Open Inquiry in Mental Health

Introducing OTI's Peer Reviewed Journal

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 22:38:38 GMT

We’re excited to announce a new iteration of OTI’s journal: Open Inquiry in Mental Health. This journal will focus on similar themes to the previously published Frontiers in Mental Health but with several changes:

Articles will now undergo formal peer review.
Articles will be slightly longer, with abstracts, keyword lists, and an extended bibliography.
Articles will be somewhat more formally written, now formatted in AMA style.

For this first issue, we’ll include nearly all of our previously published articles, which have undergone peer review and been modified to fit this new format. Our second issue will come out this fall.

The journal will retain its mission of addressing issues in mental health that have been neglected due to socio-political bias, and it will still prioritize articles that are clinically useful, innovative, balanced, and assertive. In addition to our focus on theoretical papers, literature reviews, and treatment interventions, we also hope to include more empirical studies, critiques of academic papers, and case studies.

We’re also excited to officially become the first peer-reviewed journal featured on Substack. This will enable our work to be read by a wider audience, including more practicing therapists and educated readers in the general public. We will also launch our own webpage soon, which will contain the necessary metadata and coding information so that we can eventually appear in top journal databases and on Google Scholar.

I want to express deep gratitude to all writers, editorial board members, and peer reviewers for making this possible—as well as readers and those who’ve promoted the journal. None of this could’ve happened without their work.

We’re hopeful that this journal can inspire research studies, clinical practice, institutional reform, and public awareness about countless mental health issues. Each article can lead to CE talks, press coverage, and ultimately help many overlooked patients get better care. We hope you’ll join us in reading, sharing, or contributing to this project.

— Andrew Hartz, Ph.D., Editor-in-Chief, Open Inquiry in Mental Health

Editor’s Letter

Introduction to Open Inquiry in Mental Health — Andrew Hartz

Editorial Board

Journal Aims and Scopes

Instructions for Authors

About the Open Therapy Institute

Contributor Biographies

Open Inquiry in Mental Health

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:31:05 GMT

Countless patients have had negative experiences in treatment because of therapists’ sociopolitical biases. These range from therapists making political comments in sessions and engaging in overt activism to harboring quiet judgments and expressing their personal values. As a result, many patients accept subpar care, while others struggle to find an attuned therapist or drop out entirely. To address this problem, scholars need to start documenting the blindspots, prejudices, and gaps in training that drive sociopolitical bias.

Over the past decade, some of the overt activism in the field has become so extreme that people tend to focus exclusively on the worst practices (see “The New Therapist Activists,” “Responding to Therapist Activism,” and “Codifying Bias”). But even though these practices are more prevalent than most people imagine, they’re just the canary in the coalmine. A culture of activist therapy can only emerge in a climate that’s already suffused with bias.

Political bias is a concern no matter the beliefs of the patient, but because the therapy profession leans so strongly to the left, most biases come from that direction. In practice, common biases include everything from biases against men in couples therapy and secular bias to a lack of knowledge on topics that are important to many patients such as self-censorship; anti-white racial aggression; the impact of workplace diversity, equity, and inclusion (DEI) training; and fears of cancel culture. Taken together, patients who are male, religious, or conservative easily make up most therapy patients—not to mention those impacted by other sociopolitical biases.

Given how politically charged American culture is right now, it should be no surprise that sociopolitical issues come up frequently in therapy and that they typically provoke strong emotions and greatly impact people’s lives. Politically controversial issues can be the most emotionally dysregulating issues in our culture, leading to interpersonal conflict and even mental health symptoms. Unfortunately, these are also the issues that therapists seem most likely to mishandle, in part because therapists can be just as dysregulated as patients.

Therapists vary widely in their ability to address politically charged issues. Some deliberately impose political agendas in sessions without patients’ consent, while others communicate biases less directly. Others simply lack the training and knowledge to help their patients with these issues. Effective therapy requires that therapists engage in these important topics in a knowledgeable, open, and attuned way—as they would with any other charged topic that comes up in treatment. To the extent many therapists can’t do this, the field is failing patients.

Even though these issues are so clinically important and challenging, they’re almost entirely absent from academic literature. It’s not an overstatement to say that the single largest gap in clinical literature involves issues neglected because of sociopolitical bias. The chart below gives a sample of search terms that have no results in top clinical psychology journals. (A more rigorous analysis is expected soon.)

Responding to this gap requires a robust scholarly program. The list of neglected topics is still emerging, but in addition to the articles in this issue, it includes:

People who’ve lost jobs, faced harassment, or endured social ostracization due to their views
Lack of therapist attunement to conservatives or others whose viewpoints diverge from prevailing professional orthodoxy
People of color who disagree with dominant anti-racist narratives
Gay men and lesbians who feel alienated by aspects of LGBT culture
Manifestations of anti-Christian bias and its impact on patients
People impacted by DEI-based job discrimination
Culturally skilled therapy for gun owners
Politically controversial responses that women may have to past abortions (e.g., regret, guilt, or grief)
Men facing false accusations of sexual misconduct
Political conflict and estrangement in couples and families

On each topic, case studies, theoretical papers, literature reviews, surveys, experimental studies, and proposed interventions are needed. Each of these can be explored from multiple theoretical perspectives: psychodynamic, cognitive behavior, evolutionary psychology, existential, family systems theory, etc. Hopefully, this journal can help spark the research that’s needed.

In short, this journal was founded precisely to address the large gap in clinical literature left by sociopolitical bias. Through open inquiry and a focus on topics that have been neglected due to bias, this work aims to inspire a new research program and greatly improve mental health care.

Toward this goal, the articles in this issue are only the beginning of a larger project. Ideally, these efforts will promote better training for therapists and ultimately better treatment for countless patients. Ultimately, this can restore the promise of the profession and affect changes that ripple throughout the broader culture.

Editor’s Letter

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:26:03 GMT

Articles will now undergo formal peer review.
Articles will be slightly longer, with abstracts, keyword lists, and an extended bibliography.
Articles will be somewhat more formally written, now formatted in AMA style.

— Andrew Hartz, Ph.D., Editor-in-Chief, Open Inquiry in Mental Health

New Anxieties: The Fear of Being Cancelled

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:25:04 GMT

Abstract

Political polarization has had a wide range of public health consequences. One that is beginning to come to the attention of mental health practitioners is a fear of being “canceled,” which is broadly defined as overwhelming anxiety that one will violate politically defined social norms and suffer long-lasting social scorn and occupational harm. The manifestation of this fear, which is being named here as “Akyró̱no̱phobia,” has characteristics that cut across obsessive-compulsive, social anxiety, and generalized anxiety disorders. As this is a preliminary report of clinical observations, what is being proposed is a specific phobia manifestation that shares qualities with several existing conditions. This article provides a preliminary description of the condition, informal polling of anxiety and obsessive-compulsive disorder specialists, and recommendations for future study and treatment. It is expected that Akyró̱no̱phobia will become an important condition for understanding the intersection of political polarization and mental health conditions.

Keywords: Akyró̱no̱phobia, obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder, political polarization, cancellation

Akyró̱no̱ (ακυρώνω): From Greek, Meaning “Nullify”

As American society becomes increasingly polarized, people are being placed under pressure to publicly align themselves with political narratives that are dominant in their social or professional circles.¹ It is not surprising that self-reported anxiety states are rising.² This essay argues that these punishing social conditions are now in danger of generating new mental health disorders. One particular anxiety disorder variant is becoming apparent, characterized by an irrational fear of being canceled. This condition is named “Akyró̱no̱phobia,” which is derived from Greek and means “nullify.”

Anxiety disorders are highly prevalent in the general public, with estimates suggesting that close to 20% have experienced severe anxiety within the past year and that just over 34% will experience it in their lifetimes.² Although the current diagnostic manual lists obsessive-compulsive disorder (OCD) in a separate category,³ this condition is also marked by significant anxiety and affects around 2% of the population.⁴ Collectively, this means that approximately 66 million Americans will suffer from an anxiety disorder or OCD in the next year.

Experts in anxiety disorders and OCD have begun to recognize a specific manifestation marked by intense and exaggerated fears of being canceled. Colleagues on an expert network were recently engaged regarding how frequently they have treated individuals with fears of being canceled. This informal polling showed that among 187 colleagues, 147 reported anywhere from two cases to dozens who experienced this specific fear. While anecdotal, clinicians suggested that the manifestation of Akyró̱no̱phobia included the following: avoiding social interactions and online conversations, destroying emails received from others if the individual remotely suspects they contain upsetting content, and seeking reassurance from past consensual sexual partners that their intimacy was, in fact, appropriate. This is not an exhaustive list, but one common thread is that the sufferers generally possess personal qualities that put them at particularly low risk for committing any act that might be deemed suitable for “cancellation” in their online social circle. Specifically, most OCD sufferers generally have higher levels of neuroticism, a personality trait that makes people risk-averse.⁵

The Nature of Akyró̱no̱phobia

In proposing this phobia, it is reasonable to suggest that it is characterized by three different patterns of psychopathology. One may have obsessive-compulsive thoughts about the risk of cancellation and perform compulsive behaviors to ward off these risks. Another may have generalized anxiety, with worries about actions that might result in cancellation and a dominant anxious mood and associated physical consequences (e.g., muscle tension or gastrointestinal distress). An additional condition that Akyró̱no̱phobia may resemble is social anxiety disorder (SAD), which is marked by fears of social situations where one may embarrass themselves. As Akyró̱no̱phobia includes intense public scrutiny resulting from a perceived political and social misstep, it is fitting that this would also be a characteristic of the condition.

Considering the high-profile figures who have been canceled, it is no surprise that individuals prone to experiencing anxiety would fear it happening to them. To illustrate, if one were to simply enter the search terms “people who were canceled” into Google, the results would be lists of public figures who were canceled, organized by year. Thus, it is such a pervasive social phenomenon that it is summarized annually. The manifestation of most anxiety conditions is embedded in the social context in which people live. The nature of Akyró̱no̱phobia may be broken into three different categories.

Obsessive-Compulsive Type Akyró̱no̱phobia

Obsessions are characterized by intrusive and unwanted thoughts that the sufferer recognizes as irrational. These thoughts lead to considerable avoidance of situations that might provoke them and may or may not result in compulsive behaviors. Research has shown that OCD is highly heterogeneous and marked by subtypes.^6-7 One facet of OCD that makes it a condition highly susceptible to Akyró̱no̱phobia is that obsessions are typically the result of socially unacceptable ideas or situations that are widely held concerns by the public. To illustrate, whenever a serious illness receives media attention (such as COVID-19), individuals with OCD are more likely to express extreme concerns over contracting that condition.⁸

This means that the social milieu is ripe terrain for obsessional content. When public figures face cancellation, experts in OCD can (and do) expect to see clients reporting intrusive thoughts that the same fate may await them. They suffer acutely over perceived transgressions that are objectively trivial or unlikely to provoke condemnation and would not be considered offensive by most people. For example, in an anecdotal poll of colleagues, one commented that it was not uncommon for clients they had treated to scrub their computers of any emails they had received that they believed might contain slightly offensive content within their specific social circles. Some severe cases have even included avoiding people out of concern that they would have an offensive thought in their presence. Considering the demands to precisely adhere to assumed social rules imposed within the individual’s unique personal context, the manifestation thus closely resembles scrupulosity associated with OCD.⁹ All these obsessions are thoughts, with no intent to commit any offensive actions or to utter any offensive remarks.

Generalized Anxiety Type Akyró̱no̱phobia

While obsessing over the risk of acting on offensive and unwanted thoughts is a well-known symptom of OCD, Akyró̱no̱phobia can also prompt serious worries that are associated with generalized anxiety disorder (GAD).¹⁰ Unlike OCD, the worries associated with Akyró̱no̱phobia are marked by reviewing past statements, emails, social media posts, and other public comments for the slightest potential to contain offensive content. As with any worries, a prevailing challenge for sufferers is intolerance of uncertainty.¹¹ The pain of this variation of Akyró̱no̱phobia is that individuals can point to specific acts that they interpret as potentially offensive, connect them to acts of other public figures, and claim that their offenses are in line with those that resulted in others being canceled.

Social Anxiety Type Akyró̱no̱phobia

Social anxiety is a serious and debilitating disorder, typically marked by a fear of encountering others, scrutiny of one’s own comments during and immediately following social interactions, and avoidance of social situations that are considered high risk for possible negative outcomes.¹²

In the case of Akyró̱no̱phobia, the social anxiety variant would emphasize the hazard of being publicly shamed for committing an inadvertent political misstep or the perceived risk that a political misstep was made in the past and could be revealed at a future time. The behaviors reported by clients informally described among anxiety disorder experts fit with the established science of SAD. This includes attentional biases toward possible political risks, mental imagery and visual memory distortions related to possible errors committed, inflated anticipated dangers, and post-event processing to scrutinize one’s behaviors for possible missteps. The latter often includes recalling how others reacted to further parse responses for possible disapproval.

Research, Treatment, Policy, and Politics

The above illustrations of how cancel culture can result in significant OCD, GAD, and/or SAD manifestations that have been termed Akyró̱no̱phobia should be viewed as cautionary examples of how public discourse and mob-inspired desires for retribution can indirectly inflict pain and suffering on innocent individuals. It should also be considered an area where redress is possible.

So far, this paper has described broad clinical data that is uncontrolled, post hoc, and culled from a narrow set of practitioners. Because this involves outlining a new phobic state, a new research program is necessary. This program should identify consistencies in how Akyró̱no̱phobia develops, the characteristic symptoms and boundary conditions that would rule it out, epidemiological findings to evaluate how pervasive the phenomenon is in the general population, and controlled experimental research to identify specific mechanisms of the pathology. These are all essential ingredients for ultimately defining a putative mental health problem and a first step in developing treatments. One way this new line of research may be informed is through classic models for determining the nature of new taxa within existing diagnostic frameworks.^13-16

While waiting for systematic and controlled research, some principles of behavior change may be informative in bringing relief to sufferers of Akyró̱no̱phobia now. On a granular level, sufferers of Akyró̱no̱phobia can benefit from existing treatment approaches, provided these are implemented with care. Exposure therapy is commonly prescribed for fears and OCD, and Akyró̱no̱phobia would be no exception. Specific attention to social forces can ensure that exposure is conducted not only ethically but also safely in the current social climate. This is essential and has been implemented in the analogous context of COVID-19–related exposure.⁸ Exposure-based approaches, in conjunction with cognitive therapy interventions, are likewise established efficacious interventions for GAD² and SAD.¹²

At the policy level, mental health organizations would do well to consider the extent to which their policies ensure a true embrace of pluralism. In an anecdotal poll of colleagues, several cited prevailing attitudes among their counterparts as chilling the extent to which clients feel comfortable expressing potentially offensive thoughts to their clinicians. Reorienting the profession to accept clients with the full range of ordinary human emotional and cognitive experiences will go a long way toward addressing this issue.

As for politics, mental health professionals can do far better in embracing pluralism. This would mean endorsing a sense of fairness for all and setting aside troubling movements that would allow clinicians to issue judgments about how clients may or may not receive care.^17-18 Mental health professionals can and should do better to prevent unwanted and painful anxiety conditions. Addressing cancel culture for its illiberal excesses would be a significant public health benefit.

A Look Ahead

The public is generally unaware of this, but mental health professionals are collectively engaged in an internal struggle over how to deal with politics, both as a matter of within-session discussions with clients and with respect to the policies they set for professional conduct. The presence of Akyró̱no̱phobia illustrates one of many areas in which clinicians lack clear guidance on how best to proceed, given the political focus within the profession. There is growing recognition that political processes in the profession have been unrestrained and have lacked clear guidelines. There have been calls within some mental health professional communities to explicitly screen clients for political viewpoints and reject those who hold positions contrary to those of the clinicians.¹⁹ This example only scratches the surface and represents ill-advised and heavy-handed attempts to integrate political processes into professional activities. This is hardly surprising, as mental health professionals are not formally trained in political discourse. It is hoped that as mental health professionals effectively address this challenge, attention may be paid to Akyró̱no̱phobia in a nonjudgmental manner. As a result, clinicians may feel less constrained in addressing the individual needs of clients who report this problem.

REFERENCES

Distorted Data: Political Bias and Concerning Research Practices

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:24:16 GMT

Abstract

Mental health professionals often rely on research to inform their practices. However, on politicized topics, the quality of that research can be affected by researchers’ political biases. These biases can interact with more general biases in the research process to compound the problem. This article reviews several examples of how political bias manifests, its psychological foundations, and what strategies practitioners can take to ensure that they are getting an accurate portrait of the scientific evidence when making decisions in their clinical work.

Keywords: Political bias, evidence-based practice, replication crisis

Mental health professionals, particularly psychologists, pride themselves on using evidence-based practices. Psychologists take courses on research methods and statistics, and as practitioners, they are expected to keep up with relevant scientific journals and learn about new developments in their field. However, evidence-based practices are only worth pursuing if the research evidence base is trustworthy. Is that generally the case?

About 15 years ago, psychology experienced a “replication crisis.” Researchers were unable to replicate many classic findings in psychology, and the field became much more aware of biases that affect how studies are designed, data are analyzed, and findings are published.¹ Since then, many steps have been taken to increase the field’s credibility, but concerns remain.

In a 2012 study, a high proportion of psychology researchers admitted to using questionable research practices, such as only reporting data for some of the outcome measures in a study or claiming that an unexpected finding had actually been predicted by the researchers from the start.² As concerning as this may be, questionable research practices are even more troubling when they interact with another problem: political bias. It is possible that the two problems could compound each other, as questionable practices are used in the service of shared political attitudes.

Political Bias

One type of bias has not been addressed: political bias. Most psychologists hold progressive political views, and so, to the degree that those views influence the way psychologists conduct and evaluate research, the published results tend to be skewed in a progressive direction.³ Moreover, in recent years, a variety of initiatives have asked psychologists to include political considerations in the research publication process. As a result, the research literature on politicized topics cannot represent true facts about human behavior and experiences in an unbiased way.

Consider a politically sensitive (albeit non-clinical) topic in psychology: gender differences in math performance. An early study suggested that when students are made aware of a negative stereotype that women have a lower math ability, this may cause women to score lower on a math test (the “stereotype threat” effect).⁴ This led to claims that even young girls are harmed by such stereotypes. However, a state-of-the art quantitative literature review (a meta-analysis) found that studies reporting a stereotype threat effect were more likely to get published.⁵ It seems that when researchers failed to find an effect, they either declined to share their results or journals refused to publish them. When this publication bias was accounted for, there were no significant stereotype threat effects in girls. Even so, the original 1999 study is still cited far more often than the more recent literature review.

Of course, no research study is perfect, and all studies have limitations. But political bias leads researchers to hold studies to different standards, depending on the perceived political conclusions. At times, this bias even manifests as open political pressure on authors and journals. In 2018, the journal Nature Communications published a study finding that greater ethnic diversity in researcher teams was associated with scientific papers that had more impact on their fields.⁶ The study did not raise concerns and remains well-cited. In 2020, the same journal published a second paper by the same author with the same methods, but it found that research teams containing female mentors led to fewer benefits for female mentees.⁷ This time, the methodology was harshly criticized on social media, the authors were accused of sexism (although the lead author for both papers is a woman), and under severe pressure, the paper was eventually retracted from the journal. No doubt other researchers and journal editors paid attention to this incident and will be more hesitant to publish any data that could lead to politically undesirable conclusions.

Political bias can occur at any stage of the scientific process, from the selection of questions to decisions around whether to disseminate the results to the public. However, bias is particularly powerful at the stage of data interpretation. For instance, many proponents of cultural competence in psychotherapy claim that culturally tailored psychotherapy is superior to other evidence-based psychotherapy strategies. Often, though, the studies described as supporting this conclusion never make a direct comparison. Instead, culturally tailored psychotherapy is compared to a control condition, such as being on a waitlist for psychotherapy or being provided supportive counseling.⁸ Unsurprisingly, culturally tailored therapy is found to lead to more improvement than these poor substitutes. The researchers then celebrate the effects of culturally tailored psychotherapy and demand that psychologists be trained in it, without ever demonstrating that other evidence-based approaches are inferior. Cultural tailoring may be beneficial, but given the importance of the topic, it is unprofessional to draw inferences without adequate data.

Psychological Foundations of Political Bias

Psychologists should not be surprised by these examples of bias. Much psychological research has found evidence of people’s tendency to interpret new information through the lens of their current beliefs, with a strong motivation to find support for those beliefs.⁹ Interestingly, on partisan issues, people on the left generally do not differ from those on the right in their amount of bias.¹⁰ Indeed, in one classic study, Lord et al.¹¹ found that people who had strong views about capital punishment—in either direction—were far harsher in judging a study when it seemed to contradict their prior views.

