In the aftermath of the death of George Floyd, identikit political statements were issued by nearly all the therapy professional bodies and training institutions committing their organisations to ending systemic racism. It was clear then that the therapy professions were becoming ideologically contaminated. Consequently, over the last three or so years, the priority for those of us concerned by this political turn has been to break through the wall of silence and start to speak out and challenge the encroachments of Critical Social Justice (CSJ) on the therapy field; it seemed to be particularly important to alert the general public that the contents of the tin labelled ‘therapy’ was being changed. A significant focus has been on pointing out the antitherapeutic and anti-relational nature of this politicised type of practice, an approach to therapy which believes that the client’s problems are primarily caused by oppressive societal systems. Inevitably, this focus has given the polemics a binary tone – traditional therapy all good versus CSJ all bad. Three to four years on, it is time to develop more nuanced counter arguments.
In order to make the theoretical arguments presented in this essay more relatable, I am going to interweave a creative approach which personifies the therapy professions as a client who needs help. So, Reader, imagine that Therapy arrives in the clinic, bewildered, weakened, anxious and confused. In the intake assessment, it transpires that Therapy is having problems with an abusive relationship. Therapy owns a large mansion and has rented out rooms to tenants. This system worked well until a new tenant moved in. This person who initially appeared idealistic and compassionate soon started to take over, intimidating all the other tenants and dominating the client. Using a combination of moral grandstanding, gaslighting and shaming tactics, the abusive tenant had Therapy cowed in a corner and almost ready to sign over the deeds to the building. The therapeutic work in the first stage with this client is to help them regain their sense of self and understand how they have been manipulated and controlled. It’s going to take a while for Therapy to fully grasp that the tenant is not what they claim to be.
The next stage of treatment would be to help Therapy understand how they were implicated in this abusive relationship. In order to move on, to grow and develop, Therapy needs to engage with some soul-searching questions: What were the vulnerabilities which the abusive tenant was able to exploit? What can be learned from this encounter? In other words, Therapy would benefit from being able to positively reframe this crisis as an opportunity for growth and development.
So how does this analogy map onto the field itself? It does appear that we are moving into the next phase now and it is important to take stock. It is far too simplistic to propose we can just remove CSJ even if that were possible and revert to the original versions of traditional therapy. We can’t go backwards: we have to find a way of moving forwards. Therefore, we need to be responsive and open to change so that we can support the emergence of healthy revitalized therapy professions—ones that can properly serve the needs of clients in times of cultural upheaval. This next step will surely involve returning to the theoretical and conceptual ground of traditional therapies and investigate what needs to be expanded/dismissed and revised.
With this in mind, there is one general feature of the therapy field that needs proper attention—its historical focus on the individual intrapsychic dimensions in clinical work and the consequences of this. In Cynical Therapies I argued that the underdeveloped collective dimension of therapy is one of the factors that facilitated the colonisation of the field by a collectivist political ideology. Or, in terms of the analogy, how the abusive tenant was able to first get in and then take control. It would be helpful, therefore, to find frameworks and conceptual systems that can illuminate this imbalance more clearly, so that we have a clear base from which to work on rebalancing the field. The task is to integrate the intrapsychic with the collective in healthy and therapeutically productive ways.
In this essay, I am starting by laying out the current situation and setting this crisis in an historical context and then I am going to propose that we could look outside the therapy schools for helpful theoretical perspectives which can be applied to therapy more generically. As a starting point in this endeavour, I will be putting forward Ken Wilber’s Integral Theory as a suitable candidate; his elegant quadrant framework offers a means of understanding CSJ as, on one hand, a regressive move in therapy and, on the other hand, a potentially useful message that the therapy field needs to develop its grasp of the societal/environmental factors implicated in the client’s presenting issues.
Where we have got to?
