My Experience of the Hidden Politics of Dialectical Behavior Therapy

A tweet exchange popped up on my feed recently that embodied very succinctly some ideas that have polluted modern psychotherapy. Though they appear sensitive and empathetic, these ideas may be holding clients back from recovery. I describe here some of my own experiences with the hidden politics of psychotherapy that may be a microcosm of a much larger problem.

While my diagnosis varies depending on my medical provider, depression has always been one of my symptoms. Even at my best, I am still not able to “perform” and “produce” as much as others who don’t have to deal with it. That’s a fact. There’s no discrimination or ableism involved in this reality. Nobody “decided this” in an oppressive power scheme. It’s just that when you do less, you get less. This would be true even in a primitive, pre-modern society that never knew the word capitalism. If you’re not good at hunting, you bring back less meat.

The unfairness of life is a biological reality, albeit an unpleasant one to experience if you’re on the short end of that stick. This does not mean that forcing equal outcomes from the top down is feasible, ethical, or desirable simply because being a “loser” is unpleasant. People are not all the same, and the effect of “nature and nurture” means that on a population level, perfect equality will never be possible.

Politics and therapy are incompatible

I had expressed sadness over the direction of my career and my lost sense of self to a trusted therapist who I knew had very liberal political views. Rather than encouraging me to find other ways of developing a sense of self, he told me I was a victim of ableism. I didn’t agree. We ended up arguing about politics in my session because even as a depressed person, I still don’t want to blame capitalism for my lack of worldly success. I blame the physical, mental, and emotional limitations that come with being depressed. They are mine to learn to deal with.

When I objected to his “ableism’ comment, my therapist asked me, with childlike earnesty, “What do you mean when you say it’s political?” He said it was not the first time someone had told him he was being political. Unprepared, I fumbled through an inadequate response.

This wasn’t his first offense. Whenever I talked about my career insecurities, he would explain that “the patriarchy” was the reason I felt bad about my career — because women’s careers are seen as lesser. In another session, he told me that a MAGA-hat-wearing client had threatened to shoot him because he had made a comment to them about gun control. In yet another session, he told me that after the 2016 election he was flooded with requests for phone coaching because of all the triggered clients. It happened again when the “kids in cages” stories broke — he complained of hundreds of crisis calls. When Trump would tweet, like clockwork, he would be inundated.

He told me a story of how his female graduate students turned on him after making them come to class during the pandemic. He had reserved a 300-person event space for 12 students so they could sit far apart, and required masks. Yet, they complained to the department that he was being patriarchal and white and not respecting their safety. He was honestly bewildered by their reaction, because he thought he was being helpful. In the end, he said, “I guess I just need to keep learning.”

In a group therapy session, the moderating therapist (a different guy, but same practice) brought up the summer Black Lives Matter protests. I was a new member of this support group and immediately became uncomfortable. The therapist said he was preparing to go home for the weekend and “talk to his family about social justice.” The other participants nodded in solidarity. He said he wanted to give us all space to talk about our thoughts about BLM. A lump formed in my throat. My heart started racing. I needed this group to support my recovery, I couldn’t afford to make them hate me. I couldn’t afford to stand out.

But there was no way out. “I’m sorry, I feel incredibly uncomfortable talking about this, so if you guys decide to, I am not going to participate,” I said.

They were all taken aback by how strongly I felt about not sharing my opinion. I knew either way I’d be sharing my opinion, even by not sharing it. I’d heard enough off-handed comments about the evils of colorblindness, men, and capitalism that I knew I was the lone libertarian in the group. Neutrality is crucial in support groups. This was lost on them because they work and live in ideological bubbles and have no idea that people might feel alienated by these ideas.

I eventually decided I was going to tell my therapist what my political views were. I just wanted to put it to bed. I explained how I was in favor of helping the suffering, but that walking on eggshells wasn’t the answer. I told him I didn’t think capitalism was bad. I tried to explain that feminism harmed me and my marriage. He kept trying to convince me that I was overreacting and that we believed the same things at our core. “We aren’t that different,” he would say. We wasted two sessions on this.

But we were. In one of those sessions, he said to me, “I am racist,” with a dead-eyed half smile.

“No, you’re not. You’re like, the least racist person I know,” I said, a bit surprised.

He replied, “Racism isn’t like that. It’s like…the air we breathe. I am racist. We’re all racist.”

“Well, I’m not,” I said. I don’t think it is wise to encourage depressed clients to self-flagellate.

