The Woke Couch

Published in Liberties on January 13, 2025.

We refused most emphatically to turn a patient who puts himself into our hands in search of help into our private property, to decide his fate for him, to force our own ideals upon him, and with the pride of a Creator to form him in our own image and see that it is good.

Sigmund Freud

On April 6, 2021, Dr. Aruna Khilanani, a psychoanalyst, addressed a group of mental health experts at the Yale School of Medicine’s Child Study Center. The invited speaker titled her talk “The Psychopathic Problem of the White Mind” and delivered her remarks from New York City via Zoom. As she settled into her presentation, Khilanani told an audience of psychiatrists, psychologists, and social workers about her murderous impulses. “I had fantasies of unloading a revolver into the head of any white person that got in my way, burying their body and wiping my bloody hands as I walked away relatively guiltless with a bounce in my step, like I did the world a fucking favor.” Talking with white people, she said, was a “waste of our breath. We are asking a demented, violent predator who thinks that they are a saint or a superhero to accept responsibility.”

When the Child Study Center invited Khilanani, they knew what they were getting — and many in the audience welcomed it. One black woman thanked Khilanani for giving “voice to us as people of color and what we go through all the time;” a psychologist deemed the talk “absolutely brilliant;” and one man in the Zoom audience said he felt “very shook in a good way.” These details were gleaned from a leaked audio recording of the talk made public by The Free Press two months later. Days later, The New York Times, The Washington Post, and NBC News reported on Khilanani’s talk, citing as well the statement issued by Yale School of Medicine, calling the “tone and content” of the presentation “antithetical to the values of the school.” Having myself been a resident and then a faculty member in the Department of Psychiatry at the Yale School of Medicine, I knew that Khilanani’s lecture, its crass unprofessionalism aside, flouted the very purpose of Grand Rounds, which is to impart scholarship, clinical wisdom, and original analysis.

Around the same time, another New York City psychoanalyst, Donald Moss, came to attention for his article, “On Having Whiteness,” published in the Journal of the American Psycho- analytic Association. Moss, who is white, wrote that whiteness is “a malignant, parasitic-like condition [that] renders its hosts’ appetites voracious, insatiable, and perverse.” These appetites, once established, “are nearly impossible to eliminate . . . there is not yet a permanent cure.” As one disenchanted reader of the paper remarked, “it is unfortunate that psychoanalysts like Donald Moss, who express their views in a more temperate fashion [than Khilanani], still espouse a kind of racial essentialism to explain extremely complex social realities.”

In the years since Khilanani and Moss held forth, more and more practitioners of psychotherapy — psychoanalysts, psychologists, social workers, and counselors — have become vocal about approaching their work as a primarily political, rather than clinical, undertaking. Indeed, according to the Holmes Commission on Racial Equality in the American Psychoanalytic Association, in 2023, both Khilanani and Moss might well be regarded as role models for their boundary-pushing. “To live up to its fuller potential, psychoanalysis must imaginatively, thoughtfully, and self-reflectively move beyond the boundaries set by racism and white supremacy,” said the Commission. (The Holmes report has been criticized for its myriad methodological errors.)

Social justice and “decolonizing” psychology are the twin missions of the American Psychological Association, the APA. The association has vowed to “work [to] dismantle racism in important systems and sectors of society.” A 2021 APA report on racism within its own ranks confirmed its commitment to “a critical examination of how the discipline structures opportunity in ways that uphold White supremacy.” Cited in the report was the association’s Chief Science Officer, who stated that “until we can embark on scientific practices that are not dominated by White supremacy, we’re only going to be getting part of the truth.” In a piece last year called “Psychologists Must Embrace Decolonial Psychology,” Thema S. Bryant, president of the Association, explained that “decolonial psychology asks us to consider not just the life history of the individual we are working with but also the history of the various collective groups they are a part of, whether that is their nationality, ethnicity, gender, sexuality, religion or disability.”

