oppression. A radical is anyone who is making a courageous choice to live in a way that does not conform to a mainstream model and anyone who feels strongly that some big changes need to happen in our world. And contrary to common assumption, these people, these radicals, are not motivated by a desire to create chaos and destruction, but by a desire to facilitate compassionate change.

The term “radical therapy,” which emerged from a journal published in the ’70s, provided an alternate narrative for therapy and suggested that therapy was about social, political, and personal change and not the more common psychiatric perspective that promoted behavioral adjustment and pathologized the human experience.

It was, in many ways, an anti-psychiatry movement that rejected the medical model and the concept that mental health professionals were authority figures who could, and frequently did, engage in practices that kept patients in the dark about their own treatment. Radical therapy assumes that people are good. Radical therapy, for me then, is looking at an individual in the context of the world and systems around them and supporting them in their efforts for both personal and social change, acknowledging real inequalities and forms of existing oppression that may be hindering their growth while helping them identify and embrace their strengths. I love this kind of work. As with any relationship, it is satisfying and meaningful to have a similar world view as the person you are connecting with. And though I rarely disclose any details of my views, there is often an implicit understanding that my clients have a sympathetic ear when they talk about subjects that may be of a more political nature.

But working with clients who don’t conform to cultural norms has its own set of challenges. People who feel marginalized and oppressed can sound hurt and angry, as they should be. Many are up against beliefs and practices that are so old, so insidious that they can often seem self-evident, making people question the validity of the pain felt, potentially furthering a person’s sense of lacking support, making them question their own rights and self-worth.

This is often the case with racism. Or assumptions about those living in poverty. Sometimes those who are marginalized re-enact their own trauma and feelings of alienation within the communities they created for support and alliance, oppressing others in order to gain some sense of power or control in a life lacking both. Shifting this deeply rooted paradigm is harder than it might look, despite good intentions. And even supportive and inclusive communities, while providing a buffer, cannot shield a person from an outside world that is often not so accepting. Thus, helping a client who is transitioning genders, for example, involves the very real task of weighing whether or not a person has the resources, resiliency, and support at their disposal to survive what will, at times, be a painful, isolating process.

Even when a client comes in not looking to talk politics, it is my belief that they are inextricably tied into all human experiences.

Therefore, as a change agent, therapy is inherently political.

Our bodies respond to external conditions and stimuli, and such stimuli can be a source of stress and impact our sense of safety and hope in the world around us. Over time, those who are met with hardship due to racism, homophobia, sexism, poverty, or any other oppressive force, can develop triggered responses to what might appear to be minimal challenges in ways that seem exaggerated.

The questions people grapple with every day, questions that weigh whether it is worth putting yourself through some risk and discomfort for what you believe could potentially be a greater good, are political questions. When a client questions whether or not to call out a friend for making a homophobic, racist, or sexist remark, and by doing so risk the friendship, it is political. When a client describes working in the sex industry because she finds it empowering to make such choices about her body and she enjoys the work and money she earns, but she worries that she is contributing to a greater system of patriarchy and sexism, it is political. When a client describes feeling uncertain about whether he should meet with a teacher to talk about (their) his discomfort over certain ideas or assumptions being expressed in class about a group of people, or whether he should just keep his head low and try to get a good grade, it is political. When a client wants to support an abusive friend for positive reasons of helping growth and learning (that the behavior they are engaging in is harmful), but she fears backlash from the community because she might be perceived as aligning with an abuser, it is political.

Conversely, what happens when a client comes in with a different belief system? Someone who through overt or subtle sentiments expresses ideas that are racist, sexist, or homophobic? As a therapist, do I have a moral or ethical obligation to address such beliefs and challenge them, or do I have a moral or ethical obligation to do the opposite, to respect and hold space for the perspectives of that individual? I find that this question puts me in a terrible bind. Because I believe wholeheartedly that such judgement causes an individual and the systems around them harm. I believe too that most people don’t realize the extent to which social forces of oppression have influenced individual belief systems and contributed to alienation, fear, and the sense of having only limited feelings and behaviors or choices at their disposal. And I also believe that most people come to therapy to better understand how perspectives they may have and actions they may take as a result of them might be worth changing if they are not contributing to the kind of relationships they want to have or the kind of life they want to live.