Therapy should be personal, not political

After that, I sent him a break-up text. That is how we communicated between sessions, not through secure email like other therapists I’d seen. I told him I needed to move on from the practice because I was not okay with “these Antifa ideas” being used in session.

He absolutely freaked out over that text. He sent me long panicked replies about how President Trump had declared Antifa a terrorist organization, and that social workers were being targeted, and that he’d been accused of being in Antifa before, and he just couldn’t have that word on his phone. He begged me to “please reply and explain what you mean, because if you’re accusing me of being in Antifa that puts me at risk.” I explained that no, I did not believe he was literally in Antifa, the organization, and that I could explain to him in my next session what I meant by that if it would help.

In our following session, he never asked me to clarify. But no matter, as I was burned out from politics. I was having problems in my actual life that I needed to discuss. I told him I was afraid he wouldn’t want to help me anymore because of my beliefs.

He said, “Okay, just to put your mind at ease, I’ll tell you where the line is. I will be honest. I struggle to treat Trump voters, because Trump once re-tweeted ‘The only good Democrat is a dead Democrat.’ I am a Democrat. So if a client of mine voted for Trump, I’d at least want to know why because that means they want me dead. I consider that a ‘relationship-interfering behavior.’ Since you didn’t vote for him, we’re good.”

I was stunned. It was true that I had not voted for Trump, but I knew what he said was wrong. It bothered me that who a client voted for was such a strong factor in whether or not that person deserved his help. And furthermore, he was a professional with a PhD who was caught up in social media drama as though it were real life. He extrapolated a Trump retweet to mean his Trump-voting clients want him dead? There are more than a few cognitive distortions to describe this reaction that he, as a therapist, should be well aware of.

I can see how he ended up being threatened by his MAGA client. When your job is dealing with highly suicidal people with personality disorders, and you believe things like that, one of them is eventually going to pick up on it, get upset, and say or do something crazy. It was his own self-fulfilling prophecy that he failed to recognize. I cancelled my next appointment and wrote him an email explaining that I think I had outgrown the practice and needed to try a different approach. That brought my stint with Dialectical Behavior Therapy to an abrupt end.

Dialectics in Therapy

Dialectical Behavior Therapy (DBT) is a cousin of Cognitive Behavior Therapy (CBT) developed by Aaron Beck in the 1960s. DBT was developed by researcher Marsha Linehan, now at the University of Washington, in the early 1990s. The first edition of her famous skills manual was published in 1993 and has been cited over 4,000 times. In short, the reason DBT includes the word “dialectical” is because of its emphasis on embracing the tensions of contradictions to help patients with personality disorders (particularly borderline personality disorder) engage in less black-and-white thinking.

A few months later, while reading George Orwell’s 1984, I came upon doublethink — holding two contradictory ideas in your head at the same time. I stopped cold. I remembered my DBT therapist telling me about why DBT was dialectical. He had explained, “It’s like holding two contradictory ideas in your head at the same time! You’re perfect as you are, but have the radical need to change!”

Like a tape reel on fast forward, five years of therapy played back in my head. Through these years, any time I would finally approach a core conflict in my life, like with my career (do I admit my limitations, or do I keep pushing?) or with an argument in my marriage (how do I deal with a situation when we are both convinced of conflicting beliefs?), he would conclude with, “You need to be more dialectical about it.” That would be where we would stop, rather than begin.

What did that even mean? Am I not supposed to make any decisions and just settle into the contradiction? How do I live my life once I do that? I remember once just yelling at him that I needed help knowing what was true. He said that wasn’t important. Taking that and the alarming similarity to doublethink into account, it made me wonder if DBT and Marxism had anything in common. Was Marsha Linehan a Marxist?

Turns out, no. She doesn’t appeal to Hegel, Marxism, or dialectical materialism in her writings, and is actually a devout Catholic. According to an interview with Dr. Linehan about her therapy modality, it was a friend of hers who exclaimed, “Marsha! Your therapy is dialectical!” And so the name stuck. It does not appear to be much deeper than that, save for a few appeals to post-modernism and the lack of an objective truth.

A perspective piece in The Journal of Clinical Psychology explains why DBT is not actually dialectical in the Hegelian or Marxist tradition. The “dialectics” in DBT means that life exists in shades of gray. There are some aspects of yourself that are great, and some that need to change. That is pretty unremarkable and obvious, but perhaps not to people with personality disorders. Maybe allowing certain abused clients to explore their “personal truths” can help them overcome cognitive distortions like minimization or an unstable sense of self. While that is fair, I can see why left-leaning therapists who are sympathetic to collectivism, socialism, and post-modernism would be drawn to DBT. In fact, the National Association of Social Workers has made a formal statement about their commitment to social justice. My therapist himself was a social worker, and often referred to it when I expressed discomfort with politics in session.