The code of ethics of the National Association for Social Work requires all members “to practice through an anti-racist and anti-oppressive lens.” The Association now stipulates that “antiracism and other facets of diversity, equity and inclusion must be a focal point for everyone within social work,” and has expressed its commitment to “confronting and working to change policies, practices, and procedures that create inequities amongst racial groups, understanding these systems of oppression are based in and uphold white supremacy.” In 2015, the American Counseling Association (ACA), representing over sixty thousand professional counselors, published a document called Multicultural and Social Justice Counseling Competencies, which divided counselors and clients into “privileged” and “marginalized” groups and encouraged them to “possess an understanding of their social identities, social group statuses, power, privilege, oppression, strengths, limitations, assumptions, attitudes, values, beliefs, and biases.” It identified “social justice” as “one of the core professional values of the counseling profession.” My own professional organization, the American Psychiatric Association, issued a report in 2021 that called for a four-year curriculum to teach trainees “skills [to] address racism in the clinical setting and in-patient care.”

Whether the social justice imperative will eventually dominate psychotherapy remains to be seen, but clearly it is already tainting the practice. These national organizations mandate the standards for training program accreditation, and the programs, in turn, dictate required curriculum for their students. Accordingly, faculty in psychology, social work, and counseling programs are populating their curricula and workshops with the popular rhetoric of progressive movements.

At the same time, trends in program composition are setting the stage. In psychoanalytic training, for example, fewer psychiatrists are entering as increasing numbers of applicants from the humanities and other professions are arriving with certain progressive proclivities. And with many new and radicalized graduates joining the professions at the same time that seasoned and senior clinicians, the sole bulwark against eroding professional and clinical standards, are silencing themselves or choosing to retire early, I foresee a troubled future for the talking therapies.

When I was a resident in psychiatry, learning to become a skilled therapist was an all-consuming ambition. Take it from me, the process is harder than it looks. My colleagues and I met weekly with experienced faculty to discuss our cases. We learned to keep our private passions, neuroses, and blind spots from distorting the work. We were in therapy ourselves to better understand those enthusiasms, flaws, and biases. We were vigilant about countertransference, Freud’s term for psychiatrists’ own emotional reaction to a patient, which could cloud our clinical judgment; and even our professors, we were relieved to learn, hired trust supervisors to help them manage their own countertransference.

Essential to our work with patients was the development and maintenance of the “therapeutic alliance,” a core bond of trust nurtured through a non-judgmental, empathic approach, mindful about not imposing our own values on the patient. We were taught, as well, to reach an agreement at the outset of therapy, about treatment goals and concordance about the way therapy is supposed to work. Freud called it the “analytic pact.” Volumes of data confirm that the rapport between patient and therapist is a reliably strong predictor of positive results.

Enter Critical Social Justice–driven therapy (which I will call CSJT). The British therapist Val Thomas first used this term to indicate “a practice that views people not as individual actors but rather as representatives of particular groups which are nested within systems of power and trains therapist-activists to diagnose patients through a collective lens.” Though many years in the making, Thomas says, it seemed to blindside conventional practitioners when it emerged as a finished strategy. “Therapy would no longer be focused on helping individuals;” she writes. “Instead, it would be reframed as a political practice, a means of dismantling systems of power believed to be oppressive.”

The education of Leslie Elliott shows how CSJT is taught to fledgling counselors. In the winter of 2019, Elliott enrolled as a graduate student in the Mental Health Counseling program at Antioch University. At first, she found it to be a stimulating master’s program — informative and clinically relevant — until she took a required course in multicultural counseling. “We were taught that race should be the dominant lens through which clients were to be understood and therapy conducted,” recalled Elliott, a mother of four who had majored in psychology. Race was to be broached early in therapy, regardless of clients’ stated goals and needs. The point, Elliott explained, was to increase the degree of importance that clients place upon race.