This “confirmation bias” applies not only to research participants, but to researchers as well. If the distribution of political views was balanced across different mental health researchers, with many researchers holding views at all different points along the political spectrum, this might lead to more discussion and debate within the field. However, since most researchers in the mental health professions are on the political left, research on politically polarized issues will generally reflect a bias in that direction.

Implications for Evidence-Based Practice

How should these problems affect mental health professionals’ understanding of “evidence-based practice?” Unfortunately, on politicized topics, where there is a strong political reason to want to find certain results, practitioners must be far more careful about accepting researchers’ pronouncements about what the evidence shows. This is most needed on politicized topics, but recent publication initiatives have encouraged journals to tie political considerations to all research. For instance, a group of scholars (including the American Psychological Association’s chief science officer) have put forth a Diversity Accountability Index that rates journals on criteria including whether the journal invites critical commentaries on any articles that have even “the potential to reinforce white supremacy.”¹²

Diversity-related criteria for publishing research articles would obviously have effects on potential authors and editors, and if a journal adheres to these criteria, readers must interpret the resulting journal articles with that in mind. More generally, the political bias in psychology research means that practitioners should be especially wary of brief summaries of studies that do not mention the details of the research methods and statistical results. Such summaries are common in practice guidelines and are particularly vulnerable to bias. Instead of blind trust, psychologists may need to use their training to locate and read the actual research studies and determine what conclusions are warranted.

Conclusion

The scientific method remains a powerful way to discover truth, and when used well, it reduces the biases that the human mind is prone to. Science can push back against our beliefs with clear evidence and persuade us to change our minds. It can discover which clinical practices are most effective, and it can even be used to identify effective ways of addressing concerns related to diversity and social justice. However, the scientific process is not itself immune from bias, as the replication crisis showed, and political bias may be an especially insidious type. Psychologists who wish to base their clinical practice on research evidence, as they should, must be especially attentive to political bias when reviewing that evidence.

REFERENCES

Responding to Therapist Activism: New Strategies for Change

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:23:39 GMT

Abstract

Within the last several years, mental health treatment has taken a political turn, and activist approaches to therapy are being promoted across therapy institutions. These new treatment approaches have a different telos to classical therapy: The goal is more to change society rather than heal the individual. Though lacking empirical support, this change has been imposed on the field by therapy institutions, often bypassing critical debate. This paper identifies several strategies that professionals and academics can apply in five key domains—public outreach, knowledge production, therapy practice, therapy bureaucracies, and therapy training—to challenge these changes.

Keywords: Activism in psychotherapy, therapist training, professional organizations, critical theory, social justice, sociopolitical bias

Within the last several years, rapid and radical change has spread throughout the mental health treatment field. Therapy, which was once avowedly apolitical, is becoming politicized. This shift can be detected across therapy institutions, and these bodies use professional standards to impose political goals on therapy practice.

For example, see the American School Counselor Association’s 2022 ethical framework, which opens by stating: “School counselors are leaders, advocates, collaborators and consultants who create systemic change to ensure equitable educational outcomes through the school counseling program.”^1(p1) Therapy training programs exhibit similar tendencies. Note, for example, how the University of Vermont’s PhD program for counselor educators commits “to develop critically conscious scholar-activists in the counseling profession.”² This move is happening across the Anglophone world. An independent report on United Kingdom (UK) clinical psychology doctorate programs reveals the extent of the politicization of these trainings.³

One of the most concerning issues is the almost complete absence of critical debate within the academic and professional literature regarding these changes.⁴ It would appear that a radical transformation is being wrought in the therapy disciplines that is neither properly discussed nor researched. There is plenty of anecdotal support for the negative impacts of activist therapy (presented in op-eds, blogs, and podcasts^5,6 and in emerging research^9,22) but hardly any empirical evidence derived from substantive research programs.

A more robust response from clinicians and academics is needed to address these changes. Questions about the potential negative implications of activist therapy need to be posed and answered. However, it is also important to proceed in a cautious and considered way and to be open and charitable to opposing arguments. With this in mind, five key domains of action are presented here: public outreach, knowledge production, therapy practice, therapy bureaucracies, and therapy training.

Key Domains of Action

Public Outreach:

A significant problem is caused by failing to label therapy services clearly. The terms therapist, counselor, psychotherapist, and clinical/counseling psychologist are used indistinguishably by classical/traditional practitioners and activist therapists. But there is a radical difference between these two approaches: Traditional therapy is client-centered, evidence-based, and politically neutral, whereas activist therapy views the client’s problems as created by an unjust society and so treatment involves a form of moral reeducation and political activism.

Activist approaches to therapy do not represent just another modality in a field. Instead, this new type of politicized mental health treatment is distinguished by characterizing all other modalities as merely products of a morally corrupt colonial Western psychology. (For a good example of this rhetoric see the introduction to a special issue on decolonial/liberation psychologies published in American Psychologist.⁷ See also the American Psychological Association’s formal apology for psychology’s role in promoting “human hierarchy.”⁴⁰) Taking this stance allows activist therapists to dispense with empirical evidence and well-established standards. For example, Lacerda-Vandenborn et al⁸have asserted that therapists can have “multiple relationships” with their clients.

As the general public is unlikely to be aware of the big changes happening within the therapy professions, there is the potential for a mismatch between client and practitioner. One potential source of mismatch would be different political beliefs. In a recent survey of 8,000 therapy patients, 61% said that it was important that they and their therapist shared political views.⁹ This was confirmed by another study in which clients reported feeling more comfortable with and trusting of clinicians whom they perceived as sharing their values.¹⁰

Furthermore, there is strong evidence that sociopolitical attitudes and values are not only fundamental to people’s sense of self but that these beliefs are resistant to change.⁹ In order to reduce mismatches, we should focus on educating the general public so that the selection of a suitable therapist is better informed. This could be done through the following:

A determined effort to provide information through accessible op-eds and podcast interviews: Good examples would be Lisa Selin Davis’ piece⁵on how therapists became social justice warriors and Andrew Hartz’s essay¹¹ on therapists who are hostile to their clients’ beliefs.
A campaign to differentiate established traditional/classical therapy from activist approaches in the marketplace: One strategy would be to encourage traditional/classical therapists to positively market themselves as such. Another strategy would be to characterize activist therapy more accurately as a different type of cultural practice altogether; one recent suggestion is to style activist therapists as “identity practitioners.”¹²

Knowledge Production:

Due to the lack of viewpoint diversity within the academy and the academic/legacy publishing industry, knowledge production has become biased. Activist scholars are typically informed by critical social justice (CSJ), a postmodern ideological framework emphasizing identity-based power dynamics and systemic oppression.¹³ In this ideology, concepts such as intersectionality,¹⁴ white fragility,¹⁵ and microaggressions¹⁶ are accepted as axiomatic truths.

The gatekeepers (commissioning editors and reviewers) with these views often limit the publication and dissemination of critical perspectives. Meanwhile, other academics are wary of the likelihood that being associated with nonorthodox views could lead to cancellation and reputational damage. (See the dismissal of Klaus Fiedler from his post as editor of the prestigious Association for Psychological Science.¹⁷)

However, there are a few hopeful signs that some cracks are appearing in this wall; for example, recent papers have critiqued psychotherapy’s embrace of diversity initiatives¹⁸ and the taking up by psychoanalysis of a transgender-affirmative approach.¹⁹ In addition, an important academic book titled Ideological and Political Bias in Psychology: Nature, Scope, and Solutions lays out some of the arguments and evidence for taking different perspectives on the political turn in therapy.²⁰

One area of focus must be determined attempts to empirically investigate this new politicized therapy. Although it is difficult to operationalize activist therapy for research purposes, there are some other potential avenues. Researchers could do the following:

Evaluate the mental health implications of holding particular CSJ-informed beliefs: One such recent study indicates a link between poor mental health in men and acceptance of the currently fashionable negative characterization of traditional masculinity.²¹
Assess the challenges faced by classical/traditional therapists working in politically hostile environments: For example, a recent study explores strategies used by gender-critical therapists to guard against accusations of conversion therapy.²²

Therapy Practice:

While activist clinicians focus on further consolidating critical consciousness²³ in their clients, it is important that traditional/classical therapists start to think about ways to help clients who present with harms caused by a politicized and polarized culture.⁴² In other words, a goal should be providing a therapeutic antidote. This could be supported through:

developing informal professional consultation groups where practice issues can be shared (it is hoped that within supportive professional communities, classical/traditional practitioners can begin to pool ideas on how to work with these emerging challenges in practice);
developing formulations informed by classical theories/modalities that can be adapted to clinical practice in an increasingly polarized environment—for example, understanding gender dysphoria from a psychodynamic perspective²⁴; and
not allowing CSJ concepts (terms such as microaggressions, white supremacy, intersectionality, and inclusion) to go unchallenged within wider or more general therapy professional settings.

Therapy Bureaucracies:

Professional organizations hold a great deal of power: They set standards for practice; issue guidelines; provide a stamp of official approval through accreditation systems; and, in jurisdictions such as the UK, operate as quasi-regulators. There are two possible routes forward:

Begin the slow and difficult process of building new professional organizations: This is happening in higher education with the establishment of new universities.²⁵ This strategy of creating “parallel structures” to resist oppressive authoritarian regimes was pioneered by the Czech dissident Vaclav Havel.²⁶ We can see the beginning of this in new membership organizations, such as the avowedly apolitical International Association of Counseling and Psychology²⁷, the Open Therapy Institute²⁸ with its mission of addressing sociopolitical bias in mental health care, and Critical Therapy Antidote,⁶ which explicitly seeks to preserve therapy’s healing ethos.
Attempt to reclaim legacy organizations by moving into positions of power within the bureaucracies themselves and attempt to reset the agenda along more balanced lines: This move will require determined individuals who are prepared for battles of attrition. A recent example from the UK demonstrates it is possible to break the activist stronghold. The UK Council for Psychotherapy (the UK’s second-largest membership body) recently withdrew its signature from the trans-activist Memorandum of Understanding on conversion therapy.²⁹ Subsequently, trans activists attempted to have the council’s board of trustees fired—a move that proved to be unsuccessful.

Therapy Training:

Possibly the most concerning of all the domains is the political capture of training institutions. New generations of professional therapists are being trained to view the client through an identitarian lens and diagnose the client’s difficulties as being solely determined by their membership of oppressed or oppressor groups. These ideas are being instilled with the help of unsuitable anti-relational training methods³⁰ and radical changes to the curricula. A recent independent inquiry into UK clinical psychology doctoral training programs has exposed the extent to which these courses are being “decolonized.”³ One published account by a former counseling professor described recruitment processes in which candidates were more likely to be admitted if they were sympathetic to “social justice activism.”³¹ What can be done?

Provide informal facilitated peer groups for affected trainees where they can be supported in navigating politicized training programs.
Provide online seminars and short courses in traditional theories and methods to supplement an increasingly narrow curriculum.
Use legal means to challenge aggressive and discriminatory actions of training institutions that try to impose political viewpoints. For example, see Leslie Elliott’s case against Antioch University³² and James Esses, who successfully fought a high profile case against his UK training institute, Metanoia,³³ after he was expelled for publicly expressing his gender-critical views that a person’s sex is based in biology. A current legal case is being prepared by a student on a counseling master’s course at the Catholic university Santa Clara: Naomi Epps Best objected to both the curriculum with its focus on “kink” and a mandatory assignment for which she was required to write a personal “sexual biography.”³⁴
Initiate more debate about the demographics of the therapy profession. Over the last 10 years, the female-to-male ratio has remained fairly consistent among therapists in the U.S.; currently, this data source indicates about 70.4% are women, while about 24.7% are men, and the remaining 4.9% are unknown.³⁵ This is part of a broader feminization of the helping professions.⁴¹ Because CSJ attitudes are more prevalent among women³⁶ and large cohort studies indicate younger women are more likely to sympathize with social justice activism than their male counterparts,^37,38 this means an increasing bias might entrench itself further over time.

Conclusion

A schism has emerged between traditional/classical approaches to therapy and new activist approaches, even though both operate under the same name: psychotherapy. practitioners and clients are increasingly confounded, and the therapy professions are in danger of falling into disrepute.

However, there are ways in which bad practices can be corrected. As Kaufmann³⁹ argues, the social sciences as a whole need to move beyond relativist theories and an anti-positivist philosophy of science and return to realism and the scientific method. Similarly, professionals have a duty to deliver evidence-based therapies. By implementing the strategies outlined in this paper—educating potential clients, developing research, informing practice, reforming therapy bureaucracies, and improving training—professionals working together can start to correct course. Clients need therapists who respect them as individuals and are committed to helping them become more agentic, insightful, and realistic. These strategies are essential steps toward restoring the profession to these ideals.

REFERENCES

The New Activist Therapists

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:21:55 GMT

Abstract

A new politicized approach to professional therapeutic practice has rapidly become dominant in training institutions and professional bodies. Advocates of these approaches believe that the client’s problems are caused by an unjust society and, consequently, the most salient factor in clinical work is the client’s identity. This worldview licenses therapists to impose their own political beliefs onto the client—that is, to become therapist-activists.

This paper describes the main features of this activist approach and identifies how it differs from classical or traditional therapy approaches. This difference is summed up as a radical shift in the telos of therapy from healing the individual to changing society. The paper then explains how this new therapy became established as a dominant approach in the field despite having little empirical support. It concludes by considering the implications of this shift for clients and the wider culture.

Keywords: Activism in psychotherapy, social justice, multicultural competence, critical theory, professional ethics, sociopolitical bias

During the last several years, a radical shift has been underway in the therapy field in North America and the rest of the Anglophone world: Professional therapy institutions and mental health practitioners are adopting a politicized approach to therapy.¹ Why does this matter? Because this activist therapy does not have a traditional patient-centered ethos, which foregrounds the individual’s unique experience, needs, and goals. Instead, activist therapists impose a political agenda for societal change on clients.

Despite its increasing dominance, this approach lacks empirical evidence of its effectiveness in reducing symptoms; on the contrary, there are many anecdotal reports of its detrimental impact on client welfare. This article explains what activist therapy is, how it came to prominence in the field, and the implications for mental health.

What Is Activist Therapy?

For readers who have not been following the politicized path of therapy, some examples of current activism are:

practitioners who believe it is acceptable to attack therapists with different political views—see a recent attempt to blacklist “Zionist” therapists;²
reputable academic therapy journals that publish peer-reviewed papers advocating for highly dubious racialized concepts such as “Parasitic Whiteness” (capitalization in the original paper);³
trans-activists’ influence on therapeutic services for vulnerable clients. For example, the recent scandal in the Scottish Rape Crisis services,⁴ where traumatized women have faced charges of bigotry for wanting to know the biological sex of their counselor; and
mental health professionals who actively encourage polarization and division. See the Yale psychiatrists who urged people to shun Trump-supporting relatives⁵ and expressed fantasies of killing white people.⁶

What Are the Main Differences Between Activist Therapy and Traditional/Classical Therapy?

This article does not argue that politics has nothing to do with therapy. Traditional approaches accept that therapy has a political dimension and that all therapists will have a set of values and beliefs. However, the discipline has always insisted that these beliefs should not be taken into the clinic. For example, the American Counseling Association states this explicitly in its code of ethics: “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors.”^7(p5)

Despite this, new legitimizations of political activism in therapy can be seen in practice guidance issued by various professional bodies. For example, the 2017 revised guidance on multicultural practice issued by the American Psychological Association (APA) views psychologists as agents of wider social change (termed “citizen psychologists”) who “ …seek to address institutional barriers and related inequities, disproportionalities, and disparities of law enforcement, administration of criminal justice, educational, mental health, and other systems as they seek to promote justice, human rights, and access to quality and equitable mental and behavioral health services.”^8(p4) This new political position can be rationalized because therapists are encouraged to initiate conversations with their clients about identity and subsequently center conversations about inequity and justice.

If clients resist these approaches, the guidelines offer a range of strategies to bring them around to the therapist’s view, “… such as clinician authenticity, tone, spontaneity, therapist self-reflection, practice, patience with stumbling, supervision, and consultation.”^8(p23) This is a key difference between therapy as generally practiced until recently and the new politicized approaches: Activist practitioners deliberately impose their own political beliefs onto their clients.

Moreover, the worldviews of traditional/classical therapy and activist therapy are radically different. Traditional/classical therapy is informed, to a greater or lesser degree, by the modern Western Enlightenment philosophical tradition. Consequently, these therapists, no matter what approach they espouse, share a commitment to the uniqueness of the individual and the healing ethos of therapy; broadly speaking, their practices are designed to increase the client’s insight, agency, and grasp of reality. Furthermore, all therapy approaches need to demonstrate that they are grounded in empirical evidence for their effectiveness at reducing symptoms or achieving other therapeutic goals.

This new politicized approach to therapeutic practice is informed by Critical Social Justice (CSJ)—a term coined by Sensoy and DiAngelo⁹—which is a worldview that blends postmodern ideas with elements of Critical Theory.¹⁰ This ideology has a political agenda and deploys an identitarian lens. It rejects empiricism and privileges discourse and narrative. The client is viewed merely as an avatar of a particular demographic group (or combination of groups), which is deemed either the oppressor or in an oppressed position within the wider societal matrix of power. Consequently, the activist therapist believes the client’s difficulties are caused by the broader, unjust societal context; the only treatment offered is a form of moral reeducation that urges political action. In short, the difference can be summed up as a shift in the telos of therapy from healing the individual to changing society.

How Has Activist Therapy Captured the Professional Field?

How could a politicized approach to therapy—an approach that is being labeled by some as inherently antitherapeutic¹¹ and explicitly antiscientific and antimeritocratic¹²—get such a purchase on the mental health field? Broadly speaking, we can identify four groups driving this movement, along with some other influences.

Activist Scholars:

Hostile to Western European thought, which is deemed to be an expression of white supremacy, these scholars seek to dismantle and disrupt traditional schools of thought. They operate as gatekeepers in academic psychology, shutting down critical debate and accusing critics of being reactionary, which has contributed to widespread self-censorship among academics.¹³ Academics who attempt to publish dissenting views risk reputational damage and even job loss (see the dismissal of Klaus Fiedler¹⁴ from his post as editor of the prestigious Association for Psychological Science.)

Activist Clinicians:

Influential clinician–theorists such as Derald Wing Sue¹⁵ (an early promoter of the contested notion of microaggressions)¹⁶ developed the theory and skills of multicultural competence. Their work established the ground for centering identity issues in clinical practice. Other theorists have built on this work, insisting on the salience of race in all clinical encounters¹⁷, even if both practitioner and client are white.¹⁸

Activist Bureaucrats:

Many professional organizations are increasingly governed by activists deploying bureaucratic means such as: committing organizations to dismantling “systemic racism,”¹⁹ embedding Diversity, Equity, and Inclusion (DEI) policies at every level,²⁰ and reengineering professional practitioner criteria along CSJ lines.²¹

Activist Educators:

Most therapists are trained within higher education institutions, which are monitored by DEI committees—though some institutional restructuring has occurred in the past year. Many psychology faculties have committed themselves to agendas such as “decolonization of the curricula.”^22,23 This DEI²⁴ bureaucracy, combined with an influx of educators wedded to a politicized education approach known as Critical Pedagogy,²⁵ is instilling these practices in the next generation of practitioners.²⁶

Other Influences:

All of the groups identified here operate within a changing cultural context. Therapists are affected by subtle, wider developments in society, such as decreased religiosity and increased moral relativism, an increasing emphasis on race and other demographic categories, an increasing emphasis on subjectivity at the expense of objectivity, and the postmodern emphasis on the power of words and narrative. One example of the latter is the changing definition of the term “trauma,” which now can refer to any kind of perceived harm. Given these contextual shifts, it is unsurprising that many therapists think centering identity in therapy is morally commendable.

What Do We Know About the Effectiveness of Activist Therapy?

Since Eysenck challenged the claims of psychoanalysis, researchers have endeavored to develop a robust evidence base for talking therapies.²⁷ Yet, politicized approaches to practice have been endorsed across the majority of therapy institutions without proof of improved outcomes. There has been little rigorous outcome research investigating whether these approaches improve client mental health. A review of social justice counseling outcome studies found only 35 empirical studies across 11 years of publication, concluding that more rigorous research is needed.²⁸ Where evidence is cited, studies typically examine the effects of training therapists in multicultural competence rather than measuring client outcomes of activist interventions themselves.²⁹

This lack of evidence can be explained by two factors. First, there is no general agreement on what constitutes the principles and methods of activist practice. If something is not operationalized, then it is very difficult to investigate. And second, activist scholars are informed by postmodernism, which is averse to empiricism; their interest is in changing cultural narratives.³⁰ Instead of empirical evidence, claims for this new kind of therapy practice rest on ideas of its presumed moral superiority. A good example can be seen in the introduction to a special issue of the APA’s house journal, American Psychologist, on decolonial psychology (a term for activist approaches), which presents this practice as an unequivocal moral good compared with classical “white supremacist” Western psychology.³¹

In contrast to activist claims, there are plenty of anecdotal reports published on Substack,³² on social media, and in blogs about the harms of these approaches—see, for example, Critical Therapy Antidote’s collection of insider accounts of damaging therapy experiences.³³ These writings, combined with podcast interviews³⁴ of disillusioned therapy trainees and the increasing volume of requests for “non-woke therapists” received at organizations such as the Open Therapy Institute, point to significant disquiet.