In 2023 the picture looks different to 2020 when there was no public critique of CSJ-driven therapy. Now more people are speaking out with informed articulate voices. Developments include: notable podcasts such as Leslie Elliott, Critical Therapy Antidote, Gender: A Wider Lens, Michael Dewan-Herrick and Stephanie Winn; publications such as Cynical Therapies are alerting the wider public to the capture of therapy; there is the beginning of scholarly literature critiquing the ideological direction (see Sedgwick’s paper and an important anthology of essays on ideological bias published by Springer); empirical data supporting the claim that therapist education has been captured (see Sherwood and Miller’s inquiry); significant platforms for dissenting voices on gender ideology such as Thoughtful Therapists and Genspect; and the beginnings of parallel institutions (e.g. The International Association of Counselors and Psychologists and The Open Therapy Institute).
In addition, scholars and clinicians are starting to draw on the rich repertoire of theoretical concepts in various therapy schools as lenses to critically analyse CSJ. Examples of psychoanalytically-informed critiques would include Schwartz, van Zyl, and Mills. A recent book by Alderman uses Jungian analytic psychology to make the case that postmodern deconstruction can be understood as a myth, the archetype of the Puer Aeternus.
Yet, at the same time, reflecting the wider culture, this ideology appears to have become more entrenched within our field. Social justice activists have captured the bureaucratic institutions which shape policy—consider all the official statements and practice guidance issued by the American Psychological Association (APA), for example. And spreading out across the Anglophone world, we can see how these ideological commitments are being instantiated in professional criteria (see the recent example of the revised standards for the UK’s Health Care Professions Council). In parallel, therapy training institutions are explicit about their political aims, The University of Tennessee, for example, is happy to make the following statement about its counselling psychology programme on its website ‘… we prepare students to be researchers, clinicians (i.e., therapists), and social justice advocates that bring about systemic change.’ These institutions are also exhibiting increasingly authoritarian responses to any noncompliant students (see the example of Leslie Elliott’s struggle with Antioch University and the case of James Esses in the UK expelled for holding gender critical beliefs).
So, despite some gains, whether we like it or not, a new hegemony is being established in the therapy field and we are all supposed to accept without protest a narrative that positions CSJ as an evolution. And what was once a healing enterprise is now becoming an antitherapeutic endeavour: a practice designed to morally re-educate clients and harness them to a political purpose. Put simply, the goal of therapy is being shifted from changing the self to changing society. Individuals who once showed up at therapists’ clinics with the reasonable expectation of strengthening themselves are now just as likely to encounter activist therapists who will weaken them, through encouraging their clients’ sense of victimhood and telling them their difficulties are all the fault of society.
It’s time to seize the initiative and find a way past this impasse. In order to do this, as with the treatment of Therapy, our personified client, it is vital that the therapy field develops a clearer understanding of CSJ’s insertion into the therapy field. And to do this it would be helpful to review the last few decades.
Background
A lot of attention has been paid over recent years to the problematics of therapy. And, of course, its limitations can and should be legitimately criticised. Traditional therapy having originated in the Western liberal enlightenment tradition inevitably bears the hallmarks of this culture with its commitments to the individual and empiricism. Unfortunately, CSJ has been able to drive these problematics along a pathway to a totalising conclusion: white supremacy is baked into the therapeutic enterprise. Once this move has been made then it is easy to initiate a dismantling process arguing that therapy should be decolonised (see Thema Bryant, President of APA arguing this position). New colonisers can insert themselves into the field and take it over, using well-honed rhetorical strategies such as the motte and bailey tactic (see here for a detailed account of how it has been used in therapy).
It is worth returning to the time towards the end of the 20th century when the therapy field began to wrestle with the limitations of its origins, in particular, with its almost exclusively individual intrapsychic focus (this is, of course, very broadbrush—there were some types of therapy that were systemic and contextual). We can see the start of some modifications in response to intellectual and material cultural changes: theory was expanding to integrate postmodern social constructivist concepts of the self and applications to practice started to pay more attention to the client’s social/cultural context in relation to their presenting issues. At the dawn of the new millennium, it looked as if an expansion was ready to take place so that more dimensions of the self could be integrated into the therapeutic endeavour. Pragmatic frameworks that could accommodate this expansion started to gain popularity such as the biopsychosocial model.