Thus, if a client were white, the counselor’s job was to help them see how they unwittingly perpetuate white supremacy. “We were encouraged to regard white clients as reservoirs of racism and oppression,” Elliott told me. If the client were black, Elliott was instructed to ask how it felt to sit with her, a white counselor. If the client felt at ease, “my job was to make him more aware of how being black compounded, or perhaps caused, his problems, regardless of what brought him to therapy.” White women, one professor informed a class, were “basic bitches,” “Beckys,” and “nothing special.”

Elliott was also struck by the degree to which her program inculcated “selective empathy” in the students. A faculty adviser told Elliott in an unapologetic manner that the program was producing counselors who were not going to be able to work with Trump supporters. (If Trump supporters are so deranged, as a cynical colleague of mine pointed out, don’t they need more mental health care than others?) After the death of George Floyd, Antioch’s three-year program intensified its focus on race and oppression, making clear that counselors were to be foot soldiers in the culture wars. “Incredible as it sounds,” said Elliott, “we were encouraged to see ourselves as activists and remake ourselves as social change agents.”

How could a therapeutic alliance ever blossom when patients are labeled oppressors by their therapists? They will feel alienated, or at least deeply confused, about the function of therapy. How can therapists ever maintain what the psychologist Carl Rogers called “unconditional positive regard” for afflicted patients who happen to be white, male, religious, gun-owning Trump-voters, whom many young therapists unabashedly say they are averse to treating? (As a cultural matter, it is unlikely that such individuals are stampeding to treatment anyway — but, in fairness, they sometimes do seek therapy, and they should not be ideologically disqualified from it.) In this way, CSJT is the glaring antithesis, the mirror image, of legitimate psychotherapy.

Where traditional therapy regards each client as a unique individual and working in collaboration, CSJT reduces the patient to avatars of gender, race, or ethnicity. Where responsible therapy helps patients cultivate an aptitude for self-observation and introspection, encouraging them to experiment with new attitudes, perspectives, and actions, CSJT foments grievance and feeble victimhood. Where traditional therapy helps clear a path to autonomy, social justice therapy convinces patients that they have little choice or agency. As for exploring the serious consequences of a patient’s poor choices — a waste of time, after all, as the patient is a little but a passive vessel roiled and manipulated by malign external forces.

The violations of sound practice are self-evident. Under no circumstances should a therapist derive personal or professional gratification from imposing her own worldview on a vulnerable patient and directing them to assume an activist role. Nor should she determine the agenda of the therapy, compel the patient to focus on their ethnic or gender identity, or disclose her own ideological affiliations. I am reminded of Donald Winnicott’s warning to psychotherapists — which sounds almost quaint these days — to avoid becoming enchanted with imposing their interpretations on the patient. He argued that a major part of the analyst’s role is to immerse oneself in the patient’s own particular subjectivity and not be too quick to offer our own views.

How is it possible that therapists increasingly believe that they are political activists rather than healers? Val Thomas suggests that the answer lies mainly in the deployment of sophisticated rhetorical strategies. Critical Social Justice Therapy, she says, “does not advertise itself as a new modality; if it did then it would be subject to the usual testing of new therapeutic approaches. Instead, activist clinical theorists positioned it as the natural evolution of the field.” This clever move, she continues, puts anyone who criticizes CSJT or asks for evidence of its therapeutic value, at risk of shunning, derision as a bigoted reactionary, or reputational damage that could lead to a loss of employment. “Without public debate and critique, therapy could then be subverted and harnessed to a political agenda, as happened in other domains such as education, the label on the therapy tin is retained but the contents are being radically changed,” Thomas explained. As if contemporary psychotherapy is nothing more than a contest between discourses upon which nothing empirical or evidentiary can intrude.