Implications of Activist Therapy Practice for Culture and Mental Health Treatment

Potential negative impacts on the client³⁵ include:

weakening self-efficacy and agency. Activist therapy can foster victimhood and a sense of powerlessness. Experiencing oneself as unable to make positive changes is likely to lead to demoralization. “Hopelessness, the hallmark of demoralization, is associated with poor outcomes in physical and psychiatric illness, and importantly, with suicidal ideation and the wish to die”^36(p733);
worsening interpersonal relationships. Activist therapy promotes polarization,³⁷ fosters family divisions, and guides people to view all relationships through the lens of power;
promoting simplistic reductive thinking such as either/or thinking (e.g., good/bad, right/wrong, and victim/oppressor). Either/or thinking is viewed in the cognitive behavioral therapy school as one of the main categories of cognitive distortions,³⁸ and exerts a pervasive negative influence on emotional regulation, cognitive flexibility, and interpersonal functioning. Of particular concern is how this type of distorted cognition impedes the psychotherapy process.³⁹

Conclusion

Activist therapists have spread throughout mental health treatment services, research, education, and professional bodies, and the problem persists. In response, substantive research programs are needed to understand the impact of this new type of therapy. Strategies are also needed to help mitigate the potential harmful effects of these practices on individual clients and the wider culture.

How Therapists Often Fail Religious Clients

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:21:31 GMT

Abstract

Religious belief and practice remain central to the lives of large segments of the public, yet many mental health professionals assign relatively little importance to religion and feel unprepared to address faith-related issues in clinical work. This article examines the gap between therapists’ and clients’ religiosity, reviews evidence that religion is often intertwined with mental health outcomes, and considers how neglect of religious concerns can impede therapeutic alliance and effectiveness. Without advocating faith-based therapy or proselytization, the article argues for greater religious literacy, cultural competence, and openness among clinicians, emphasizing the need for a more balanced, research-informed approach to religion in psychotherapy.

Keywords: religion and psychotherapy, cultural competence, religiosity, bias in psychotherapy, spirituality, mental health

A typical client who walks into a therapist’s office is likely to encounter a practitioner who assigns far less importance to religion than does the client. One survey found, for example, that only about one-quarter of cognitive and behavioral therapists professed a certain belief in God. Just under half of the clinician sample deemed themselves nonbelievers.¹ Another study found that 50% of academic psychologists considered themselves atheists, and an additional 11% were agnostic.² In this survey, psychology professors emerged as the least religious of all academics studied.

Background

The United States public overwhelmingly values religion and believes in God.³ Only about 4% say they are atheists, and—although the past decade may have witnessed some slight declines in religiosity—for quite a while, about eight to nine out of every 10 American adults reported a belief in God. Roughly three-quarters of the public identifies with some religious faith. According to a 2025 survey of United States respondents, 67% report praying at least sometimes and 44% pray daily. About one American in three says grace (or prays) before meals “always or often.” For people affiliated with historically Black Christian churches, this number rises to approximately two in three.⁴ While Western Europeans are somewhat less religious than Americans, many from other parts of the world tend to view religion as even more central to their lives. In quite a few non-European countries, atheism—or at least a willingness to report atheism to pollsters—is virtually nonexistent; for example, in Bangladesh, Egypt, Pakistan, the Philippines, Nigeria, Thailand, Indonesia, Ghana, and Georgia (among others), less than one-half-of-one percent of people say they do not believe in God.⁵ As the United States becomes increasingly diverse, immigrants from such backgrounds become an ever-larger percentage of the public served by mental health practitioners.

People in need of psychological assistance may resist seeking care if they feel they will be openly or secretly denigrated because of their religious beliefs. The therapist-client gap in religiosity does not necessarily lead to insensitivity, but clinicians and patients report various difficulties that can impede therapeutic progress, even when everyone is well-intentioned.

Pastoral counseling can, of course, meet the needs of religiously observant clients who seek therapy within the context of a particular religious tradition. But plenty of people who do not choose this path still want—and would benefit from—a therapist with religious literacy and knowledge about faith-based issues.

How Current Practices Impact Clients

Though therapists exist at all levels of religiosity and a growing number today think of themselves as “spiritual but not religious,” many are uncomfortable discussing religious matters in therapy, and some—when they do consider organized religion—view it mainly as a source of dysfunction. This is partly a legacy from Freud, Ellis, and other founders of clinical psychology. In 1993, the prominent Yale clinician Seymour B. Sarason commented with some concern that, if a psychologist learned that a colleague was “... devoutly religious, or even ... [tended] in that direction,” most of the time he or she would “... look upon that person with puzzlement, often concluding that [the] psychologist [in question] had or has personal problems.”^6(p187) However, the reluctance to deal with religious matters also stems from a reasonable unwillingness to cross the line between therapy and proselytization for one’s own religious or nonreligious views, whatever they may be.⁷

Another concern is the inadequacy of clinical training in teaching practitioners to address religious issues in therapy.⁸ In one study, about one-fifth of therapists admitted to never discussing religious matters in therapy.¹ Several studies document psychologists’ belief that religion and spirituality have not been adequately addressed in their clinical education, despite the imperative to incorporate such issues as part of the diversity agenda.⁹

Sometimes, religious knowledge is needed to address specific client conditions. Research suggests, for example, that schizophrenia is no more likely among the religious. However, religiosity may influence how the condition manifests, for instance, in the content of particular delusions and hallucinations. Similarly, therapists might need some background in religion to distinguish culturally sanctioned religious behavior from pathology.¹⁰

What Should Be Done?

Mainstream therapy should not become faith-based, but several recent works have argued that neglecting religious issues can negatively impact the therapeutic process and client outcomes.¹¹ For starters, if a therapist seems uncomfortable or unreceptive to discuss religious matters, a client may not share problems and potential solutions steeped in religion because they fear an ignorant or negative response. Thus, a central part of the client’s life and significant resources for improvement would be inaccessible to the therapist.

Thousands of studies conducted over the past three decades have explored the relationship between religion and health, encompassing both physical and mental aspects.¹² It is now clear that religious beliefs and practices are often intertwined—for better or worse—with psychological well-being. Most meta-analyses of this literature conclude that, on balance, religious belief and affiliation are net positives. For example, the religiously affiliated seem to receive benefits in longevity, mental health, the ability to cope with severe illness, avoidance of substance abuse, and an obedience to the law. Needless to say, there is much room for debate about why these correlations occur and their generalizability. Park and Slattery¹³ offer one thoughtful model highlighting the many variables that mediate the relationship between religiosity and mental health outcomes.

Proponents of a greater integration of religion into therapy argue that the world’s religious traditions, both Eastern and Western, can sometimes be a source of insight and mental health.¹⁴ They suggest that religion can provide a positive outlook, hope for the future, a sense of control, a pathway to meaning, constructive role models, and an ability to integrate loss.¹⁵ No reasonable person would claim that religion always provides these benefits, and it is not hard to see how religion could be a destructive force for some clients. Regardless, the religious aspect of clients’ lives should often be examined in therapy by therapists who are at least willing to bracket their own preconceptions about faith. Even a modest familiarity with a patient’s religious practice can greatly support the therapeutic alliance.

Most psychologists would benefit from greater cultural competency in religious matters and from an evenhanded, open-minded, and more research-based attitude toward the role that religion plays in clients’ lives. Recently, some psychologists have argued in favor of formalizing religious and spiritual competencies for psychologists. Vieten and her colleagues¹⁶ developed 16 religious and spiritual competencies and evaluated their acceptability to a sample of practitioners. Applying these competencies to practice, a therapist needs to:

show “empathy, respect, and appreciation”¹⁶ for clients from diverse spiritual, religious or secular backgrounds;
understand how one’s own religious or nonreligious outlook might influence one’s clinical approach;
develop awareness of the kinds of experiences clients might have with religion;
acquire familiarity with research on religion, spirituality, and the psychology of religion;
help clients explore spiritual and religious resources that might aid in managing life concerns;
ask about spiritual and religious matters when they take a client history; and
consult with, or refer to, persons more knowledgeable about particular religious practices when needed.

The boundary between religious belief and health care may be growing more porous.¹⁷ Several scholars, for example, have proposed various models for integrating spiritual and religious matters more effectively into cognitive-behavioral and rational-emotive therapy.^18,19 Future research and debate should address whether and how these projects should proceed.¹²

Conclusion

Even if one accepts that religion and spirituality can be constructive forces, there are reasonable arguments for keeping some aspects of religion out of therapy. It is essential to avoid turning therapists into proselytizers or arbiters of questions of faith. The therapist possesses power, and such power could, of course, be abused. Still, given the history of negativity toward religion among many early theorists and practitioners of clinical psychology, the field would benefit from a serious and foundational reassessment of the desired relationship between religion and therapy. Therapists should evaluate just how porous they want the wall between religion and therapy to be. As with other aspects of one’s treatment approach, there is no reason to insist on a single solution or to require that one size fits all.

Nonetheless, nearly all psychologists would benefit from a richer understanding of the centrality of religious belief and practice in the lives of many who seek their assistance. After all, religion is commonly a defining aspect of a patient’s culture. Religion also frequently lies at the core of a person’s identity and self-definition. Few contemporary psychotherapists would consider it responsible to ignore matters of culture and identity, and it is therefore hard to see how the current neglect of religion can be justified.

REFERENCES

Treating Patients Impacted by Anti-White Racial Aggression

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:20:13 GMT

Abstract

This article examines anti-white racial aggression as an understudied phenomenon with significant implications for clinical psychology. While discrimination affecting other identity groups has been widely researched, aggression directed at white individuals remains largely absent from scholarly work and clinical training. Limited database findings, combined with academic discourse that portrays “whiteness” as pathological or morally suspect, may normalize hostility and obscure potential harms.

The article describes manifestations of anti-white aggression, including harassment, exclusion in workplaces and schools, institutional practices tied to diversity initiatives, and occasional violent incidents. It argues that such experiences can contribute to trauma, shame, anxiety, depression, hypervigilance, or reactive radicalization. Regulatory guidance that reframes these reports as “white fragility” is critiqued for discouraging validation and placing patients in a destructive double bind.

The author calls for systematic research, policy review, clinician education, and compassionate therapeutic services that recognize anti-white aggression alongside other forms of bias to support ethical practice and social cohesion.

Keywords: Anti-white aggression, racial discrimination, anti-racist abuse, whiteness discourse, clinical psychology, racial trauma

Racial discrimination, bias, or aggression toward people of any race is unethical. These experiences can affect people’s lives, leave lasting wounds, and negatively affect mental health. However, one form of racial aggression is often overlooked, namely, aggression directed against people for being white. Although many clinicians have reported observing this phenomenon in their patients, training and clinical services addressing this issue are almost entirely nonexistent.

Research Shortfalls

A search of existing papers on this topic in the most common psychology database, PsycINFO, yields alarmingly few results, none of which appear in prominent clinical psychology journals (see Table 1 below). While academic research has focused on the prevalence, effects, and interventions related to discrimination based on race, gender, and sexual orientation affecting other identity groups, there is hardly any research available in which the group in question is white.

^a Journal of Consulting and Clinical Psychology, Clinical Psychological Science, and Journal of Clinical Psychology. PsycINFO search conducted March 3, 2026.

What can be found, however, are academic papers that advocate in favor of anti-white discrimination, diminish concerns about anti-white bias, and use language that is hostile or demeaning toward white people. Anti-racist authors often argue that race is a social construct and that whiteness is a malignant identity or a way of thinking that needs to be eradicated.¹ Because whiteness as an identity construct exists in the minds of people, and it is assumed that white people can never be free from whiteness, they often become the targets of moral condemnation.² These theorists argue that white people are inherently racist,³ ignorant,⁴ fragile,² or privileged⁵ oppressors whose social structures and institutions need to be dismantled.⁶

For example, one academic paper describes white racial identity as a “malignant, parasitic-like condition” without a “permanent cure.” Such “parasitic whiteness renders its hosts’ appetites voracious, insatiable, and perverse.”^7(p355) Similarly, Noel Ignatiev^8(p30)wrote that “the goal of abolishing the white race is on its face so desirable that some may find it hard to believe that it could incur any opposition other than from committed white supremacists.” Carter J. Carter^9(p258)links whiteness to character pathology and even mass shootings. A widely circulated paper describes people with a white group identity as having “forms of pathological narcissism.”^10(p93) Another author^{11(para 2)}writes, “toxic whiteness keeps me bogged down in hesitation, fear, second-guessing, needs to get it right, and more.” These articles are full of language that communicates racial hostility and contempt.

Elsewhere, concerns about anti-white discrimination and its possible harm are framed as “whitelash.”¹² These concerns are therefore trivialized as a threat of status loss, where the mere expression of such concerns can be seen as a risk factor for delinquency.¹³ In most cases, this literature draws on a range of theories, such as critical race theory, decolonial theory, and whiteness studies, as theoretical lenses. Similar language and sentiments have made their way into multiple domains of civil society, including entertainment,¹⁴ news media,¹⁵ education,¹⁶ the corporate world,¹⁷ and politics.^18-19 The proliferation of anti-white animus has been rationalized and even moralized by claims that aggression directed at historically dominant or privileged groups is necessary for radical anti-racist activism.²⁰

Forms of Aggression and Bias

We can imagine how anti-white aggression and bias can take many forms. At its most extreme, this may include recent crimes that were racially motivated and perpetrated against vulnerable working-class underage girls.²¹ Accounts of serial sexual assaults against underage girls in the United Kingdom have emerged for many years, but only in recent months have they gained mainstream media attention and prompted some appropriate response by law enforcement. Estimates suggest that between 250,000 and 1 million victims were subjected to racially targeted sexual brutality. Exact numbers remain unknown due to investigative shortcomings by law enforcement, including fear of being deemed white supremacist or racist.²² As recorded in the Casey Report,^21(p135) “[P]olice and local authorities failed to investigate allegations of child abuse and rape because the victims were perceived as unreliable witnesses and through fear of being accused of racism.”

Other forms of anti-white bias and aggression include workplace and school bullying, verbal insults and harassment, hiring and selection discrimination, and training programs that deliberately or inadvertently humiliate²³ participants for being white.²⁴ Less obvious forms of anti-white bias may include neglect of the elderly, patients, children in foster care, and victims of crime. Some may also be aware of diversity, equity, and inclusion (DEI) initiatives in which white people, white males in particular, are excluded²⁵ from workplace hiring, promotion consideration, and training selection.

In February 2023, a group of Black elementary school students in Ohio assaulted white students and ordered them to say, “Black Lives Matter.”²⁶ Likely, the vast majority of incidents such as these never make the news. All this is to say that examples of the various types of anti-white aggression and bias are numerous.

Though empirical studies are lacking, it is clear that these incidents adversely affect mental health. For instance, in July 2023, a highly respected principal in Toronto, Canada, took his own life after he was falsely accused of racism during a DEI training course in 2021.²⁷ Information about similar cases is underrepresented, likely due to research exclusion.

As some may be aware, such anti-white sentiments and racially motivated discrimination have also reached the therapy room. Increasingly, clinicians and counselors report clients struggling with institutionalized discrimination and systemic indifference toward anti-white racism.²⁸

The standard guidance from British (e.g., see here²⁹ and here³⁰) and American regulatory bodies (e.g., see here³¹) has been to redirect and reframe the experiences of targets and bystanders of anti-white injustice as white fragility.^2,32 Targets of anti-white aggression and bias are often left disoriented and unsupported in a double bind: if they accept attacks against them, they are guilty, but if they challenge them, they are considered even guiltier. Understandably, such anti-white bias may have significant social and mental health implications.

Harmful Consequences

Depending on the form of anti-white aggression they experience, recipients of such action could:

develop clinical post-traumatic stress disorder following violent physical attacks perpetrated against them for being white;
experience shame and disorientation resulting from unfair hostility and discrimination, either directly or vicariously;
be burdened by a confusing double bind, feeling resentful about unfair discrimination while simultaneously feeling guilty for such resentment;
experience hypervigilance,³³ chronic stress, depression, and anxiety resulting from constant stigmatization at school, in the workplace, or in the media;
resort to racial radicalization or violent retaliation in response to racialized abuse; or
engage in self-destructive behavior or attempt to appease attackers through self-denigration, imagining that allyship and self-hatred might appease them.

Strikingly, none of these forms of anti-white racial aggression receives attention in mainstream civil society. Perhaps these experiences are dissociated, or individuals have been conditioned to accept them as normal. Yet for society at large, the normalization of anti-white aggression and bias could lead to significant problems, such as:

social fragmentation, eroding social cohesion and trust, as individuals in socially fragmented communities tend to become suspicious, withdrawn, and noncooperative;
relational deterioration among members of different groups, as individuals are reduced to group avatars;
heightened risk of escalating violence and retaliation among fragmented communities;
perceptual blindness and reduced empathy toward vulnerable individuals, such as victims of crime, the injured, the infirm and elderly, patients, and children; and
younger generations potentially experiencing identity confusion and diminished self-worth.

Remedies

Anti-white aggression ought to be addressed in policy, research, and practice like every other form of aggression. From a multifaceted perspective, this may include:

research into the prevalence, effects, and treatment of anti-white aggression and bias;
policy changes to eliminate systemic discrimination arising from ideologies such as critical social justice;
clinical services (individual and group therapy) that are free from divisive ideology, where clinicians genuinely empathize with the experiences of affected individuals and populations;
public education highlighting the harm of race-based essentialism and the demonization of all identities, including white individuals;
curriculum development and training for mental health professionals to adequately meet the needs of those who have experienced anti-white aggression and bias; and
protection and support for individuals who have experienced anti-white aggression and bias.

Conclusion

Racial discrimination, bias, or aggression toward people of any race is unethical. Being targets of such treatment can be painful, disorienting, and, in some cases, tragic. When these experiences are ignored, bias and aggression can become normalized. Popular discourse and anecdotal evidence suggest an increase in the incidence of anti-white aggression and bias, as well as apathy and perceptual blindness toward victims of such abuse.

Clinical attention and high-quality mental health services for this population are of utmost importance. These patients need therapists who are knowledgeable, open, and understanding, not those who judge, attack, or invalidate them. Additionally, research is crucial for determining the extent and impact of such events. This would improve understanding of the mental health effects of these experiences, which is necessary for developing effective interventions and promoting recovery in individuals and societies affected by bias and aggression directed against white individuals and communities.

REFERENCES

Improving Mental Health Care for Police Officers

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:18:02 GMT

Abstract

This article examines how therapists’ sociopolitical bias against law enforcement officers affects mental health care and synthesizes existing literature on anti-police rhetoric within mental health professions and its influence on therapeutic relationships. Cultural and organizational factors are reviewed regarding their effect on officers’ willingness to seek care, and evidence-based interventions and training approaches for therapists are identified. Findings indicate that negative narratives about police within mental health institutions can erode trust and discourage officers from accessing services. Recommended interventions include motivational interviewing, mentalization-based therapy, group therapy, cognitive-behavioral approaches, and family counseling.

Therapist training in police culture, trauma-informed care, and resilience-building is essential for fostering cultural competence and trust. Mental health professionals and their organizations must reject ideological approaches toward law enforcement and adopt balanced, fact-based perspectives. Implementing specialized training and culturally competent practices can enhance therapeutic alliances and improve mental health outcomes for police officers.

Keywords: Police, law enforcement, therapists, sociopolitical bias, mental health

“Therapists are not your friend and really could care less about you as a person. Never ever talk to them. They are liberal scumbags, or they wouldn’t be in that career.”¹

This police officer’s overgeneralization reveals a sentiment with more than a grain of truth: Many therapists have unsympathetic or even hostile views of the police. Recognizing this potential bias, this essay argues for developing and implementing effective strategies to address these negative views and promote effective mental health treatments for law enforcement officers.

Bias in the Mental Health Field Against Law Enforcement Officers

There is widespread anti-police rhetoric across the different professions involved in the mental health field. Typically, this rhetoric makes sweeping negative generalizations about police officers, fails to note evidence that contradicts these claims, and ignores the positive and challenging work police do for their communities. The result is language that makes many police officers feel misunderstood, attacked, or demonized. Examples of this are:

Many social work academics argue that the police are tools of “social control and White supremacy”² and perpetrate “structural violence.”³ They add that social workers should cease to collaborate with these agents “enforcing racial dominance.”⁴
A subfield within social work focuses on the complete abolition of the police.⁵
In 2022, the American Psychological Association adopted a resolution⁶ related to racism in policing, in which it officially endorses many claims of anti-police activists.
The Journal for the American Academy of Child and Adolescent Psychiatry has declared itself to be an “anti-racist journal,”⁷ thus linking itself to myriad contentious ideologies within anti-racist” thought (some of which advocate for defunding the police).⁸

Police officers’ overly negative portrayal, whether from academia or the media, often reflects a larger societal context that has adopted a social justice narrative about policing. Three simplistic ideas are popular in mental health organizations⁹ and academia:¹⁰

Traditional power structures are mostly harmful to society.
Discrimination is the fundamental cause of all unequal outcomes.
Problems should be seen primarily through the lens of race or gender or other markers of identity.

