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Can Therapists Be Politically Neutral?

We do not have the option of seeing a person as a single creature who can provide everything they need for themselves. We are social beings who affect each other's lives constantly. So when I am working with clients, I am considering how their environment shapes them and how they shape their environment. Therapy turns out to be a wonderful opportunity exploring both.

"Politics"

This may all start to sound very politically charged. Shouldn't therapists be neutral? The truth is that our environment is all around us, including in the therapy room. Not mentioning what's happening around us as it's happening is not neutral. It is avoidance and complicity. And it is a privilege to be able to say "I don't talk politics." Because for some people, like me and many people I work with, even being allowed to live freely is not politically neutral.

That being said, I do try to be very mindful of my own power and privileges as well. After all, society basically gives therapists the choice of deciding if someone is mentally well or not. And by extension, what being mentally well means. That's a lot of power. What if your goals or ways of reaching those goals don't line up with theirs? What if they use their power as professionals to tell you that the way you think or feel is wrong? And who do you think would benefit from having an easy excuse to discredit "inconvenient" people as "insane?"

I know it all sounds morbid, but it's been done many times before. Being gay or trans was diagnosed by the medical community as a disease until very recently. Some people still think that way. It makes you wonder what we will look back on 50 years from now as a "misunderstanding." That's the sort of thing that keeps me vigilant. And keeps me up at night.

Therapy

Yeah, this isn't exactly the best sales pitch for therapy, is it? But that's the thing: I'm not trying to sell you on therapy. Again, I do not think my job is to sugarcoat or neglect to mention what is happening right in front of both of us. But I see it as the basic obligation of someone with the power to potentially cause harm to not only be very mindful of it, but also be explicit about those risks with the person in front of me.

So, I've been upfront with you. And you're still reading. Good for you. Hopefully I've earned a bit of good faith with this disclosure. Therapy isn't a perfect system. It's something made by humans, so it has flaws. But that doesn't mean it doesn't work. We just need to be very careful and make a plan to account for the risks.

Trust

Do you see why I think this is so much more important than answering "Do I do DBT?" There are many lovely techniques that can get good results. Just make sure that the person you decide to work with has your best interests at heart and is working on your terms. They may know a lot about the brain, but you are the expert of your own life. Nobody knows you like you do. If something isn't working or makes you uncomfortable, say something. And if you feel unsafe saying something, there is a bigger problem to address before you will have much luck with therapy.

By now I hope you realize that this is not all about the money for me. I do need money like anyone does to survive in this current world. At the same time, I have a long waitlist, so this isn't about keeping you on the books paying for my expensive D&D dice collection. This is about giving you the info you need to find somebody--anybody--who will sincerely help you achieve the goals you want to achieve. Because that's how you know therapy is working. That's how you manage the risks. By listening to what you are feeling, talking about those feelings with your provider, and trusting in your own gut.

You want to know the wild part of all this? That very process of learning to trust yourself is a big part of how we heal our minds, hearts, and bodies. By showing ourselves that we are capable of keeping ourselves secure, we learn new lessons about what we can handle in the future.

What is trauma and memory reconsolidation?

If you ask five therapists to define trauma, you'd probably get at least seven answers. The one I use is "a persistent learned emotional response to a past event that overwhelmed your resources to respond to and process it as it was happening."

In other words, trauma isn't something that happens to you. It's an emotional strategy you learned to survive a difficult situation. However, this becomes a problem if those strategies are not as useful in day-to-day life as they were in the heat of a traumatic event.

For example, let's suppose someone grew up in poverty and rarely had enough to get by. Even if that person had greater security later in life, they might be hesitant to spend money on things, even if they are necessary for their quality of life. Or, maybe they will spend impulsively because their experiences taught them to take advantage of times of plenty. Either way, this could come with serious downsides to their quality of life now. They may even be perfectly aware that their decisions don't make sense, but they still feel like they need to follow that instinct.

We could go into a lot of interesting neuroscience about how trauma physically changes the brain. It forms pathways between neurons that become reinforced over time. Pathways that can be so strong that, even if you're trying your hardest and know your choices don't make sense, they are hard to shake. If you think about it, that makes sense. It's your body trying to keep you alive the only way it knows how.

So what do we need to do to change?

These connections in our brains may be hard to change, but it's not impossible. Researchers have found that under certain conditions, these neural connections can actually break apart and form new pathways, allowing us to think differently. This process is called memory reconsolidation.

What conditions allow for this? That can get pretty complicated, but the simple version is this: you need to emotionally experience the reaction of trauma at the same time as you emotionally experience proof that your old strategies are not necessary anymore. Think of it this way: if you can convince your brain that things are different than they were during the traumatic event(s), it won't have to cling to the patterns it thinks are so important.