Let me pause here to set out the somewhat confusing professional typologies at play here. The word “therapist” is generic. Anyone who talks to patients or clients with a view toward providing psychological aid is a therapist. The term “psychotherapy” may sound more specific — but, in practice it, too, is loosely applied. I tend to think of psychotherapists as individuals with formal degrees and professional licenses, but again, no hard rules prevail. Analysts, by contrast, can come from a variety of educational backgrounds, but generally must attend a lengthy program of formal psychoanalytic training at a recognized institute. Until 1992, several years after the American Psychoanalytic Association settled a lawsuit charging the association of violating antitrust law, only medical doctors could train and practice as analysts. As for counselors and social workers, they usually have a master’s degree. Their patients tend to be looking for a therapist who is very engaged and offers emotional support, practical advice, and shores up their coping skills. Sophisticated counselors will also pay attention to the patients’ self-sabotaging routines and self-defeating patterns in relating to others. And lastly, I use “client” and “patient” interchangeably, although, more formally, counselors and some psychologists help “clients,” while psychiatrists treat “patients” and analysts treat “analysands.”

Established therapeutic approaches fall within three basic schools: psychodynamic therapy (which is aimed at helping patients understand how their past experiences and unconscious processes influence their present behavior and relationships); cognitive-behavioral (treatments that seek to change maladaptive behaviors and dysfunctional beliefs through learning); and humanistic-existential (unstructured exploration of issues such as life, meaning, freedom). By locating a person’s difficulties within the self, these methodologies focus on helping the patient to achieve insight, agency, and accountability. The ultimate purpose is emancipation from constricting beliefs and behaviors.

Critical social justice therapy, by comparison, identifies external forces as the most determinative or even sole cause of the patient’s problem. Its origins can be traced to two conceptual root systems. The more visible of the two was the postmodern project that flooded academia with the idea that a person’s identity is a near-exclusive product of cultural conditions and social dominance. Little surprise that such a philosophy seeped into psychoanalytic training — a study as likely to be facilitated these days by humanities professors as by psychiatrists — and into university-based graduate programs in clinical psychology.

The other root system is a practice called multi- cultural counseling, which is taught in psychology, social work, counselor training. The first textbook on the subject, Counseling the Culturally Different, was published in 1981, and was grounded in the idea that conducting therapy with minority populations required a distinct set of competencies. By 1992, the ethics code of the APA held that a psychologist could be sanctioned if he or she is not behaving in a manner that could be considered “culturally sensitive.” The APA’s “Guidelines on Multicultural Education, Training, Research and Organizational Change for Psychologists,” from 2002, set a perfectly sensible standard for culturally sensitive practice, stating that “psychologists are urged to gain a better understanding and appreciation of the worldview and perspectives of those racially and ethnically different from themselves.”

Indeed, there are broad variations in culture, such as individualist versus collectivist values, and variations in levels of acculturation within immigrant groups, as well as variations in family-of-origin differences. Some ethnic and racial groups are more likely to report emotional distress in the form of bodily sensations; sometimes culturally specific metaphors allow therapists to make a point more clearly. Such cultural adaptations have been incorporated with success into well-tested cognitive behavioral therapy strategies. A “culturally competent” practitioner is, in reality, little more than an otherwise competent therapist who has made necessary and thoughtful accommodations to patients with different traditions of disclosure, habit, and help-seeking.

Less recognized as potential key aspects of identity are sociopolitical values. “This element may form the core of a client’s personality and identity,” I am told by the psychologist Richard E. Redding of Chapman University, one of the first scholars to research political values in psychotherapy. “Because mental health professionals overwhelmingly tilt to the left politically, they should be cognizant of the fact that their politically conservative, libertarian, and centrist clients will not share many of their values.” Redding refers here to the moral intuitions driving attitudes about issues such as abortion, affirmative action, welfare policy, crime-control, immigration, or gender politics. “Clinicians must be sensitive to the impact this may have on the therapeutic alliance and the ways in which this influences their diagnostic and therapeutic choices,” he cautions.

