Therapy
Is It Ethical for a Therapist to Refuse to Treat a Trump Voter?
Some therapists report hesitation about treating Trump supporters. Is it valid?
Updated November 22, 2024 Reviewed by Gary Drevitch
Key points
- Therapists are responsible to self-monitor their feelings and how they may impact therapy.
- Therapists with stigmatized patients may fear it could be harmful to have Trump supporters in their practice.
- It's not ethical to subject a patient to a political quiz before agreeing to therapy.
Psychotherapists are a generally progressive body of individuals. Therapy is an industry with more women practitioners than men, for example, and they have to have at least a Master’s degree. Most therapists are motivated by a desire to help and listen to others. These trends stack the deck toward professionals with progressive social values. Unfortunately, some conservative men report feeling uncomfortable seeking therapy due to political differences. One woman shared with me: “I used to get so tired of my therapist bashing Trump and talking politics” during therapy sessions. He’s not her therapist anymore, but it’s clear his political views impacted her therapy.
Current Politics and Therapy
In 2016, therapists began talking openly about the struggles they had supporting patients who voiced support for then-candidate Donald Trump. Now, following the 2024 elections, I’m hearing from therapists who report that they are simply refusing to treat prospective patients if they identify as having been a Trump voter.
A wave of “religious objection” laws swept the United States a few years ago, empowering therapists and counselors to refuse to treat LGBTQ persons when therapists felt their religious values conflicted with non-heterosexual orientations. These laws protected therapists from lawsuits or licensure actions, so long as they referred these patients to other therapists and didn’t terminate in the midst of a suicidal crisis. As I wrote then, for therapists to reject patients based on sexual identity may still cause harm to those patients, as it could potentially lead them not to seek therapy again.
Most ethical codes therapists follow prohibit discrimination, typically based on race, sex, gender or national origin. Most ethics codes also require that therapists not knowingly participate in or condone discrimination or prejudice. Given the vitriolic issues raised in the recent election, with political prejudice vocalized against trans persons, immigrants, and minorities, is it ethical for therapists to remain silent? And must they be tolerant and nonjudgmental of everyone? Karl Popper defined the paradox of tolerance as “a philosophical concept suggesting that if a society extends tolerance to those who are intolerant, it risks enabling the eventual dominance of intolerance, thereby undermining the very principle of tolerance.”
For therapists who are LGBTQ, or who treat sexual or racial minorities or undocumented immigrants, these issues may feel like life-or-death concerns. They report that having Trump supporters in their offices makes them feel unsafe and they worry that a person may make harmful statements to other patients. There are, of course, memebrs of sexual and racial minority groups who voted for Trump, and there are liberals who oppose gender-affirming care or the arrival of undocumented immigrants. All of these individuals deserve the same access to effective care as others, regardless of politics.
Therapist Self-Awareness
Therapists are mandated to self-monitor if biases or personal issues impact their ability to be an effective therapist. My colleague Eric Sprankle shared that these therapists referring away persons based on political differences “could be ethical, if the therapist is acknowledging they are incompetent in treating those who are different from them in this way. This would identify the therapist as the person needing to pursue professional development and would protect the client from potential harm by the therapist.”
Educator Stella Harris shared, “I could have been saved a lot of unpleasant experiences if therapists had recognized their own biases and admitted they couldn’t effectively work with me.
Self-awareness is critical for a therapist. As a supervisor, I tell student therapists: “You can’t be the right therapist for everyone and if you try, you’ll be the right therapist for no one.”
Murky Ethics
It’s certainly not ethical for a therapist to subject a potential patient to a virtue interview about politics before agreeing to treat them. The power differential in therapy could easily influence a desperate patient to espouse political views they think the therapist supports in order to get needed healthcare.
It’s almost certainly ethical, however, for a therapist whose feelings are unmanageably elevated over these political issues to nonjudgmentally refer patients away. Colleagues from the AAMFT assert: “As therapists, we need to be able to do whatever work we have to do with ourselves so we can manage our own emotions, enabling us to sit calmly and non-reactively with our clients to help them navigate the political tensions that are straining their relationships.”
If a therapist feels they cannot work effectively with patients with different political values, it’s probably ethical for them to make that clear to prospective patients in their marketing materials. However, they may face legal liability, as many contracts they may have signed, through managed care or federal/local funding, prohibit discrimination. While some therapists may have legal protection for bias due to their religious views, no such protection exists around politics.
My colleague Kelvin Pace shared a story from 2016, when a female therapist reported concern and confusion over an African-American teen reporting in therapy that she supported Trump. When Kelvin met with the girl, she shared that she'd been shamed for carrying a Bible and praying, and although she didn't understand the politics, she'd found that people who supported Trump didn't shame her for her prayers. The girl asked Kelvin, "Is my therapist mad at me for liking Trump?"
Years ago, I did intensive therapy with a self-identified “Nazi skinhead.” We had almost nothing in common and mutually acknowledged this. Over our work together, he gained empathy and recognition of how his fears influenced his anger towards others. At the same time, I better understood how he came to see the world in the way he did. While I still disagreed with his views, I could see that his views stemmed naturally from his experiences.
Ultimately, the best therapy is about moving beyond either/or, black-and-white conversations. It’s about developing personal awareness and understanding, increasing empathy, and using the therapeutic relationship to improve relationships outside therapy. While these times are incredibly challenging, they are also opportunities for us to learn about how others see and experience the world, as challenging as those insights might be.
To find a therapist, visit the Psychology Today Therapy Directory.
