The Challenges of Being a Psychotherapist in the Age of Trump

The last three years have been a tumultuous time to be a psychotherapist. I’ve had to contend with the effect of President Trump and Trumpism not only on the well-being of my clients, but also on my own mental health. As a Jewish woman with a half-Latino daughter, President Trump’s misogyny and his dog whistles (hell, sometimes overt support) to anti-Semites and white supremacists feel deeply personal. I continually have to confront and manage my own anxiety and despair before I can be helpful to my clients.

I’ve counseled clients—as I’ve tried to do myself—to strike a balance between self-care and political activism. This is a good time to do more meditation and yoga and to take breaks from the news with comedy shows and escapist novels. But we cannot deny the reality of what is happening to our country. For me, the balance has swung more towards activism in the last year and a half. I seem to be in a heightened state of fight as opposed to flight (although I’ll admit that in November 2016, I did check to see that my family’s passports were up to date and I considered the practicality of moving to Canada, Europe, or Israel). My anxiety manifests as a strong desire to fight the system. In the past, I have tended to dip, in brief spurts, into activism around issues of reproductive freedom, apartheid in South Africa, and Jewish advocacy, but never before have I called and written my congresspeople, signed petitions, written editorials, and marched with such regularity as I do now. I never fully understood on a neurological level the meaning of the phrase “the political is personal” until now.

In this changed cultural miasma, I’ve become increasingly aware that it is not enough to address the typical issues I usually address with clients: family of origin themes; internalized negative self thoughts; maladaptive patterns of behaviors in relationships; or how to manage symptoms of depression, anxiety, or trauma. Taking a page from feminist psychologists, who focus as much on how the social system impacts clients as their family systems do, I am very curious about and sensitive to their experiences under the present administration. As one woman put it, “My inner world feels okay; but how do I deal with the outer world?”

The moniker “Trump Anxiety Disorder” began as somewhat of a joke among liberal therapists, but it was born out as an actual “thing” when the American Psychiatric Association published evidence that, since 2016, rates of anxiety and depression have been rising at alarming rates. A May 2018 APA survey found that thirty-nine percent of people reported that their anxiety level had risen over the year, and fifty-six percent were either “extremely anxious” or “somewhat anxious” about “the impact of politics on daily life.” A 2017 study reported that two-thirds of Americans see the nation’s future as a “very or somewhat significant source of stress.” Among those I’ve seen particularly affected in my office are those with narcissistic or sadistic parents or partners, who already suffer daily from the dysfunctional system they live in and now see similar behaviors in their president; survivors of sexual harassment and assault; members of minority ethnic and religious groups; women; and teens whose schools have received threats of gun violence. There is also a new psychological term, “eco-anxiety,” which describes the symptoms of clients who feel despondent about the climate change crisis, despite the president’s denial that it is happening. In 2017, the American Psychological Association published “Mental Health and our Changing Climate,” which explores the psychological impact of climate change. Younger clients considering starting families, for example, wonder if it’s fair to bring new life into a dying world.

I’ve been exploring the boundaries between my training as a therapist and a newer voice compelling me to become an activist. As a therapist, I was trained to be a blank slate, who disclosed little-to-no personal information to clients, but I was also trained to be authentic. When it comes to politics, those two approaches to my work can conflict. When clients talk to me about their anger, fear, and frustration at the current state of politics, it feels wrong not to validate their experience sincerely, in a manner that I’m sure conveys that I agree with them. There is also an element of reality testing for me here. In an age of “alternative facts,” I want to affirm that I see the same concerning elements in the actions of this president and his inner circle as they do. I also believe that empowering clients to take action, by educating them about various local political groups and encouraging them to speak up, can be healing, not only giving them a sense of agency regarding current politics but more generally teaching them that their voice matters.

