Therapy Isn’t for Everyone
Let’s talk about the people harmed by mainstream mental health
This Is Us
Let’s talk about the people harmed by mainstream mental health
The first time I sought out therapy, I was met with a smiling gender-conforming white lady who furrowed her brows when I described the pain I was in and said softly to me that it “must be so hard.” It made me immediately want to bolt from the room. Instead, I just sat there and cried.
I was in graduate school, depressed and unmoored, and the therapist was overseeing a social anxiety group I was desperate to join. She sat me down on a couch across from her and asked a few gentle, quiet questions about what it felt like for me when I tried to make friends. I didn’t know how to answer. I never really tried to make friends at all. Friendships were driven by an invisible machinery I didn’t know how to take apart or reassemble. There was a deep longing inside me for connection, but if you put another human being in front of me, I’d freeze up. Which is exactly what I did in the therapy office.
It seemed pathetic that I couldn’t give voice to my problems. It was clear the therapist was disappointed by it. More pathetic still was the fact that I was in my mid-twenties and had no close friendships and no conception of how to make them. My inner life was a painful, pitiful mystery to me, and this woman wanted me to somehow lay it bare so it could be fixed. What did trying to make friends “feel like”? What did anything feel like? Every day, in every situation, I felt the exact same: pissed off and freaked out and miserably lonely. What did she expect me to say?
The therapist sat with her hands resting in her lap and pulled a ton of frowning, empathetic faces while I sobbed and sobbed before her. I choked out a few words about not knowing how to make friends and feeling very trapped by my own inhibitions, but none of them seemed to move her. After I was done sputtering, she told me that perhaps, in the social anxiety support group, I’d be able to explore some of those difficult feelings as I got to know the group’s other members. Maybe I’d even find myself trying to befriend some of them.
It seemed like a bizarre comment to make. I’d hoped this group would impart some specific social skills or that by helping me “get to the bottom” of my fear of other people, I’d learn to open up to potential friends out in the real world. But if this therapist thought I was going to try and befriend the people in the social anxiety group, she had to be misunderstanding why I was even there. I didn’t know how to initiate, socially, with anyone. I certainly wasn’t going to do it with people who I already knew felt anxious. This wasn’t a meetup group. I was here to get unbroken.
I left the therapist’s office that day feeling more hopeless than I had when I entered. The next week, when the support group was supposed to begin, the therapist called me on the phone several times wondering where I was. I’m sure I wasn’t the only social anxiety group member to ditch social anxiety group. Surely that comes with the territory. So I was peeved when she kept calling me, week after week for eight whole weeks, wondering if I was ever gonna show up. With each call, I became even less interested in going.
The next time I sought out therapy, I had just found out my former abuser was going around doing far more violent things to the victims who had come after me. The news and the details of what he had done was immensely triggering, and I knew I needed help. But I was an adjunct professor, hopping from campus to campus teaching seven classes per semester for far too little money, and therapy felt like an extravagance I couldn’t sustain.
“I’m not sure how long I can stay in therapy with you. I feel anxious spending so much money on it,” I told my new shrink, a very conventionally attractive, slender white woman with a frozen smile and a long curtain of reddish-brown hair. “I just want to work on this trauma and talk through my feelings about my abuser and then probably go.”
“You can tell me about your trauma if you would like,” she said, “but I find that it’s far more helpful to work slowly with a client and build in them a strong foundation of mindfulness. The details of what happened to you won’t help you overcome the stress you have in your body.”
“I’m here specifically to talk about my trauma though,” I told her. “And I just don’t know if I can pay for therapy for months and months to work on more general things.”
This seemed to offend her. “Well, let’s talk about your fears around money,” she said. “It sounds like it concerns you a lot. When you go to the grocery store, do you look at the price of a tube of toothpaste before you buy it?”
“Um, yeah,” I said, perplexed.
“I used to do that too, but then I realized I was worrying about information that didn’t matter and letting small irrelevant data points guide my decision making in irrational ways,” my new therapist told me. “So then I learned to give myself permission to buy things that I need and simply not consider the price of them.”
I tried to explain to her that my “financial anxieties” weren’t as simple as fretting over the cost of toothpaste. Besides, with how little I was making, worrying about the cost of toothpaste was rational. But whenever I raised these issues, she got prickly and undermined my concerns. “Taking care of yourself is worth it,” she would say, as if being able to pay for something was as simple as realizing you deserved it.
She had photos displayed of herself on vacation: her pretty face set before a lush jungle. Her tall, thin silhouette on a sunlit beach, holding hands with a tall white man with a cut jaw. Her in front of old European buildings I didn’t recognize, wearing textiles that looked expensive and unattainable. Other than a trip to day drink at a casino in Windsor, I’d never been out of the country before.