While I wholeheartedly believe that all clients are experts on themselves, the role of a therapist is often, in addition to an empathetic and skilled listener and guide, an educator. We share our knowledge of what we have come to observe and understand about not only our client, but of the larger body of human experiences we have come to know over our years in practice. So when discrimination crops up in my office from a client, I ask them more about what they mean and about the origins of their values. I also ask the ways in which such values have helped or hurt them throughout their lives. As of yet, I have not met with someone who did not see the benefit to challenging such beliefs, but in my practice, as I said, I rarely meet with clients who hold more conservative values, and even less with clients who are downright prejudiced. Only once have I had a client, a former skinhead, with whom I predicted challenging work and with whom I felt uncertain about how to properly engage. He was, after all, there for help and support. But in his case he was already moving towards a place of acceptance and a realization of the ways in which his earlier values had caused him and those around him harm. In this case, my role was ultimately to support what he was already seeking, further movement in that direction and assistance in moving away from that community. So while I rarely am given the opportunity to work with people who have vastly different values from mine, those clients usually self-selecting other therapists, I do find that I often encounter clients who express more subtle forms of discrimination. And I choose to address it. Because often such thoughts come from a place of lacking awareness, not of hatred. And when such things can be brought to one’s attention, it often opens up a wonderful line of communication and introspection about other areas in which similar assumptions may be happening. It’s incredibly powerful and exciting work.

As a therapist I have my own political dilemmas to grapple with as well. Diagnosis is one such dilemma. Diagnosis is a necessary part of billing insurance for a client. But some diagnoses carry with them a stigma that is personal, and institutional and insurance companies can use them as justifications to deny coverage to clients. Because of this it is traditional for therapists to provide the least stigmatizing but still accurate diagnosis for a client, which is both difficult and highly subjective.

How much I charge is another such dilemma. When I first started my private practice, I was committed to charging a low enough fee that anyone who wanted therapy could afford it. It was terribly important to me that people be able to get help when they sought it out. I started at a low fee and offered a sliding scale with even lower costs for those who were students, nonprofit workers, or were experiencing economic hardship. But after doing this for a year or so I came to understand that it was simply not sustainable for me. The cost of my office rent, malpractice insurance, student loan debt, self-employment taxes, and the multitude of various other expenses that come from running your own business meant that if I continued to charge such low rates, I would no longer be able to survive myself. My decisions to raise my prices, limit my number of available reduced-fee slots, and provide clients who still cannot afford therapy with alternative options for low-cost community mental health clinics were the hardest decisions I have made in my work and ones that I still grapple with.

We live in a complicated and highly imperfect world. Each of us faces enormous challenges simply by being human, and some of us face even greater challenges due to factors that are beyond our control, such as the color of our skin or who we love. One of the things I love most about being a therapist is that the change that comes from a positive therapeutic alliance is so much bigger than what it appears to be — a conversation between two people. Within the parameters of what I believe to be ethically appropriate and consistent with a client’s goals, I choose to utilize therapy as an opportunity for growth that extends beyond what a client might have come in to address or initially hoped to achieve. And that makes me a radical therapist.

Alyssa Siegel

Alyssa Siegel is a Licensed Professional Counselor in Portland, Oregon. She earned her MS in Counseling and her BA in Psychology and is a member of The Oregon Board of Licensed Professional Counselors, The American Counseling Association, The National Board of Certified Counselors, The National Coalition for Sexual Freedom, and The Society for the Scientific Study of Sexuality. She works with individuals and couples and specializes in relationships, sexuality, and women's identity development. Alyssa is a contributing author to the book "Your Brain On Sex, How Smarter Sex Can Change Your Life". For more information please visit PortlandSexandRelationshipTherapy.com.

About Alyssa Siegel 29 Articles
Alyssa Siegel is a Licensed Professional Counselor in Portland, Oregon. She earned her MS in Counseling and her BA in Psychology and is a member of The Oregon Board of Licensed Professional Counselors, The American Counseling Association, The National Board of Certified Counselors, The National Coalition for Sexual Freedom, and The Society for the Scientific Study of Sexuality. She works with individuals and couples and specializes in relationships, sexuality, and women's identity development. Alyssa is a contributing author to the book "Your Brain On Sex, How Smarter Sex Can Change Your Life". For more information please visit PortlandSexandRelationshipTherapy.com.
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