Attention to myriad aspects of the patient, from ethnicity to sociopolitical values, is part of the routine methodology of conventional treatment. The relative weight, or insignificance, of various dimensions of the patient will announce itself in the course of treatment, a collaborative enterprise informed by liberal values of patient choice, autonomy, and truth-seeking. By stark contrast, CSJT represents an authoritarian regime. Not only is the patient compelled to conform to the unyielding social vision of the therapist, CSJT feeds off the misbegotten notion, as my colleague, the psychoanalyst Ira Moses, puts it, “that innate attributes are the core driver of one’s experience of himself and his world.”

Moses warns, too, about the outsize emphasis placed on the idea of patient–therapist racial/cultural matching, an arrangement presumed by champions of CSJT to facilitate therapy. “No doubt the patient might feel more comfortable starting with a clinician of similar race or culture, but therapists should realize how they place themselves in an untenable position if they believe that they have a special understanding or a unique empathy with patients who share these external similarities.” It is a fallacy, he notes, that our identities give us wisdom, “Therapists who share a similar background or identity as their patient, he argues, should be cautious about over-identifying or assuming they have an increased likelihood of understanding the patient.” Moses calls this a “symbiotic fantasy,” of understanding each other without communicating. A related paradox of CSJT is captured by the psychologist Craig L. Frisby. “It doesn’t acknowledge universals, because groups are supposedly too distinct from one another,” he says, “and it doesn’t acknowledge individuals’ uniqueness, because only group affiliation matters.”

To see what CSJT looks like in the real world of the clinic, imagine a depressed white man in his twenties talking to his therapist, a psychologist, about career woes. He has just been turned down for a coveted research fellowship and speculates that he lost out because of affirmative action. The hunch so unnerves the therapist, who is non-white, that he looks for guidance from colleagues during a weekly staff meeting where difficult cases are shared. In the Brooklyn clinic at which this scenario played out in real life, a colleague of mine, another psychologist, was at those meetings. “The group discussed the patient’s comment about affirmative action and the consensus was strong,” recalled my colleague. “They strongly advised the therapist who consulted them to tell the patient that if he didn’t overcome his biases, he would be transferred elsewhere.” The rationale? The group argued that it would be unfair for a clinician of color to be asked to treat a “racist” patient, my colleague explained.

Andrew Hartz, a psychologist in New York City, recently published an account of his experience in City Journal:

A few years ago, I provided therapy for a young heterosexual white man . . . he told me that he had experienced pervasive racially charged bullying at both his elementary school and his high school. . . . Much of it was explicitly racial, including comments like “white faggot” and “white bitch.” . . . He said that he had held back from telling me about it in part because he worried that I would frame him as privileged or “just not get it” — reactions he had experienced in the past from his friends.

The patient had grown so used to keeping this experience buried that he became numb to it. “[I]n some ways more upset at the current cultural attitudes about race than about the bullying he had endured [and] the inability of the culture to express concern for white people who were attacked.” As therapy went on, Hartz writes, the patient became “more relaxed, more reflective, more open, authentic, and assertive.”

Consider, also, the case of Paul O. Having read of my interest in the issue of politicized psychotherapy, the fifty-three-year-old-year-old from Sturbridge, Massachusetts emailed me to share his experience. Several years ago he suffered a pulmonary embolism and spent a week in Mass General in Boston. Paul’s health deteriorated and had to quit his job. “My physician recommended that I speak with a counselor due to the dramatic changes I was going through. After a few visits with the psychologist, he got to know me and he had the nerve to ask me how I could possibly take public funding since I was a conservative and Republican (I’m actually an independent here in Massachusetts) I was shocked by his lack of empathy. Needless to say, I never went back to him or any other counselor.”

Some are alienated before ever setting foot in the therapist’s office. I learned about a politically conservative patient who saw a Black Lives Matter poster on the wall of a psychologist’s office and simply turned on his heel and walked away. In another, a young Christian woman was alienated by the they/them pronouns that her assigned therapist used on her website and stationery. Strictly speaking, of course, the poster and the pronouns say nothing about a therapist’s capacity for empathy for patients who might not share their politics. But in the face of such thoughtlessness, a patient could be forgiven for suspecting this would be the case. Even more repellent, I would surmise, is hearing your therapist refer to women as “AFAB people with vulvas” — assigned female at birth — as one of Elliott’s professors told her class to do.

