The contentious political climate in the United States has long been a source of distress, particularly for marginalized or oppressed communities. Distress associated with politics has a dramatic role in daily life and, necessarily, therapy. Impacts of political distress touch all areas of health addressed in the biopsychosocial-cultural model and have significant implications for clinical work (Hilty, 2015). Yet, an important question remains for many clinicians: Should politics be explicitly addressed in therapy? The 2016 presidential election triggered a significant emotional response. Fifty-seven percent of Americans surveyed shortly after the election endorsed politics as a major source of stress and roughly 49% tied their increased stress directly to the election, which suggests that there is some clinical value to openly exploring politics in therapy (Solomonov & Barber, 2018). In fact, 46% of participants in the same study described wishing politics were discussed more in therapy (Solomonov & Barber, 2018). However, the intensity of American political divisions has its own potential to affect the therapeutic alliance. News media sympathetic to post election anxiety often characterized therapy as a valid source of support while other outlets demonized therapy as a refuge for “snowflakes” who could not come to terms with the election results (Sointu & Hill, 2020). Therapists also operate within this milieu as cultural, social, and political beings impacted by political structures themselves. In some instances, therapists may feel inclined to self-disclose regarding their own political beliefs as a form of building rapport and joining with their clients, as they support their clients in managing politics-related stress. In the era of ‘Trump anxiety,’ mounting political distress, and division, how can therapists engage in ethical self-disclosure that centers their clients’ needs and improves therapeutic alliance (Gibson, 2012; Solomonov & Barber, 2018)? Shared experiences can be important for clients experiencing marginalization, can shape therapist usage of self-disclosure, and are of particular importance in times of political distress and oppression (Goode-Cross & Grim, 2014). This article seeks to examine the ethical implications of political self-disclosure.

The ethics of self-disclosure are important to consider as they can affect client outcomes and the quality of a working alliance. The strength of therapeutic alliance can be a key indicator of when to employ self-disclosure as stronger alliances have a positive correlation with clients’ experiences of therapist disclosures (Henretty & Levitt, 2010). Most therapists engage in some disclosure and scholars have identified two major subtypes: self-disclosing, or sharing information about therapists’ experiences outside of the therapy context, and self-involving, which includes sharing process-oriented observations or feelings about clients (Gibson, 2012). Though the latter type appears better received by clients, the research literature around political self-disclosure is still in its infancy (Gibson, 2012). With rising political self-disclosure, psychologists may consider reviewing guidance provided by the American Psychological Association’s code of ethics (APA, 2017). Standard 3.04 exhorts psychologists to avoid causing harm to clients, indicating that clinicians should maintain awareness of their own emotions and the risk of harmful disclosure due to political distress (APA, 2017). In addition, standard 3.06 calls on psychologists to consider whether their “objectivity, competence, or effectiveness” are affected by personal or other interests and to refrain from practicing in situations where there is a conflict between those interests and their duty as a psychologist (APA, 2017). This suggests that psychologists should be mindful of countertransference when clients disclose their beliefs and seek other avenues to support them if difference in political views may negatively impact the quality of care.

Solomonov and Barber (2018) provided several insights about these ethical considerations. They found that 64% of people surveyed discussed politics with their therapists. Participants were recruited through online listserves, websites, social media, and community clinics, and completed the survey online. Therapists’ implicit disclosure of political beliefs were perceived most positively, especially when disclosures revealed similarities in political views. Even in the absence of disclosures, the researchers found that clients regularly made assumptions about their therapist’s political views and a majority of Trump and Clinton supporters believed their therapists held similar views. These findings emphasize the significant need for greater psychologist competency when engaging with political topics in therapy. Knowing that many clients have discussed political distress in therapy and naturally make hypotheses about their therapist’s political beliefs, what are therapists’ experiences with this kind of self-disclosure? Psychologists are encouraged to review the ethics code section 2.01, “Boundaries of Competence” when considering engaging in these discussions (APA, 2017).

Solomonov and Barber (2019) found that therapists themselves endorsed engagement with political topics in therapy at a higher rate than clients. Eighty-seven percent of participating therapists, the majority of whom identified as White, reported discussing politics in session during the previous 3 weeks. Despite the frequency of their political discussions, few therapists reported explicitly disclosing political beliefs. Only 21% explicitly disclosed beliefs to clients, 37% did not disclose at all, and roughly 42% stated that clients could easily identify their views. Fifty-three percent of therapists indicated that clients disclosed their political views. However, the rate of mutual self-disclosure between clients and therapists varied significantly based on the perceived similarity or difference in their political affiliations. Barely 16% of therapists who believed their views diverged from their clients’ self-disclosed, compared to 50% of therapists who believed that they shared most of their clients’ political beliefs. Therapists perceived that political agreement in session had either a slightly (52% of responses) or highly (17% of responses) positive impact on the therapeutic alliance. Interestingly, 68% of therapists believed that in-session political disagreements had no influence on their therapeutic alliance. Therapist and client political affiliation were a determining factor of who experienced increased distress. Clinton-supporting therapists saw major increases in political discussions after the 2016 election but therapists who endorsed Trump did not. Clinton supporters with increased stress indicated that these discussions were helpful and Trump supporters, who did not experience an increase in stress, did not want more in-session political conversations.

