Therapy

What’s Trump Doing in Your Therapy Room?

What's happening to psychotherapy may be unprecedented.

Posted Jun 07, 2018

Susan Bodnar, a Jewish psychotherapist, prided herself on her ability to help anyone, regardless of race, class, culture, or religion. For example, she had bonded with a brilliant, Black, Obama-loving teenage girl and their work together was progressing nicely.

Then Trump got elected. The teen did not show up for three weeks. When she returned, Bodnar said, the girl told her, “You’re nice and smart and you helped me a lot. But right now you are a White person. I can’t trust you, the world you came from, because that world is equal to the death of me.”

Before Trump, many psychotherapists would have kept the focus on the client. By training, their personal feelings and political beliefs would have no place in the therapy room. Bodnar did not see that as an option. November 8, 2016, she said, was “the day I became a White clinician.” To maintain her therapeutic alliance with her client, she had to distinguish herself from the president, and establish herself as a person rather than a White person. (To which one of her African-American clients replied, “Welcome to my world.”)

In striking contrast to decades of precedent, therapists are now routinely making their political opinions known to their clients. In a recently published survey of 604 psychotherapy clients from 50 states, only 32% said their therapist did not disclose their political beliefs. Thirty percent said their therapists divulged their views, and the other 38% said their therapists made their beliefs known implicitly. 

Donald Trump is in the therapy room and he is blowing it up. Counselors, clinicians, and life coaches report that their clients are showing up with exacerbated experiences of “paranoia, hypervigilance, anxiety, depression, intrusive thoughts, somatic complaints, difficulty concentrating and sleeping, and nightmares.” The therapists aren’t exempt, either; some say they just can’t stop thinking about Trump.

With increasing urgency, mental health professionals have been reaching out to each other to try to understand what is happening and how best to deal with it. Sessions of professional meetings have been devoted to the topic. And now, an entire issue of the Journal of Clinical Psychology has taken on the matter. Columbia University Professor Barry A. Farber, who wrote the book on self-disclosure in psychotherapy, edited a collection of 10 articles, “‘Clowns to the left of me, jokers to the right’: Politics and psychotherapy, 2018.” One of the articles describes the findings from the survey of therapy clients, eight more describe case studies, and the other is Farber’s introduction.

Political anxieties are not new to the therapeutic exchange, but Trump anxiety is uniquely unnerving

Long before Trump was elected president, the mere thought that he could ascend to that position was making many Americans nervous. In a Washington Post/ABC News poll from spring of 2016, 69 percent said that they were anxious about the possibility. Then it got worse. In their annual surveys on “Stress in America,” the American Psychological Association found that symptoms of stress, such as anxiety, anger, and lying awake at night, increased between 2016 and 2017. In the 2017 survey, which included participants old enough to have lived through World War II, more than half said they considered the current moment the lowest point in our nation’s history.

The Stress in America surveys are based on representative national samples, suggesting that Trump anxiety is widespread. Some people, though, feel particularly vulnerable.

“Once Trump became the official candidate, every abused client I was seeing needed to revisit her traumatic experiences for at least one session,” said counseling psychologist Patricia Raskin.

A gay client told his therapist, Jean Birbilis, “It feels like the President has declared open season on gay and trans people, and all of the brakes that have been keeping homophobes from going beyond discriminating are suddenly gone.”

For an 18-year-old who sought therapy for help with anxiety and intrusive thoughts about the sexual abuse she experienced as a child, the Trump presidency left her feeling hopeless. She was an undocumented immigrant from Peru, brought to the U.S. by her mother when she was nine. “I think that half the country doesn’t want me here, and that Trump wants to deport everyone,” she told her therapist, adding that lots of people seem to “hate me even though they have no idea who I am.”

Significant world events have often followed clients into the therapy room, upping the anxiety quotient and dominating discussions. In the U.S., the most recent momentous event was 9/11. That, of course, was devastating.

With Trump, the psychological dynamics may well be unprecedented. His election was not a discreet event with a clear ending. Instead, the Trump phenomenon is relentless, unfolding nearly every moment of every day, with tweetstorms, press briefings, choreographed events, scandals, and investigations, followed by resistance in forms such as the Women’s Marches, and all of it broadcast by the 24-hour cable news shows and harried teams of reporters scurrying to keep up. As Farber noted, the ongoing events “are hard to avoid,” and what’s more, many clients don’t want to avoid them.

A core sense of unpredictability further aggravates anxieties. The North Korea summit is on. No wait, it is off. Oh, maybe now it is back on. Dreamers? Trump wants “a bill of love.” Or is it a wall and an end to what he calls “chain migration”?

Polarization is also adding to feelings of anger and alienation. “Some of my friends won’t even talk to me anymore,” said one client who was a Trump supporter. A Clinton supporter said, “I don’t understand how people could hear his comments about Mexicans, Muslims, women and others and then vote for him.”

How psychotherapy in the age of Trump is different for Clinton supporters and Trump supporters

According to the survey of psychotherapy clients, a striking majority of both Clinton supporters (70%) and Trump supporters (66%) said that they discussed politics with their therapist. That was where the similarities ended.

