How Therapy Trumps Politics

A recent case study of "My Trump" sheds light on the political divide.

Posted Apr 25, 2018

Source: heblo/Pixabay

In a paper with the curious title, “Mr. Trump: How I learned to stop worrying and love the patient-aggressor,”1  Sidney Coren, relates his psychoanalytically informed treatment of a middle-aged white patient with a history of sexual abuse. Complicating the treatment is that the patient happens to hold political views opposite to that of the therapist.

Where does Coren himself stand politically? Well, this is how he begins the article:

I woke up on the morning of November 10, 2016, in a piercing state of sadness and despair. We the American people had elected a businessman who used angry, bigoted rhetoric to heighten divisions amongst Americans into our highest political office. This is real. Donald Trump is our President. This is real.

His patient, on the other hand, happens to be unreservedly pro-Trump.

As a therapist, Coren initially finds it difficult to see past the patient’s (and his own) politics. Shortly after Trump won the US elections, for instance, the patient “struts” into Coren’s office, saying “I can't believe it happened. The American people finally woke up. I'm elated.”

The author’s reaction to the patient’s announcement is “visceral, angry, and aggressive.” Why? Because Coren feels that within the patient’s “genuine ‘elation’ there is also a hostile, self-satisfied” message that Coren’s “side” has lost.

The author is also bothered by the fact that the patient “identifies with and idealizes aspects of Trump's character, most notably his grandiosity, narcissism, and ‘truth-telling.’” What other aspects of Trump the patient might identify with, Coren ponders anxiously.

The author notes that his therapeutic relationship with the patient is shaped by “sadomasochistic dynamics,” with struggles for control and power.

At one point Coren even refers to his patient as “my Trump” because the patient projects negative aspects of himself onto the therapist, just as Trump displaces his aggression onto, say, minorities—and sees them as hostile and dangerous. That is, Coren views his patient’s political identification as a kind of projective identification.

In projective identification, a blurring of boundaries occurs: One disowns intolerable internal parts of the self (e.g., animosity, weakness) and projects them onto another, unconsciously compelling the other to identify with these projections.

The result is that both parties become locked in an inflexible relationship, a relationship that becomes necessary for the existence of the parties and at the same time denies their independent subjectivities.

For example, consider Trump’s rhetoric in reaction to the recent anthem protests—when a number of black athletes had peacefully protested social injustice. He tweeted, “Wouldn't you love to see one of these NFL owners, when somebody disrespects our flag, to say, ‘Get that [obscenity] off the field right now. Out! He's fired. He's fired!’” 

But Trump’s rhetoric created “oppositional categories by amplifying differences and disavowing similarities, negating intentions and denying subjectivities.”

In other words, Trump subverted the protest’s intention into “an oppositional power dynamic with few options.” That is, either “submit and stop protesting” or choose to “resist, and by virtue of sadomasochistic dynamics, take on the very qualities that Trump's orotundity embodies: aggression, recalcitrance, intimidation, anger, power.”

In therapy with his “Trump,” Coren struggles with similar dynamics: He feels the powerlessness that the patient disowns and projects, experiences shame, and feels “closeted” in his role as a therapist and feels forced to hide his true self.

Nevertheless, as therapy progresses, Coren experiences moments when he feels “emboldened to respond authentically,” for instance, by discussing the differences between himself and the patient in a respectful and caring way, by showing that he is still committed to the patient’s well-being, and that he will not try to force his own views on the patient.

This, in turn, Coren claims, allows the patient to feel safe enough to be more vulnerable, and to share some of his larger concerns and fears.

Over time, the patient begins to integrate those disowned and intolerable aspects of his identity, like his tenderness and sensitivity, with his sense of self. He is also able to dig into his sources of shame, revealing more details of his childhood sexual abuse, and talking about his recent same-sex fantasies and encounters.

Though the therapy ends prematurely (when the author moves to another position), Coren observes that the patient is doing better and has even started working part-time and volunteering, by the end of their work together.

Reflecting on his earlier reactions to the patient’s politics, the author ponders, “How do we as clinicians effectively treat patients whose personal values...are diametrically opposed to our own? How do we stay true to our values without demanding, subtly or coercively, that our patients’ values align with our own?”

He proposes that the solution is to aspire to adopt the seemingly impossible stance of holding “the tension between two therapeutic values, neutrality and conviction.”

He thinks he may have been able to do so for the patient, and might have provided him with “enough of a neutral stance.” Coren feels that by finding the courage to share his own genuine emotional reactions (of “personal conviction and humanity”) with the patient, he may have allowed the patient more freedom to be himself too.


1. Coren S. (in press). Mr. Trump: How I learned to stop worrying and love the patient-aggressor. Journal of Clinical Psychology. doi: 10.1002/jclp.22603