When I asked her about the photos, she smiled and said, “Yes, travel is one of my passions. I’ve been to over 50 countries, and it would be a miserable year if I didn’t add another three or four to the list. My next trip is to Bogotá.”
Shortly after that conversation, I was laid off from one of my adjunct teaching jobs. The Christian college where I taught had become increasingly hostile to me, as my gender queerness became increasingly visible. After Trump was elected, I came out to my students as nonbinary and added my pronouns to my email signature. When I saw students being mistreated and not given accommodations for mental illness and other disabilities, I spoke out. My future classes were canceled, just like that.
When I told my new therapist that I truly could no longer afford to see her, she was shocked and apologetic. “I didn’t realize you actually had to worry about money,” her replies seemed to say. “I thought you were like me.”
I have a PhD in social psychology, and in graduate school, I sat in classrooms alongside many clinicians-in-training. I have also taught clinical psychologists in statistics and research methods and various social theories of behavior. And I’ve been in therapy a few times myself, usually with pretty horrible results.
From these collected experiences, I can confidently conclude: Therapy is not for everyone. To put it more pointedly, “therapists” are not for everyone. Most therapists are cisgender white women from upper-middle-class backgrounds, who mostly know how to communicate with people very much like themselves. Furthermore, I have seen how newly minted therapists are trained, and the process rarely has the needs and struggles of marginalized people in mind. Therapy presents individual-level solutions that can work for small-scale problems. If your anxieties are irrational, a couple rounds of cognitive behavioral therapy might be able to nip them in the bud. But if the challenges you face are pervasive and structural, you may walk away from therapy feeling shamed and overlooked, rather than healed.
My first therapist didn’t understand that soft-voiced “active listening” and asking lots of questions about feelings doesn’t work well for Autistic people like me. Many Autistics experience alexithymia, the inability to recognize and name emotions. I can’t just spit out how I’m feeling when I’m put on the spot. I need time to reflect on my emotions. Sometimes it takes weeks to make sense of how an experience made me feel, and other times, I need people to explain my own reactions to me. I find eye contact overwhelming at times, and when someone directs a big, intense emotional expression my way or tries to emotionally mirror me, my blood turns cold.
Of course, lots of non-Autistic people are also put off by the traditional “active listening” therapy approach. Not everyone is equipped to sit across the table from a smiling sad-for-you white lady who vacuously tells you that your struggles must be “so hard.” A lot of men are put off by such interactions, and most therapists have very little training in treating men’s issues.
Clients of color can feel condescended to or not truly understood when they get the empathic, “that must be so hard” treatment from a white therapist. Diasporic and immigrant clients may also blanch at being asked to name emotional symptoms, if, in their families, such topics were verboten. People who aren’t outwardly emotionally expressive can walk away from the therapeutic exchange feeling cold. But this is the standard approach taught to clinicians—one that centers a very conventionally feminine (specifically, white feminine) way of talking and emoting.
The issues with my second therapist went even deeper. She came from immense privilege, so she couldn’t understand my anxieties around money. She truly believed I was being irrational. When I described my trauma to her, she also brushed it off as irrelevant to my “deeper” issues. I was trapped in a miserable situation, broke and overworked, living in fear that my abuser might return and punish me for speaking to his other victims.
Meanwhile my therapist wanted me to meditate and buy toothpaste without looking at the price. Foundationally, her outlook was incompatible with my reality. Her solutions were custom-built for people with wealth and status, like her. She couldn’t help someone who was being pushed down by forces they could not control.
The problems with my therapists were not unique — they were like so many of the thin, rich, cisgender, white clinicians I had met in graduate school—women who spoke about problems such as addiction and homelessness in a pitying tone of voice but when faced with an actual homeless person drew back in disgust. Therapists who claimed to be allies to LGBTQ people and to be anti-racist, but whenever someone visibly diverged from their conventional Waspy mold, they mocked it. They believed the goal of therapy was to return people to a state of productivity and conformity — if someone couldn’t work a full-time job and have a conventional marriage and children, something was broken and needed to be cured.
When prospective graduate students came to visit campus, these women analyzed them top to bottom and sunk their teeth into every visible sign of nonconformity, mental illness, queerness, or poverty they could find: “How can you be a therapist with that bad of a snaggle tooth, wouldn’t clients get distracted?” “She took three showers a day at the hotel. I wonder what her problem is.” “He smelled like the food my neighbors stink up the hallway with.” “She talks so slowly, like she’s depressed.”
