References
American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association.
Covitz, Howard. 2016. Oedipal Paradigms in Collision: A Centennial Emendation of a Piece of Freudian Canon (1897–1997). 1988. Repr. New York: Object Relations Institute Press.
Freud, Sigmund, Walter John Herbert Sprott, and James Strachey. 1933. New Introductory Lectures on Psycho-Analysis. Vol. 22. New York: Norton.
Freud, Sigmund. 1955. The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 24. London: Hogarth.
NEW OPPORTUNITIES FOR THERAPY IN THE AGE OF TRUMP1
WILLIAM J. DOHERTY, PH.D.
The boundary between the personal and public has ruptured in the age of Trump. A fixed, hard boundary was of course a fiction—we are always influenced by what’s going on in society, and our personal actions affect the whole. Yet, before Trump, we therapists who felt comfortable in the mainstream of a democratic society could assume that our therapist “hat” and our citizen “hat” were separate. In our therapist role, we told ourselves, we were professional healers; as citizens, we followed public issues, supported candidates, and cast votes. The main crossover was our advocacy for better mental health policies and reimbursement.
Feminist, ethnic minority, and LGBT therapists have argued for decades against this personal/political split in the therapy world—witness the big literature on therapy and social justice. But that perspective was relegated to the sidelines of the therapy world, confined to situations in which the clients were part of an oppressed minority. For the most part, psychotherapy marched along with its traditional focus on the intrapsychic and interpersonal realms—in part, I think, because many of us assumed that we and our clients had personal lives adequately buffered from public turmoil and stress. Yes, occasionally an event such as 9/11 burst that bubble, but it soon re-formed.
After the election of Donald Trump in November 2016, however, the bubble did not return. Many of our clients across social classes and racial groups are distressed by what’s happening to the country and are living with current anxiety, worries for the future, and the reactivation of past fears. This is occurring both for people immediately at risk, such as immigrants, and for those less personally vulnerable who are watching the rise of hate, the disregard for the truth, and the flouting of core democratic values such as a free press and respect for the rule of law. What’s more, we have a president whose public behavior represents the triumph of the antitherapeutic—a lionizing of the unexamined life where personal insecurities are boldly projected onto the world and where self-serving beliefs become public facts.
In the face of these challenges, a number of professions are facing a paradigm crisis: How do they go forward with business as usual when the democratic foundations of their work are being threatened? As an example, consider the soul-searching among journalists now: they are having to call out systematic lying, not just reporting the shading of the truth or one take on the facts versus another.
For psychotherapists, the challenge is to integrate our roles as therapists and citizens so that we can help our clients do the same. This has to begin with the “self of the therapist”—how do our personal lives intersect with our professional practice? Nearly every therapist I know is feeling personal stress and is dealing with clients whose reactions range from reliving experiences of being bullied to fears of deportation to a sense that the arc of the moral universe no longer seems to bend inevitably toward justice. We’re seeing families and friendships fracture along political lines. I do know some therapists who are glad that Trump ascended to the presidency, but they, too, are concerned with the polarization in the country and the tearing of the social fabric.
This is bigger than Trump and the November 2016 election. It’s the culmination of at least two decades of increasing divisiveness in our culture and in politics, where those who differ are seen as dangerous enemies, not just misguided opponents. So how do we respond as therapists and citizens to the impact of Trump in the context of these broader trends? How do we handle our personal reactivity to these events? The starting point is to acknowledge that we need new ways to think about ourselves and our clients as members of the broader public (i.e., citizens), and not just as providers and consumers of services.
Expanding the Frame of Psychotherapy in the Age of Trump and Beyond
Clearly, we have to help our clients deal with the Trump Effect in their lives. Yet, the challenges are bigger, just as Trump represents larger trends. If our approach to therapy is to go beyond helping clients deal with the impact of this one president, we need new conceptual categories for what we address in our work. I’d like to introduce two: public stress and political stress. I define them in this way:
• Public stress refers to challenges for personal and relational well-being stemming from forces in neighborhood, the community, and local institutions (such as schools and the police), as well as forces in the larger political, economic, cultural, and historical environment.
• Political stress (a type of public stress) refers to how the words, actions, and policies of government bodies, elected officials, and candidates for public office create challenges for personal and relational well-being.
Using the language of public and political stress allows therapists to expand beyond our traditional intrapsychic and microsocial frames while still paying attention to the personal: how our clients are thinking, feeling, and acting in the face of stress.
This broader thinking about our clients’ lives can be reflected in the questions we ask at intake. Every profession communicates its area of interest in its intake forms. For example, medicine is dominated by biological disease–based questions. Mental health professionals ask mainly about psychological symptoms and interpersonal functioning. I’ve developed two intake questions to signal my interest in the public lives of my clients. The first asks about public stress and the second about clients’ engagement in their world.