Compared to how they were feeling before the election, Clinton supporters said that they were now feeling more despair, fear, anger, disgust, and other negative emotions. They were also experiencing less joy and hope and other positive emotions. For the Trump supporters, in contrast, there were no changes at all. They said that they were not currently experiencing any more relief from negative feelings or enjoyment of positive ones than they were before Trump was elected.

The survey asked clients to indicate, for 14 political topics (such as immigration, taxes, and distrust of the media), whether they were discussing them any more or less often now, compared to before the election. Clinton supporters said they were discussing 13 of them more often now than they were before. For Trump supporters, there was not a single topic they were discussing any more or less often in the therapy room.

Finally, asked whether they wanted to discuss politics in their therapy sessions more often than they did, it was the Trump supporters who more often said yes (59%, compared to 44% of Clinton supporters).

The Trump-supporting client in a (mostly) progressive therapeutic world

A few days after the election, New York psychotherapist Sidney Coren woke up “in a piercing state of sadness and despair.” Stepping onto the subway, he found that his fellow passengers were unusually quiet, as if “collectively contemplating a national tragedy.”

It was up to him to comfort the clients he would see that day, including a woman with whom he had been discussing experiences of sexual abuse. As they sat down, she declared, “I’m so happy that Trump was elected.”

She would not be the only client to react to Trump’s victory with elation, and Coren would not be the only therapist, progressive or otherwise, to have Trump supporters as clients.

When Mark, a client who was more incensed by the Clintons than enamored of Trump, began ranting to David Yourman, his therapist, Yourman told him where he stood: “Mark, I have zero fondness for the Clintons. Why are you yelling at me about this?” Yourman is a Marxist, and his political views and his client’s were at opposite ends of the political spectrum. By self-disclosing, though, he was able to bond with Mark over their shared status as political outsiders.

When professional helpers do not reveal their political leanings, clients make assumptions. A colleague told Farber, “It’s far better that my clients know my position than to constrict their willingness to talk because they are not sure of what I believe.”

When Coren disclosed his progressive views to a different Trump supporter, that gave the client an opening to tell Coren “that he is terrified that I will try to control him by using our differences to demean him or coerce him into thinking like me.” The client did not know that for many therapists, such as Coren, the goal is to help people “find their own beliefs and convictions so that they can become more nearly themselves.” Coren was able to convey that he was “curious about [the client’s] excitement,” even though he did not share his worldviews, and that he cared about him.

Findings from the survey of therapy clients showed that clients had better therapeutic alliances if they thought their therapist shared their political views. But they also had stronger alliances if they experienced their in-session political discussions in very positive ways. Therapists who can foster meaningful political conversations despite political differences can probably have their self-disclosures and their therapeutic alliances, too.

The survey showed that what therapists most often do about their political beliefs is to make them known implicitly (rather than explicitly or not at all). That also seems to be the most effective approach, in that the clients whose therapists revealed their political views implicitly had the strongest therapeutic alliances. (The findings on therapeutic alliances, though, were all correlational, and so should be regarded as merely suggestive.)

Trump talk isn’t for everyone. Birbilis noted that a client came to her after leaving a therapist he was finding helpful, because the therapist spoke too often of his antipathy for Trump. “I can’t stand Trump, either,” the client explained, but the Trump talk was only making him more anxious.

Trump in therapy and in clients' lives

Some clients like to begin their sessions by venting about Trump, then move on. As Birbilis notes, “This appears to give clients a chance to offload the anxiety associated with arbitrary and capricious political events. It also appears to facilitate trust and rapport. And best case scenario, it points the way to more fundamental therapeutic issues.”

For other clients, though, political themes are more central to their therapeutic work. Tony, a client who had previously been treated for OCD, returned to treatment after the election, when he began experiencing intrusive thoughts about the inferiority of the U.S. government. Michael was a successful professional working with Laurie Thomas, an executive coach, when he lost his job. The Trump candidacy was gaining steam, and that gave Michael an idea: in his job interviews, he would act more like Trump, who “doesn’t let his opponents get a word in edgewise.”

During the 2016 campaign, “J” was seeing Patricia Raskin for help in mustering the courage to confront a relative who had sexually abused her. J had a trying childhood and young adulthood, dealing at times with poverty, homelessness, and drug addiction. But now she was stacking up successes, earning a college degree and another advanced degree while working full-time. She was thrilled by Hillary Clinton’s candidacy. When Clinton lost to Trump, J was enraged. Then, for the first time, she became an activist, “organizing women in her community and chartering buses for the Women’s March to Washington.” She’s thinking of joining the growing list of women who are running for office.

How Susan Bodner reconnected with the teen who no longer trusted her

For Bodner, the road back to a trusting relationship with her client was a long one. Eventually, she decided to open up to the teen. She shared that her father had struggled with alcoholism, and that the destructive effects had rippled through his life and the family’s. But he loved the natural world, and the family hikes he led through spectacular places are now among her most cherished memories. The Trump administration's effort to dismantle environmental regulations, Bodner explained to her client, was personal.

Bodner conceded that to make such a disclosure, she had to defy “that voice in my ear telling me that I have done something terribly, terribly wrong.” But considering how the conversation subsequently unfolded—forming a bridge between Bodner and her client based on what she had revealed about her own story—she is not worried about that voice anymore.