However, instead of this promising expansion—a deeper integration of the individual self and cultural/societal/environmental factors in treatment—the field pivoted over from an individual focus to a collective one; the social and cultural dimensions became the most significant factor trumping the intrapsychic aspects of the client. Furthermore, CSJ piggybacked in on this shift; it wasn’t long before this new worldview, a conflation of applied postmodernism and Critical Theory, became the dominant voice in therapy. With this move, therapy was harnessed to political activist goals (see the first chapter of Cynical Therapies for more detail about this thirty year period.)
In order to correct this disastrous antitherapeutic move, it would seem important to return to the foundations of therapy and expand our conceptual frameworks; we need ones that can integrate the individual and the collective dimensions of human experience. Such frameworks should offer an expansion of the therapeutic endeavour not a narrow reductive regressive inversion whereby the collective just replaces the individual; let alone one that lends itself to an ideological goal of moral re-education.
In the next part of this essay, I am going to propose Wilber’s Integral Theory as a potential meta framework suitable for this project.
Wilber’s Integral Theory
I will need to give some background for readers unfamiliar with the work of Ken Wilber, an American psychologist/philosopher who has been developing his ideas over the last five decades. In essence, Integral Theory is a ‘theory of everything’. It provides a comprehensive framework comprising two axes: a vertical developmental axis and a horizontal one that locates itself in the four primary domains of existence. This Integral framework shortened to AQAL (All Quadrants, All Levels) can be applied to both the individual and also to the macro level of society.
Wilber began his work through an attempt to synthesise Western and Eastern psychology systems publishing his first book in his 20’s titled The Spectrum of Consciousness. Over the next couple of decades, he continued to develop his comprehensive developmental theory which views human development as a progress towards higher stages of consciousness and divine wholeness (although it has to be said that the explicitly transpersonal framing of AQAL has probably restricted its take up more widely).
In the 1990’s he was able to expand his framework to include a horizontal dimension. Over a period of several years, he found himself faced with a seemingly impossible to resolve conundrum: he could not find a way to integrate/synthesise a huge variety of developmental theories and maps produced across a range of disciplines. His breakthrough happened when he realised that the different theories/maps focussed on different domains of existence. In 1995 he published his magnum opus, Sex, Ecology, Spirituality: The Spirit of Evolution, which explained how each developmental stage expressed itself in four fundamental domains of existence. These domains which he termed quadrants were always present. In his next act of synthesis, he was then able to marry the quadrants—the horizontal axis—with the vertical developmental axis. Then, with the final addition of states of consciousness, Wilber believed that he had a theory of everything. This meta framework was labelled AQAL (an acronym for All Quadrants, All Levels).
All aspects of Integral Theory could be usefully applied to understanding the current situation in the therapy field. However, thinking in any depth about such a vast framework lies beyond the scope of this essay. Instead, I want to focus on the quadrants, as this horizontal axis is of particular relevance to the integration of the societal/environmental with the individual/intra-psychic—the issue which I contend is the one we need to be focusing on.
The Four Quadrants
As mentioned earlier, the quadrants refer to the four fundamental domains of existence (see this short video explanation here). It is important to remember that the integral framework applies to a generic individual entity— Wilber terms this a ‘holon’. This mapping can be applied to both an individual human being as well as a whole culture.
