When the Clinical is Political and the Political is Clinical
Updated: Jan 23, 2019
• By Danna Bodenheimer •
On May 6, 1931, Sigmund Freud received a birthday card from the President of the Indian Psychoanalytic Society in Calcutta. It was Freud’s 75th birthday and the card was written to signify that the practice of psychoanalysis was now being practiced “all over” the world. He was given an ivory statue to commemorate the occasion and the accomplishment.
I raise this, in 2018, because it seems worthwhile to bow at the feet of the tradition and the staying power of psychotherapy; long considered to be the sole force that ameliorates trauma and relational ruptures. It also seems worthy to consider the long history of colonization that psychotherapy has played throughout the world since Freud’s cult of personality first grew. As therapists we are forced, at all times, to hold incredible tension to do our work well.
The tasks that Freud set forth for his patients, as a founder of psychoanalytic psychotherapy, were twofold and simple: the client was supposed to graduate from treatment upon solidifying the ability to love and to work. Nearly a century later, these two constructed cornerstones of “wellness” dominate psychological thought and therefore, treatment.
The Walnut Psychotherapy Center was formed in 2015. The goal, similar to that of Freud’s original goals, was to provide psychotherapy that enhances functioning in society and overall life quality of life. Our wish, however, was and is to specifically decrease suffering for members of the LGBTQ population and anyone who identifies as adjacent to this community.
We already knew, when we opened, that we were going to be serving a population that has been demonized and pathologized by almost every psychological apparatus that existed up until that point. LGBTQ people have always been a large part of the bread and butter of the DSM. The Diagnostic and Statistical Manual serves to guide clinicians in their effort to categorize mental health functioning, and it makes billing possible through the naming of symptoms under the heading of a diagnosis.
It wasn’t until 1973 that homosexuality was removed from the DSM as a disorder.
We still rely on the DSM to support the possibility of treatment for trans people, who must meet the diagnostic criteria for gender dysphoria in order to receive medical interventions.
We knew all of that. What we didn’t know, when we opened, was just how politically disenfranchised we would become just a year after opening, with the election of 2016. The fact is that life for LGBT people had never been simple or easy. But progress, honestly, had been made. What we didn’t know is that an administration would take power that would do everything in its power to systematically disenfranchise the queer population even further.
Week after week, new hits to queer rights have been rolling in, while a movement to celebrate Whiteness, Heterosexuality, and Cis-gendered bodies grows. Whether a ban on trans troops serving in the military, or the construction of hysteria around a LGBTQ caravan of immigrants coming to seek asylum, the safety of queer bodies is eroding quickly.
And, so, this is the atmosphere that we find ourselves practicing therapy in.
We have the ancestral leanings of Freud who built his work on a hierarchical structure of treatment: The White cisgender man knows best and holds the position of expert. He says little while the client writhes in their own discomfort, curiosities, and free associations. The client is then analyzed through the use of interpretation, a very powerful force that suggests that there is knowing outside of the client that must be shared with them. And once these interpretations are absorbed, the client can integrate the “truth” about themselves, freer of defensive functioning, and ready to meet those two main goals: love and work.
Beyond the leanings of psychotherapy and the role it has played in colonizing minds through diagnosis, interpretation, and the withholding stance of the therapist, we are living in a moment in time that is defined by the erosion of truth, the assault of anything ‘different’, and vicious racism, homophobia, and transphobia.
Which leaves us with the mandate to accept that the political is the clinical and to allow the clinical to inform our political thinking. And to think about what this really means.
First, it means to start taking seriously the theorists who have been erased by Freud over time and to think about the reasons why clinical thought has been as whitewashed as it has. This means that we need to start practicing with the voices of people of color in mind, even if those voices cannot be found in traditional, academic sources. It means that we also need to seek out the voices of queer practitioners and thinkers who have long considered how to subvert the dominant paradigm of therapist as expert and client as learner.
We also need to consider that perhaps the chief learner in the therapeutic dyad is the therapist themselves. And, oftentimes, the client is indeed the educator have lived life at the margins of multiple oppressed identities. When a client comes in tears over the recent separation of children from parents at the border, do we know why they are crying better than they know? It is the sheer injustice of it? Is it the triggering nature of seeing attachments ruptured at the hands of government bodies? Is it the fear over the clients own immigration status? Is there something to actually interpret or make sense of? Is this about transference or countertransference? The fact is that we, as therapists, don’t know. And we can’t know until we simply give our clients the space to explore their own truths and to define what substantiates truth for themselves.
We also can’t sit there, continuously unaffected, ourselves. That is the model set forth by years of traditional psychotherapy: the fully contained and perfectly analyzed therapist sits and listens, hovering above the emotional rivers that flow within their own room. So if a client comes in not crying about what is happening at our border, can we be the one to cry?
Can we be the one to bring it up?
Can we wonder aloud about where the empathy or concern is? Traditionally, the answer to these questions is: of course not. But if we are really to respond to this political moment and the proliferation of dehumanization that is happening around us, don’t we have a clinical responsibility to say something? Isn’t it more important to feel than it is to love and work? Is it possible to love and work if we can’t feel?
We also have to wonder to what extent the ability to love and to work is possible in a world where work often means needing to mask one’s identity. And, love means building a mutual and trusting bond when many of one’s attachments have been ruptured. We need to question these fundamental treatment guidelines and goals and reconstruct wellness in favor of a client living fully, in a body and an identity that feels self-actualized and authentic. We need to reconstruct wellness in favor of a person’s inability to adjust to the world around them, rather than by adapting the travesties that surround us all. These travesties ought to be impacting us to the point of what looks like crazy, but is actually the truest possible sanity that can be achieved right now.
As always, thanks for reading and sharing! We welcome your feedback at firstname.lastname@example.org. To support mental health in the LGBTQ community, check out www.walnutwellnessfund.com.