When do our “relational ethics” turn into prescriptions for how to be a “socially just therapist"?
Recent conversations have left me questioning: when do our “relational ethics” turn into prescriptions for “how to be a “socially just” therapist”? And what are the effects when these ethical positions become prescriptions?
My journey from more structuralist training in clinical psychology to being introduced to post structural ideas through narrative therapy training has changed the lens through which I see psychology, mental health and my ethical principles as a therapist. To simplify quite crudely, I was initially trained to identify and formulate “disorders” with people and use psychological techniques to help reduce peoples’ symptoms. My journeys with narrative training- and life experiences- have taught me that problems are not located within people, but are political. They are created and maintained within the contexts and structures of society; the normative lenses, the structural inequality and oppression in the world, more recently the capitalist prescriptions for how to live/grow/lead the good life.
In recent years, these ideas have become more visible and more mainstream (probably still not actually mainstream, but mainstream amongst left leaning groups). And whilst this is an important and hopeful shift in making us more aware of power, inequality, oppression, context shaping problems, the way certain ideas are being circulated or taught sometimes leave me with discomfort. And this relates to when ethical positions are turned into prescriptions for things you should or shouldn’t do to be a “just” therapist. Essentially, when “relational ethics”- the responsive, nuanced ethics that centre the person seeking our support- turn into “rule-based ethics”- fixed rules set by the systems or structures we are in.
Recently I have been in some different discussions with therapists around the idea that as white therapists we should be naming our whiteness with BIPOC people we are in conversations with. That this is a necessary and important step in dismantling power inequalities in the therapy room and opening up avenues for conversations. The intentions here are clear- a desire to make visible how structural racism and inequalities might show up in the therapy room and these intentions are important.
However, I have started wondering if this is becoming a prescription for “how to”, which can inadvertently become a “rule”. And the hazard of rules is that they can become what is centred in conversation, instead of what we hope to centre- the person consulting us and their hopes, preferences and intentions for therapeutic conversations. I am concerned that prescriptions or rules may have us missing the nuanced, responsive and co-researched discussion that we hope to invite people into. That we may then inadvertently impose conversation onto people or make assumptions this is territory they want to step into.
Whether explicitly or through the questions I ask, my politics are not hidden. And I hope in doing so it makes visible that whiteness and other cultures of inequality are conversations I am open to stepping into- if people wish. I have also named my whiteness, that I’m neurotypical, heterosexual etc when there has been a specific intention. Always alongside: “would this be a helpful conversation to have or not?” Sometimes people have said “yes” to exploring how this might influence our shared understandings, and others have said “no”- this is not a conversation they wish to have. I worry about the inadvertent harm of introducing these topics from a more centred or prescriptive position. Who would be holding the power then and whose agenda would it be serving?
These is also a risk of these becoming stand-alone topics we introduce for discussion; but attention to power and how social inequalities and norms might be replicated in the therapy room are embedded throughout conversations. It’s in the very fabric of how we show up in conversations, invite people into discussions, pay attention to what we are centring, and to dominant ideas or prescriptions we might be colluding with.
Another idea I have been noticing recently is one around needing to share your political position as therapist so people seeking help can know whether you are the right person to be supporting them. This is alongside the more traditional but still widely circulated idea that you shouldn’t share personal information as a therapist.
I am not at all against the idea of sharing politics as a therapist, and at times it can be a powerful and important step. When abuses or injustices have been done, speaking up and taking a position might be a helpful prescription to hold. But, when this is held as a general prescription I worry we might encounter hazards of missing the nuance, the complexity, the choice over participating in the discourses affecting peoples’ lives. I worry that being in relationship with the prescriptions has us participating in a world that is increasing polarised and segregated.
I believe my political position is embedded in my practice and probably visible to most who consult me. But when I am directly asked for my political opinion I consider what I am being invited into in the context of what the person has been hoping to centre in the therapy work. Without doing so I might be inadvertently colluding with unhelpful discourses influencing their lives.
For example, the time I was asked for my political opinion by someone who was feeling pressured to cut off people who’s political orientations didn’t align with her own. Ideas around the “good versus bad”, “right/wrong side” were dominant in their life and weighing on them in their relationships. Had I rushed into responding without co-researched consideration, I questioned what sort of partnership I might be taking up with these ideas and what effect would this partnership have on this person’s hopes for our conversations.
My discomfort of all this lies in some of the effects I am seeing. The polarising of viewpoints and people; the inability to sit in messiness, nuance and difficult conversations. Even in writing this piece I am aware of a loud foreboding voice challenging me: “what if you are getting it wrong?”. It’s a familiar voice and sounds similar to one that’s been showing up for several people I’m in conversation with.
My hope in this “thinking out loud” piece this piece reflects a hope I have for my practice. But in thinking out loud, inviting and engaging conversation I am also speaking to a hope for the world outside of therapy. Whilst state/government actions across the world continues to divide, segregate and polarise, I hope we can respond by embracing messiness, nuance and difficult/uncomfortable conversations. For me this is an important step in holding onto our shared humanity.
(With thanks to the people who brought these important topics for consideration and to Hannah and Nadia- my shared thinking team)
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