So, at the most basic level, an individual entity (holon) has four aspects to it. These aspects consist of the interior and the exterior of the individual holon and the interior and exterior of groups of holons. This map then becomes a quadratic one subdivided in two ways. The left side of the framework represents the interior dimensions (that which can’t be viewed from the outside world) and the right side represents the visible exterior. The other subdivision is composed of the upper section which is the individual and the lower section which is the collective dimension. This gives each quadrant a particular reference. See fig.1 below.
| UL (Upper Left) Individual interior Intra-psychic Subjective Experiential | UR (Upper Right) Individual exterior Body Objective Behavioural |
| LL (Lower Left) Collective interior Inter-relational Inter-subjective Culture | LR (Lower Right) Collective exterior Systems Inter-objective Society |
So simply put, in terms of existential domains, the individual has: a physical body and displays behaviours; an invisible interior experiencing self; is situated in a relationship to others/or in a culture with a set of associated values and beliefs and practices; and is positioned within an exterior social group where cultural values and beliefs become manifest. If this were all there was to it, then the quadrants would be purely descriptive and self-evident.
However, there are the two key features prioritised by Integral Theory that turn the quadrants from a merely descriptive framework into a potent explanatory one. The four existential domains are linked in a particular way: they are simultaneously irreducible to one another, and they are also interdependent. Both of these features have important ramifications as follows.
In terms of the former, each existential domain is always operational on its own terms and one cannot be collapsed into another. For example, in the midst of a serious illness, the focus of the individual will be on the body (UR/exterior-individual) but this does not mean that the other quadrants disappear, they will still be in existence so the self may be consumed with thoughts and feelings around mortality (UL/interior-individual), she is affected by society’s beliefs about illness (LL/interior-collective) and the physical environment of healthcare provision (LR/exterior-collective) shapes her experience.
In terms of the latter, this means that each existential domain both influences and is influenced by the other three domains. In simple terms, this means that negative or positive changes in any one domain will influence all three other domains. So, to return to the previous example, consider two versions.
In the first event it is a change in the body, the medicine used to treat the person’s illness. This medicine is taken into the body (UR/exterior-individual) but may have side effects on mental and emotional functioning that affects the self (UL/interior-individual); the medicine might be new and not readily available through the healthcare system (LR/exterior-collective) creating anxiety (UL/interior-individual) and a delay in administering it with some suboptimal consequences for recovery (UR/exterior-individual).
In the second scenario, the individual has had a successful accompanying experience of therapy (UL/interior-individual) strengthening her psychologically and alleviating strong emotional reactions. This calmed the nervous system (UR/exterior-individual), allowing her to relate more positively to her carers (LL/interior-collective) and prompted her afterwards to advocate for improvements in systems of medicine provision (LR/exterior-collective).
Viewing the therapy field from the perspective of the four quadrant framework
From the previous description, it should be obvious how Integral Theory would be a useful analytic tool for considering the individual client’s presenting issues (see its clinical applications here). However, as mentioned earlier, Integral Theory can also be applied at the macro level to the therapy field itself. Of particular relevance to the focus of this essay, the four quadrant framework can be used to give a helpful coherent map of the bewildering complex pluralistic therapy field itself as follows.
Each therapy approach can be viewed from the perspective of which quadrant(s) is the main focus. The early schools are almost exclusively focused on the upper portion—the individual dimension—of the quadrant map, for example the psychoanalytic/psychodynamic perspectives concern themselves with the intrapsychic UL quadrant and this is also true of early humanistic approaches such as the person-centred approach. Behavioural approaches focus on the body and observable behaviour and are thus in the UR quadrant. Some are a blend of both individual quadrants such Cognitive Behavioural Therapy which combines behavioural (UR) and cognitive (UL) procedures. Later developments of relational psychoanalysis are more concerned with the collective in terms of relating and thus widen out from a purely individual focus combining UL with the LL quadrants. And, finally, some humanistic schools such Gestalt with its emphasis on context also include the LL quadrant.
However, and importantly, it is the LR quadrant, (the exterior-collective dimension) which is the most underrepresented aspect in traditional therapy (although there were some earlier approaches that did focus on this dimension including feminist therapy and systems-based therapy such as family therapy).