You probably know in your head that things are different now. The tricky part is letting your heart and gut catch up to you. Trauma isn't just part of your thoughts. It's held in your body and breathes within your emotions. To convince those parts of us, we will need to speak to them in ways they will understand. This is why many effective forms of trauma therapy go beyond talking and incorporate approaches that directly work with the body, such as in EMDR, Sensorimotor Therapy, and Somatic Experiencing, among others.

My goal in trauma work

When I work with someone on their trauma, my guiding principle is to help them be able to know, feel, and sense in their bodies that things are different now. Our brains are resilient. They will often heal on their own as long as they are given the tools to do so. Think of a traumatic event like a heavy meal. Much of the time, it will be digested and flow through your body on its own. Sometimes we just need a little help getting things moving again, and a therapist can help give you what you need to do that.

To anyone reading this and feeling helpless about their trauma, let me assure you that there is hope. For some of you, the danger has already passed and can not harm you anymore. While your body's trauma responses can hurt, your feelings--as terrifying as they are--won't harm you. The harm was already done. You are just feeling it now. It is time to leave that burden behind and carry yourself into the rest of your life, and there are people who can help.

I'm aware that some people are not free from the situations that cause their trauma. You may not be in the "Post" part of "Post-Traumatic Stress Disorder." It will be difficult to convince your body that things are different now if they really are the same as they have been when you've been hurt. You are not alone. There are people who can help you find resources to better your situation, give you skills to cope with where you're at, and offer paths forward towards resilience and hope.

Trauma can be excruciating, but it is not your enemy. It is your body trying to help and not knowing how. If you're having trouble teaching it a new way on your own, please reach out to someone who can help. You deserve to be able to be present and in the moment again, instead of feeling stuck in the past. You may have to be brave, but you can do it. You have what you need inside of you. And sometimes all we need is somebody to help us turn together towards that inner wisdom.

What is Parts Work / Internal Family Systems?

We often feel conflicted about even the simplest of things. Maybe one part of you wants to go to the grocery store today and another part of you wants to stay home. Now imagine how noisy it gets inside your head on a decision even more complicated and emotionally charged. It can almost be like having a bickering family inside your head.

How do we establish effective communication between these parts of ourselves? One way is to use a type of therapy called Internal Family Systems (IFS) Therapy. This uses techniques from family therapy and uses them on the different parts of yourself (also called your Internal Family System).

While IFS is among the most popular ways of working with parts at the moment, it is not the only way to work with parts. The umbrella term for all of these different methods is Parts Work, which makes up a large portion of how I work with clients. I believe that through Parts Work, we can build greater internal harmony between the different parts of ourselves and live a life of greater peace, confidence, and joy.

Are you saying I have split personalities?

If you're referring to Dissociative Identity Disorder, that's not what I mean. I'm not saying that everybody has distinct personalities that they switch between and have little-to-no memory of what happens when another one fronts. Some do, and there's nothing wrong with that. In fact, folks with DID often find Parts Work to be very helpful for them.

Many people without DID also find it helpful to separate out their parts and talk to them as if they were a loved one. Sometimes people are cruel to themselves, but they would never say those things to someone else. Parts Work provides helpful tools for tricking our brains into being more compassionate, thoughtful, and understanding of parts of ourselves we would ordinarily discount.

The goal of Parts Work is not to get rid of parts. That would be getting rid of a piece of ourselves. It's there for a reason, and it has a positive intention for you or else it wouldn't be there. We just have to figure out what it's trying to do and how to help it do that in a way that doesn't hurt you or any of your other parts.

What does this work look like?

Let's take an example. Suppose part of you wants to be able to give a toast at a friend's wedding, but another part of you is terrified of public speaking. You may be tempted to say you just need to "Get over it" and push past that part. What if we worked with the part instead?

First we would identify the parts (beliefs, emotions, sensations, etc.) and pick one to start with. Let's go with the part afraid of speaking in public. We could ask that part some questions, as if they were a person sitting in front of us, like "What do you want us to know?", "What do you need?", "What are you afraid will happen?", and "How can I help put you more at ease?"

It might be uncomfortable at first to talk to yourself in this way. You also might not know what the part would say. In these cases, it's often helpful to just respond with the first thought that pops into your head. With practice it gets easier to identify and communicate with parts. And eventually you can learn the process of noticing when a part is distressed, checking in with it, and using the information it is presenting to you to make good decisions moving forward.

Because that's what parts want: to give us information. And if you were to push a person in your life aside (or shove them down) who is trying to get your attention, they'd probably only shout louder and cause more chaos. What parts have to say is important. Ignoring it is like putting tape over a check engine light so you can ignore it. That doesn't make the problem go away or help you feel better. It just ignores the bigger issue.

You can see how Parts Work could be very helpful for things like trauma, anxiety, depression, and many other difficult feelings and patterns. It's flexible and can be tinkered with to work best with how you think. This is why it's a grounding principle in much of the work I do as a therapist. I hope you will keep an open mind to see if something like that would work for you. As I often say about parts, "If you can learn to be happy by your selves, you're never really alone."

