Critical Therapy Antidote

Over the last couple of years, critics have been spelling out the antitherapeutic character of the politicised practice which has established itself as the new orthodoxy in our professional bodies and training institutions. However, one thing is still unclear and needs urgent attention—what do we call this departure from classical/traditional therapy practices?

In this essay, I will be considering the importance of nomenclature and why the labels being used for this new practice are inadequate descriptors. I will be proposing a new term—one that properly differentiates healing practices from political ones—and arguing for its suitability.

The importance of names

No one would dispute the importance placed on language in these postmodern times, witness the ongoing battle being fought over the definition of the term ‘woman’, for example. From a social constructivist perspective, the words we use to describe the world create our social reality.

This pre-occupation with the power of words is playing out in the therapy field with unfortunate consequences. Terms that once had a clearly defined concrete meaning such as ‘trauma’ lose their anchoring and expand to become so general as to be almost meaningless such as ‘trauma-informed therapy’. Perceived minor insults to the self can become magnified and legitimised under the rubric of ‘micro-aggressions’. Innocent sounding terms such as ‘inclusion’ are deployed as a means to exclude the majority or the non-compliant.

What we call something matters.

Once the power of language is understood then rhetorical strategies come to fore. I have pointed out in Cynical Therapies that it was partially down to rhetorical skills that activists were able to originally insert this new politicised practice into therapy.

One of their rhetorical masterstrokes, in my opinion, was to position this politicised therapy as a natural evolution of the field— ‘the social justice turn’ in therapy (Fleuridas and Krafcik refer to it as the already established fifth force in therapy). Needless to say this tactic has worked, for who could object to social justice as being a legitimate concern of therapists.

And the real world consequences? Clinicians are now waking up to find that a fear of being labelled a reactionary bigot has led them to cede control of their professional bodies and institutions to authoritarian zealots. Trainees now find themselves on ‘decolonised’ professional courses where they are being trained as activists rather than clinicians.

So, back to the terms—where are we now?  In a place where ‘therapy’ is now an umbrella term which encompasses both healing practices and political practices—a source of great confusion especially for the general public.  

Overstating the case?

So, an objection might be that therapy is a pluralistic field which has always encompassed a range of mutually exclusive approaches; what possible similarities could be detected between traditional psychoanalytic practice and existential  psychotherapy or drama therapy, for example. But, all of these therapies, however different, are grounded in the modern Western Enlightenment philosophic tradition. Consequently, traditional/classical therapists, no matter what approach they espouse, share a commitment to the uniqueness of the individual and the healing ethos of therapy; their practices are designed to increase the client’s insight, agency, and grasp on reality.  

This new ideological and politicised approach to therapeutic practice does not fit into the broad classical/traditional category: the differences are insurmountable. This type of practice approach to therapy is informed by Critical Social Justice (CSJ)— a world view that blends postmodern philosophical commitments with Critical Theory. It privileges the collective over the individual dimensions of the self. Consequently, the client is not viewed as a unique individual but rather an avatar of intersecting identities; the aetiology of the individual’s distress is exclusively located in the wider societal context; and the only treatment offered is a form of moral re-education which urges engagement in political change.

Consequently, an important task is to clearly differentiate between classical/traditional therapy and this radically new form of political practice. This task has not received proper attention because the ‘therapy’ umbrella shields the inserted CSJ ideology from proper scrutiny.

Terms so far

In general, critics of this new ideological turn in the therapy field have struggled with nomenclature. So far, one main place holder has emerged, ‘politicised therapy’ accompanied by a couple of terms for practitioners, these being ‘activist therapists’ and ‘Critical Social Justice-driven therapists’ or, its slangy equivalent, ‘woke therapists‘.

Putting the general self-evident place holder of ‘politicised therapy’ to one side, let’s consider the more specific terms currently used for practitioners. ‘Critical Social Justice-driven therapist’ is a clear descriptor but, although technically accurate, it is clunky and requires some familiarity with new concepts. Its slangy equivalent, ‘woke therapist’ can easily be dismissed as a pejorative term pushed by a right-wing agenda.  ‘Activist therapist’ is easier to grasp and conveys a sense of practitioners who have embraced a social change agenda for their profession. However, it doesn’t convey how these commitments might translate into therapeutic practice. It also unhelpfully suggests that there are nonactivist therapists who are passive in orientation.

However, there is much more fundamental problem with these names—by retaining the term ‘therapist/therapy’ in the descriptor, this new type of practice can be kept under the same umbrella as traditional/classical therapy.

Until we can clearly differentiate these two different practices, the therapy disciplines will  continue to lose the trust of the general public. In order to establish some clarity, we need to be much more accurate and assertive in our terminology. We need to engage with the power of rhetoric.

If it isn’t therapy, then what is it?

Clearly, ‘activist therapists’ believe they are engaged in a worthy cultural service and the trainees on ‘decolinised’ training courses are being taught to practise something deemed to be helpful with their clients. Descriptions by clinicians who espouse a ‘decolonised’ psychology, such as Thema Bryant (President of APA 2023-2024), would indicate that it is an emergent type of cultural practice. So how can it be more accurately termed?