This language, which is now common in mental health institutions, professional bodies, and therapy services, could easily influence therapists to:

view police as agents of oppression rather than unique individuals;
conceive of law enforcement officers with simplistic, false narratives; and
have reduced empathy toward officers.

What does this mean for police officers themselves? This rhetoric could likely undermine police officers’ general trust in mental health professionals and discourage their use of services. Reasonably, police will monitor therapists for signals as to whether they hold views hostile toward the police. Conversely, expressions of gratitude and support for the police could meaningfully reduce these concerns.

Mental Health Needs of Law Enforcement Officers

The appropriate view from the mental health community should recognize that every law enforcement officer is an individual, requiring a personalized approach that reflects their needs, stressors, and treatment goals.

Therapists working with officers should consider the stresses of police work: trauma exposures, shift work, organizational stress, and disturbed sleep cycles. Law enforcement officers often interact with people at their worst. Police are scrutinized by the media and public and are easily criticized on social media. There is a reputational asymmetry; citizens and journalists can, and do, attack officers’ reputations by portraying their actions as misconduct. Yet officers have few opportunities to explain their perspective, and exoneration often takes years and does not make headlines.^11,12 Police may have good benefits and adequate salaries, but they are certainly not rich.¹³ Judging by the mass exodus from police work and the lack of recruits, being a police officer seems a less desirable job than ever.¹⁴

Law enforcement officers may witness terrible traumas, and their work leads to increased rates of emotional distress when compared to the public at large. Officers often suffer from compassion fatigue, emotional numbing, and cynicism.¹⁵

Most officers handle even traumatic events well, but some develop severe trauma reactions such as posttraumatic stress disorder¹⁶ along with work stress-related mental health disorders, such as depression and anxiety. Shift work is also hard on families. The public needs police around the clock, including holidays, meaning officers’ schedules often conflict with family routines and special gatherings.

Police officers require determination and toughness, values that sometimes conflict with asking for help. Officers must decide whether, over time, their symptoms will decline or whether they would benefit from professional mental health care. Fortunately, the law enforcement community has made a laudable effort to erode the stigma¹⁷ that portrays those seeking mental health care as lazy or weak. Yet, due to the critical nature of law enforcement, police administrators have procedures for removing officers who may pose a risk to themselves or the public. As a result, officers may worry that seeking help may signal an inability to handle their job, thereby risking their removal from active duty.

Adding to this complexity, there is wide variation among police departments in their administrative guidelines, support systems, and culture regarding mental health. Many departments devote considerable resources to making psychotherapy available and to encouraging officers’ participation. Some departments even mandate a yearly mental health check-in. However, other police departments maintain a skeptical culture toward psychotherapeutic approaches and may actively stigmatize engaging in mental health treatment. These differences necessitate that therapists become familiar with the local administrative structure and culture and adapt their clinical approach accordingly.

Promising Interventions to Improve Mental Health Care for Law Enforcement Officers

Given the specific needs of police officers seeking help, we can identify potential interventions. To start with, innovative programs can combine technology with anonymous surveys to identify officers most likely to benefit from these services and help them access them.¹⁸ Police officers’ mix of physical and emotional stressors¹⁹ suggests that physical wellness programs are desirable to encourage healthy lifestyles and vigorous physical conditioning and reduce substance abuse.

The following approaches could be helpful in the clinical setting:

Motivational strategies aid by prioritizing goal setting and addressing barriers to change²⁰
Mentalization, the ability to notice, access, and reflect on mental states in oneself and others, is an important skill for police and may be an important focus of training for both interfacing with the public and as a focus in individual therapy.²¹
Group therapies, whether online or in person, show promise for destigmatizing and efficiently spreading mental health treatment while utilizing the benefits of the group process.
Cognitive behavior therapy approaches have been applied to police,²² as have solution-focused therapies.²³
Family and marriage counseling may be especially beneficial for law enforcement personnel.²⁴
Favoring directness over ambiguity, especially regarding confidentiality and transparency about the therapist’s process, helps to promote trust.

However, none of the above approaches is likely to work if police officers do not trust their therapists. Police counseling referral networks need to create a supportive, collaborative, and confidential environment. It is important to ensure that therapists are equipped to collaborate effectively with police officers. Therefore, specialized training programs and workshops should be developed to address the unique challenges and stressors faced by law enforcement personnel. This training should include:

building skills in trauma-informed care, resilience-building techniques, and evidence-based approaches tailored for the police community;
contributions from approaches across a range of psychotherapy modalities;
a comprehensive understanding of police culture and experiences; and
incorporating peer consultations, a ride-along with current officers, or training from former officers to provide therapists with practical insights into the experience of law enforcement.

These practices should enable therapists to use specific, actionable steps to signal cultural competence, including knowing common acronyms such as “arrested person” (AP) and “field training officer” (FTO), as well as knowledge of terms such as “brass” (used for command-level staff or high-ranking officials who are no longer on the street.

Therapists should demonstrate knowledge of the basic daily challenges of law enforcement, including heavy paperwork loads and the stressors associated with high-stakes interactions with the public. They should signal that they understand that police work may, for better or worse, engender tight-knit camaraderie and allegiance to other officers but could also lead to tribalism and wariness toward outsiders. Police may also develop hypervigilance, which can be problematic, but also serves as a functional adaptation and survival trait.

To better prepare for this work, mental health professionals can access a wide range of books, including Gilmartin’s well-regarded text, Emotional Survival for Law Enforcement,²⁵ among others.^26,27,28 Likewise, several documentaries, series, and movies provide windows into some aspects of police work. For instance, the series “Southland”²⁹ is cited as an accurate portrayal of off-duty life, whereas “The Wire”³⁰ is a representative portrayal of jurisdictional squabbles, manipulation of crime statistics, and the tedium of investigative work. The movie “End of Watch”³¹ is known for its portrayal of the camaraderie between partners and the daily transition from high-intensity calls to the mundane. While engaging with popular media may seem like an unconventional form of clinical preparation, doing so can provide therapists with a richer, more nuanced understanding of the law enforcement world and, ultimately, enhance the quality of care they provide.

Conclusion

Some mental health professionals promote negative views of police officers and morally elevate, promote, and apply police-hostile theories through aforementioned policy statements, training programs, and scholarly journals. Mental health professional organizations must condemn anti-police rhetoric arising from within their own ranks. Therapists must replace anti-therapeutic ideologies for intellectual humility and an open exchange of ideas and focus on helping individuals.

Mental health professionals, and the organizations that represent them, should espouse balanced, fact-based views toward law enforcement, including noting research that raises questions about pervasive racism and acknowledging positive trends in policing and the criminal justice system.^32,33,34

There is no evidence that American police are especially racist, callous, or corrupt.³³ The police did not create, nor can they solve, all of society’s problems. It is troubling that ideological approaches, under the banner of mental health, have undermined trust with the law enforcement community. Those in mental health need to acknowledge and correct these problems.

REFERENCES

Recovery from Transition: Psychotherapy with Detransitioners

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:15:40 GMT

Abstract

This article examines the growing population of individuals who detransition or experience regret following medical transition, with particular attention to the psychological, clinical, and ethical challenges they face. Drawing on clinical experience, peer-reviewed research, qualitative studies, and media accounts, it highlights a persistent shortage of evidence-based therapeutic support for this group. The article argues that professional reluctance to engage in exploratory or non-affirmative care, shaped by political, institutional, and reputational pressures, has contributed to significant gaps in care. It reviews emerging evidence on detransition, including reported mental health comorbidities, social isolation, and physical complications associated with hormonal and surgical interventions, while acknowledging substantial limitations in the current research base. The article concludes by calling for cautious, developmentally informed, and psychologically grounded approaches to gender dysphoria, alongside urgent investment in longitudinal research and competent therapeutic support for individuals navigating detransition.

Keywords: Gender dysphoria, detransition, desistance, psychotherapy, gender-affirming care, mental health outcomes, clinical ethics

Recovery From Transition

Over the past decade, gender dysphoria has emerged as one of the most complex and sensitive issues facing young people, families, and clinicians. Since at least 2017, a sharp rise in adolescents seeking support for gender-related distress has drawn increasing clinical and public attention.^1-3 Central to this trend has been overwhelming demand for thoughtful, well-informed therapy—and a corresponding shortage of services willing to support those whose distress is not resolved through transition.

This demand for appropriate services has outpaced what individual practitioners can offer. Some organizations are now advocating for a nonmedicalized, evidence-based approach to gender dysphoria, including support for those questioning or reversing medical transition (e.g., Genspect).⁴ The stated goal of such organizations is to ensure that individuals struggling with identity are met with curiosity, compassion, and clinical integrity rather than being rushed toward a medical pathway. In other words, they argue that gender nonconformity should not lead to medical intervention, maintaining that children should be free to explore and express themselves without being labeled transgender or subjected to irreversible treatments.⁵

Moving Beyond a Medicalized Approach to Gender Dysphoria

Background for this paper was gathered through the Beyond Trans initiative,⁶ a program that offers daily online support groups and therapeutic services for families, detransitioners, transgender individuals, and those experiencing distress following medical transition. To date, these services have reportedly reached over 400 detransitioners and more than 1,200 parents affected by these issues.

Clinicians facilitating these groups routinely encounter individuals who feel isolated, regretful, and abandoned by the systems meant to support them. Despite growing need, access to psychological care remains limited, as professionals offering exploratory or non-affirmative care to detransitioners face political pressure and professional risk. High-profile controversies involving researchers who examined detransition and regret have reinforced this climate of caution.^7-9 Kenneth J. Zucker, one of the most prolific researchers in childhood gender dysphoria, published extensively on this topic,^10-12 yet his leadership of the Centre for Addiction and Mental Health gender identity clinic later became the subject of institutional controversy and legal settlement.¹³

Clinical work with individuals who have detransitioned reveals the complexity of this process. The decision to detransition often follows years of psychological struggle, with many individuals experiencing heightened suicidality during this uncertain stage. Social rejection and isolation are common, compounding the emotional burden.¹⁴

Long-term outcome data for both transition and detransition remain limited, underscoring the need for prospective, longitudinal research that tracks mental health trajectories over time.¹⁵ Detransition appears to be increasing, possibly due to the rise in medical transitions or the influence of the gender-affirming model, which is patient-led and centers on self-identification, often resulting in medical intervention.¹⁶ However, limited research, shaped by broader reluctance to study detransition, makes it difficult to determine prevalence or causal pathways.¹⁵

Increasing Numbers of Detransitioners

The Reddit forum r/detrans¹⁷ had fewer than 1,000 members in 2019; as of this writing, it has over 57,000. This pattern likely reflects increased visibility rather than reliable prevalence data in a field where detransition remains understudied. Media reports now frequently feature detransitioners whose accounts often involve regret, isolation, and irreversible medical outcomes. These experiences warrant greater attention from clinicians, researchers, and policymakers alike.

Existing quantitative research on detransition is limited by small sample sizes, reliance on self-selected participants, short follow-up periods, and institutional or ideological constraints that have discouraged systematic investigation of regret, reversal, and adverse outcomes.^18-23

Vandenbussche (2022)¹⁴ surveyed 237 detransitioners and desisters—92% female and 8% male—recruited from online communities. Desisters are individuals who no longer identify as transgender and have not undergone medical transition, whereas detransitioners have medically transitioned and later reversed course. The study found that 70% attributed their gender dysphoria to underlying issues such as mental health difficulties, trauma, or internalized homophobia, and many reported that they had been inadequately informed about the treatments they received.

Psychoanalyst Lisa Marchiano (2021)²⁴ documented the case of “Maya,” a distressed adolescent with an eating disorder who underwent medical transition and later detransitioned. In the same article, she referenced “Livia,” a woman who regretted transitioning after undergoing a mastectomy at 20 and a hysterectomy at 21. Reuters²⁵ profiled Max Lazzara. At 14, Max began questioning her gender identity and found affirmation through online communities. By 16, she had started testosterone, and at 18, she underwent a mastectomy. Although she initially felt relief, her mental health later deteriorated, resulting in renewed suicide attempts, substance abuse, and disordered eating. In 2020, she came to identify as a lesbian, ceased testosterone, and now regrets that medicalization was offered as the solution to her distress.

Meanwhile, the New York Times²⁶ recounts the story of Grace Powell, who, as a teenager, believed transition would resolve her distress related to puberty, bullying, and depression. She began cross-sex hormones at 17 and later underwent a double mastectomy, yet underlying issues, including past trauma, were not explored before her transition was affirmed. She has since detransitioned and expressed regret. Paul also profiles Kasey Emerick, who grew up in a conservative Christian community and transitioned to escape the stigma of being a lesbian. After five years living as a trans man, Emerick realized her mental health had worsened, detransitioned in 2022, and faced intense online backlash.

Littman (2021)²⁷ found that 55% of 100 detransitioners reported inadequate evaluation before transitioning, 38% linked their dysphoria to trauma, abuse, or mental health issues, and 23% cited homophobia or difficulty accepting their sexual orientation as contributing factors in both transitioning and detransitioning. Similarly, Vandenbussche (2022)¹⁴ reported that 52% of detransitioners and desisters expressed a need to cope with internalized homophobia. These findings highlight the importance of addressing underlying psychological issues in therapy rather than reinforcing the belief that medical transition is the only path forward. However, internalized homophobia is only one of many challenges detransitioners face—unacknowledged comorbidities also pose significant barriers to recovery and well-being.

Challenges Facing Detransitioners

Working with detransitioners can be among the most meaningful, and at times harrowing, aspects of clinical practice in this area. These individuals typically view their medical transition as a form of self-harm and deeply regret the hormonal and surgical interventions they underwent, highlighting the potential risks of medicalization.

In the Beyond Trans support groups, participants frequently report deep regret regarding hormonal treatments, mastectomies, vaginoplasties, hysterectomies, and other irreversible procedures. Detransitioners remain a minority within a minority, yet their perspectives are essential to fully understanding the realities of gender dysphoria.

Consistent accounts reported by detransitioners underscore the urgent need to approach gender dysphoria with caution, compassion, and a focus on long-term well-being.^27-28 Internalized and externalized homophobia is a recurring theme in clinical work with this population. Many young people who later identify as gay, lesbian, or bisexual describe struggling to accept their same-sex attraction and now regret pursuing medical transition as a way to “trans the gay away,” a phrase commonly used online to describe this phenomenon.

Physical complications from medical transition are a constant source of distress for group participants. Long-term follow-up studies of cross-sex hormones and surgical interventions document risks including bone density loss, cardiovascular complications, sexual dysfunction, and chronic pain.^{15,18-19,22,27}Combined with deep regret over harmful medical interventions and sadness over lost years, these challenges create an almost unbearable burden. The age range of participants is striking, spanning from 18 to 85 years.

As awareness of detransition grows, so too must the willingness of clinicians and researchers to listen without defensiveness or ideological bias. Those who come to regret medical transition are not anomalies or statistics; they are individuals whose experiences expose critical gaps in clinical practice, healthcare systems, and cultural assumptions.

The field owes it to these individuals to take their experiences seriously. This includes investing in robust psychological support, ensuring proper assessment and informed consent, and creating space for identity exploration without rushing toward medicalization. Above all, it requires compassion—not only for those who transition but also for those who choose a different path.

REFERENCES

Cultural Misunderstandings: On the Misuses of the Term “Culture”

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:13:05 GMT

Abstract

Misuses of the term “culture” are explored in a contemporary discourse on mental health. Two models illustrate the contrast between them: the trait model (now predominant), which treats culture as a static identity trait (e.g., demographics such as race), and the meaning system model, which is dynamic and akin to an anthropological concept of culture. The trait model is compared to the psychoanalytic concept of “fetish” in that it focuses narrowly on a concretized part of a person rather than the whole. It can have corrosive effects, such as reductionism, dehumanization, divisiveness, and the impoverishment of language. Finally, the healing and enriching effects of the meaning system model, such as depth, complexity, and true diversity, are addressed. Ultimately, a richer understanding of the term culture can bridge ideological pitfalls, offer greater clinical utility, and provide an escape from the traps of identity- and trait-based framing.

Keywords: Culture, trait, race, meaning system, identity politics

In recent decades, the concept of “culture” has been widely used in mental health as a kind of buzzword in the field.¹ It’s seen in cultural diversity, cultural competence, cultural humility, multiculturalism, and other hotly contested terms. At its best, culture can refer to the rich, myriad dynamics that shape and give meaning to people’s lives, but in contemporary practice, it often serves as shorthand for demographic categories emphasized by progressive social justice frameworks—particularly race, gender, and sexual orientation. This represents a significant conceptual error. When the term culture is reduced to race or other demographic traits, it blinds us to real human diversity and the complex processes through which we can comprehend ourselves and one another.

Static Trait vs. Dynamic System

Two contrasting models of culture illustrate how each leads to very different understandings: culture as a trait and culture as a dynamic system.

Culture as a trait (e.g., race): This view dominates much of today’s discourse. Material indicators of culture (e.g., demographic categories) render culture a static and concrete trait. This model is shallow and partial, leaving out so much of culture. It can encourage labeling of oneself or others in ways that deny human complexity; and
Culture as a system: This view adds depth and complexity. Cultural systems carry knowledge, practices, and values through generations. Used this way, culture is closer to a story than a label. Broader and deeper than any person or trait, it’s the context within which we live. It extends beyond racial categories to include, for example, American or Catholic culture.^1,2,3 Anthropologists study culture as a meaning–system, and a theoretical lens, such as Cultural Psychology,⁴ explains the back and forth between culture and psyche: Culture shapes each person’s upbringing, just as each person in turn helps shape the next generation through cultural norms and interactions.

Given that the system model offers much greater depth and accuracy in defining culture, why is the trait model ascendant? In part, the trait model is appealing precisely because it provides oversimplified, concrete ways to understand vexing problems.⁵ Society is in flux, and complex models are harder to understand. The culture-as-trait model could reduce anxiety and distress about this flux and complexity, making culture feel more knowable and controllable, even as it hollows out the concept of its richness.

This reductionism resembles the psychoanalytic concept of a “fetish.” Here, fetish doesn’t refer to “kink,” but to a narrowness, a fixation, or a maladaptive focus on concretized manifestations of desire. Consider the classic example of a foot fetish. Attraction for a whole person collapses into desire for a part-thing, such as a foot. Similarly, today’s trait model of culture preoccupies itself with part-things such as skin tone or genitals—things that aren’t culture at all, but appear as partial representations of it. Fetishizing superficial traits can reduce distress and uncertainty, but doing so can also erase our humanity.

The Psychosocial Toll

The trait model of culture can cause several problems:

It’s reductionistic: Forcing people into procrustean beds of trait labels or body parts closes our eyes to internal nuance and paradoxical aspects of character. Therapists are now trained¹⁰ to impose racialized categories¹¹, even for clients who don’t primarily view themselves or their problems that way. Tying people too closely to these categories can prevent them from accessing individuality and depth, reduce them to superficial traits, or deny them free will;
It derails human connection: The trait model prominently uses labels such as “Asian” to categorize people, but this can misdirect away from genuine human connection. For example, it grossly oversimplifies the enormous variation in cultures and histories among (including conflict between) Asian societies. The label Asian may conflate a young, urban, Korean secular Marxist woman and an elderly, religious, rural Japanese CEO man, overlooking vital aspects of culture and character that are as important, if not more important, than shared connection to the Asian landmass;
It impoverishes language: Trait identity labels often oversimplify, confuse, or demean more than they describe or comprehend. For instance, “LGBTQIA” lumps together several groups (lesbian, gay, bisexual, transgender, queer, intersex and asexual), but it isn’t clear how same-sex attraction (body intact and comfortable) increases comprehension of or affiliation with someone else’s gender dysphoria. This fixed categorical structure of traits is poor. By contrast, cultural meaning systems are rich, played out in stories where character development and nuance can be fleshed out; and
It divides: When identity traits define cultural categories, people get equated with those categories and traits. But this fuses the thought with the thinker¹². Instead of a person with an idea to consider, one becomes a mere avatar or representative of group membership, purportedly representing the group as a block. Today, people often begin statements as follows: “speaking as a … ” [fill in group identity trait here]. Such conflation of thought and thinker presupposes that a person adheres to their group’s line of thinking, quashing a person’s individual freedom to think. It also undermines efforts to disagree civilly, because once one’s idea is fused with one’s identity, then any attack on one’s viewpoint feels personal. Thus, the trait culture approach pits group against group, and culture wars become ever-present and intractable.