Solomonov and Barber’s (2019) final sample was significantly less diverse than the US national population, which impacts the applicability of these results for the work of Black Indigenous and people of color (BIPOC) in therapy; 89% of surveyed therapists identified as Caucasian, 5% as Asian, 3% as African American, and 2% as American Indian. The overall psychology workforce in the U.S. is slightly more diverse and rapidly changing as more BIPOC psychologists join the profession. In 2015, 83.6% of psychologists identified as White, 5.3% as African American, 5% as Hispanic, 4.3% as Asian, and 1.7% identified as another ethnicity (APA, 2015). National demographics affect the availability of psychologists who share lived experiences of the mental health impacts of the Black Lives Matter civil rights movement or state discrimination against Latinx communities.

Several principles of the APA ethics code inform providers navigating ethical considerations of political self-disclosure. General principle A, Beneficence and Non-maleficence, calls psychologists to “strive to benefit” their clients and to “do no harm” while also being aware of their professional power and guarding against the misuse of their influence (APA, 2017). Using implicit or explicit political self-disclosure when one’s own views align with those of clients with experiences of political marginalization and increased distress may be a way to uphold this ethical principle. Psychologists must also consider the potential for self-disclosure to unintentionally pressure clients to agree with the therapist’s political views, and take great care to maintain a focus on client’s experiences. Furthermore, principle E, Respect for People’s Rights and Dignity, urges psychologists to limit the impact of bias on their work and to not knowingly participate in or condone activities of others based upon prejudice (APA, 2017). These principles call psychologists to build awareness of their biases and to remain attuned to serving their clients. They further require psychologists to not condone or participate in acts of prejudice during their work. This indicates that psychologists who hold privileged identities compared to clients should continue centering clients instead of justifying their own political beliefs or disclosing the impacts of current events on themselves. Finding balance in applying these principles during moments of self-disclosure also requires psychologists to develop an awareness of sociopolitical constructions of therapy.

Therapy remains a uniquely collaborative healing space that is as private as it is touched by the political climate. But what effect does the increasing polarization of news media have on the political construction of therapy and how clients may choose to engage with these spaces? Many in the US experienced the 2016 election as a political trauma and turned to therapy to address subsequent distress. The influx of first-time participants in therapy and progressive calls to examine national and personal values in post-electoral periods of crisis contributed to a shift for many in therapy from a space of individual introspection to a process of understanding connections with others and their purpose (Sointu & Hill, 2020). Through this process, individual therapeutic spaces grow into larger therapeutic communities that at their best can encourage transferring the lessons of individual attempts to enhance wellbeing to activism and shared political action. In contrast, conservative media and movements painted this political trauma as overblown and viewed seeking therapy as engaging in self-pity and indulging over-sensitivity or castigated it as weak and effeminate (Sointu & Hill, 2020). Psychologists and other clinicians must maintain an awareness of this context as they consider political conversations in therapy and ethical self-disclosure. Principles A, Beneficence and Non-maleficence, and E, Respect for People’s Rights and Dignity, offer the beginnings of a response to attempts to demonize seeking support. Principle A suggests that psychologists should seek to maintain therapy as a shared healing space and to work to reduce politicized mental health stigma. Principle E encourages psychologists to respond to rhetoric that dehumanizes communities by instead upholding their commitment to the dignity of their clients with particular attention to how this rhetoric and general political distress affect marginalized communities.

Ultimately, therapeutic practice has always been politicized as it connects clients and therapists who are both entangled in political systems. Psychologists must consider ethical obligations when responding to political polarization and distress in therapy. Changes in the trends of political distress or whether conservative clients may report greater distress in response to the 2020 election remains to be seen. However, political self-disclosure rooted in ethical practice appears to largely benefit clients and may be a critical area for increased practitioner competency.  

References

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Solomonov, N., & Barber, J. P. (2019).
          Conducting psychotherapy in the Trump era: Therapists’ perspectives on political self-disclosure,
          the therapeutic alliance, and politics in the therapy room. https://doi.org/10.1002/jclp.22801