In terms of how the current political reality impacts my subjective experience in the room with clients, since the massacre at the Etz Chaim Synagogue in Pittsburgh by a neo-Nazi terrorist, I have become increasingly self-conscious of being Jewish. My clients have on rare occasions in the past made anti-Semitic remarks. One teenager thought Jews had horns. I chose to make that a teachable moment by disclosing my religion to him. Another referred to someone “jewing someone down,” and then quickly apologized. In this national climate when anti-Semitic incidents are up by almost 60% in the past year, according to the Anti-Defamation League, I brace myself when I need to address an issue of collecting fees, or when a client opens a topic that feels like it could veer into an anti-Semitic trope. My religion was always an aspect of my life in the background, rarely touched upon or relevant, except to Jewish clients. But after the Pittsburgh tragedy, when clients acknowledged their awareness of how I might be affected, I again chose authenticity over being cagey or over the therapist’s trick of turning their questions back on them. As an American citizen as well as their therapist, I validated their disbelief, shock, and rage at what is happening in our country. This holiday season, more clients than in seasons past have wished me “Happy Chanukah.” I feel touched and also a bit vulnerable. I cannot help but recall how Jewish doctors were forced to close their practices in Nazi Germany or how Sigmund Freud had to flee Austria. Part of me wants to wear my Star of David proudly in the streets. Another part actually considers my daughter’s request that we hang our mezuzah inside rather than outside our doorpost, after our local Starbucks is graffitied with a swastika. I never would have thought this question would have crossed my mind in our Northern California, progressive community.

I took another step towards integrating my life as a psychotherapist and as an activist by becoming involved in the Duty to Warn movement. This movement grew out of a petition, signed by seventy thousand mental health professionals, who feel compelled to warn the public about the danger President Trump exhibits from a psychological perspective. The petition, started by Dr. John Gartner, calls for invoking the twenty-fifth amendment to remove the president from office because of mental incompetence. There is controversy, based on the Goldwater rule, about the ethics of mental health practitioners weighing in on Trump’s pathology. The Goldwater rule states that it is unethical for psychiatrists to give a professional opinion about public figures whom they have not actually examined and from whom they’ve not received consent to discuss publicly. However, the arguments on the other side are compelling. With pundits throwing around words like narcissism and sociopathy, ought we not be hearing from those with actual training in these conditions? The Goldwater rule was written at a time when the art of diagnosis was far less precise than it is now, when it was not based on observable behaviors. Furthermore, one need not issue an actual diagnosis to observe the behaviors and attitudes of this president, readily visible to the entire country on the nightly news and on his Twitter account. Dr. Bandy Lee, a psychiatrist at Yale Medical School who leads the sister movement Duty to Protect and who specializes in domestic violence, explains that one need not assign a diagnosis in order to warn about a danger of violence from someone who routinely threatens, bullies, and intimidates—one who also happens to have access to the nuclear codes.

Aside from my more overtly political work with the Duty to Warn group, which included organizing a town hall and participating in the group’s upcoming film #UNFIT, I have realized that since psychotherapists are in the business of promoting communication and interpersonal relationships, within our private offices we have a crucial role to play in fixing our broken system. People on different sides of political issues have forgotten how to debate civilly or even how listen to each other, much less how to negotiate and compromise. I never imagined that empathy would become a political act, but—alas!—it has. People on different sides of the political divide, as well as people of different cultural backgrounds and faiths, seem unwilling and sometimes unable to empathize with others’ perspectives. But when we listen deeply to one another’s stories—meaning we practice seeing things from another’s perspective while silencing the voice inside us that wants to disagree or tell our own side—we learn that we all want the same basic things: a good life for ourselves and our families, good health, an adequate income to provide for our needs, and a sense of meaning and purpose. When I teach clients to feel compassion for themselves and to empathize with their partners and family members, I hope that I am also providing them with the skills to empathize with their fellow human beings, whomever they may be. This may be the most important political action I can take in this period in the country’s history.

Notes:

Dockett, Lauren. “The Rise of Eco-Anxiety.” Psychotherapy Networker, January/February 2019.

Harris, John S. and Susan Zimmerman. “Trump May Not Be Crazy, But the Rest of Us Are Getting There Fast.” Politico Magazine, October 12, 2018.

From: Fury: Women's Lived Experiences During the Trump Era, edited by Amy Roost and Alissa Hirshfeld |Regal House Publishing (March 20, 2020)

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