How Therapists Cope When the World Goes Awry
Content Warning: The article below mentions the recent overturn of Roe v. Wade which allows states to decide how to legalize or criminalize abortion. While I personally support reproductive justice initiatives, I attempt to be sensitive to the many complicated viewpoints and feelings about the abortion experience.
Up until very recently, I used to be part of an email list for therapists across the country practicing a specific form of cognitive behavioral therapy (CBT). CBT helps people identify cognitive distortions, or thinking traps, to help modify thinking and mood. Here’s the following CBT list email I received from a therapist on the morning of Saturday, June 24th:
“Subject: Roe Decision
A view from another perspective. It seems amazing that the strongest objections to the decision come from states like California and New York, both states for whom abortion will likely remain legal for the foreseeable future. The decision does not outlaw abortion. It allows for choice. The choice to live in a state consistent with one’s values. The slippery slope theories do seem to fall under the umbrella of (distortions) A/N [all-or-nothing] thinking, ER [emotional reasoning], and FT [future thinking].
May those who disagree be as respectful as I have tried to be.”
Not all CBT practitioners use this form of therapy in this way. In this circumstance, my colleague was using CBT cognitive distortions ineffectively to dismiss the medical realities of abortion in the country. They conflated the right for a state government to make healthcare laws to be the same as the right for someone to choose for themselves. In addition, they assumed that people can leave and move to another state if they don’t agree with their state’s laws—not everyone can afford to just up and leave. And they chalked up the likely medical consequences of maternal sepsis, ectopic pregnancies, miscarriage, and other reasons for getting an abortion as distorted, imaginary thinking. They are not a medical doctor, but they are a psychologist and should be trained in understanding public policy’s impact on human suffering, even if it does not personally affect them. The real kicker: the last statement asking for respect, after disrespecting the complex experiences of many people. Imagine a therapist insensitively questioning the reality of your experience, and then asking for respect in return.
It was Saturday, and this person thought to bother me about this on my day off work. So I responded:
“Subject: Re: Roe Decision
If you have an ounce of empathy…you would understand that just because I’m not personally affected by something doesn’t mean I don’t care.
So yeah, I live in NY, but I understand that people who have uteruses in states such as Idaho, Arkansas, and Utah will die. And I can fight for their protection. The reversal of Roe V. Wade and states that outlawed abortion in all circumstances overnight makes this a mental health issue too.
To dismiss this as “all-or-nothing” thinking is a form of gaslighting. What’s worse is to hear this from a THERAPIST.
Please take me off the email list.”
I can’t speak for all therapists, but most therapists I know, as well as graduate school programs for social work and counseling psychology, tend to lean on the progressive side of social issues. In fact, the field of “social work” was created to address the human suffering born from systemic injustice, hence the term.
There are people who are addicted to power and the feeling of being right—not necessarily being right, feeling right. Some of these people are attracted to the field of therapy. Some therapists make the mistake of assuming they are the expert and that their client knows less or is unaware of their needs. Therapy turns into telling the client what to do and how to feel, instead of digging deeper into the emotional process and getting curious. Even more concerning is that yes, there are therapists who commit sexual harassment, just like any profession. I have personally witnessed therapists across the country brag about invalidating the experiences of BIPOC clients to their faces. There are therapists who support conversion therapy. I don’t blame BIPOC and sexual minority populations for being wary of therapy as a source of help. There is some REALLY BAD therapy out there.
What does Roe v. Wade have to do with therapy? I believe it’s our job to understand the complexity of the abortion experience, whether pro-life or pro-choice, and how these decisions affect people and their self-worth, confidence, and anxiety. People with uteruses who have had abortions have conflicted thoughts and feelings about them, regardless of their beliefs and values. To hear a therapist downplay these realities as a surface-level, political decision is a failure of the therapist and their training.
In addition, these legal decisions affect our ability to do our job. If a therapist wants to provide therapy in another state, they have to undergo the licensure process in that state. Even if they’re already licensed somewhere else, they have to re-apply for licensure due to states having different healthcare laws. Let’s say I were to get my license in Texas, and a client in Texas comes to session and tells me they’re contemplating an abortion. They’re not sure whether or not to go through it, and they need to talk through their decision. Ethically, it’s my job to not impose my personal values about abortion, and help them make the best decision for themselves based on their beliefs and values, without my influence. If someone in Texas can report them and is aware this person is going to therapy to talk about it, I could be at risk of losing my license. Imagine having to turn away a client who needs to talk through a very difficult and serious decision because you don’t want your healthcare license to be at risk. Sometimes the ethics of counseling and healthcare laws contradict each other.