We could start by thinking about what happens in the clinic of a practitioner who is committed to this politicised approach. The overarching goal is societal change and the practitioner will be directing the work with the client to that desired end. In other words, the client is being recruited, subtly or otherwise, for a political enterprise. The clinician does not focus on the uniqueness of the individual and there is little concern with psychology and intra-psychic processes. Interpersonal relationships are viewed solely through the lens of power relations. Insight is discouraged and is replaced with a form of moral re-education under the rubric of compassion. Notions of victimhood will be nurtured at the expense of increased agency and self-determination. The only treatment prescribed will be political activism and advocacy.

And, the method for obtaining these ends? Through maintaining an unwavering focus on identity.

• From the moment the client enters the clinic, they will be viewed by the practitioner  through the lens of identity. From the CSJ perspective of intersectionality, each person represents a combination of various group memberships (ethnicity, sexuality, gender, etc); each identity bestows a set of associated viewpoints and lived experiences.
• The therapeutic alliance is deployed, not to establish a trustworthy container for therapeutic processes, but, instead, to increase the salience of identity. (See, for example, Dustrup’s argument that the significance of race should be introduced into the white therapy dyad no matter what the client’s presenting issue is.)
• The aetiology of the client’s problems is always attributed to their positioning in an intersectional matrix. If a black client presents with anxiety, the diagnosis will automatically link the condition to the effects of systemic racism. Depression in white people would be linked to ‘white guilt’, female clients’ problems in living are generated by patriarchal oppression, etc., etc.
• The main method used is ‘broaching’, an intrusive tool employed by the practitioner to impose an ‘identity-centred’ agenda.  The clinician is highly alert to any opening which will allow an opportunity to bring the client’s attention to issues of identity. (See, for example, The APA Multicultural Guidelines ( 2017) which recommends that the psychologist actively fosters conversations with clients about their different identities and uses strategies to overcome the client’s resistance.)
• The ‘treatment’ will be determined by the client’s intersected identity and this will always be some form of political activism: clients with membership of oppressor groups will be encouraged to become advocates or allies; whereas clients with an oppressed identity will be urged to engage in activism.

Thus, the entire experience of the client in this clinic from beginning to end will be saturated with a preoccupation with identity at the expense of all other concerns.

So, we could say that one way of understanding this new type of cultural practice sheltering  underneath the umbrella of ‘therapy’ is to see it as a form of identity practice. And we could now label our ‘activist therapists’ more accurately as identity practitioners.

The advantages bestowed by this new term

The premise is that once this new type of cultural practice is clearly differentiated out from traditional therapy, some unhelpful confusion will be cleared away. Will these new terms work in practice? Let’s consider the highly contested arena of therapy with clients presenting with gender issues.

First, employing differentiated terms for the professionals immediately helps to make sense of the ongoing bitter struggle between two opposing perspectives on treatment. Traditional/classical therapists would view this client as no different from any other client presenting symptoms of disturbance that require exploration. However, trans activists who have been highly influential in the politicised professional therapy bodies have argued for trans-exceptionalism and an affirmation-only approach.

Once the politicised clinicians are more accurately labelled as ‘identity practitioners’, the picture becomes much clearer. For traditional/classical therapists, the client is presenting symptoms that warrant exploration. Identity practitioners, on the other hand, will automatically view the client as presenting an emerging identity which requires affirmation and consolidation. The view is different; the practice is different; and these radical differences are reflected in the terms. Once the practice is more accurately labelled, potential clients can make an informed choice.

Another advantage of differentiating the professional labels is that it helps to strengthen the position of traditional/classical therapists making the case about the dangers of affirmation therapy for children and young people. The ‘Identity practitioner’ label makes the CSJ commitments explicit. Under this umbrella is Queer Theory which collapses the distinctions between child/young person and adult. In other words, identity trumps stages of development.

What this means in practice is that trans-activists have pushed very aggressively for  affirmation therapy for children with gender dysphoria. Traditional/classical therapists who have raised objections on the legitimate grounds of child safeguarding issues have found themselves on the backfoot fending off accusations of transphobia. Once affirmation-only treatment approaches can be labelled as not therapy but identity practice, traditional/classical therapists are better positioned to stand their ground. Identity practitioners are not suitable referrals for children and vulnerable young people.

Conclusion

Rather obviously, the clinicians who warrant the label ‘identity practitioners’ are likely to strongly resist this new term. But the name isn’t designed for them: no purveyors of suspect goods welcome accurate labelling. This label is designed both as a means for classical/traditional clinicians to separate themselves out from a politicised therapy field and also as a help to the general public in search of real therapy for problems in living.

And, importantly, this new label makes the link clear between the current demoralisation of the therapy professions to the wider cultural landscape of ‘identity’ politics. The term points to what is happening: the public sphere is identity politics, its ideological instantiation at the private level takes place in the clinics of identity practitioners operating under the guise of therapy.

Let’s be clear – this relabelling is a rhetorical strategy. Therapy practitioners, unfortunately, have not fully grasped the tactics used to subvert their professions. We need to wise up now and be crystal clear in our terms and definitions. A new cultural practice has inserted itself into the therapy field and hijacked it for political ends. The terms ‘identity practice’ and ‘identity practitioners’ help to draw a clear boundary between the therapeutic and the political. It is up to us to hold that line.

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By Val Thomas, DPsych, a psychotherapist, researcher, writer and formerly a counsellor educator. 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.