In other instances, patients are rejected out of hand by the people assigned to treat them. I spoke to a newly minted psychologist who works in a Veterans Affairs medical center in Florida. His peers, he told me, are not interested in treating combat veterans; “they’d rather deal with ‘racial trauma’ and ‘LQBT issues.’” I have heard of psychiatric residents refusing to treat patients whose politics they dislike, patients who, in the throes of psychosis uttered a racial slur, and veterans who are too white, straight, and out of touch with the advanced opinions of the day.

The magnitude of the betrayal inflicted by this new species of therapist cannot be overstated. Imagine yourself arriving at the clinic for your first visit. You are demoralized, in distress, perhaps in crisis. You are summoning the nerve to share with a stranger your most intimate, mortifying, and traumatic experiences. And instead of encountering a wise and empathically attuned presence, you are met with a therapist who seems to think that progressives are the only ones who need psychological safety and understanding. A therapist who forgot that she exists to heal pain, not to propagate doctrine.

The mental health professions today are home to therapists who are overwhelmingly female, liberal, and politically aware. As self-declared enemies of privilege, they are primed to imbibe the social justice narrative and accept it as the proper objective of therapy. They reflexively impose the narrative on individuals who seek their help and react harshly to those who resist their efforts. The talking professions, I’m afraid, seem to be attracting as trainees people least suited to the job — and making that job inhospitable to would-be therapists who do not wish to be part of a highly politicized profession, one where therapy becomes politics by other means.

The pipeline to the professions is skewed from the outset. A Yale psychologist colleague told me that he was “struck” by the number of applicants to his program “who were unabashed activists with their minds made up about best practices in psychology.” One of them declared that she had already staked out black feminist theory as her template for practicing therapy. “If what I saw is at all representative of incoming graduate classes, the future of psychology doesn’t look good,” my colleague said. Signing diversity statements and pledges are now part of the application process at many training programs. But perhaps the most potent deterrent is the exposure of poor training and psychological abuse in some programs.

Which brings us back to Leslie Elliott. To warn would-be graduate students as well potential clients, she sought to expose what she calls “the ideological capture” of the counseling profession. She began to create YouTube videos and to post Substack commentary in the fall of 2022. She also recounted how the dean of Antioch’s counseling graduate program reacted to these online postings and to her refusal to sign a “civility pledge.” Not only did he urge students and faculty not to watch her videos, he also asked that they reach out to an ad hoc “crisis team” to help them handle their reactions to the “hate speech” — his term — that Elliott, by now labeled a “transphobe” and a “white supremacist,” had disseminated. She decided to leave the program, and has hired a lawyer so that she can complete her master’s degree without signing the pledge should she choose to return. Leslie is now working as a wellness coach in Seattle and continues as an active YouTube presence, spreading the word, in a preternaturally calm and measured style, about the corruption of the counseling profession

Thousands of miles away in Knoxville, Suzannah Alexander enrolled in the University of Tennessee’s Clinical Mental Health Counseling Master’s Program in the summer of 2022. For six months, she endured colleagues and professors implying that she should be ashamed because she was white. “Professors taught us,” Alexander relayed, “that if you’re white, you are privileged and you need to ‘do the work,’ but at first it was never clear exactly what the work was or how we were supposed to do it.” Later, it did become clear: doing the work, Suzannah said, “really meant assuming that black or brown clients had more difficult lives due to their skin color, and it must be awful for them to have to be therapy with a white counselor.” What’s more, she explained, “we learned that it was not okay to ask a marginalized person, meaning someone whose skin was tan to black, not hetero, or disabled, about their experience. Why? Because that put an additional burden on them while they are already working hard to tolerate your whiteness.” The idea of treating individuals without delving into their unique experience makes a mockery of treatment, unless of course the therapist is more concerned about where the patient is located within the hierarchy of privilege relative to the clinician’s position in it.