What is Eye Movement Desensitization and Reprocessing (EMDR)?

One of the tools I use in my practice (especially in working with trauma) is Eye Movement Desensitization and Reprocessing (EMDR). It's a wordy name and a bit of a complex theory to get into, but I want to summarize it briefly here.

Imagine you are online using a web browser (which, I mean, you evidently are). You know how when you have too many tabs open, the next page you open loads really slowly? While that's inconvenient and distracting for day to day life, you might be able to imagine some thoughts in your life that you wish would slow down and reduce the impact of.

Let's say you were in a car accident. Afterwards, you may be afraid to get back in a car. This is understandable, but this may also present some challenges in getting back into the flow of your life. You may have intense imagery of the crash, feelings of panic, pain in your body, and maybe even a belief like "I am not safe in cars." This can be overwhelming in the moment and cause you to take efforts to avoid thinking about it. Unfortunately, this only makes the thought of thinking about the memory even scarier and more intense.

In another article I talked about how in order to process trauma, you have to be able to feel a trauma response. This is often so intense for people that they are afraid to even think about the prospect of facing this feeling. But what if we could slow down the response and make it less intense, while still engaging with the feeling enough to process it?

Bilateral Stimulation

This is where EMDR shines. EMDR is named after its original method, which had clients watch the provider's fingers as they move their hand from side to side rapidly. While there are a few theories of how EMDR works, a growing one is that by distracting the person with some form of stimulus (like watching a moving object), the person is able to both access the trauma response while also staying present in the moment. Like the web browser with too many tabs, the speed and intensity of the memory are reduced by the person devoting so much of their mental resources to the other task they are performing at the same time.

It doesn't have to be eye movement, though. Another popular method is to have the client cross their arms over their chest and tap on their shoulders, alternating from side to side, at a quick speed. It accomplishes the same thing as the eye movement, but is often easier to facilitate over things like telehealth. There are lots of other options if neither of those are appropriate. Whatever the activity may be, it is typically a form of something called Bilateral Stimulation. That is, input that alternates back and forth from one side of the body to the other.

I know it seems a little odd. Some people think I'm talking about hypnosis when I bring up EMDR. However, EMDR has been studied extensively for decades and found to be among the most effective treatments for trauma and other forms of distress. You can find out more at the EMDR International Association website.

What does EMDR look like?

First we would look at a couple factors to make sure you are a good candidate for EMDR. This mostly has to do with potential medical complications, such as light-sensitive epilepsy.

If there are no major concerns (or if the ones that are present can be accounted for through adapting treatment), then usually the therapist and client work together to ensure clients have necessary coping skills to manage difficult feelings that may arise. Processing with EMDR often occurs in between sessions, so it will be important for a client to know how to handle intense emotion if it comes up outside of session.

From there, the therapist will work with the client to determine exactly what to treat with the EMDR. Usually it's some combination of a memory, belief, feeling, and/or physical sensation. After settling on a target topic to focus on and a safety plan is in place, bilateral stimulation typically begins.

There is a general flow to bilateral stimulation. The practitioner will give you a thought to start with and then start the bilateral stimulation. While you are watching their moving hand, tapping, or whatever else you might be doing, allow your mind to wander. There's no wrong way to do this. Just notice where your thoughts naturally go.

After a short period of bilateral stimulation (usually under 30 seconds), the provider will ask "What did you notice?" This is your cue to give a brief description of where your mind went during the bilateral stimulation. Your provider will tell you what to do next, but more likely than not, they will say "Go with that." That just means that you will repeat the bilateral stimulation with the new starting thought being what came up during the last set.

This process will continue several times. There's no real guarantee of how long it might take. Could be for an entire session, could be for several sessions. If you're feeling frustrated, you can bring it up with your provider, but it's advisable to give the process some time before giving up on it. EMDR also benefits from consistency, so it may be good to set expectations with your provider about how focused they want you to be on EMDR from session to session versus talking about something happening in your day-to-day.

The eventual hope of EMDR is to reduce the intensity of distress when you are feeling triggered, to replace unhelpful beliefs with more empowering ones, and to resolve bodily sensations related to trauma held in your body. It is a process that can lead to memory reconsolidation, which often leads to people saying things like "That's something that happened to me" instead of "It's happening to me right now."

Summary

EMDR is a powerful, evidence-based tool for processing memories, beliefs, emotions, and bodily sensations. It's especially useful for beliefs and feelings that you may have rationally understood to be untrue, but haven't been able to shake the emotional feeling that they must be true anyway. This could be beliefs like "I'm not good enough" or "I'm powerless." EMDR will not erase memories, but they often will feel more tolerable to think about. It can be a difficult and exhausting process, but I have seen it help many people be able to take their lives back who never thought it was possible.