1. Sometimes people in counseling feel stress from events and forces in their community, the nation, or the world. If that’s true for you, I encourage you to briefly let me know. (Otherwise, just skip this section.) Here’s what is causing me stress:_________________.
2. Sometimes people in counseling have commitments to groups or causes outside their family and close social world. If that’s true for you, could you briefly write down what those commitments are for you? (Otherwise, just leave this section blank).
I’ve found that these intake questions provide door openers to conversations about the public realm in clients’ lives—both how they are affected and how they engage as citizens. And then there are other door openers at the outset of sessions. One is to inquire whether clients are following what’s going on in the political world right now, and if so, how it’s affecting them. The result is that many clients open up about Trump-related anxieties and relationship strains they hadn’t previously shared, probably because they had thought the therapy room was supposed to be a politics-free zone—as we ourselves may have believed.
Another way to signal openness to discussing public/political stress is an open letter placed in the waiting room. Here’s an example of such a letter:
Dear Clients,
We’re living in troubled times. I feel it, and most people I know feel it. I’m writing this note to let you know that I’m open to talking about something not always brought up in therapy: how what’s going on in the public and political world is affecting you and your relationships, and how you’re coping.
• After a divisive presidential election, a lot of people are upset and feeling discouraged by the political infighting in this country.
• There’s great uncertainty about what the upcoming years will look like. Some people are feeling alarmed, insecure, and threatened, while others feel hopeful that necessary change will happen. And those two kinds of people are often at odds with
one another.
• I see both liberal and conservative members of our community feeling as if their values are no longer acceptable in the public arena—or to some of their friends and family.
The list could go on. For now, consider yourself invited to bring your concerns about the public world into our conversations in therapy. No expectation or requirement that you do so, of course—just if you think it might be helpful.
I’m here to listen, support you, and help you figure out how to manage today’s stresses while living a life that’s in keeping with your personal and community values.
Once clients open up, we can help them cope with political stress just as we do any other kind of stress: through buffering methods such as reducing exposure to the 24/7 news cycle, refusing to be baited by people who just want to goad them, and self-care efforts. The other kind of coping, active coping, is about helping clients enact their civic values in the world via action steps such as getting better informed through reputable sources, donating to causes they support, volunteering to help others, getting politically active, or (as one client decided) being kinder in public to society’s “others.” And when clients are having powerful, dysregulated emotional responses to the political situation, we can help them unpack how it connects to their personal journeys.
I see our job as helping clients avoid the twin dangers of being either numb/reactive or agitated/reactive in the face of political stress. The middle is where we’re aiming, for ourselves and our clients: being grounded/responsive, where we’re in touch with our feelings and can act thoughtfully according to our values. Therapy like this can be an incubator for an empowered citizenry in a democracy in which we’re neither victims nor flamethrowers.
The Citizen Therapist in the Larger World
Donald Trump has done me the favor of helping me better see the connection between psychotherapy and democracy. In fact, there is a close connection between the personal agency focus of psychotherapy and the work of democracy understood not just as an electoral system but as a collective agency for building a shared life in community: We the (responsible) People. In our offices, we promote the kind of personal agency that’s necessary for a self-governing, democratic people, a people whose worlds are public as well as private. In other words, we are growing citizens of democracies. And therapy needs the larger system of democracy in order to thrive. (I’ve trained non-American therapists who went home to dictatorial systems that greatly inhibited what they could encourage their clients to say and do in their social world.)
Still, to truly fulfill the potential of our professional role in a democracy, we have to be active outside our offices. I feel passionately that we’re healers with something important to offer our neighbors and communities. Here’s a short definition of the concept of the citizen therapist: A citizen therapist works with people in the office and the community on coping productively with public stress and becoming active agents of their personal and civic lives. Citizen-therapist work is not separate from the traditional practice of psychological and interpersonal healing—it’s integrated with it.
As an example of citizen-therapist work in today’s toxic public environment, I’ve been doing depolarization workshops with “Red” and “Blue” Americans. One stands out in particular: thirteen hours over a December weekend in rural Ohio with eleven Hillary supporters and ten Trump supporters. The goal was to learn if people could better understand their differences (beyond stereotypes) to see if there were common values, and to share, if possible, something hopeful with their community and the larger world. For me, it was like couples’ therapy with twenty-one people—intense, painful, illuminating, and ultimately gratifying. After a second, equally successful weekend in southern Ohio, a new action-for-depolarization group was formed of Red and Blue citizens, a chapter of a national organization called Better Angels. I’ve also developed a series of different kinds of workshops and trainings, offered through Better Angels, that therapists can learn to conduct in their local communities.
The age of Trump calls therapists beyond the personal/public split, a blind spot that has kept us from engaging in comprehensive care for people who bring to us their whole selves, private and public, intimate and civic. It’s an invitation to expand and enrich the work we do for our clients and communities.