In one of Suzannah’s classes, a professor asked who they thought their most difficult client would be. “To a person, the class said a bigoted white man was their nightmare client,” she told me. In class she had mentioned that the Buddhist practice of reducing focus on one’s self could make it easier to act on one’s values — a tenet that Suzannah saw as consistent with the goals of secular psychotherapy. After all, suspension of obsessive self-regard is an element in cognitive behavioral therapies, she pointed out, further arguing that it could help therapists foster compassion for even the most challenging client. The professor disagreed.

After several months in the program, her professors told Alexander that her thinking was, as she puts it, “too concrete.” They also objected to her allusions to Buddhism, calling it “bad thought” and resented her refusal to concede that she should be ashamed for being white. “I knew this was abusive,” she later wrote is a wrenching account. “I was determined not to quit until I absolutely had to. But I was discouraged.” Eventually Alexander’s adviser told her that she would not be able to take practicum (hands-on clinical experience), an activity without which she could not graduate and obtain a counseling license. Alexander left the program and is now seeking legal redress for her wasted tuition. “I doubt I’ll ever be a counselor now. I’m not even sure I still want that. More’s the pity, so many have told me I would have been great at it, and I do feel for the many men who find suicide to be their only outlet.”

In 2020, Lauren Holt enrolled in a mental health counseling program at a Jesuit university in New Orleans where “social justice indoctrination consumed a great deal of the training.” Many of her teachers were chronically unprepared, presented course material that was superficial, failed to grade assignments in a timely fashion, and ignored student emails — derelictions of duty that other students experienced as well. In response to complaints, the program held a mediation session between staff and students. Grievances were aired, though no faculty were in attendance to hear them or to respond to them — apparently, faculty members were to be briefed later on the complaints. Subsequent mediation sessions would be held, but only students who were marginalized (minorities, or gender non-conforming, or disabled) were allowed to participate. Lauren asked: “What about those of us who are not in “marginalized groups?” Do our concerns no longer matter? I find that difficult to swallow.” All hell broke loose. “Within minutes, I received a mountain of emails from other students calling me a bigot, a racist, a white bitch, all sorts of heinous things,” Lauren wrote in an article describing her ordeal. Eventually, she was told by a lower level administrator that the department head had decided she could not return for her second year unless she fulfilled the hours of therapy he requested she attend to manage her, as he put it, “incompetency” as a counselor and her “inability to listen to people.” The head also expected her to sign documentation stating she was, at that juncture, unfit to be a counselor. Lauren was not allowed to state her case or to defend herself.

Unwilling to be bullied by him, she filed a grievance. Though her complaint was successful and she was technically permitted to resume her coursework, faculty members were icy to her and her new advisor ignored her emails, and so she left school. Now she lives in Asheville, North Carolina, where she runs her own accounting business and teaches English to immigrants. As for the students who called her racist, she says, “they have presumably completed the program and are now collecting their hours towards licensure.” Lauren is seeing a therapist. It took her over two years after leaving the program, she said, “to feel comfortable seeking help from a mental health professional after my experience in counseling school.”

By no means are all training programs so ideological, but the experiences of Leslie Elliott, Suzannah Alexander, and Lauren Holt are not rare outliers. In the years since Val Thomas, the British therapist, launched Critical Therapy Antidote in 2020, an online community for practitioners and clients dedicated to “protecting the integrity of talking therapies,” she has posted dozens of articles written by trainees who resorted to self-censorship (and near-nervous breakdowns) upon finding themselves the targets of indoctrination by professors, intimidation by faculty, mobbing by fellow students, and retaliation by their schools despite Orwellian reassurances that their programs were “safe spaces.” They include also many testimonies on professors scrimping on the basic facts and models of human psychology in favor of teaching dumbed-down mental health propaganda.

