Is Psychotherapy Contributing to a Culture of Victimhood?
Do we validate our clients in a way that has problematic systemic consequences?
Posted Nov 20, 2018
Jan’s marriage is on the rocks. Her husband is a lousy communicator and is self-centered and fails to attend to her needs and the needs of their kids. Jan has a history of Generalized Anxiety Disorder and the situation with her marriage is making her symptoms much worse. She makes an appointment to see Dr. Franklin, a supportive psychotherapist who emphasizes the importance of the therapeutic relationship. Dr. Franklin has a gift for empathy and helps Jan feel known and valued in the therapy. At the end of the first session, Jan reports that she feels heard and that she understands her needs better and looks forward to continuing her therapy.
Later that afternoon, Dr. Franklin is having her weekly peer supervision with Dr. McClean, a fellow psychotherapist who works at the practice. Per usual, Dr. Franklin asks about how the week was and if there were any new clients. Dr. McClean reports that he had an intake with a man who is having serious marital problems. “I feel for him,” says Dr. McClean. “His wife has a long history of mental health problems, is constantly nagging him, doesn’t respect him and their sex life has gone to hell. So, he is thinking of leaving her but is worried about their kids. I think he will be back for more sessions. He said it felt good to talk to me because I understood where he was coming from.”
Unbeknownst to both, Dr. McClean’s new client is Jan’s husband, David.
Now think about how David and Jan look, depending on whose perspective is being taken. From Jan’s perspective, David is self-centered and insensitive, whereas she is trying to do the best she can given the situation she is in. Of course, from David’s perspective, Jan is excessively neurotic, whereas he is trying to do the best he can, given the situation he is in 1. Now consider that the foundation of good psychotherapy is a good working alliance, and the foundation of developing a good working alliance is being a good clinical interviewer, and the foundation of being a clinical interviewer is frequently described in terms of the L-U-V triangle, which stands for listen, understand, and validate.
Let’s zoom in on that last term. What does it mean to validate someone? The word "validate" means, concretely, to demonstrate the legitimacy of. Synonyms include substantiate, corroborate, verify, support, back up, bear out, confirm, justify, vindicate, and authenticate.
I share this scenario to orient us toward what I think are some of the key philosophical, theoretical, and value-based questions that must be reflected upon and addressed by the field of psychotherapy. How and in what way do we validate our clients? Put in the context of this everyday scenario, what is the framework we (as psychotherapists) are employing that would allow us, as a system (i.e., the field of psychotherapy as a whole), to validate both Jan and David?
I generated this example to make clear that the field of psychotherapy cannot validate clients at face value, at least not in a concrete or a naïve realist sort of way. Both Jan and David’s narratives can’t be equally legitimate and true. Indeed, to the extent that both of them are validated in a concrete way, it leads to the conclusion that they both are entitled to feeling angry and are deserving of retribution. Of course, this would result in more and more hostilities and problems.
Sophisticated therapists know that the word "validate" in this context does not mean providing a blank check that officially legitimizes every claim the client makes as a general truth. Validating in the context of therapy means to hold and accept the person’s subjective point of view on the world and his or her feelings about them, and to do so in a mindful and reflective way. This is then held (hopefully) in some broader understanding that fosters movement toward personal growth, maturity, social skills, adaptive living or whatever the model of therapy suggests “good” ways of being are.
Of course, there is no professional consensus about what that general framework is. There are lots of complicated issues here, relating to values and worldviews, among other things. The complications are just some of the many reasons why the field of psychotherapy is not at all unified but instead exists in a state of fragmented pluralism consisting of almost an endless number of approaches and philosophies. Given the example above, cognitive therapists would generally approach the situation quite differently than feminists.
But this brings us back to the problem. If the only thing psychotherapists can agree on is that the relationship is important and that we should validate our clients’ claims or pains (at least in some sort of way in the early sessions), then doesn’t the standard or generic definition of validation become the default message? Does it follow from this that we are, as an institution, professional validators of psychological injury and distress? If so, what would that mean?
Given recent analyses that there is a rise in the culture of victimhood and the massive increases in treatment utilization, I think this is a topic that needs attention. The field of psychotherapy needs to know if it is colluding with clients in a way that is contributing in a problematic way to a more general grievance culture.
1 I am intentionally using gender stereotypes in the example because I want it to be generic. I also think it helps make the point about how complex things are by including “stereotyped male and female concerns.” As our field and now the larger society are aware, a claim such as this raises many questions about what is valid or not, in what context, and from whose perspective (e.g., from feminists or cognitive therapists or any other position).