William J. Doherty, Ph.D., is a professor of family social science and director of the Minnesota Couples on the Brink project and the Citizen Professional Center at the University of Minnesota. In May 2016, he authored the Citizen Therapist Manifesto Against Trumpism, which was signed by more than 3,800 therapists. After the election, he founded Citizen Therapists for Democracy (www.citizentherapists.com). He is a senior fellow with Better Angels, an organization devoted to depolarizing America at the grassroots level. He helped pioneer the area of medical family therapy, and in 2017 he received the American Family Therapy Academy Lifetime Achievement Award.
PART 3
THE TRUMP EFFECT
TRAUMA, TIME, TRUTH, AND TRUMP
How a President Freezes Healing and Promotes Crisis
BETTY P. TENG, M.F.A., L.M.S.W.
In the days following the November 8, 2016, election of Donald Trump as president of the United States—the most powerful leadership position in the world—many individuals, particularly those targeted by Trump’s rageful expressions of xenophobia, racism, sexism, and Islamophobia, experienced the event as traumatic, without quite knowing why. “I feel like I did after 9/11,” said one colleague. “I am in shock,” reported a patient. “I don’t know what to think.”
Throughout the next weeks, patients and colleagues alike told me that the very idea of a President Trump left them feeling exposed, vulnerable, and helpless. “I have four out of six identity markers Trump will target: Arab, gay, immigrant, and woman,” commented one patient. “I don’t feel safe walking around anymore.” One woman who was conflicted about whether to report her rape decided she would not. “How could it matter anymore?” she asked. “No one would believe me now.” Another survivor was more blunt: “We elected a rapist to the presidency,” referring to the accusations of sexual assault (Crockett and Nelson 2017) that several women brought against him, to no consequence. A colleague who treated New Yorkers in the months following the 9/11 terrorist attacks on the World Trade Center said the reactions he has seen in his patients to Trump’s election and presidency are far worse. “The difference is, the attacks of 9/11 were finite and enacted by an outside source,” he observed. “Trump was elected by those among us, and his aggression feels incessant and never ending.”
These reactions were also my own. I, too, was in shock; sitting with patients, I struggled to focus. I was prone to spontaneous tears. When asked, I found it difficult to summon the words to explain my distress. I recognized these responses as symptoms of traumatic shock, the possible harbingers of PTSD—posttraumatic stress disorder—which is commonly experienced by traumatized patients.
I am a psychotherapist—specifically, a trauma therapist who treats at a major hospital in New York City adult survivors of sexual assault, domestic violence, and childhood sexual abuse. My job is to have some clinical understanding of trauma and how it impacts individuals and knowing how to treat its subjugating effects. Yet, I was baffled. How could a nonviolent event such as the peaceful election of a president generate a trauma response? Whatever one’s political leanings, one could not equate Trump’s win with an actual physical attack or a natural catastrophe.
Or could one?
The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape, or natural disaster.” And for many people—especially, but not confined to, those in groups that Trump targeted during his campaign—his election and now his presidency are truly terrible, even disastrous, events.
Indeed, in the months since November, psychotherapists nationwide have reported an unprecedented focus on politics in their sessions, and a surge in new patients (Gold 2017) s
eeking help with the high anxiety and stress they feel in reaction to Trump’s steady stream of extreme tweets and impulsive actions. Indeed, from the confusion and worry caused by his disastrous immigration travel ban; his irrational accusations that President Obama wiretapped Trump Tower; and his sudden military actions against Syria and North Korea, President Trump appears more concerned with drawing attention to his power through creating crises rather than resolving them.
It is inevitable that such destabilizing behavior in one who holds the most powerful leadership position in the world will heighten anxiety and fear in not only the previously traumatized, but the untraumatized as well. Media pundits and clinicians have coined terms such as post-election stress disorder (Gold 2017), post-Trump stress disorder (Pierre 2016), and headline stress disorder (Stosny 2017) to draw parallels between the anxiety reactions suffered by increasing numbers of concerned Americans and the symptoms of PTSD. If what we read about is true—and I will return to this, as Trump and his top advisers have also shaken our notions of truth and fact—PTSD-like symptoms of insomnia, lack of focus, hypervigilance, irritability, and volatility now afflict not only combat veterans, first responders, and survivors of rape, violent crime, natural disaster, torture, and abuse, but many of the rest of us as well.
Again, as a trauma therapist, I puzzle over this correlation of symptoms in greater numbers of the general American populace to PTSD, where the source of trauma is not a physical attack or a natural catastrophe, but the incessant barrage of aggressive words and daily reports of the erratic conduct of a powerful, narcissistic, and attention-seeking world leader. There is much debate over whether post-Trump stress disorder is “real” or just another example of how “snowflake liberals,” goaded on by a “hysterical” left-leaning media, overinflate their suffering. There are questions about whether this trivializes the suffering of “true” trauma survivors, who have experienced “real” attacks and harm.
The Dangerous Case of Donald Trump Page 21