Escaping the Culture Confusion Trap

True culture is fascinating and evocative, like a novel, the arts, or cinema. A person, an education, or the arc of a therapy can be fruitfully understood in this way. In contrast, fetishized culture diminishes anything or anyone viewed through that lens. No one should be regarded as a mere set of concrete traits, least of all by professionals, whose job it is to see beyond—not be bound within—dehumanizing tendencies.

The recognition of culture as a meaning system helps therapy in the following ways:

True diversity: Therapists mindful of dynamic cultural systems can more effectively embrace diversity: varied perspectives, intergenerational values, mythic tales, spiritual accounts, art and architecture, families, and other social bonds;
Bridging ideological pitfalls: Controversies such as policing and race can impair treatment if a hot topic detracts from psychological awareness or if there’s a perceived incompatibility between the client and the therapist. Such topics are often viewed exclusively through a trait-culture lens (i.e., assuming trait discrimination is the only explanation for bad events). Therapists can more fully comprehend ideological preoccupations and navigate disagreements by familiarizing themselves with cultural accounts^6,7 that acknowledge discrimination while moving beyond superficial trait-level thinking;
Depth of experience: The trait model emphasizes competitive group status (e.g., privilege), whereas deeper comprehension is invited in the meaning system model. A therapist’s duty is to help improve one’s sense of meaningfulness in life, regardless of one’s group or status. Grief stings no less—and sometimes more—if good luck has been had in other ways. The delights of life should be honored for everyone, perhaps especially for those who’ve experienced too few joys; and
Clinical utility: Culturally rich concepts such as “disgust” and “soul” have immense therapeutic value. For example, they predict judgments about suicide.⁸ Therapists aware of authentic culture can more readily explore feelings surrounding concepts such as disgust or soul with the many patients who could benefit from such exploration. Superficial culture-trait labels lack such depth.

None of this should suggest that trait-related cultural labels should be dismissed out of hand. When traits embody deep, enduring meanings, those should be honored. The point, instead, is that therapists should be alert to deeper resonances rather than accepting superficial labels or identities as the sole determinants of a client’s cultural experience.

Conclusion

Our society is now gripped by a harmful fixation. It mistakenly views culture as a set of traits rather than the dynamic meaning system it properly is, causing psychology to fall into an identity politics trap⁹ that concretizes and demeans people rather than elevating them and engaging in their complexity. By shifting toward a more dynamic and accurate view of culture, we can avoid these traps, improve mental health care, and help people access their uniqueness, humanity, and depth.

REFERENCES

Antisemitism After October 7: Problems on Campus and the Mental Health Response

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:11:46 GMT

Abstract

In the aftermath of the October 2023 Hamas attacks, Jewish college students have faced increasing antisemitism on university campuses, accompanied by significant psychological distress. This article examines the mental health consequences of contemporary campus antisemitism for Jewish students and the secondary impact on Jewish parents navigating institutional failures. Drawing on emerging research, trauma theory, and reports from higher education settings, the paper identifies common stressors, including exposure to graphic violence, social invalidation, ideological exclusion, and perceived threats to safety and future opportunities. Attention is given to traumatic invalidation in therapeutic and administrative responses. The authors conclude with practical recommendations for clinicians, ethical considerations regarding therapist self-disclosure, and directions for future research.

Keywords: Antisemitism, multicultural competence, clinical bias, Arab-Israeli conflict, campus climate, diversity equity and inclusion

Since the October 2023 Hamas attacks, antisemitism has emerged as a particularly significant issue on college campuses. This has resulted in discrimination, aggression, harassment, and other forms of bias—each of which are likely impacting students’ mental health. The ideological climate on campus has also had a negative impact on the delivery of psychological services that Jewish students have required. Part One of this article outlines the background of trends in the United States and the therapy profession. Part Two examines the implications for Jewish students and their parents.

Part One

Antisemitism is immensely complicated. As journalist Bari Weiss has noted, it is “a shape-shifting worldview that slithers away just as you think you have it pinned down.”^1(p18) The Jew hater on the right or left may attack an individual, people, culture, or state. Sometimes the Jews are denounced as capitalist right-wingers; on other occasions, they are seen as communist leftists. They may be perceived as race contaminators or as the last remnant of an evil and racist colonialism. Theorists have seen the roots of antisemitism in religion, economics, politics, ideology, sociology, and psychology. No doubt, all these forces have been important in various contexts.^2-4

Psychologists and other social scientists—despite extensive training in prejudice and discrimination—often misunderstand the history and logic behind contemporary antisemitism, which limits their ability to recognize it when it appears in clinical or institutional contexts. What seems on the surface like a response to a recent event may, in fact, be the product of much more. Antisemitism can be linked to religious beliefs, contain underlying views that seem purely political (especially anti-Zionism), or animate a myriad of conspiracy theories.

Over the past several decades, therapists have received extensive training in the psychology of prejudice, discrimination, and systemic bias. This training may have improved clinical sensitivity to some marginalized groups, but it is often ill-suited to understanding contemporary antisemitism. This gap is not merely theoretical. It has direct implications for assessment, empathic attunement, and ethical clinical practice with Jewish clients.

To complicate matters further, in recent years, antisemitism empirically has often been most intense in people who themselves have been victims of discrimination. This dynamic can be particularly confusing in clinical settings, where therapists may assume that individuals or movements rooted in experiences of oppression are unlikely to perpetuate serious prejudice themselves. Such assumptions can inadvertently undermine clinical neutrality and empathetic responsiveness, causing therapists to miss a big part of the story.³

The Current Moment:

Despite the historical prominence of Jews in psychotherapy, quite a few contemporary therapists have been ill-prepared to meet the needs of the many Jewish clients that have emerged following the Hamas attacks of October 2023. In part, this problem is a consequence of a widespread failure to grasp or acknowledge how rapidly the circumstances of Jews have deteriorated in recent years around the world, in the United States, and, above all, on university campuses.^5,6

Moreover, the ideological predilections of many psychologists and counselors, including some therapists who hail from Jewish backgrounds, have rendered them especially unlikely to provide helpful services at this critical time for Jewish students—in particular, to those who identify religiously or as Zionists.⁷ Too many therapists have allowed their sympathy for anti-Zionist political positions to interfere with their ability to empathize with the pain resulting from October 7th and its aftermath. In their eyes, the Jewish students have not experienced bias or mistreatment; instead, the perpetrators are just people on the other side exercising “free speech” in service of a just cause. For some, the “justice” goals of society (as they see them) have been prioritized over patient needs. Deficiencies in how the antiracist community has conceptualized antisemitism also contribute to insensitivities, as do some inadequacies in clinical training.⁸

For many Jews in the United States and abroad, the atrocities of October 7th, the murder of hostages, and the perceived abandonment of Israel by the far left have been personal events with personal consequences. The prominence of the anti-Israel left on campuses where students live and work and the perceived tolerance for antisemitism by some university officials have amplified these consequences for many young Jews. Much research has documented the adverse effects of perceived discrimination on psychological well‑being.⁹Reactions to antisemitism can include anxiety, depression, low self‑esteem, reduced life satisfaction, and feelings of marginalization, as well as physical symptoms.^10-11

Several weeks after the Hamas attacks, FBI Director Christopher Wray declared that antisemitism was reaching “historic” levels and “the Jewish community is targeted by terrorists … across the spectrum,” including foreign and domestic militants.¹² The United States House of Representatives approved (with bipartisan support) a resolution that condemned support of terrorist organizations and denounced antisemitism on college campuses. Supporting the resolution, Utah Republican Representative Burgess Owens said, “Hateful acts of antisemitism are spreading like wildfire across American college campuses.”¹³ President Biden similarly announced his concern about the rise in campus antisemitism.

Some are, of course, inclined to dismiss this as not antisemitism, but rather a response to the devastation caused by Israel’s counterattacks in Gaza. This explanation does not work for many reasons, especially because campus rhetoric was prominent well before that counterattack. More generally, others have suggested that what happened on campus was not antisemitic but merely anti-Zionist. To see evidence against this position, consult Nelson or Kesslen.^14-15

Therapists need not share the political, religious, or ideological views of their clients, but they should be culturally sensitive and aware of basic facts affecting the lives of those they counsel.¹⁶ Many current therapists who are not ideologically biased still do not have the necessary training to be helpful.

Recent History of Antisemitism in the United States:

Antisemitism in the United States was intense and widespread in the 1930s, but surveys showed a dramatic drop by the 1970s, and levels remained fairly low for decades. Many Americans expressed positive sentiments about Jews and overwhelming sympathy for Israel in the Arab-Israeli conflict. However, perhaps starting about a decade ago, things began to change—at least in some subgroups of the population⁵:

A study of FBI statistics indicated that anti-Jewish hate crimes increased 63% from 2023 to 2024.¹⁷
Another 2024 study found that, although most non-Jewish students showed no hostility toward Jews or Israel, about a third did hold such negative feelings.¹⁸ Almost a quarter of non-Jewish students overall said they did not want to be friends with people who supported Israel’s existence as a Jewish state. Many sympathized with Hamas, despite its overt antisemitism, advocacy of violence toward civilians, and designation as a terrorist group by the United States government.¹⁹
A 2020 Pew study found that 45% of Jews in the United States thought there was “a lot” of antisemitism in the country; an additional 47% thought there was “some.”²⁰ This finding might capture incidents that are not reflected in studies of hate crimes and survey reports.

Antisemitism and the Therapy Professions:

Despite these findings, antisemitism is not generally addressed in any depth in multicultural materials used to train psychologists, psychiatrists, and others who deliver mental health services.^10,21 Textbooks and courses in racism and discrimination—sources for many therapists—also tend to ignore or downplay contemporary hatred of Jews.^2,22-23 Moreover, according to at least one qualitative study, students who, during their training as counselors, attempt to raise concerns about the omission of Jews from multicultural modalities can find themselves bullied and ostracized.²⁴ On the other hand, one recent empirical study found that Jewish therapists who made a special effort to treat Jewish patients post-October 7th or who engaged in pro-Israel activity sometimes found themselves feeling marginalized within broader therapeutic spaces.²⁵ They also reported experiencing burnout and stress without adequate supportive mechanisms.

While the concept of microaggressions is somewhat controversial, it is widely employed in counseling and psychotherapy contexts. Hodge²⁶ lists several categories of microaggressions that specifically relate to Jews: exoticizing Jewish spirituality, assuming uniformity among the Jewish population, sanctioning antisemitic tropes and stereotypes, and denying the existence of antisemitism. A recent German study similarly concluded that Jewish mental health suffers in response to a broad range of antisemitic acts—even those that do not seem to be major hate crimes.²⁷

After the reaction to the 2023 Hamas attacks, some newspaper headlines referred to Jewish feelings of abandonment by the left, which many Jews previously had thought of as allied in the war against hatred.²⁸ Some writers further charge that neglect of antisemitism may, paradoxically, be strongest in parts of the antiracist and human rights communities.^23,29 Speaking about antisemitism associated with the Israel-Hamas conflict, Senator Chuck Schumer, the Senate majority leader, claimed that the antisemitic bigots “aren’t neo‑Nazis, or card‑carrying Klan members, or Islamist extremists. They are in many cases people that most liberal Jewish Americans felt previously were their ideological fellow travelers.”³⁰

Especially in the aftermath of the 2023 Hamas attack—but also before—journalistic reports asserted that some elite universities had become centers of anti‑Zionist and antisemitic sentiment.³¹ Many Jewish students have become so uncomfortable on university campuses that large numbers are now considering the campus culture of hatred for Jews in making decisions about where to attend.

Still, psychologists—despite their history of important work on the Holocaust—have devoted notably little attention to contemporary antisemitism. The topic is essentially absent from texts and courses dealing with racism and bigotry.²³ As David Bernstein²⁹ has argued, diversity, equity (DEI), and inclusion programming tend to exclude it, often on the grounds that Jews are deemed to be privileged within the societal power structure.

Despite the positive opinions that many Americans hold regarding Jews, the threat of antisemitism has grown substantially in recent years, with its effects felt acutely in academic settings. The response of clinical and research psychologists to this growing bigotry has been inadequate, and—as a result—Jewish students have suffered. The central claim of this article is that misunderstanding antisemitism is not simply an academic problem. It is a clinical problem. When therapists lack an adequate conceptual framework for antisemitism, they are at greater risk of misdiagnosing distress, invalidating clients’ experiences, or allowing ideological commitments to interfere with therapeutic judgment.

Part Two

As previously noted, antisemitic incidents have seen a marked increase since the October 7th Hamas-led terrorist attack in Israel, with school campuses seeing a sizable number of reported incidents. This increase, coupled with the inadequate response by many administrators and educators, has serious implications for the mental health of Jewish students and for Jewish parents who must rethink how to support their children as they face antisemitism on campuses across the United States.¹⁵ This article focuses on the psychological consequences of campus antisemitism, common clinical presentations among Jewish students, and challenges that arise when therapeutic or institutional responses are shaped by ideological commitments.

Mental Health Implications of Current Antisemitism for Jewish Students:

Jewish students on campus are likely to find therapists steeped in a DEI ideology that frequently downplays the prevalence and intensity of antisemitism, according to Hodge and Boddie.²¹ Yet, during the past year, Jewish students have experienced a host of problems for which many seek counseling and therapy.^5,32-33

Perhaps the most significant psychological stressors are associated with watching the videos documenting Hamas atrocities.³⁴ Clinicians and researchers have shown that viewing videos of the murders and sexual assaults of October 7th can frequently result in posttraumatic stress disorder and other forms of intense anxiety.^35-36 Depression and physical symptoms occur often. The subsequent release of films showing tortured and terrified hostages over a lengthy period has been immensely challenging for many students.

The psychological consequences are even more devastating for students with family in Israel and those who identify emotionally with the young people who were brutalized during a peaceful music festival in the desert. After all, some of the hostages (such as Edan Alexander) are Jews who were raised in the United States. All of this can become intensified and extremely psychologically disorienting for Jewish students who see administrators, faculty, and other students—some Jewish—who do not share their horror at Hamas activities and who may even express sympathy for the perpetrators of the atrocities. Many Jews are frustrated that they cannot convince others that “Globalize the Intifada” and “From the river to the sea” are calls for violence against them. Additionally, the release of the living hostages and the return of the bodies of murdered hostages have not diminished the trauma for many. Many people experience symptoms in reaction to the atrocities, videos, lack of support, and active attacks by fellow students and faculty.

A wide range of problems may stem from the attacks and responses observed on campuses. There is, of course, some degree of actual terroristic threat, and while this may not be highly probable, the perceived threat may loom large in the minds of some students. Recall that after 9/11, many millions of Americans worried intensively about becoming victims of terrorist attacks, even though the actual risk was minimal.³⁷ More commonly, issues associated with the reaction to October 7th can cut to the core of student identity, impacting friendships, romantic involvements, and career ambitions. Such concerns can easily become psychologically consuming and a dominant clinical concern for Jewish clients. At the very least, events on many campuses have caused a segment of Jewish students to feel alienated from their universities and various campus institutions. They may face:

a loss of friendships after October 7th due to political realignment;
exclusion or mistreatment by DEI policies and officials;
a sense that they are targeted by Boycott, Divestment, and Sanctions (BDS) resolutions and—sometimes—a need to switch academic majors away from disciplines that have endorsed BDS (e.g., some anthropology, American studies, and women’s studies departments);
if desired, an inability to find supportive LGBTQ+ and feminist organizations (where such organizations are dominated by anti-Zionists);³⁸
psychological—and sometimes physical—harassment by pro-Palestinian and pro-Hamas campus activists (especially where encampments existed);
difficulty establishing certain careers in certain fields (e.g., in the arts, academia, and human rights) where DEI, BDS, anti-Israel, and antisemitic attitudes predominate; and
fears concerning a future where demographics and politics seem likely to make things worse.

It is worth pointing out that some parts of the mental health community are so ideologically involved that a quarterly magazine of the British Association of Counselling and Psychotherapy rejected a previously accepted piece on the trauma many Jews experienced post-October 7th because of “unease” about possible “ramifications.”³⁹ The magazine ultimately relented and published the piece on its website when accused of censorship.³³

All these issues deserve the attention of sensitive therapists. Unfortunately, many Jewish students worry that they will encounter antisemitic or anti-Zionist therapists who consider the promotion of Palestinian activism as one of their therapeutic goals.^7,40 Recently, Bar-Halpern and Wolfman³² have applied Linehan’s⁴¹ notion of traumatic invalidation to explain the predicament some Jewish students face in seeking support from administrators, professors, fellow students, and above all, psychotherapists. They write, “Rather than being met with compassion and care, many were instead met with a stunning mix of silence, blaming, excluding, and even outright denying the atrocities of October 7 along with any emotional pain stemming from them.”^32(p1367) Such invalidation, especially when it comes from significant people in one’s life, such as good friends, professors, or therapists, leads to feelings of psychological exclusion.

The Implications for Jewish Parents:

The failure to address campus antisemitism at the college level reached peak attention after October 7th, especially with the building of Zionist-free encampments and the subsequent congressional hearings. According to a survey from Hillel International,⁴² 83% of Jewish college students have experienced or witnessed antisemitism firsthand since October 7th. There are also numerous media reports of Jewish parents pulling their children out of K-12 schools and either transferring them to other public school districts or enrolling them in Jewish day schools or other private schools.⁴³ Clinically, parental responses may shape students’ coping strategies, help-seeking behavior, and trust in institutional authority, making family dynamics a relevant focus in treatment.

When Jewish students report antisemitism, poor responses can manifest in multiple ways, including (a) denying that the incident was antisemitic, (b) justifying the incident, or (c) not responding at all. Unfortunately, some administrators are exacerbating campus antisemitism by actively or passively engaging in it, further victimizing Jewish students and leaving Jewish parents without proper recourse.⁴⁴

Because many Jewish people highly value education, antisemitism at schools can be a particularly shocking and painful experience for students and their parents. Often, they feel a loss of connection to these institutions and subsequent grief and confusion about how to continue their pursuit of knowledge.

Many Jewish parents are experiencing a sense of powerlessness. Normal steps taken to address antisemitism are proving to be less effective.⁴⁵ Responses from parents vary widely, from strong advocacy to more avoidant styles. Many parents often attempt diplomacy first, encouraging their children to report the incident, notify the authorities, or “not rock the boat.” If administrators ignore, minimize, or justify antisemitic incidents, some parents may tell their children to avoid engaging with the individual(s) who perpetrate the antisemitism, while others may be able to respond more assertively. This variety of responses highlights the importance of individual differences in their reaction to the same incident, which clinicians should bear in mind.

Future Research:

Research should more deeply examine the psychological effects of October 7th, the atrocity videos, the subsequent hostage videos, and the disconnect between many Jews’ feelings of horror and campus reactions of disinterest and/or opposition to Israel. Research should also examine how these issues have been impacting families and children of different ages. Literature could also suggest how clinicians can intervene effectively to help Jewish clients navigate these new challenges. Research should analyze the impact of this environment on therapists doing this clinical work.²⁵

Research could determine whether it is possible to change the attitudes of faculty, administrators, DEI professionals, and others who have sometimes shown insensitivity to the psychosocial needs of Jewish students. Finally, research could seek to identify cognitive and emotional coping strategies for Jewish students (and parents) facing the range of problems identified above.

Clinical Implications:

For clinicians working with college students and their families, contemporary campus antisemitism should be recognized as a legitimate and potentially serious source of psychological harm. Common clinical presentations include anxiety, depression, trauma-related symptoms, identity disruption, social withdrawal, and impairment in academic or vocational functioning. These reactions are frequently compounded by experiences of invalidation from peers, institutions, and, at times, mental health professionals. When clinicians minimize or reinterpret antisemitic experiences through ideological lenses, they risk misdiagnosis, erosion of therapeutic alliance, and ethical breach. Competent assessment therefore requires taking reports of antisemitism seriously and understanding how political and institutional climates shape clients’ experience.

Psychotherapy is not an appropriate forum for political advocacy, ideological instruction, or the advancement of agendas unrelated to a client’s psychological welfare. Clinicians whose political commitments prevent them from empathizing with clients are not providing competent care and should not be treating these patients. While therapists are not required to share their clients’ beliefs, they are ethically obligated to bracket personal ideology. When this is not possible, referral to a more suitable clinician is a professional responsibility. Failure to observe these boundaries risks reproducing the very invalidation and exclusion that psychotherapy is meant to remedy.

REFERENCES

How Intensive Parenting Damages Childhood Mental Health

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:11:01 GMT

Abstract

Over the past few decades, parenting has shifted toward intensive styles marked by excessive involvement, control, and accommodation, especially in middle- and upper-class families. This approach is known as helicopter or overinvolved parenting and is associated with reduced self-efficacy and childhood anxiety. This review paper examines current cognitive-behavioral approaches to child anxiety and introduces Independence Therapy, a child-driven method that uses daily independence activities unrelated to fears to harness generalized exposure and alleviate symptoms.