How the four quadrant framework provides a powerful critical analysis of CSJ
So where would CSJ-driven therapy approaches land in this quadratic framework? To begin with, it is important to note that CSJ-driven therapy does not label itself as such. It resists being characterised as a particular modality, one of many other competing perspectives. Instead, it presents itself generically as the next evolution of therapy, one that supersedes all others. By doing this, it can dismiss the legitimacy of other schools and types of clinical practice. Up until now, this has been a successful strategy allowing its advocates to insert CSJ into the field with almost zero opposition. How can we employ the four quadrant framework to get more of a grasp on the slippery rhetorical claims of CSJ to be the future of therapeutic practice?
Putting to one side other objections to CSJ-driven therapy such as its political agenda and its hermeneutics of oppression, Integral Theory identifies a fundamental fallacy in CSJ-driven approaches to therapy: by diagnosing all individual difficulties as arising out of systems of oppression, CSJ is collapsing the individual quadrants into the collective ones (with a particular emphasis on the LR (exterior-collective) one. It is important to contrast its position with other approaches such as the psychodynamic school which, although focused on one quadrant the UL (interior-individual or intrapsychic) does not make similar totalising claims that all difficulties without exception arise from the client’s internal dynamics.
Wilber terms reductive moves such as the one made by CSJ-driven therapy as ‘quadrant reductionism’. Recall in the previous description that each quadrant is irreducible therefore this move would be seen as a first order error. Viewed from this Integral Theory perspective it is clear that CSJ-driven approaches to therapy and the accompanying totalising claims are fundamentally and fatally structurally flawed.
How Integral Theory can help provide a positive reframing of the existential crisis provoked by CSJ
So, let’s return to Therapy, personified as a client in the clinical space. In the first stage of treatment, the focus would have been on strengthening Therapy’s sense of self and helping them gain some insight into how the abusive relationship began. Useful questions would include— how have Therapy’s vulnerabilities and blind spots contributed to this threat? Once Therapy has a clearer grasp of the situation it could then be useful to help them make sense of their experience; to help them find a meaning which could promote growth and development. What does this encounter with the abusive tenant mean for the client? The various therapy schools would approach this second stage in a range of ways. However, most of these approaches would converge on a generic notion: the possibility that, in the encounter with the abusive tenant, the client is being confronted with a split off part of the self that needs some acknowledgement, development and re-integration into the totality of the person.
How does this metaphorical framing map back onto the therapy field? Here we can also employ an Integral lens. As mentioned earlier, in traditional therapy, for obvious historical reasons, the collective aspects of the client (the lower part of the four quadrant axis) have received less attention than the individual dimensions. More recently, due to the influence of postmodern theories of social constructionism, more attention has been paid to the cultural aspects of therapy (LL/interior-collective). However, as noted earlier, the most neglected aspect is the LR/exterior-collective, how the beliefs and values of culture are made manifest in society (systems/institutions etc.).
Now, putting to one side, CSJ’s simplistic reductive characterisation of the social world as grounded in systems of oppression, its arrival and rapid spread is forcing attention on the collective dimensions of the client. And it is these unintegrated and underdeveloped collective dimensions (especially the LR quadrant) in clinical theory and practice—the abusive tenant in our analogy—that is causing havoc. Integral Theory would argue that, in terms of the four quadrants, the therapy field is out of balance. CSJ has arrived to force the therapy field to contend with a missing dimension, one that I would argue is an increasingly significant factor in clients’ issues, more so now than in recent times.
We are living through rapidly changing times, deeply unstable and unpredictable. In addition to all the previous ongoing contextual challenges of neo-liberalism and capitalism with its incessant push towards commodification and consumption, we are technologically interconnected in unprecedented ways. Old certainties are dissolving and there is great confusion in the West about reality. Consider just a few of the factors implicated in these cultural changes:
- Social media and the smartphone have introduced extraordinary rapid changes in how we relate to one another (for example, see Henderson discussing his research with Peterson into the way that dating apps are affecting how people and women find partners).