The authors of the psychiatry article posited that pure DBT programs such as the one my therapist ran would have gained wider acceptance by mental health professionals if they had led with the emotion regulation aspects of it, which are admittedly the only parts that actually helped me.

Therapy is a safe space, but only for progressives

He wasn’t my only “woke” therapist, lest you think this is an isolated case. The DBT group I’d been in before that only allowed women to attend and had radical feminist leanings. Another one of my past therapists, recommended by a doctor, was a radical feminist who told me I should divorce my husband because he didn’t move across the country with me while I worked on my PhD. My attempts to explain to her why we chose the arrangement we had fell on deaf ears. She thought I was being abused and manipulated. This is not a good thing to tell a person with an abuse history, PTSD, and trust issues. I almost ran away from my husband forever because of that, and it is a year of immense pain that we both could have done without.

These ideas interfere with the recovery process. My DBT therapists were unknowingly stoking their clients’ panic, rather than teaching them resilience. DBT even recommends a skill called “check the facts” that my therapist himself was not doing. My graduate school therapist was stoking my anxiety and distrust of my husband, rather than helping me sort out the difficult give-and-take of marriage. They were allowing my anxious, depressed brain to weave a cynical picture of the world, with myself as the victim.

With clients who have been abused, jumping to these politically-motivated conclusions can lead a client to actually sabotage their own support system. While validation matters, so do evidence and truth. Unfortunately, there is a widespread fear among therapists to acknowledge the need for truth. It’s a herculean undertaking for therapists to do this work. Instead of doing it, they fall back on post-modernism in an attempt to protect clients’ feelings.

I fear that many therapists help to create extreme left activism. Clients leave therapy believing they are victims of vague societal forces outside of their control. Therapy is supposed to help clients become more flexible, resilient, and clear-minded, given that we live in an imperfect world full of invalidation and struggle.

Real talk about mental illness

I don’t believe ableism explains my career failings, nor do I believe it is an injustice to correct. I don’t believe that bright, intelligent, successful people with large amounts of energy to influence the world should take a backseat while I hobble along. I want science and business to produce useful things that make life better for people. It’s not about me feeling good about myself. I don’t care who produces the knowledge as long as someone does, and does it well.

It’s not an internalized “ism” to admit your limitations. At the end of the day, there’s a minimum bar you need to surmount in any field to do something useful with your training, and some of us don’t make it over that bar. What to do about those who fall short is a complex question that needs its own article.

I grew up in the 1980-90s, the era of Participation Trophies. I am a product of the public school system. I grew up believing it wasn’t enough to just get job training. I needed to change the world. I believed that if I just “tried hard” then I would be rewarded. I am a product of social-climbing, insecure Democrat baby boomers who taught me that success was everything, but then shielded me from all the consequences of my mistakes. Today’s upper middle class progressive youth cling to collectivist ideas because they are largely unaccustomed to feeling the true, abrasive effects of failure. They may or may not recognize themselves in this story. That is how deep the problem really is.

Realistically, so few people ever get to change the world. Teaching children to have such unrealistic goals emotionally stunts them, narrows their value systems, and allows self-hate and perfectionism to fester. Coddling is not the answer. Neither is beating your kids senseless for not folding the laundry, but there has got to be a sanity point. My husband and I don’t claim to know what it is, which is why we chose not to have children.

Back then, many secular professionals raised their children to believe that their value as a person directly corresponds to their “success” in the world — ability to make money and produce useful knowledge. It’s great to make money and produce useful knowledge, but those of us who can’t are not less worthy of love.

We may, though, be less deserving of high salaries, prestigious jobs, and credit for great achievements. But, so what? Those things are not the same as love. A newborn baby has never achieved a thing, and nobody ever says a newborn is worthless. The far left’s outrage over capitalism and competition directly stems from being raised to wrap self-worth in career.

I did spend much of my youth on the far left of the political spectrum, marching to the activist drum. Never once did a mentor or therapist tell me that I didn’t need to change the world. They failed to recognize my unhealthy relationship with work because they didn’t see it in themselves. It took me having a complete breakdown during my final year of graduate school to ask myself what I really wanted out of life. I realized I’d been asleep at the wheel for decades. I was waiting for the self-actualization that never came. I didn’t need to change the world. I just needed to participate in it.

By “Velma Olden” (a pseudonym)


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