Keywords: Intensive parenting, child anxiety, parental accommodation, independence therapy

Parenting styles have shifted radically over the past few decades. But as parents spend more time and resources on their children, rates of childhood mental illness are increasing. How could this be? One possibility is that over-intensive parenting deprives children of opportunities to explore and build competence. While intensive parenting is well-intentioned, it can leave parents exhausted and kids fragile and immature. This paper will outline the problem and propose solutions for both parents and therapists.

Background

Research indicates that parents have spent progressively more time with their children since the 1970s.¹ For example, today’s working mothers spend as much time with children as stay-at-home mothers did in 1975.² Parenting behaviors have also changed over the past half-century, with parents adopting more controlling behaviors.³ This is particularly the case among middle- and upper-class families.

This shift in child-rearing, sometimes referred to as helicopter parenting or parental overinvolvement, is a parenting style characterized by excessive involvement in most of a child’s decisions, including those where parental action is inappropriate given the child’s level of development. Research suggests that overinvolved parenting is associated with poorer autonomy development, self-efficacy, and emotional regulation in children.⁴

There are several subtypes of overinvolved parents, the most common being the anxious-overinvolved subtype. Anxious parents are prone to overparenting because they have heightened perceptions of risk,⁵ which leads to restrictive parenting, including less willingness to allow their children to play alone.⁶ A parent who has elevated anxiety can create relief for themselves when they intervene. In a strange twist, it is more rewarding for anxious parents to intervene because of the outsized relief they feel.

Parental overinvolvement can affect children in several ways. These behaviors include:

Parents may teach their children to avoid anxiety-provoking situations through vicarious learning.
Anxious parents are also prone to accommodating children’s avoidance of difficult or anxiety-provoking tasks. Parental accommodation may facilitate children’s avoidance and safety behaviors.
Parental accommodation of child anxiety can include preemptive accommodations that are meant to help a child avoid anxiety-inducing situations (e.g., avoiding drop-off playdates for a child with separation anxiety), or they can include reactive accommodations that are intended to help a child escape a current anxiety-inducing situation (e.g., ordering ice cream for a child who refuses to walk up to the counter and order himself). While the relationship between parental accommodation and child anxiety appears to be bidirectional, it is also clear that these well-intentioned parental responses reinforce maladaptive coping mechanisms, impede corrective learning, and sustain elevated anxiety sensitivity.⁷ The resulting short-term anxiety reduction induced by accommodation reinforces further dependence and avoidance in children, thus maintaining anxiety symptoms.

How Intrusive Parenting Shows Up in Psychological Clinics

The effects of overinvolved parenting on children can be widespread and profound. Parental overinvolvement is positively associated with anxiety severity in children.⁸ Children of overinvolved parents are given fewer opportunities to handle challenging experiences independently, which in turn limits their ability to develop coping and problem-solving skills. This may increase their belief that they cannot tolerate stress and discomfort.⁴ These skill deficits can turn normative childhood challenges into more serious mental health problems, as anxious avoidance can quickly feed on itself and rapidly increase in severity. For example, children who have normative and even healthy anxiety about speaking to strangers may begin to refuse all interactions with strangers, such as the parents of friends, extended family, and school personnel. These children may present for professional intervention when avoidance begins to interfere with functioning, such as in the case of school avoidance.

How Can Psychologists Provide Solutions?

Two psychological approaches for child anxiety have been demonstrated to be effective. The first, exposure therapy with blocked escape, involves repeatedly facing feared stimuli and is meant to deliberately violate negative expectancies of harm, decontextualize inhibitory associations, and increase tolerance of distress.^9,10 Exposure therapy is underutilized by therapists, as many hold concerns about its safety, effectiveness, and ethics, despite little evidence that the treatment may cause harm.^11,12 The second, parent accommodation-based approaches,¹³ such as Supportive Parenting for Anxious Childhood Emotions, are meant to block parental involvement in reducing manageable child anxiety.¹⁴ Both approaches can be challenging for parents, particularly those who are troubled by seeing their children distressed. Children also commonly exhibit extinction bursts, behavioral and emotional escalations that occur when parents set limits on accommodation. For example, children often throw tantrums when a parent tries to prompt them to sleep in their own bed that night, leading the parent to withdraw the directive. This can paradoxically increase parental accommodations to secure short-term relief from the child’s escalation.

A new treatment for child anxiety, Independence Therapy (IT), targets overparenting by leveraging children’s universal desire to do things independently.¹⁵ In this treatment, children indicate which independence activities (IAs), such as riding a bike to the park alone, shopping for food alone, or taking a train alone, they would like to do. Parents are not present during IAs and, therefore, cannot intrusively intervene. Recent compelling evidence suggests that exposure therapy has beneficial effects on stimuli that are not even in the same fear category as the targeted fears. For example, exposure to spiders reduced anxiety about heights in participants with phobias of both spiders and heights.¹⁶ It is precisely this dissimilarity that may make IAs more acceptable to children, their parents, and clinicians. For example, a child with a fear of the dark who is allowed to ride his bike to the park alone may experience a reduction in his fear without ever being directly exposed to the dark. This is due to the shared underlying mechanisms operating in both cases.

Preliminary data suggest that daily IAs lead to less anxiety in children and greater parental confidence that their children are capable.¹⁵ We consider one IA per day to be a strong “dosage” of independence for significant reductions of anxious symptoms in kids. Recent data found that parents reported IT to be equally acceptable as a treatment to traditional cognitive-behavioral therapy.¹⁷ Additionally, IT may be more acceptable to therapists who administer it, as it does not involve direct exposure to the content of children’s fears. IT is designed to be cost-effective, transportable, and fun. Further research is needed to examine IT’s long-term effects and moderators on treatment outcomes.

Clinical Vignette

Kelly was a nine-year-old girl living with her mother, father, and two siblings. Her parents were working-class. On intake, her mother reported that she experienced substantial separation anxiety and fear related to “any and every” activity in the absence of a parent. This included going upstairs alone in their house, where her bedroom was, leading her to sleep in her parents’ room on the ground floor every night. She was anxious about attending school and experienced frequent shaking, stomach issues, nail biting, and crying.

The family took part in a six-session course of IT. During the second session, Kelly expressed a desire to meet her best friend at a local pizza place without their parents. It is not uncommon for anxious children to nonetheless desire to do things independently. Kelly’s parents were surprised by the request but delighted to grant it, though they expressed some trepidation. Kelly was driven to the pizza place and given cash, and her parents told her they would be back in 45 minutes to pick her up. Kelly’s friend was given similar instructions. The two kids reported having a lot of fun and feeling grown up. One of the pizza workers asked Kelly where her parents were, and she stated that she was allowed to be there.

This was one of many IAs Kelly did during the six-week treatment, including riding her bike alone to a local park, having a sleepover with friends in the backyard, whittling with a knife, and baking cookies. All IAs were done without adults present.

Over the course of treatment, Kelly’s parents reported far less separation anxiety, more persistence, and more willingness to try new things. At each session, Kelly and her therapist discussed what she had learned from her activities, and the common theme was that Kelly was capable of doing things without adult help.

Common Challenges and Solutions

Although many parents express generally positive attitudes toward child independence, they often arrive at the initial IT session with considerable hesitation about allowing more of it in practice. The first session is therefore designed to address that reluctance by thoughtfully outlining how reductions in child independence have coincided with increases in child anxiety, while validating parents’ understandable concerns about safety and well-being. Parents are shown videos of children engaging in age-appropriate IAs and reflecting on the benefits they have experienced, including increased confidence, self-efficacy, problem-solving skills, and related developmental gains.

Potential risks are addressed directly and transparently. IAs are framed as involving no greater level of risk than everyday activities routinely undertaken by most functioning members of society (e.g., crossing the street, cooking over a flame, or using a knife). Importantly, parents are encouraged to consider that they are balancing two types of risk: the risk of permitting independence and the risk of restricting it. Within this framework, we suggest that the potential developmental costs of limiting independence, such as reduced opportunities for mastery, autonomy, and anxiety regulation, may be more consequential over time than the relatively low physical risks posed by age-appropriate independent activities. In this way, the session emphasizes that fostering independence is not a rejection of safety, but a necessary component of healthy emotional and developmental growth.

Parents often worry that other adults will step in and obstruct IAs when they see a young child acting unsupervised. As a result, we equip each child with an Independence Pass, a wallet-sized card that grants the child permission to be without an adult. The card includes written consent, the parents’ contact information, and a safety note. Most importantly, it helps the child feel confident knowing they have the card to fall back on should an adult intervene.

Lastly, parents often worry that other parents will judge them as irresponsible for allowing their child more freedom. We help parents understand that this judgment is unsupported and reactive and that they can feel confident knowing they are implementing research-backed practices to support their children.

Key Takeaways

Here are some important concepts to retain from this article:

Parents are parenting more than ever.
A child’s independence is essential for their growth and development.
Lack of child independence appears to be an important mechanism of child anxiety.
Increasing independence in fun and interesting ways, without exposing the children to the content of their fears, shows promise as an acceptable treatment for child anxiety.

Conclusion

The rise of intensive or overinvolved parenting appears to be a fundamental cause of rapidly increasing rates of child anxiety. Evidence-based approaches, such as exposure therapy and a reduction of parental accommodations, have not adequately addressed this troubling increase. Novel approaches, such as IT, that are rapidly scalable and require less training may be a promising alternative that can work separately or in tandem with existing approaches to help these children and their parents.

REFERENCES

Masculinity Crisis: Psychological Insights for Men and Boys

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:09:39 GMT

Abstract

Men in the United States are experiencing declining outcomes across educational, economic, relational, and mental health domains. While these trends are widely recognized, their causes remain contested. This paper argues that three underexamined sociocultural forces—anti-masculine attitudes, the widespread absence of fathers, and the disappearance of culturally sanctioned rites of initiation—significantly undermine male identity formation. Drawing on contemporary research in psychology, sociology, and gender studies, as well as classical psychoanalytic insights from Freud and Jung, the paper outlines how shame, inadequate paternal modeling, and the lack of structured developmental transitions contribute to distress, despair, and maladaptive expressions of masculinity. It further proposes psychotherapeutic interventions aimed at restoring positive models of masculinity, strengthening the father–son dyad, and creating men’s groups. The paper argues that clinicians have an essential role in reshaping cultural narratives around masculinity and mitigating the psychological and societal fallout of male disconnection and disenfranchisement. Counterarguments such as concerns about reifying gender stereotypes or overlooking structural factors are addressed; however, the paper maintains that ignoring gendered developmental needs has produced measurable harm.

Keywords: Masculinity, male mental health, fatherlessness, initiation, psychotherapy with men, deaths of despair

Boys and men are struggling in the United States across a variety of different metrics. Below are several recent findings highlighted by Case and Deaton¹:

Women are 15 percentage points more likely than men to complete a bachelor’s degree.
Men’s wages are lower today than they were in 1979.
Nearly 25% of children grow up in a home without a father.
Men account for almost three out of four “deaths of despair” (suicide or overdose).^*
These findings are widely agreed upon, but there is significant debate regarding why men are experiencing these outcomes and what can be done to improve them.

Factors Impacting Men

Societal changes might be contributing to these poor outcomes among men in the United States. Below are several hypotheses requiring further development and research, as well as suggestions for psychotherapists:

Anti-masculine attitudes: Although sometimes contested, masculinity is in part biologically determined.³ Personality traits closely associated with masculinity (including competitiveness, risk-taking, aggression, and protectiveness) have become anathema in certain prominent political circles. The “absence” of masculinity⁴ in political conversation in certain Western circles is symptomatic of a cultural devaluing of masculinity. The MeToo movement is commonly cited as an inflection point in the West’s relationship to masculinity. The villainization of masculine gender norms may have been an overcorrection for the abuses of a male minority in positions of power. This resulted in a significant cultural erasure of masculine virtues in politics and media and likely contributed to a pervasive sense of shame and inadequacy among men collectively.⁴ Academia and Western media became desensitized to, and in some ways embraced, an anti-male posture, which commonly portrayed men as buffoons in Hollywood films or were “memed” on social media as toxic or trash. These attitudes contributed to male subcultures that were disenfranchised, ashamed, depressed, and at times aggressive.^5-6 The last decade saw communities such as “mgtow,” “redpill,” and “incel” emerge on the internet and come into cultural focus.⁷ These communities, suffused with racism, misogyny, and self-loathing, expressed the voices of dangerous, hopeless, and angry men. These expressions of anger and hate further perpetuated anti-masculine attitudes, completing a self-reinforcing cycle.⁸
Absent and abusive fathers: Nearly one in four children grows up without a father in their home.⁹ Research has found that boys growing up without a father are at greater risk of a range of poor outcomes,¹⁰ including poverty, behavioral problems, infant mortality, incarceration, criminal conviction, abuse, addiction, obesity, and school dropout.¹¹ Without an adequately present father, boys lack an essential model of healthy masculinity. Additionally, an absent or abusive father can contribute to intense feelings of rage. This rage is often internalized as depression, hopelessness, despair, and impulsivity; at other times, it is externalized. Rather than self-destruction, anger may be expressed as the destruction of others through hateful rhetoric and harmful action. The psychological consequences for individuals and society generated by conflicted father–son relationships are foundational to modern psychology, and their significance is reflected in Greek mythology, which inspired the writing of Freud and Jung.
Absence of initiation: Adolescence marks a biological and psychological sea change in human beings. For thousands of years, this change was welcomed through communal rituals. Initiations marked a child’s metamorphosis into adulthood.¹² Puberty rites and rituals of initiation were almost always gendered. These ceremonies offered adolescents a sense of meaning and purpose related to their gender and emerging maturity. Boys were initiated into roles that helped form their personal identities and made sense of their gender. These roles were often born out of necessity and included hunting, warring, farming, building, and shamanism, among others. Initiation communicates to initiates that they have a part to play in the preservation of their community. Individualism, secularism, safetyism, and anti-masculinity all contribute to a culture in which communal ritual for boys is rare. The absence of communal initiation has contributed to a gap in identity formation as it relates to gender.

What Therapists Can Do

What can psychotherapists do to raise cultural awareness and improve the psychotherapeutic treatment of men?

Generating positive models of masculinity: Psychotherapists can play a crucial role in supporting healthy and prosocial expressions of masculinity. By inviting clients to explore their expression of masculinity without judgment, clinicians can reduce shame and facilitate change in alignment with their clients’ values and predispositions. Male therapists can help men recognize and challenge harmful stereotypes and societal pressures that might be contributing to their presenting issues. When masculinity is explored without bias, male clients feel less threatened and are more receptive to the development of key therapeutic factors such as relationality, empathy, emotional intelligence, and resilience.
Celebrating fatherhood: Psychotherapists can play a pivotal role in supporting fathers and promoting their involvement in their children’s lives. Fathers have a unique familial role in modeling socially adaptive masculinity. Clinicians can also help sons better understand and interact with their fathers. In therapy, sons and fathers can explore their fears, expectations, and societal pressures related to their roles, allowing them to develop a healthier self-concept and curiosity about the possibilities of a father–son relationship. Group therapy sessions can also create a supportive community for fathers to share experiences and learn from one another, reinforcing the importance of their presence and active participation in their children’s lives. Through these efforts, psychotherapists can facilitate a model of fatherhood that benefits both fathers and their families. Psychotherapists can also do more to communicate the beauty and importance of the father–son dyad in the current sociocultural moment.
Supporting men’s groups: Psychotherapists can support the existence of men’s groups by recognizing and validating the unique needs and experiences of men inside and outside the psychotherapy context. By facilitating group sessions for men, therapists create an environment in which men can discuss contentious or socially taboo issues related to their experience and expression of gender. These spaces allow men to explore their emotions, challenges, and personal growth in ways that are more difficult in mixed-gender settings. Ultimately, these spaces offer men an opportunity for introspection, solidarity, and personal development that can enhance their overall well-being and contribute positively to their male identity, as well as their roles in family and society.

Conclusion

Anti-masculine attitudes, the absence of fathers, and the loss of initiation each contribute to the struggles boys and men face in forming a healthy sense of male identity. These factors correlate with increased deaths of despair among men, lower rates of college education, and extreme expressions of masculinity.⁴ Psychotherapists can make a difference by changing the sociocultural dialogue around masculinity and embracing aspects of masculinity within the context of psychotherapy. Fathers and fatherhood have long been theorized to be vital contributors to male identity. Psychotherapists have a role to play, in session and beyond, in revitalizing the father–son dyad and educating others about its significance. Finally, men’s groups can offer men a source of support, validation, and shame reduction.

^* It is worth noting that while men account for the majority of completed suicides, women are more likely to attempt suicide. The gender disparity in completed suicides is largely attributable to differences in method lethality.²

REFERENCES

Why Therapy with Men Must Recognize Biological Sex Differences

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:07:50 GMT

Abstract

The field of clinical psychology often adheres to a social constructionist view of sex differences that ignores biological sex differences identified by research. To offer effective psychotherapy to male clients, clinical psychologists must understand male psychology grounded in the context of biological sex. This information does not appear to be part of standard training in clinical psychology; thus, clinicians are, generally speaking, not equipped to address issues that are more common among males. This may pose a particular problem because the mental health profession has become disproportionately composed of female practitioners who may be less likely to relate to these issues without specific training. The article ends with a discussion of challenges in treating men and suggestions to improve psychotherapy for male clients.

Keywords: masculinity, men, therapy with men, sex differences, clinical psychology, evolutionary psychology

The mental health field is becoming increasingly female.¹ For example, more than three-quarters of doctoral psychology students are women.² As this trend continues to accelerate, female representation in the profession is likely to exceed 90%³ within the next several years. Are there reasons to be concerned if male patients are primarily being treated by female therapists? Possibly—but potential problems can be reduced if therapists acknowledge that sex differences can impact treatment.

These issues, however, will be far more difficult to address if mental health professions remain wedded to the notion that all observable differences between male and female behavior are solely the result of culture, with no biological contribution. This paper aims to shed light on this blind spot by exploring its implications for clinical practice and recommending ways to adapt therapy to better meet the specific needs of male clients.

Why Does the Mental Health Field Ignore Sex Differences?

In recent years, the American Psychological Association⁴ (APA) accreditation process has mandated diversity training as a required competency. This move was based on the idea that therapists did not reflect the cultural and racial diversity of the population seeking treatment and that it is crucial for practitioners to better understand clients from diverse backgrounds. However, given that the male–female ratio is the largest demographic disparity between therapists and patients, it raises the question of why men’s issues have been ignored as an area of diversity training.

One persuasive explanation for this gap is that much of the field of clinical psychology minimizes the significance of evolutionary psychology,⁵ consistent with the broader field of psychology.⁶ Evolutionary psychology provides an empirical view of human nature, including explanations for the nature and function of sex differences.^7-8Instead, clinical psychology typically adheres to the standard social sciences model⁹ of human behavior, especially the blank slate hypothesis.¹⁰ The blank slate hypothesis is the idea that all behavior is learned through experience and largely determined by the cultural environment. From this viewpoint, all observed differences between males and females are seen as a product of cultural socialization.

While the APA’s Guidelines for Psychological Practice with Boys and Men¹¹ might appear to reflect an understanding of male–female differences, they again err by overestimating the cultural influence¹² on masculinity. In fact, there is no mention of biology at all. The guidelines also broadly denigrate the nature of traditional masculinity—marked by stoicism, competitiveness, dominance, and aggression—as harmful,¹³ without highlighting the potential upside of these traits. This omission is presumably because these are not aligned with socio-political ideologies that currently dominate the field of psychology.¹⁴

Why Should Therapists Care About Sex Differences?

It is important to note that even though broad sex differences have robust empirical support, there is also significant variation among males,¹⁵ and thus, not all may respond to therapy in the same way. That being said, given that males and females tend to differ, numerous problems¹⁶ can arise from ignoring sex differences, including misunderstanding or missing men’s issues, failing to address the pressures of masculinity that may underlie psychopathology, and negatively stereotyping male or masculine qualities.

This may lead some therapists to struggle to connect with male patients. As a result, some patients may not benefit from therapy, may prematurely drop out, or may simply avoid therapy altogether. Scaffidi et al¹⁷ found that although men have increased their use of mental health services in Australia, therapy dropout rates remain high, most commonly due to a lack of connection with therapists.

More nuanced research suggests that males who are more likely to drop out of psychotherapy hold traditional masculine beliefs. For example, research using the Gender Role Conflict Scale suggests that men who feel a high need for success, power, and emotional control are significantly more likely to terminate therapy prematurely.¹⁸ Moreover, Seidler et al¹⁹ concluded from their results that high male dropout rates were a function of some therapists not adequately recognizing or responding to men’s needs.

