I practice in the Boston area, the bluest part of a very blue state, Massachusetts. In the wake of recent world events — Trump’s election, mass shootings, and limitations on access to abortions — most of my patients have until now assumed, not wrongly, that we are aligned politically. For the few whose politics differ from the majority here, they have come to trust that I am open-minded enough to hear their positions without compromising our relationship.
It is a long-standing cliché that therapists answer a question with a question. Typically, if patients ask me direct questions, such as whether they should take a new job or get divorced, it is easy for me to parry the question back to them. But some patients’ tolerance for this practice has waned as they want me to make explicit my position on the war. To them, a position of neutrality or silence feels unsafe and, for some, even immoral. As the war has continued, patients’ positions have shifted somewhat but the intensity of their feelings has not lessened.
Existential and moral questions have always had a place in therapy as people struggle to reconcile concerns about the meaning of life. But in the last decade, patients frame wanting to share their feelings with me in the context of feeling safe. Therapy sessions were meant to be “safe spaces” long before that term became part of the vernacular. Promises of privacy, confidentiality, and acceptance are the backbone of establishing a therapeutic alliance and, with rare exceptions, are guaranteed. But, for some of my patients this war shook their sense of what it means to feel safe in some fundamental ways and that has translated into wanting me to agree with them.
He also questioned whether my silence was actually neutral, and worried that I too would think less of him for not already having a position. “What do you think?” he asked. “I want to hear how you are talking to your friends.” He hoped I would share my position to model for him what a cogent answer might sound like. Rather than satisfying his request, I chose to discuss strategies for having effective difficult conversations and support his right not to know how he felt at this moment in time. It was a meaningful interchange if not wholly satisfying for him.
Another patient vented her fury about her friends whose beliefs on this topic did not align with her own. She saw the potential for this issue to rupture relationships which had stood the test of time through many other challenges. Now she wanted my help, but she expressed grave concern that I would be unable to understand her position since I am not Jewish.
Despite our long history, I wondered if our relationship would survive this difference. Even though I appreciated the amount of distress she was living with, it pained me to think that given the current state of affairs, the fact that we have different backgrounds could limit her trust in me. We are both choosing our words carefully and I check in with some frequency to see how she is feeling about our relationship.
I have a number of patients who are college faculty members or students, and the heated debates on campus came roaring into my practice. Questions about the positions leaders were taking on their campuses and the implications for future career choices were on the minds of these patients and those who are parents of college-aged students.
Patients with younger children raised questions about how much to discuss the war with their children and how to keep their children safe from hate speech and potential violence. There was a general sense of people feeling unmoored and frightened. Taking time to understand the personal connections to this world event became a dominant theme over the course of many sessions.
Most of my patients do not belong to a religious community. I am by no means an expert on Middle East affairs, nor is that my role. For those who feel devastated or set adrift by current events, they look to me for answers and reassurance that I cannot give. Furthermore, in this day of AI and polarized news feeds, people do not know where to turn for information they can trust. At the same time, they want something more than equivocal answers from their therapist.
A weekly therapy hour cannot solve the problems of the world, but good therapy can promote mental health. The goal of therapy is not to shut the world out, but to help people manage feeling overwhelmed by the world. As the challenges of the world continue to come into the therapy hour, I strive to maintain the therapeutic connection. I might not always pass the litmus test, but I am hopeful that my efforts to encourage patients to empower themselves, improve their skills at having difficult conversations, and increase the number of places where they feel safe to share nuanced feelings will mitigate some of the damage done by this war.
File under: The Art of Psychotherapy, Musings and Reflections
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It is a long-standing cliché that therapists answer a question with a question. Typically, if patients ask me direct questions, such as whether they should take a new job or get divorced, it is easy for me to parry the question back to them. But some patients’ tolerance for this practice has waned as they want me to make explicit my position on the war. To them, a position of neutrality or silence feels unsafe and, for some, even immoral. As the war has continued, patients’ positions have shifted somewhat but the intensity of their feelings has not lessened.
Existential and moral questions have always had a place in therapy as people struggle to reconcile concerns about the meaning of life. But in the last decade, patients frame wanting to share their feelings with me in the context of feeling safe. Therapy sessions were meant to be “safe spaces” long before that term became part of the vernacular. Promises of privacy, confidentiality, and acceptance are the backbone of establishing a therapeutic alliance and, with rare exceptions, are guaranteed. But, for some of my patients this war shook their sense of what it means to feel safe in some fundamental ways and that has translated into wanting me to agree with them.
Inviting Politics into the Therapy Space
Days after the attack on Israel by Hamas, a patient started his session by saying, “I need to talk about the war, but I feel so afraid of being wrong, I just keep my mouth shut.” He went on to discuss how limited his understanding of the Middle East was and the pressure he felt to take a side. He knew his silence was not read as neutral and that his friend group wanted to know where he stood.He also questioned whether my silence was actually neutral, and worried that I too would think less of him for not already having a position. “What do you think?” he asked. “I want to hear how you are talking to your friends.” He hoped I would share my position to model for him what a cogent answer might sound like. Rather than satisfying his request, I chose to discuss strategies for having effective difficult conversations and support his right not to know how he felt at this moment in time. It was a meaningful interchange if not wholly satisfying for him.
Another patient vented her fury about her friends whose beliefs on this topic did not align with her own. She saw the potential for this issue to rupture relationships which had stood the test of time through many other challenges. Now she wanted my help, but she expressed grave concern that I would be unable to understand her position since I am not Jewish.
Despite our long history, I wondered if our relationship would survive this difference. Even though I appreciated the amount of distress she was living with, it pained me to think that given the current state of affairs, the fact that we have different backgrounds could limit her trust in me. We are both choosing our words carefully and I check in with some frequency to see how she is feeling about our relationship.
I have a number of patients who are college faculty members or students, and the heated debates on campus came roaring into my practice. Questions about the positions leaders were taking on their campuses and the implications for future career choices were on the minds of these patients and those who are parents of college-aged students.
Patients with younger children raised questions about how much to discuss the war with their children and how to keep their children safe from hate speech and potential violence. There was a general sense of people feeling unmoored and frightened. Taking time to understand the personal connections to this world event became a dominant theme over the course of many sessions.
Most of my patients do not belong to a religious community. I am by no means an expert on Middle East affairs, nor is that my role. For those who feel devastated or set adrift by current events, they look to me for answers and reassurance that I cannot give. Furthermore, in this day of AI and polarized news feeds, people do not know where to turn for information they can trust. At the same time, they want something more than equivocal answers from their therapist.
A weekly therapy hour cannot solve the problems of the world, but good therapy can promote mental health. The goal of therapy is not to shut the world out, but to help people manage feeling overwhelmed by the world. As the challenges of the world continue to come into the therapy hour, I strive to maintain the therapeutic connection. I might not always pass the litmus test, but I am hopeful that my efforts to encourage patients to empower themselves, improve their skills at having difficult conversations, and increase the number of places where they feel safe to share nuanced feelings will mitigate some of the damage done by this war.
File under: The Art of Psychotherapy, Musings and Reflections