The US has weathered tremendous political upheaval in recent election cycles, and 2024 is no different. In recent years, we have seen the removal of reproductive rights and a disarming of individuals’ ability to make decisions about their bodies, an increase in voter suppression laws aimed at racial minorities, the banning of gender-affirming care for transgender youth, and the stripping of educators’ rights to teach history accurately, among others. We have witnessed relentless gun violence across states and settings, including two assassination attempts against a former president seeking reelection. There has been division and heartbreak in handling wars being waged worldwide. According to a February 2024 Pew Research Center poll, 65% of respondents reported they felt exhausted when they thought about politics, 55% felt angry, and only 10% and 4% felt hopeful and excited, respectively (Infield, 2024). Further, Smith (2022) found between a fifth and a third of adults surveyed blame politics for causing fatigue, loss of sleep, feelings of anger, loss of temper, and difficulties with impulse control. An alarming 25% of Americans reported seriously considering moving due to politics. Given the direct link between politics and psychological well-being, clinicians must consider how they might handle these issues.

Though psychologists may pride themselves on their unique ability to remain objective, be a mirror to the client, and remain vigilant for transference, they are simultaneously navigating the same sociopolitical landscape as clients—which can be difficult. There are a myriad of topics that may be sensitive to both the client and the clinician. Though this article was written prior to the election, by the time it is published, the election will have already taken place. No matter the results, discussing sociopolitical topics in session will likely increase significantly. Therefore, this is a necessary time to reflect on ethically navigating the most difficult issues and interactions between client and clinician.

Below, we guide the reader through some of the salient aspirational principles and enforceable stands that may apply during this heated time (American Psychological Association, 2017).

Principle A: Beneficence and Nonmaleficence

Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons, and the welfare of animal subjects of research. When conflicts occur among psychologists' obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm. Because psychologists' scientific and professional judgments and actions may affect the lives of others, they are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence. Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.

Race, sexual orientation, gender identity, religious affiliation, past experiences, and traumas are all personal topics that tap into the very core of human experience. Clinicians are not immune to the impacts of microaggressions, generational trauma, discriminatory systems, and inflammatory language. While clinicians are taught how their words may negatively impact a client, there is often little to no training on handling an inverse situation. What if a client uses bigoted language? How about if they believe the clinician should have fewer rights based on their gender, race, or sexual orientation? There is no right or wrong answer - it is often gray. Abrams (2022) put forth advice from experts on how to navigate sensitive topics, including reflecting on your views, avoiding unintentional disclosures, responding to questions from patients, handling a disagreement therapeutically, questioning hate speech, avoiding pushing back on misinformation and conspiracy theories, and providing a referral. There are many avenues a clinician can take to work through complex issues with clients and make it “grist for the mill.” It is our professional responsibility as psychologists to endeavor to bring only benefit to our clients. If clinicians find themselves in a situation where their values conflict with a client to the point they can no longer remain objective, it is essential to consider whether the client would be better served by a clinician who can remain objective. This discussion focuses on the ethical aspects of navigating when termination and referral appear to be the best course of action.

3.06 Conflict of Interest

Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to (1) impair their objectivity, competence, or effectiveness in performing their functions as psychologists or (2) expose the person or organization with whom the professional relationship exists to harm or exploitation.

If, after great thought, consideration, and consultation, a clinician determines they cannot provide the best service for the client sitting in front of them, it may be time to consider termination and referral to other providers. It is crucial to consider the level of difference in values. Oftentimes, as with most relationships, clinicians and clients vary in their values and political opinions. Additionally, it is vital to consider the clinical setting - there are likely different standards and considerations when working in a forensic setting than in an outpatient setting. We must consider if those we are treating are part of a vulnerable population, if their cognitive abilities have been compromised by neurological injury, the depth of the individual’s psychological impairment, what the typical discourse in the setting involves, etc. The seriousness of the conflict of interest must be considered. Of course, each individual psychologist must come to their own judgment on whether conflicting principles rise to the level of interfering with therapy. As an illustrative example, say the client is volunteering with a particular presidential candidate’s campaign. The clinician is volunteering with the opposing presidential candidate’s campaign. The client then finds out about their clinician volunteering with the opposing candidate. How might you, as the clinician, discuss this with the client should they bring it up in-session? What if they now feel your values conflict with their own? What if they feel betrayed by your political views and in some way take it personally? There are no correct answers to these questions, but these are the kinds of questions and situations about which we should be proactively thinking.

Principle D: Justice

Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.

Part of psychologists' responsibility is to refer clients when they present with difficulties for which the clinician is not competent to provide services; this idea is clearly outlined in principle 2.01 Boundaries of Competence. Similarly, psychologists are responsible for ensuring their potential biases do not lead to ethical violations and unjust practices. If clinicians conclude that their personal biases are too great to overcome with a client, they must consider how to handle the termination process in a way that centers on the client’s therapeutic experience. We would be remiss not to discuss an ethical principle that is squarely at the heart of this issue: 3.01 Unfair Discrimination. Discrimination on any basis proscribed by law is unacceptable and must be seriously considered when discussing client termination. It can be difficult for individuals to see their blind spots; this is one of the many reasons it is important to consult colleagues and supervisors when considering the grounds for termination. If clinicians do find themselves in need of further support, the Oregon Psychological Association’s Ethics Committee (OPA EC) is an excellent resource for clinicians. Clinicians may contact the OPA EC at opaethicscommittee@gmail.com confidentially with any ethical questions or concerns.

10.10 Terminating therapy (b) - Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.

Often, these discussions revolve fully around clinicians bringing no harm to clients, and rightfully so. However, it is also important to acknowledge the harm that clients can bring to clinicians. Microaggressions, aggressive or discriminatory language, and threats of physical harm from the client are all realities that occur in sessions with clinicians, the result of which may or may not be repairable. Psychologists must take care of their individual mental and physical well-being, including stepping back from therapeutic relationships that cause them to feel endangered or threatened - mentally, emotionally, or physically.

10.10 Terminating Therapy (c) - Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

Lastly, clinicians should take reasonable steps to ensure a smooth transition to a new provider, including discussing termination in-session with the client prior to completion of services. When termination of services occurs, it is crucial that clinicians provide appropriate referrals for the client to continue receiving services. Despite any conflict, it is a part of our ethical duty to ensure the termination process is handled with the utmost consideration given to the welfare of the client.

While clinicians and clients alike navigate through the upcoming months fresh off of an infamously contentious presidential election, it is perhaps more important than ever to be aware of one’s level of burnout and need for self-care. A proactive approach to self-care can be monumental in safeguarding clinicians from burnout and has numerous benefits for themselves and their clients. Benefits include modeling healthy behavior for clients, increasing the capacity for empathy, reducing compassion fatigue, and promoting the quality of care.

References

Abrams, Z. (2022, March 1). Navigating thorny topics in therapy. American Psychological Association. https://www.apa.org/monitor/2022/03/career-navigating-therapy

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code/

Infield, T. (2024, February 2). Navigating the challenges of the U.S. political landscape. Pew Research Center. https://www.pewtrusts.org/en/trust/archive/winter-2024/navigating-the-challenges-of-the-us-political-landscape

Smith, K. B. (2022). Politics is making us sick: The negative impact of political engagement on public health during the Trump administration. PLOS ONE, 17(1), e0262022. https://doi.org/10.1371/journal.pone.0262022