Challenges of Masculinity and How To Resolve Them

While data on increasing male engagement in therapy is lacking, several clear recommendations are worth considering until a more substantial evidence base emerges. To provide practical guidance for female and male therapists seeking to enhance their competence when working with men, these recommendations focus on engaging with common masculine traits rather than trying to deconstruct or challenge masculinity itself. For example, research shows that men score significantly higher than women on the Emotional Control and Self-Reliance subscales of the Conformity to Masculine Roles Inventory. These subscales specifically measure the belief that one should hide feelings and solve problems without help.²⁰ Thus, not surprisingly, these are among the most commonly raised issues addressed across the existing literature on males in therapy:^17-18,21-22

Emotional control: Men are likely to attempt to remain emotionally controlled and may be less inclined to identify or express both positive and negative feelings. This can result in them appearing detached in therapy, which is focused on exploring emotional reactions.
Adaptation: Treatment is likely to be more effective if therapists frame the therapeutic process as a way to build control, skill, and mastery that increases success across all areas of life. This skills-focused approach can make emotional engagement feel empowering, rather than presenting therapy as simply “helping men engage their feelings,” which could feel condescending, pointless, or emasculating to many men.
Self-reliance: Men are more likely to aspire to be self-reliant and may therefore be more reluctant to ask for help. Psychotherapy inherently involves some degree of reliance on the therapist. This attachment or dependence can make men feel overly dependent, leading them to compensate by minimizing the therapist’s role in treatment, which may reduce therapy’s effectiveness.
Adaptation: Therapists can frame therapy as a collaborative, active, problem-solving process rather than positioning themselves as the sole expert who will identify the problem. Using terms such as consultation or mentorship (especially for younger patients) may also resonate with some men. Normalizing help-seeking as a strength—similar to consulting a lawyer or other professionals—rather than a deficiency is a useful reframing.
Toughness or avoidance of weakness: Men are more likely to downplay emotional pain or distress to demonstrate toughness and are therefore reluctant to show vulnerability. This often leads to avoidance of exploring and expressing vulnerable emotions such as fear or sadness.
Adaptation: The therapist should identify the patient’s strengths and toughness across a variety of situations while also normalizing that giving and receiving help and guidance at different points in life is a universal experience used by all leaders and other successful people. Metaphors to discuss the costs of toughness can reduce avoidance (e.g., ignoring physical pain and continuing to engage in a physical task will cause more harm in the long run).
Emotions viewed as universal and useful: Some men may devalue emotional expression in general because they perceive this as feminine, weak, or unnecessary. This may be particularly enhanced around topics such as relationship distress or work concerns if these are perceived as contexts that men are expected to master. This belief may be amplified in therapy with a female therapist because the patient may automatically associate the approach with femininity.
Adaptation: Providing psychoeducation to normalize the universal human experiences of all emotions²³ can lead to increased comfort discussing emotions in therapy. The therapist can note that emotions serve important evolutionary functions and can be a source of inspiration, motivation, insight, and connection to others. In short, emotions exist and influence us whether they are acknowledged, and therefore, it is better to acknowledge and deal with them directly rather than let them have unintended effects (e.g., use of alcohol to mitigate feelings, which can create other problems versus therapy).

Conclusion

Clinical psychology is disproportionately influenced by female practitioners and is overly tied to a particular social constructionist view of sex differences. To offer effective psychotherapy to male clients, clinical psychologists must understand the specific nature of male psychology grounded in biological sex. Training in the psychology of men is uncommon in academic programs and continuing education offerings, apparently for ideological rather than empirical reasons. In the long run, this will lead to a significant disservice to men seeking psychotherapy, leaving them without a useful resource to address various psychological concerns. The downstream negative impact of males not utilizing psychotherapy beyond the individual includes negative effects on marriages, families, and children. Perhaps most concerning is that boys who watch their fathers suppress emotions and avoid help are socialized into the same pattern, perpetuating the cycle of non-engagement in future generations.

REFERENCES

How Socio-Political Values Shape the Therapeutic Alliance

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:07:20 GMT

Abstract

Values are an inescapable feature of psychotherapy and are relevant to clients and therapists alike. Sociopolitical attitudes and values (SPAVs), which are often overlooked in clinical training, are especially salient, evoking positive and negative emotions and influencing the working relationship (depending on the value similarities and differences within the therapeutic dyad). Therapists can navigate these topics effectively with the use of strategies. This article presents several models to consider and recommendations for strengthening SPAV competency, such as developing cultural humility and attention toward commonplace cognitive biases.

Keywords: Values, therapy, sociopolitical competency, attitudes, therapeutic alliance, cultural humility, polarization

We understand that the therapeutic relationship has a great bearing on the success or failure of psychotherapy, more so than any other relevant factor.¹ The mystery and intrigue of the therapeutic alliance have been captured in popular culture, portrayed comically and dramatically in media, from TV series such as Monk and Ally McBeal to movies such as Anger Management and Good Will Hunting. While it is not always apparent what theoretical orientation or therapeutic interventions are at play in these portrayals, the centrality of the therapeutic alliance is palpable.

Values are inescapable in the formation of the therapeutic relationship. This is because values are enduring features in people’s lives, unlike transient emotional states, fluctuating symptoms, or fickle whims.² Values, distinct from attitudes and interests, are foundational commitments upon which the latter two rest.³ They are frequently informed by spiritual, religious, and/or ideological worldviews, which posit answers to questions about the meaning of life and suffering, the nature of human relationships, and how we should live in the material world. Beyond these most existential questions, values that arise in therapy pertain to a wide range of issues, such as marriage and romantic relationships, parenthood decisions, career choices, spiritual and religious beliefs and practices, the use of social benefits, and civic engagement.

Values as Glue or Solvent

Birds of a feather flock together, and understandably, people prefer others who share their values and are less comfortable with those who do not.⁴ This pattern is replicated in other areas of public life, such that people seek proximity to or affiliation with those who possess shared traits—whether demographic characteristics, sociopolitical values, religious beliefs, income level, lifestyle, or recreational interests.⁵ This often-unconscious affiliative process is relevant in clinical settings as well. People are attentive to others’ attitudes, beliefs, and values, and clients and therapists are no different when navigating clinical services. Clients carefully select therapists from directories based on first impressions and according to personal recommendations. Therapists consider client characteristics when accepting referrals and devising treatment plans. Additionally, establishing a therapeutic alliance during the early sessions is predictive of whether the therapy will end prematurely.⁶ Incongruency in values can rupture the therapeutic alliance, while congruency in values strengthens it.⁷

Politics as a Source of Values Conflict

Unsurprisingly, the intensifying climate of political polarization is straining communities as well as the therapeutic relationship in treatment.⁸ The adoption of virtually monolithic left-wing politics by mental health professional organizations and their members has resulted in a range of concerning downstream effects, including open hostility and willingness to discriminate against outgroups (i.e., those who are not firmly left-wing).^9,10 This development is shocking for professionals who are trained to self-reflect, value equality and fairness, and, in most other circumstances, be temperamentally open to new experiences and ideas. Self-selection into these professions is, in part, due to such traits. Therapists also value cultural competence, but sociopolitical values are often overlooked as a credible component of multiculturalism, though neglected in graduate education and training.¹¹

Are Values Differences Always Bad?

While differences in values, especially sociopolitical values, can elicit a range of negative emotions and undermine a sense of psychological safety in the therapeutic relationship, therapists should also consider the relevance or even potential merits of these differences.^11,12 For example, certain value differences on social policies may not be relevant to many client-presenting concerns, and thus, they remain unknown to one another. In many cases, values implicated in a mismatch between the client and therapist may also be less emotionally salient or evocative and are therefore easier to overlook while working on therapeutic goals.

In other cases, values disparities may help facilitate personal growth and healthy change efforts. When a therapist shares a client’s set of values, he or she may be less likely to challenge assumptions and behaviors related to values that contribute to the presenting problems or cause clinical distress. For instance, a therapist and client sharing a worldview predicated on “systemic oppression” may overlook the psychological harms caused by maintaining an external locus of control. While therapists must exercise extreme caution about trying to change a client’s values, especially in a self-serving manner, a therapeutic relationship ought to support the identification of values, honest dialogue, and introspection.

Models for Managing Values in Therapy

Long-standing disagreements have existed regarding the feasibility of therapists adhering to value neutrality and objectivity—an aspiration set forth by Freud, who sat behind his clients to avoid distracting them during the articulation of their streams of consciousness. Values neutrality was reinforced during subsequent schools of psychology.¹³ Since then, many have questioned whether this degree of neutrality is possible or appropriate.¹⁴ Others believe that therapy is inherently value-laden because therapists cannot avoid drawing on their conceptions of human nature when guiding the therapeutic process and determining what is in a client’s best interest.¹⁵ As such, therapists must exercise caution in determining how their values might manifest in psychotherapy or under what conditions a therapist’s influence on their client’s values is acceptable.² It is well known that clients are readily influenced by therapists’ values.¹⁶

Rather than practicing the American Psychological Association¹⁷ Ethics Code recommendations (e.g., respect others’ cultural and spiritual backgrounds, guard against personal bias, and strive for impartiality), many left-wing therapists call for promoting social justice in clinical practice and advocating for “critical consciousness” among clients, irrespective of their personal therapy needs and goals.^18,19 Yet, especially compared to the recent “therapist-activist” movement, an aspiration toward tempered and careful engagement with the values of psychotherapy is essential out of concern for client autonomy and an appropriately constrained therapist role.

Several methods have been suggested for navigating values carefully in therapy. Jackson et al²⁰ propose numerous strategies that involve serious considerations.They include making thoughtful decisions to:

distinguish between professional values (e.g., values about decreasing psychiatric symptoms during therapy) and personal values (e.g., sociopolitical values), which some may believe to be a false dichotomy;
carefully disclose relevant personal values at the outset of treatment, which could potentially jeopardize the therapeutic relationship;
refer clients to other therapists who share similar values, though doing so could limit access to care (i.e., too few non-left therapists to meet the population-level need);
adjust therapeutic goals, such that a therapist truncates their vision and professional values to prioritize a client’s personal values and autonomy; and/or
seek outside consultation to develop professional perspectives and skills.

Jackson et al^20(p11) ultimately suggest that therapists need in-depth training to effectively “articulate their ontological and philosophical assumptions and show how they relate to their theory of change, interventions, and evidence of change.” In this way, therapists can make their decisions clinically guided and relevant to clients.

Another suggestion for mitigating the influence of inappropriate values has been the concept of time- and context-bound “value bracketing” and the integration of values.²¹ According to McWhorter’s model,^21(p210) therapists bracket personal values (“private values from values regulating professional work”) during the clinical interviewing stage before accounting for both therapists’ professional and personal values, as well as the client’s values, during the treatment planning stage. McWhorter suggests that this is appropriate, as therapists would not “agree to pursue client-proposed goals that are inconsistent with a client’s assessment results, diagnosis, customary evidence-based treatment practices, or professional legal obligations.”^21(p216) While treatment goals would originate from the client, both the therapist and client would ultimately assess and consent to them. This model simultaneously preserves client autonomy and protects therapists’ moral conscience.

Additional Recommendations for Therapists

Educators, therapists, trainees, and students seeking to enhance professional work across value differences would benefit from reviewing Redding and Silander’s proposed competency principles for sociopolitical diversity.²² These principles span clinical skills, education, and research. Specific suggestions include:

cultivating cultural humility and intellectual curiosity to enhance the therapeutic relationship and promote quality therapeutic services,
recognizing and being mindful of common cognitive biases that can distort perceptions of others with different values, and
identifying values overlaps, shared moral foundations,²³ or common experiences in relation to values (e.g., the experience of being the “political outsider” in certain contexts²⁴).

Ultimately, a genuine interest in other people, consciousness of one’s own biases, awareness of one’s personal convictions and limits, and an effort to ensure adequate informed consent will serve as important overarching safeguards in supporting therapeutic relationships and promoting ethical practices.

Conclusion

Unlike the objective neutrality required for scientific research and psychological evaluation, navigating values in psychotherapy is an inescapable task that each therapist will encounter eventually and repeatedly. In an increasingly politically polarized cultural climate that persuades and pressures therapists to function as activists, therapists must consider how to professionally manage their personal values. Sociopolitical values, once arguably relegated to an entirely personal domain, must also be accounted for, especially for the sake of developing a robust therapeutic relationship—the linchpin of effective treatment.

REFERENCES

Navigating Political Polarization with Individuals, Couples and Families

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:05:00 GMT

Abstract

Political polarization increasingly threatens family cohesion, with approximately 20% of Americans currently estranged from relatives over partisan differences. Political disagreements across romantic partnerships, parent–child relationships, sibling dynamics, and extended family often serve as proxies for deeper emotional rifts and long-standing relational patterns. This article presents a family systems approach emphasizing differentiation of self, identification of higher-order family bonds, interruption of dysfunctional communication cycles, and establishment of boundaries around political discourse. Clinical interventions include helping clients reframe political conflicts as expressions of unmet emotional needs, reconnect with shared family history, and develop skills in emotional regulation and respectful dialogue. Rather than attempt to resolve ideological differences, clinicians can facilitate relational healing by helping clients prioritize respect, empathy, and connection over partisan loyalty. Recommendations for clinician self-awareness regarding political biases are also discussed.

Keywords: Political polarization, family therapy, relationship conflict, family systems theory, partisan division, therapeutic intervention

Mental health professionals are increasingly confronted with clients experiencing the impact of political polarization on their most important relationships.^[a] In an era of increasing political division, therapists are seeing firsthand how partisanship is straining intimate and familial bonds. Currently, approximately 20% of Americans are estranged from a relative over partisan political beliefs.¹ Clients cancel holiday gatherings, avoid romantic partners with opposing views, and endure long-term estrangements from family members over ideological differences. In many families, there is an assumption that family members should share common values or beliefs. Consequently, when one or more members do not, it can be profoundly upsetting, even a betrayal of the family ethos or traditions. As these issues surface in clinical settings, mental health professionals must be equipped to navigate and help repair the relational damage caused by political polarization.

The Family System Under Strain

Political orientations have come to signify someone’s foundational values and core beliefs on social issues. The partisan divide between men and women has become more pronounced, which complicates both forming romantic attachments and maintaining a committed relationship.² Politics has become a more important consideration than religion, race, or other factors that may differ in a couple. Couples who don’t share a common political orientation are often challenged to negotiate those differences or risk deep divides in their relationship.

We finally stopped going out socially with our friends. Someone would always bring up something political, and we would get into an argument with each other. Now, we mostly sit in separate rooms at home watching different news stations or see our friends separately. I don’t want this. (Husband of a couple married 24 years)

The impact of political discord extends beyond couples. Parent–child estrangements are becoming more common, with political disagreements sometimes acting as stand-ins for deeper emotional rifts. Recent research indicates that almost half of all adult children in America now adopt political affiliations that diverge from those of their parents.⁴ Political disputes can provoke anxiety and anger and create a deep disconnection between parents and their adult children.

I just couldn’t believe that my mother would vote for that man! It’s like she was blinded and couldn’t see for herself who he is. I can’t be around her. That’s lasted for two years now, and I can’t seem to forgive her. (A 24-year-old female college student)^3(p161)

Sibling relationships are particularly vulnerable, with partisanship exacerbating long-standing rivalries and other family dynamics. Politics are second only to conflicts over aging parents and inheritance in destroying sibling bonds.⁵ Political conflict often masks unresolved sibling issues, such as parental favoritism or divergent values and beliefs. Siblings can lose sight of the positive memories and enduring qualities of family identity beyond politics. These dynamics require therapeutic unpacking.

My older sister was always “the smart one” and my mother’s darling girl. They agreed about a lot of things that I had different beliefs about. They are relentless in trying to change my mind about politics, and I’m sick of it. (A 31-year-old male)^3(pp162-163)

Extended families are also fracturing under political stress. Even minor conversations about current events can escalate into personal attacks and mutual recriminations. Clients report dread over attending family gatherings, with some choosing isolation over potential confrontation.

“We decided to not host the family for Thanksgiving anymore. The past two years, the dinner ended in a shouting match, with someone walking out and slamming the door. Last year, we asked everyone to avoid talking about politics, but Aunt Edna just couldn’t shut up. They can cook their own damn turkey” (a married couple in Florida).

Therapeutic Frameworks

Family therapy provides a range of theoretical models to address political polarization. Structural approaches are particularly useful in helping families identify maladaptive communication patterns and rigid roles that reinforce partisanship. From a family therapy perspective, strong partisanship may create conflict roles within the family and establish boundaries that prevent healthy interaction and problem-solving. We believe that the primary focus of the therapist is to work collaboratively with family members to foster family unity despite political differences.

Therapists can help clients achieve the following:

Reframe political arguments as symbolic of unmet emotional needs: Clinicians can assist family members in identifying established patterns that create distress or disharmony and how those are being played out in conflicts about politics. What family roles are being activated by ideological conflicts? How do the dynamics around partisanship mirror historic patterns of conflicts or divisions?
Identify higher-order bonds that unite and define the family: Foundations such as religious beliefs, cultural traditions, a family “mission” (e.g., service to others), or shared values about respect and appreciation of each other can help develop a stronger sense of family history and build an identity and bond that transcends politics.
Identify and interrupt dysfunctional cycles of blame, anger, and moral condemnation: Therapists can help family members practice emotional regulation and respectful interaction skills to lower the levels of distress and conflict. Learning to observe thoughts and feelings rather than immediately react and developing self-soothing behaviors are important.
Explore family of origin influences and intergenerational patterns: A focus on the family’s history, traditions, and shared experiences can help bring a greater sense of connection and move political debates off center stage. Exploring how family members embrace certain beliefs and perspectives can build a greater sense of individual autonomy and understanding between family members.
Set boundaries around political discourse that promote mutual respect: Therapists can assist family members in learning strategies to engage in respectful dialogue. In some cases, it may be important to establish boundaries that help family members limit certain topics or exit respectfully from highly contentious interactions. The goal is not termination of a relationship; it is to learn strategies for self-management and de-escalation, such as redirecting conversation topics or not responding to provocations.
Encourage differentiation of self as a core goal: Differentiation allows individuals to maintain their identity and beliefs while staying connected to family members who don’t share those perspectives. Therapists can support clients in developing emotional resilience, asserting personal values, and engaging with family members from a stance of curiosity and respect rather than animosity.

Foundational Skills for Clinicians

Therapists should be prepared to teach and model skills that foster constructive dialogue and reduce defensiveness. These include

reflective listening and emotionally focused communication,
de-escalation techniques and self-soothing practices,
boundary-setting strategies to limit exposure to toxic media or conversations, and
reminding family members to focus on shared connections and respect each other’s perspectives despite political dissimilarity.

Clinicians can also provide information on the psychological drivers of political identity (e.g., safety, belonging, and meaning). Therapists must also be aware of biases and beliefs that might influence their work with a family or couple.

Building Better Relationships

Couples:

It is important to encourage open conversations about political beliefs and teach techniques such as engaging curiosity, reflective listening, and emotional regulation. These skills can help reduce or prevent polarization from undermining connection. For all couples, prioritizing love over politics and avoiding attempts to convert each other are central goals. Couples who believe that “I love my partner more than I love my politics” can better maintain a mutually respectful relationship.⁵

Parents and Adult Children:

We embrace the concept that family members can disagree and still show love and commitment to each other. It can be useful to work with subsets of the family, such as in separate sessions with the parents and with the adult children, to help them determine their goals for therapy before bringing them together. It’s helpful for parents to express feelings of betrayal, confusion, fear, or failure before engaging in sessions with their adult children. For the children, exploring the dynamics of their relationship with their parents; examining any history of conflicts, fears, and frustrations; and acknowledging the importance of respectful differentiation can be important topics. For all family members, letting go of the need to politically convert each other will allow more tolerance, differentiation, and acceptance.

Siblings:

Therapists can help reconnect siblings to a shared family history and rebuild broken bridges between polarized brothers and sisters. Exploring both their shared and unique experiences and acknowledging common bonds can build a better connection. When there is a history of discord or rivalry, it is important to assist them in addressing and resolving long-standing issues as they work toward reconciliation.

Extended Family:

With extended family, the therapist’s role becomes one of guiding clients to reframe political disagreements as opportunities for growth and healing rather than existential threats. Healing politically divided extended families requires abandoning abusive rhetoric and moral condemnation and reconnecting to the shared history and importance of family connections. De-escalation skills, boundary setting, and emotional regulation training are helpful in maintaining connections with extended family members.

Conclusion

More people are coming to therapy to cope with toxic political divisions in family relationships. Mental health professionals must be prepared with information, training, and resources to help guide clients through these challenges. Therapists have a vital role in addressing the fallout of political polarization—not by resolving ideological disputes but by helping clients reconnect with the relational values of respect, empathy, and love. We can help our clients learn skills to better manage and respond to challenging political confrontations with family members. Building mutual respect and acceptance across political differences while also nurturing shared connections provides a pathway to mitigate relational harm resulting from destructive polarization. By viewing political conflict as both a symptom and an opportunity, clinicians can facilitate healing within couples and families, one relationship at a time.