It’s not just about Roe v. Wade. It’s about all of the heartbreaking events that have happened in the past two years that have changed healthcare. Earlier in January, I was at a friend’s house, and she asked me how I was doing. I answered honestly that I was feeling depressed since I started living in a new neighborhood, and that the pandemic and everything it came with was taking a toll on me. She looked at me and said, “Uh oh, the therapist is depressed? There’s no hope for the rest of us.”
My friend didn’t mean any harm by it and meant well. It made me pause, though, and reflect on my clients. Since I started my private practice in January 2021, many of them came to process current events and how they relate to their referral concerns. Politics have a huge affect on mental health, because they can influence whether we have access to resources, protection, and security. They can affect how we interact with family members and friends. They can also affect whether we can reasonably enjoy our lives, or afford therapy. Considering what our nation has been through the past three years—hell, the past five decades—it’s no wonder that mental health symptoms are exacerbated. In the timespan of one month, we had about two to three mass shootings, and Roe v. Wade. That is A LOT.
People ask us how to cope when their world feels like it’s falling apart. The thing is our world is falling apart too. We have had abortions. We have experienced police brutality, immigration issues, sexual assault, domestic violence, homophobia, and transphobia. And contrary to popular belief, there are many of us who face poverty. And yet clients ask us how to go on with the tasks of daily life even when we are all facing dread. How can therapists cope when the world goes awry and we’re facing the same challenges too?
Can I be honest? This is one area where I don’t have a clue! And how insensitive would it be to tell a client to “just breathe”, or “meditate”, or “read a good book, or “take a bath”? It’s not going to make the problem go away! But that’s the point: there is no “magic wand” in therapy. We can’t sprinkle fairy dust and make stress go away completely. It creeps back up again because stress, and any other emotion, is part of the human experience of interacting with society and the world. The fact that we respond to world events with such emotion shows that we have empathy, probably better empathy than most others. If we didn’t have this empathy, we would struggle with narcissistic or antisocial traits, possibly even personality disorders. Feeling a type of way about the world is a normal and encouraged human response. All we can do is focus on our control.
I can’t make this all go away. Frankly, I don’t know my head from my ass about how to solve this kind of shit. But here’s what’s worked for me to maintain my inner peace, and I’m hoping it can work for you:
Donate to a cause you care about. If you support reproductive rights, it’s important to donate to a local abortion fund, specifically in states who are most hit by aggressive anti-abortion laws. If you are pro-life and believe that pregnant people should have access to resources, consider donating to causes that support low-income, expectant parents of color, foster care, or resources for newborn babies.
Set boundaries with people who are not open to hearing you, but want to keep sharing their contrarian opinion with you. People who aren’t open to listening, but play Devil’s Advocate with you, are rewarded by your reaction. As said earlier, they crave the feeling of being right. If you react angrily, they get a power thrill. Their ability to influence your mood makes them feel good. While it’s important to engage in healthy debate, someone who is not open to listening to you is not open to understanding, and you end up hurting in the process. Setting boundaries is a form of behavioral conditioning—they need to know that how they interact with you will no longer be tolerated and will have consequences. Pick and chose your battles. Not everyone deserves access to you, and you DO NOT NEED to hear anyone out. And remember, you don’t owe them your friendship either.
Surround yourself with people who understand. This does not mean avoiding healthy debate. It means that you don’t have to engage in healthy debate all the time. Even healthy debate is exhausting. Being surrounded by people who understand is a form of consciousness-raising and community support.
Take a break from social media. Turn off your phone. Remember that the community that surrounds you is closer than the one on your phone. Most people are harsher online than they are in-person.
Allow these events to increase your activism and decrease your complacency. You are not the only person in the country who is activated by what’s going on. Many people care just as much as you do; we just don’t know what to do or where to turn. Remember you are allowed to be angry!
Accept that things will not change right away. Sometimes change takes decades. Unfortunately, change may not happen in our lifetime, but we can still fight for it. The most important thing is to learn from our history.
I am lost and hurt. I had to enact all of the above in the name of my inner peace, even if it pisses somebody off. That’s the price I’m willing to pay to maintain my sanity and focus on what matters to me. I think it’s important that we as therapists aren’t “emotionally perfect” all the time. We teach people to tolerate difficult emotions, so we should too. It doesn’t mean we shouldn’t act on these emotions to make the world a better place. We should say, “Actually, it’s not fine, and we have a responsibility to do something”.
Nolite te bastardes carborundorum. Don’t let the bastards get you down!
If you need to talk to someone about your personal abortion experience, regardless of your beliefs about abortion, please call Exhale Counseling Services at 617-749-2948 for Pro-Voice, nonjudgmental support. They are available to speak with you most days until 9 pm, Sundays until 7 pm PST.