Therapy

Is It Always Wrong for Therapists to Impose Their Worldview?

Some approaches to therapy encourage clients to change their basic outlook.

Posted Jun 26, 2020

It is a widely-held belief that practicing psychologists and psychotherapists should never impose their worldview (i.e., core values, personal beliefs, and basic outlook on life) on their patients or clients. Instead, they should try to help their clients make their’s work better for them. While generally true, the fact is, it depends on the theoretical orientation and therapeutic approach of the clinician.

For example, psychoanalytic and psychodynamic practitioners (i.e., adherents of Freudian and neo-Freudian ideas) are “closed books” and hardly ever disclose personal information to their clients. Many other therapists who are not totally closed books are passive and non-directive, meaning they offer no personal views, concrete advice, or specific recommendations. But some therapeutic approaches, such as CBT, are “psychoeducational” and emphasize “teaching” as much as “treating.” That is, rather than “treating” diagnoses and conditions practitioners of CBT prefer to identify specific problems and propose practical and empirically supported solutions for them.

This is because most CBT, and especially Multimodal CBT, recognizes that people are not born with complete repertoires of reality-based, rational and adaptive ideas, nor with a wide range of effective social skills. Thus, correcting misinformation and providing missing information is often necessary to accomplish the therapeutic goals clients want to achieve (e.g., Lazarus, Lazarus & Fay, 1993). For example, explaining that panic symptoms are not dangerous and controllable rather than medical emergencies and uncontrollable is correcting misinformation. Teaching patients methods to combat panic symptoms involves helping them learn a variety of anxiety management skills, thus providing missing information.

Hence, in some cases, it might be necessary to challenge some aspects of someone’s worldview such as when it is shaped or strongly influenced by potentially dangerous misinformation and missing information. For example, if an anti-vaxxer sought my services, in addition to addressing their primary reason for seeking therapy (e.g., anxiety, stress, depression, relationship problems, etc.), I feel it would be my professional and social responsibility to educate them about the truth of vaccination’s powerful health benefits (i.e., correcting misinformation) and the importance of herd immunity that ironically protects them from the diseases they refuse to get vaccinations for (i.e., providing missing information).

Of course, there are some patients with whom transcending the firm boundaries of formal therapy is contraindicated. But with many who do not have character pathology, psychoses, bipolar depression, etc., it has been shown that certain boundary transgressions often produce enhanced therapeutic outcomes (A. Lazarus and Zur, 2002; C. Lazarus, 2017).

Therefore, challenging some obviously erroneous, personally and socially dangerous beliefs—like that vaccines cause autism, or are a scam by the pharmaceutical industry—is an important part of holistic and comprehensive therapy. As is challenging other dangerous and potentially damaging core beliefs.

Another example of some people’s basic outlook on life and central beliefs that they often benefit from being disabused of is the idea that science is bogus.

This is particularly important now, during the current COVID-19 pandemic.

The great irony is that the vast majority of science deniers—especially in America—owe their first-world quality of life and most likely their very lives to the science they reject. For instance sterile techniques, antibiotics, vaccinations, diagnostic testing, noninvasive imaging, and myriad other modern medical procedures. In addition, the dramatic increase in life expectancy we all enjoy is attributable to science due to reduced infant mortality, awareness of sanitary practices, and our ever-increasing understanding of nutrition, exercise, and other scientifically verified health behaviors (e.g., sleep hygiene, not using tobacco products, and avoiding excessive alcohol consumption.)

What’s more, our modern conveniences are also rooted in centuries of cumulative scientific thought, experimentation, invention, and innovation. For example, gunpowder, steam power, electricity, the lightbulb, indoor plumbing, internal combustion, aviation, refrigeration, telecommunication, air conditioning, computers, MRIs, the internet, cellular/smartphones, not to mention a host of other mechanical and electrical appliances and devices.

Similarly, in the course of therapy, if a patient discloses deep-seated racist and sexist beliefs and attitudes, I would not simply say, “So how do you feel about that?“ Or even leave it at, “Why do you feel that way?” In addition to their presenting and identified difficulties, and therapeutic objectives, it would be incumbent upon me to educate them about any mistaken and potentially dangerous, antisocial, and regressive views they hold and espouse. To do otherwise would be like a medical doctor not saying anything about a patient’s suspicious growth because the patient came in for some other problem.

Indeed, there are many other aspects of people's worldviews that often require discussion in therapy. And successfully changing their outlook on these issues often serves their best interests as well as those of their families, communities, and beyond.

Thus, in addition to the issues stated above, I am indeed guilty of routinely “imposing my worldview” on my patients when it comes to matters of honesty; integrity; ethics and morality; being assertive; not smoking, drinking excessively or abusing drugs; exercising regularly; healthy eating habits; and the importance of maintaining a work-life balance.

Of course, there are some zones of a person’s basic belief system that are best left out of the therapeutic process—for example, religious ideology. Also, many believe that politics should be left alone in therapy. And while I personally agree with the political taboo in general, there are some circumstances wherein “political” discussions are decidedly apolitical and instead deeply humanitarian. For example, challenging a patient who derides socially important movements such as Black Lives Matter, #MeToo, global warming, and climate disruption, to name only a few.

But, perhaps, one of the most critically important yet hot button aspects of a person’s worldview that can benefit from change through correcting misinformation and providing missing information is their stance on governance and leadership.

Obviously, in most instances, it is a clear ethical violation and lapse of professional judgment if a therapist tries to foist their political beliefs on a client. But when the motivation is an entirely pro-social, humanitarian one, that exists outside of the political arena, it can easily be seen as nothing more than part of thorough and socially responsible therapy. For instance, talking about vitally important issues such as Black Lives Matter, #MeToo, public safety, access to affordable health care, environmental protections, mitigating climate disruption, and gun violence are commonly part of the therapy process. While some might disagree, it is clear to many people that these endeavors are not always based on a political agenda, or even strictly political. Rather, especially in therapy, they can be motivated purely by a clinician's professionalism, prosocial and humanistic views.

Remember: Think well, act well, feel well, be well!

Copyright 2020 Clifford N. Lazarus, Ph.D. This post is for informational purposes only. It is not intended to be a substitute for help from a qualified health professional. The advertisements in this post do not necessarily reflect my opinions, nor are they endorsed by me.

References

Lazarus, C. N. (2017). Multimodal Therapy. In A. Wenzel (ED.), The SAGE Encyclopedia of Abnormal and Clinical Psychology (Volume 4, pp. 2163-2166). Los Angeles: CA.

Lazarus, A. A., Lazarus, C. N., & Fay, A. (1993). Don't Believe It For A Minute!" Impact Publishers: San Louis Obispo, CA.

Lazarus, A. A. & Zur, O. (2002). Dual Relationships And Psychotherapy. Springer: New York, NY.