Resources

Braver Angels is a bipartisan resource whose mission is to bring Americans together to bridge the partisan divide. They offer free “Depolarizing Within” workshops and “Families & Politics” online training to help family members build better skills in connecting with each other. More information about their resources is available at https://braverangels.org.

An example of working with a politically divided couple is available on YouTube: “Helping Loved Ones Divided by Politics” with Dr. Bill Doherty.

[a] This article is a summarization of Chapter 10 of the book Psychotherapy in the Age of Political Polarization by McCown and Chamberlain.³ Quotes are edited examples from clients of the authors and their colleagues.

REFERENCES

Biases Against Men in Couples Therapy

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:03:50 GMT

Abstract

This article explores biases against men in couples therapy. While feminist critiques rightly challenged rigid gender roles in early therapeutic models, some of these corrections have overcompensated, creating new blind spots in how male clients are understood and treated. Such biases manifest through pathologizing typical masculine traits, employing double standards in interventions, unconsciously assigning men perpetrator roles, and invalidating male experiences. These prejudices can alienate clients, contribute to relational problems, and exacerbate mental health disparities—particularly among men who may already be reluctant to seek help. The article proposes targeted interventions, including bias-aware training, male-friendly therapeutic environments, and routine bias checks in clinical supervision, arguing that, with effort, therapists can strengthen therapeutic alliances, reduce dropout rates, and improve outcomes for all partners.

Keywords: Couples therapy, anti-male bias, masculinity, male psychology, men and boys, psychotherapy

Couples therapy aims to provide a neutral space where both partners can address relationship dynamics fairly. However, evidence suggests that many men experience dissatisfaction in therapy, contributing to higher dropout rates. A disproportionate percentage of couples prematurely discontinue therapy against therapist advice, with family and couple therapy clients showing a higher likelihood of dropout compared to individual therapy clients.^1,2 While about 25% of people drop out of therapy overall, this number rises to 44.8% among men, with 26.6% quitting after just one session.³ These trends highlight the need to examine potential biases that may alienate male clients. This article argues that biases against men in couples therapy manifest through stereotyping, blaming, and ignoring or misunderstanding male experiences. It explores the origins of these biases, their implications for men and society, and how therapists can address them to facilitate more equitable treatment.

Background

Couples therapy emerged at a time when gender roles were rigidly defined. Early models reinforced these structures, positioning women as emotional nurturers and men as rational providers. Feminist critiques in the 1970s and 1980s rightfully challenged these limiting paradigms, and therapeutic practice evolved to recognize the harmful effects of restrictive gender expectations.

However, this necessary change has overcorrected in some contexts. The term “toxic masculinity” exemplifies this problem, as the phrase inherently conveys hostility toward the entire group it is presumably attempting to change. While women can engage in harmful stereotypically feminine behaviors, we do not normally use the phrase “toxic femininity” because it is obviously derogatory toward women as a whole. This linguistic double standard reveals bias in which masculinity itself is increasingly treated as pathology rather than a complex gender expression containing both constructive and potentially destructive elements.

The American Psychological Association’s Guidelines for Psychological Practice with Boys and Men acknowledge the need for gender-sensitive approaches, yet implementation often falls short.⁴ Research has found that therapists are more likely to pathologize identical behavior when exhibited by male clients rather than female clients, suggesting systematic interpretive bias rather than individualized assessment.⁵ Additional studies indicate gender biases in mental health providers, where men’s depression may be missed or misdiagnosed due to stereotypes of male resilience.^6,7 Surveys reflect broader societal attitudes, with 25% of Americans perceiving mostly negative views of men who are “manly or masculine,” particularly among certain demographic groups.⁸ This negative perception of masculinity is linked to poorer mental health outcomes for men.⁹ These biases arise from cultural narratives that frame men as inherently problematic and are compounded by therapy-specific training that may not adequately address diverse gender expressions.

Manifestations of Bias in Couples Therapy

In couples therapy, biases against men can manifest in several key ways:

Pathologizing typical masculine traits while failing to validate positive ones:¹⁰ For example, it may be labeled as “emotional avoidance” when men express emotions through actions rather than words, such as fixing a household issue to show care, rather than recognizing it as a different but equally valid emotional style. Females expressing emotions via words is rarely called “emotional indulgence.” Masculine tendencies toward problem-solving are often framed as “avoiding intimacy” rather than legitimate approaches to connection. Female avoidance of problem-solving is seldom called “avoiding intimacy solutions” or “conflict escalation.”
Employing double standards in intervention:¹¹ For example, when a woman withdraws from conflict, it may be interpreted as self-protection; when a man does the same, it is often labeled stonewalling. Or when a woman raises her voice, it might be seen as an appropriate assertion; when a man does so, it is frequently pathologized as aggression or intimidation.
Unconsciously assigning men the role of perpetrator and women the role of victim before understanding unique relationship dynamics:¹² This prejudgment appears in subtle ways: directing more challenging questions to the male partner, offering more empathy and validation to the female partner, or interpreting ambiguous situations through a lens that assumes male misconduct. Empirical evidence supports this, with studies showing therapists perceive men with depression as harder to treat than women when they’re influenced by traditional masculinity ideologies.⁷
Gaslighting clients: The term “medical gaslighting” has been used in recent years to describe women who’ve experienced invalidation, dismissal, and inadequate care—especially when providers deny these problems. However, there are instances when men might also experience these issues.¹³ For instance, the man who insists his silence stems from feeling overwhelmed rather than a desire to control may be told he is not being honest about his intentions. Likewise, the man who points out double standards may be accused of defensiveness rather than legitimate advocacy for fair treatment.

Negative media portrayals of men and biases in clinical training may reinforce beliefs about men being overly aggressive or dominant.¹⁴ Research may show similar biases, such as magnifying negative male traits while minimizing positive ones.¹⁵

To illustrate, imagine a heterosexual couple seeking therapy for communication issues. The male partner, a construction worker, describes feeling overwhelmed during arguments and prefers to cool off by going for a walk. The therapist labels this as stonewalling and probes him extensively on avoidance tactics, while validating the female partner’s emotional expression as “assertive communication.” The man feels unheard, leading to disengagement. This example highlights how bias can skew interpretations, leading to assumptions about male misconduct without exploring contextual factors.

Clinical Implications

These biases have profound implications for mental health treatment in Western contexts, particularly in the United States, where cultural narratives often portray men negatively.¹⁶ Men may enter therapy reluctantly, only to encounter environments that reinforce feelings of judgment.¹⁷ This contributes to higher dropout rates and poorer outcomes, as men are more likely to disengage when their experiences are invalidated.¹⁸

For society, unchecked biases perpetuate cycles of relational discord. Anti-male bias in couples therapy does not work for men or women; it reinforces divisions rather than healing relationships. Women may receive short-term validation but miss opportunities for mutual accountability, potentially enabling unhealthy dynamics. If biases lead to overlooking female contributions to conflict, true resolution remains elusive, harming both partners and any children involved.

Broader implications include alienated subpopulations, such as men in law enforcement or conservative backgrounds, who may avoid therapy altogether.¹⁹ This exacerbates mental health disparities, with men facing higher risks of suicide and addiction.²⁰ Addressing these biases is essential for improving patient care.

Possible Solutions

There are many potential interventions that professionals can use to reduce these biases:

Develop training that explicitly addresses potential anti-male biases alongside other forms of prejudice. Therapists must recognize that masculine emotional expression may look different than feminine expression without being inherently deficient. Training should include case studies demonstrating how similar behaviors can be interpreted differently based on gender.²¹
Develop and utilize assessment tools that account for diverse communication styles. Rather than expecting men to conform to feminine-typical modes of emotional processing, create validated instruments that recognize multiple paths to connection and healing, including activity-based interventions and solution-focused approaches.
Establish clear protocols for balanced intervention that ensure equal therapeutic attention and challenge to both partners. This includes structured approaches to questioning, validation, and confrontation that prevent unconscious gender bias from directing therapeutic focus. One option is co-therapy, where cases are evaluated by both a male and a female clinician to provide diverse perspectives.
Create male-friendly therapeutic environments by incorporating elements that research shows improve male engagement: clear structure, goal-oriented frameworks, and recognition of strength-based masculine traits alongside areas for growth.²² This might involve sessions focused on actionable plans rather than open-ended emotional exploration.
Integrate routine bias checks into supervision and peer consultation. Regular case reviews should specifically examine whether gender biases are influencing case conceptualization and intervention choices.

These proposals draw on evidence and standards in the existing male psychology literature.²³

Conclusion

Creating truly gender-inclusive therapeutic spaces requires courage from clinicians to examine their own biases, creativity in developing more flexible therapeutic approaches, and commitment to seeing each couple as unique individuals rather than representatives of their gender. It requires moving beyond simplistic narratives to recognize the complex reality that both men and women bring strengths and challenges to relationships.²⁴

By addressing these biases, therapists can strengthen therapeutic alliances, reduce male dropout, and improve relationship outcomes. Openly discussing and addressing biases against men in therapeutic spaces, just as we discuss biases against women, creates the possibility for more truly equitable treatment. The future of effective couples therapy lies not in taking sides in gender conflicts but in transcending them—creating spaces where both men and women can be seen, heard, and understood in all their complexity. Only then can therapy fulfill its promise of repairing relationships rather than unconsciously reinforcing the divisions it should be healing.

REFERENCES

Secular Bias in Psychotherapy

Open Therapy Institute (OTI) — Mon, 16 Mar 2026 21:02:30 GMT

Abstract

Despite America’s relatively religious general population, professional psychology has historically had a tenuous relationship with religion, especially Christianity, and most therapists feel ill-equipped to respond to matters of religiosity raised by clients. Unfortunately, religion is often overlooked or ignored by therapists despite being a clinically relevant feature of individual identity. Religiosity—implicitly regarded as a second-tier cultural diversity factor relative to other demographic factors—is well understood to entail numerous health-related benefits at the intrapersonal, interpersonal, and communal levels that may otherwise be missed by secular psychology. Moreover, these benefits can be leveraged in therapy for client well-being. This article outlines important considerations for therapists about the values of religiosity in therapy.

Keywords: Secular bias, religion, therapy, well-being, Christianity, multicultural competence, spirituality

The United States is a religiously diverse nation. Yet, mental health professionals are much less religious than the average American and, thus, most patients.¹ Unsurprisingly, many therapists are uneasy about discussing matters of faith in therapy, and often, they’re ill-equipped to manage issues at the intersection of psychology and spirituality. Fortunately, some scholars have made valuable efforts to address these gaps.^2,3 This article provides a preliminary review of secular bias in mental health professions, a discussion of how religion benefits well-being, and some suggested solutions.

Secular Bias

Historically, professional psychology has often been disinterested in or even antagonistic toward religion. Secular bias refers to implicit negative assumptions directed toward religiosity and those who are religious (especially Christians⁴) by those who are not religious. This is in part due to the secular, materialist roots of the psychology field and its aspirations to be an exclusively scientific discipline. In the provision of clinical service, the field has also shifted what was once the domain of clergy—nurturing spiritual and interpersonal development—into a nonreligious context. Most famously, Freud^5(p53) viewed religion as a “childhood neurosis,” likened to wishful thinking and in need of a cure. The behaviorist Skinner⁶ rejected notions of the “soul” and religion as “pre-scientific.” Ellis,⁷ a humanist, believed religious beliefs were irrational and responsible for neurosis. In the decades since, secular bias has taken new forms. Many modern therapists have acquired politicized attitudes about religion, especially Christianity, and regard its practitioners not only as pathological but also as extremists.⁴ Consequently, some prospective clients exercise caution in selecting a therapist when religiosity is personally important.^8,9

Several notable exceptions to secular bias exist. Some key figures in psychology’s history were receptive to religiosity or observant (e.g., Jung, Mowrer, McMinn, and Worthington Jr.); professional psychology includes religiosity as a facet of currently esteemed multiculturalism; and the APA has a division for spirituality/religiosity (36). Yet, while there is a growing receptivity to religiosity as a pertinent component of mental health, many graduate training programs neglect it as a core competency area, and many contemporary therapists are uncomfortable with addressing it in therapy. Thus, they often avoid it.¹⁰

As minimal formal training may result in the negation of religiosity in therapy at best and secular bias toward religion at worst, psychology—like other domains of academia¹¹—risks

treating all religions as if they’re the same,
overlooking the extent to which many renowned scientists throughout history held deep religious convictions (e.g., Blaise Pascal, Isaac Newton, and John Dalton),
negating the limits of science (i.e., that science cannot make claims about morality and meaning),¹² and
leaving little room for the ways in which science and religion may, in fact, complement one another.¹³

These problems are subsequently compounded by academia’s specific aversion to Christianity.¹⁴ It is sometimes even described in harsh terms as a white supremacist, patriarchal, or oppressive religion.¹⁵ Notably, Christianity (like other Abrahamic religions) is not originally Western or Anglo; Western Christians are dramatically outnumbered by Christians in other parts of the world¹⁶; and Christianity has often been an unprecedented force for good (e.g., in the abolition of slavery). Nonetheless, this antagonism toward Christianity further limits any opportunity for discussion about religion’s centrality to the cultural identity of many diverse therapy clients (originating from both within and outside of the Western world) and its associated health benefits.

The Benefits of Faith

Inadvertently, the preponderance of secular bias, which, at a minimum, results in the minimization or negation of religiosity as a bona fide domain of multicultural competence, means that many therapists are unaware of the benefits of faith and miss opportunities to leverage them in therapy. Consider the following.

Intrapersonal Benefits:

Religious and spiritual beliefs and practices typically provide a foundation for personal growth and development. An orientation toward transcendental ideals and divinely informed worldviews allows many to live beyond material preoccupations and hedonistic impulses. Themes related to self-sacrifice and perseverance promote resilience in the face of adversity, and the hope for eternal life can serve as a powerful bulwark against nihilism and its destructive logical consequences. Horatio Spafford, upon losing his four daughters during an ocean voyage in 1873, demonstrated this by authoring the profound hymn “It Is Well With My Soul.”¹⁷

Research confirms much of what is intuitively understood about the individual-level effects of religion/spirituality. Religiously affiliated and practicing people experience lower rates of psychiatric illness, substance use, and chronic illness, as well as improved marital satisfaction and increased longevity.^18,19,20 Additionally, the more active one is within a religious community, the clearer these individual-level health benefits appear to be.²¹ The precise relationship between religiosity and these outcomes is complex, given the interacting social, physiological, and psychological factors.²²

Interpersonal and Communal Benefits:

Participation in a religious community offers the support of a social network (a “spiritual family”), often transcending immediate geographic communities and even having international reach (e.g., the Jewish diaspora). The religious community also strengthens the building blocks of society more broadly in supporting marriages and families by bolstering committed relationships. In turn, this fosters healthy home lives for children’s development and nurturing of quality relationships, fortifying them against stressors that strain familial bonds.²³

Religion also offers communities social cohesion (i.e., shared values, aspirations, and lifestyles) and reciprocal investment. Religious communities have long provided support for the widowed, orphaned, financially destitute, and infirm, influencing the development of modern-day health and social services. The role of religion at the communal level can also promote balanced civic-mindedness, in which overarching, transcendental ideals may limit the effects of chronic stress²⁴ and the susceptibility of democracy to tyranny.²⁵

Religion in Therapy:

As with difficulties in navigating sociopolitical values in therapy, clients may also be reluctant to discuss religious beliefs, particularly when they perceive their therapists as having unsupportive attitudes or lacking cultural humility.²⁶ Unfortunately, these concerns are often reasonable, since many therapists are uncomfortable discussing religion in therapy and may pathologize certain religious beliefs, practices, and experiences.³ Examples of such beliefs or practices can include the belief that one hears or is speaking with God, engagement in rituals that involve poorly understood elements (e.g., incense and baptism), and self-sacrificing and countercultural choices, such as remaining in a seemingly hopeless marriage due to beliefs about the religious significance of the marital covenant, or promise. Therapists misinterpreting these situations can unfortunately result in missed opportunities to truly understand clients, leverage protective factors for their well-being, and promote the development of meaningful roles and long-lasting relationships within clients’ communities. More immediately and practically, it can undermine the therapeutic relationship and lead to the premature termination of treatment.

Aside from those practicing within a religious framework, therapists may feel very limited in terms of being able to address matters of morality, which are inextricably linked to psychological well-being and are inherent features of religious belief and practice. Therapists can thus be caught in the strictures of affirmation and unconditional positive regard and unable to address needs related to character and moral development,^27,28 concepts which are often absent from clinical education, training, and research. As a result, some therapists could risk superficializing therapy (e.g., focusing on skills training and the pursuit of “self-care”) and perpetuate a loss of meaning and responsibility among clients (i.e., “Do whatever makes you happy”—with little regard for the impact on others in these clients’ lives). Ultimately, people typically benefit from prioritizing (long-term) purpose ahead of (short-term) gratification.

To remedy many of these concerns, Vieten and Lukoff³ have developed pertinent clinical competency guidelines for spiritual/religious diversity. Attending to these, as well as to models of cultural humility, utilizing validated measures to evaluate spirituality/religiosity,^29,30 and consulting with clergy can all promote therapists’ ability to effectively respond to and engage with clients’ religiosity. Additionally, some academics have advanced evidence-based therapy approaches effectively adapted for the religious/spiritual,³¹ and therapeutic interventions have been developed specifically for faith-based individuals, such as the use of the “God image” in therapy.³² Though religiously diverse people are not trending priorities for many secular therapists, the acute and intentional recognition of religiosity/spirituality as a fundamental component of cultural competency can significantly improve the practice of psychotherapy.

Conclusion

While religious/spiritual topics are clearly not always present or immediately related to presenting concerns in therapy, they are often more relevant than many therapists assume. With professional humility, intellectual curiosity, self-study, and consultation, therapists can explore ways of leveraging the advantages of religiosity to the benefit of their patients—in conjunction with other therapeutic interventions. Graduate programs, especially those that are secular in orientation, should also prioritize inclusion of spiritual/religious diversity in their curricula and training. All of these steps will be to the benefit of religious (and perhaps even nonreligious) clients, increase trust in the profession, and improve therapeutic outcomes. Graduate programs, clinical training sites, and professional organizations face an ethical imperative to foster religiosity competency to avoid alienating many prospective clients.

Open Inquiry in Mental Health

Introducing OTI's Peer Reviewed Journal

Table of Contents

Political Pressures on Mental Health

Bias and Activism in the Profession

Clinical Challenges

Overlooked Patient Populations

Contributor Biographies

Open Inquiry in Mental Health

Editor’s Letter

New Anxieties: The Fear of Being Cancelled

Abstract

Akyró̱no̱ (ακυρώνω): From Greek, Meaning “Nullify”

The Nature of Akyró̱no̱phobia

Obsessive-Compulsive Type Akyró̱no̱phobia

Generalized Anxiety Type Akyró̱no̱phobia

Social Anxiety Type Akyró̱no̱phobia

Research, Treatment, Policy, and Politics

A Look Ahead

REFERENCES

Distorted Data: Political Bias and Concerning Research Practices

Abstract

Political Bias

Psychological Foundations of Political Bias

Implications for Evidence-Based Practice

Conclusion

REFERENCES

Responding to Therapist Activism: New Strategies for Change

Abstract

Key Domains of Action

Public Outreach:

Knowledge Production:

Therapy Practice:

Therapy Bureaucracies:

Therapy Training:

Conclusion

REFERENCES

The New Activist Therapists

Abstract

What Is Activist Therapy?

What Are the Main Differences Between Activist Therapy and Traditional/Classical Therapy?

How Has Activist Therapy Captured the Professional Field?

Activist Scholars:

Activist Clinicians:

Activist Bureaucrats:

Activist Educators:

Other Influences:

What Do We Know About the Effectiveness of Activist Therapy?

Implications of Activist Therapy Practice for Culture and Mental Health Treatment

Conclusion

How Therapists Often Fail Religious Clients

Abstract

Background

How Current Practices Impact Clients

What Should Be Done?

Conclusion

REFERENCES

Treating Patients Impacted by Anti-White Racial Aggression

Abstract

Research Shortfalls

Forms of Aggression and Bias

Harmful Consequences

Remedies

Conclusion

REFERENCES

Improving Mental Health Care for Police Officers

Abstract

Bias in the Mental Health Field Against Law Enforcement Officers

Mental Health Needs of Law Enforcement Officers

Promising Interventions to Improve Mental Health Care for Law Enforcement Officers

Conclusion

REFERENCES

Recovery from Transition: Psychotherapy with Detransitioners

Abstract

Recovery From Transition

Moving Beyond a Medicalized Approach to Gender Dysphoria

Increasing Numbers of Detransitioners

Challenges Facing Detransitioners

REFERENCES

Cultural Misunderstandings: On the Misuses of the Term “Culture”