Many graduates of these debauched programs will go on to occupy slots at public mental health clinics, university mental health clinics, schools, and other institutions. Surely some of them will be well-prepared — not every single school is infested, and even marginal programs still have a remnant of qualified professors — but too many American therapists will base their work with patients on a distorted idea of their roles.

The practices of CSJT roundly violate the code of ethics adopted by the American Counseling Association in 2014, which states that “counselors are aware of — and avoid imposing — their own values, attitudes, beliefs and behaviors.” Counselors are obliged to respect the diversity of clients, trainees, and research participants — and more, “to seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” The American Psychological Association also has a solid code of conduct that counsels psychologists to be “aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status.” And yet, the major governing entities in the field have turned a blind eye to blatant ethical breaches, because — this conclusion is impossible to avoid — what they believe in most of all is the primacy of the political.

What to do? One strategy is to warn prospective students while shaming poorly performing programs. A cohort of dissatisfied (former) trainees and a handful of disillusioned counseling professors are doing this on social media and online postings. Another option includes robust referral networking for people searching “non-woke” therapists, as the requests for therapists are generally phrased. The website of “Conservative Professionals” provides names of conservative therapists because, as it says, “half of Americans have Conservative values, yet the majority of professionals in various occupations are guided by a Liberal mindset. (Unfortunately, this “matching” service reinforces the notion that only like can counsel like, an ironic and unattractive complication of the effort to make the couch a safe space for conservatives, too.) Another new site is called ethicaltherapy.org, established this year by a former professor of counseling at the University of Vermont to “help new and existing psychotherapy patients find psychotherapists who endeavor to leave ideology out of therapy.”

Parallel institutions can play a role. In 2021, a professor of clinical mental health counseling at Florida Atlantic University and former president of the American Counseling Association launched the International Association of Psychology and Counseling. Its mission is to “promote critical thinking over indoctrination” and help the mental health field to return to “its roots of liberal education” and to “professionalism where advocacy should be the domain of individual conscience, not one’s professional identity.” Andrew Hartz, mentioned earlier, seeks to restore trust in the professions by launching the Open Therapy Institute in 2023 to “foster open inquiry in mental health care and support those underserved in the face of politicization of the field.” The institute will offer professional development for therapists and promises to provide therapy from professionals who “strive to be open, curious, and empathic,” he told me.

Administrative and legal avenues also exist. A group of already certified counselors could appeal to the state legislatures or licensing boards to tighten accreditation standards or introduce an alternative accrediting body. Wronged or dissident trainees could undertake legal action of some sort, either individually or as a class action with others in the same program or across programs. It is hardly an exaggeration to allege that some training programs are perpetrating educational fraud or malpractice.

Transforming therapy into a vehicle for political change fails on yet another count: there is no evidence for the effectiveness of an approach that conceives of patients’ problems as a function of oppression. By contrast, a robust research literature exists on the generally positive to very positive impact of behavioral and psychodynamic interventions. There is substantial literature purporting to show that dynamic psychotherapy is as effective as or more effective than cognitive-behavioral therapies, and also a very strong body of research suggesting that all therapies are effective and at about the same level. Certainly private insurers and Congress should be alerted to the fact that they are paying for a lot of therapy that is unproven and, worse, potentially harmful.

If I have not said much about organized psychiatry in the context of CSJT, it is because psychiatry is, foremost, a medical specialty. Psychiatrists do offer psychotherapy, but it is not the defining activity of the field. Consequently, traditional approaches remain largely intact. And yet in 2021, the American Psychiatric Association issued an apology to black Americans, announcing that the association “is beginning the process of making amends for both the direct and indirect acts of racism in psychiatry.” Three years later, it remains unclear what amends were made and whether anyone was helped. I have a better proposal. The field should compensate for historical offenses — and make no mistake, transgressions, including overtly racist ones, were indeed committed in the past — by educating the therapy-seeking public about what they deserve: practitioners who are free of ideological agendas; who see themselves as healers, not activists; who extol the primacy of the individual; and who inspire their patients to participate in their own flourishing.