- Digital media appears to be having very poor effects on adolescent mental health (for example, see Twenge discussing her work in I/V with Williams).
- Unprecedented and atypical differences in generational attitudes (see Kaufman’s report on the political culture of young Britain indicating generation Z [especially females] is more authoritarian than previous generations).
- Exposure to screen time is changing our consciousness in ways we do not grasp (for example, see this review of recent research findings).
- We are subject to moral panics and as a society we are allowing delusions about biological reality of sex to result in medical surgeries on children. (for example, see Joyce discussing this topic in I/V with Bogossian).
- The whole world has recently experienced a global pandemic accompanied by lockdowns to prevent the spread of disease. Everyone has been affected by this world event (see a research review confirming that the COVID-19 lockdown has resulted in psychological distress).
- And, ironically, CSJ is part of the problem. The increasing grip that this ideology with its oppressor/oppressed worldview has on our culture and its institutions is helping to polarise and destabilise society creating social and family divisions (see Haidt discussing political polarisation with Anderson here).
The people entering the clinical space are all, to a greater or lesser extent, affected by these unprecedented changes in culture and technology. What this would strongly suggest is that there should be a greater research focus in the therapy field on how these cultural and societal factors are showing up in clients’ presenting problems. From the perspective of Integral Theory, we need to work with this split off LR quadrant, making it more conscious so that it can be properly integrated into the therapeutic endeavour.
Conclusion
CSJ has delivered an existential threat to the therapy professions. In the first phase, the defensive position taken was, understandably binary: traditional therapy good versus CSJ-driven therapy bad. But now it is time to think more constructively about this position. Just as it can be helpful for a client to reframe a problem as an opportunity for growth and development, it behooves us to use this therapeutic lens on our own professions. I think it is important to accept that CSJ, whatever we might think of it, has exposed a fundamental weakness at the core of contemporary therapy—a weakness that has allowed healing practices to be hijacked for political ends—and that a particularly significant issue is the imbalance between the attention paid to the intrapsychic and intercultural/societal dimensions of the client.
So CSJ is correct, therapy needs to pay attention to the collective dimension and gain a more comprehensive understanding of the way that collective factors are implicated, particularly now, in clients’ presenting issues. This has been an underdeveloped aspect. But ironically, this project will include understanding how CSJ itself is implicated in the negative environmental factors that clients bring to therapy. The systemic problem is not the one proposed by CSJ, a patriarchal white supremacist system of power. Instead part of the problem is the divisive CSJ oppressor/oppressed worldview that has been inserted into almost all of our cultural institutions.
Clinicians and theorists need to seize the initiative now and be more proactive, engaging with potentially useful conceptual frameworks such as Integral Theory that can expand the ground for a productive integration of the intrapsychic and collective dimensions of human experience.
So, let’s end on a point of superficial agreement with CSJ. In the refrain of one notorious advocate, Robin DiAngelo, we need to do the work and this work is never done. Yes, we can agree to that but the nature of the work we are engaged with is much deeper, not harnessed to a narrow reductive regressive ideology, but instead in service to the ever evolving needs of the people who step into the clinical space.
It’s time now for Therapy, our personified client, to pull rank on the abusive tenant and reclaim the mansion, rededicating it to a healing ethos. The therapy professions need to reframe the existential crisis provoked by the arrival of a malignant ideology as an urgent call for conscious growth and development.
By Val Thomas, DPsych, a psychotherapist, researcher, writer and formerly a counsellor educator (including lead lecturer on the PG Diploma in Integral Therapeutic Counselling at Anglia Ruskin University). Her specialism is applications of mental imagery. She is the author of two Routledge publications: Using Mental Imagery in Counselling and Psychotherapy (2015) and Using Mental Imagery to Enhance Creative and Work-Related Processes (2019). She is also the editor of the 2023 collection of essays, Cynical Therapies.
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