These remarks, and others like them, made me hesitate to try therapy for many years. I knew that behind the placid, sad smiles of empathic therapists there often lurked all manner of judgmental barbs and an ideology that saw people like me as fundamentally broken. I was too trans for a cisgender therapist to really “get.” I was also too awkward, too messy, and too close to the hillbilly relatives from whom I’d inherited my approach to money. When I spoke, smiling white ladies found me crass and offensively candid. When I withdrew, they couldn’t see I was in pain and presumed I was an unfeeling robot. When I spoke about my problems, they wanted to argue them away—as if being financially strapped and traumatized was something that could be persuade out of me.
I’ve met a lot of people who have been done a deep disservice by therapy. I’ve heard from several Black and immigrant folks who’ve been told by white therapists that their families are “toxic” and “enmeshed” simply because their culture doesn’t prioritize rugged individualism and their family structure doesn’t look like the standard white American nuclear one. I’ve heard from Black women who have been told by their white lady therapists that they are too “bitter” and too “angry”—particularly about their daily experiences of racism. My friend Kim (who was homeless for several months) was told by their therapist that prejudice against homeless people doesn’t exist, that they must have been imagining the insults, discrimination, and invectives thrown their way.
Mental health institutions need to admit that people are not broken — it’s the systems failing us that are.
In classrooms, I have heard therapists-in-training mock patients for having tangled hair or unusual interests or for speaking in an odd vocal cadence — all harmless, neutral things that tend to correlate with ADHD and Autism. I’ve taught clinical PsyD students who believe self-diagnosis is “delusional” and “self-absorbed.” They say these things with seemingly no awareness of how difficult it is for most people to access mental health services. They’ve swallowed the lie that an identity doesn’t exist until someone with expensive university credentials comes and observes it.
I have to keep these experiences in mind when people reach out to me, asking for advice on how to find an affirming therapist. Often, my answer is, “Be careful, and don’t get your hopes up.”
I’ve also met many mental health practitioners who are working desperately to swim against this tide. There are Black, Brown, and Indigenous therapists who are working desperately to decolonize their practices. There are queer therapists who affirm their patients’ identities and call into question all the professional norms that equate “health” and “stability” with gender conformity. There are social workers who are acutely aware of how the state leverages power and violence against people of color and people in poverty, who recognize that a few therapy sessions can’t undo a lifetime of abuse. I know marginalized people who have found great therapists. It’s not always a hopeless pursuit.
Still, I know that the very foundations of psychology and psychiatry are racist, sexist, transphobic, and ableist to their core. I know that these bigotries bleed into who gets to become a therapist and how new therapists are trained. I know that mental health is in part defined by “functioning,” which is to say a person’s ability to “work.” I know that it’s impossible for a social worker to be in charge of whether a client gets to see their children ever again and to treat that patient’s mental health at the same time. I know there is not one single therapist in the entire Chicago area who is trained in working with Autistic adults.
I have heard hundreds of horror stories of ineffective, system-justifying therapists, and I have seen firsthand how bad therapists get made, so I can’t chalk it all up to a few bad apples. The barrel rots the apples. The barrel selects apples that are predisposed to rot. The barrel hates apples that come in different shapes and colors. The barrel is inaccessible to most apples, yet being inside the barrel is how apple-ness has come to be defined.
I want to destroy the barrel. I want to see a network of community care that cares for people who experience daily racism and transphobia. I want therapists to recognize poverty can’t be fixed by doing a workbook, and a childhood filled with sexual abuse can’t be undone by a handful of breathing exercises. I want therapists to fight for economic justice while they help their individual clients cope—therapists who aren’t afraid to name capitalism, white supremacy, and the gender binary as the roots of so many problems.
I also want to see therapists like me — Autistic, queer freaks who swear too much and fidget in their seats and know what it’s like to see their own minds as inscrutable and frightening. I want my Black and Brown friends to have therapists they can recognize themselves in. I’d like people with commonly demonized disorders like borderline personality disorder to have places where they feel accepted and safe rather than maligned. As we work to rebuild, I want mental health institutions to admit that people are not broken; it’s the systems failing us that are.
Until these changes come, I will have to keep reminding people that therapy is not for everyone. If you see the wrong kind of therapist, with the wrong attitude toward people like you, it can do a lot of harm. Replacing cops with social workers will not fix all our problems. Mental health systems are oppressive, exclusionary, and violent in their own rights.
I do wish that “go to therapy” was the helpful refrain so many people seem to think it is. Everyone deserves to have a nonjudgmental space to share their pain and have their concerns heard. Unfortunately, for most of us, therapy is no such place. It’s just another room where we are stared at and made to feel defective—and that’s if we can afford to go at all.