Acknowledging the Impact of Cancel Culture on Therapy By Maggie Mulqueen, PhD on 6/21/22 - 1:16 PM

As therapists we are taught to shy away from making assumptions, and to do the hard work of bringing to light our patients’ inner thoughts and feelings. Unfortunately, the current social climate has cast a chill on posing such questions. Cancel culture is making its way into therapy sessions, to the detriment of all involved. The antidote to cancel culture is trust, not agreement.

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Cancel culture is a term that is widely used and not always well understood. It is an attempt to ostracize a person or group for behavior or values that another person or group deems to be offensive. It can manifest as shaming on social media or an attempt to have a person fired from a job. To be canceled is to be persona non grata. The problem, of course, is that what is offensive to one person may not be offensive to another person.

Assumptions abound in this current climate, assumptions that can feel like the third rail in therapy and come from both ends of the political spectrum. Living with litmus tests and fear cannot be good for either the therapist or the patient. Working from assumptions, patients may think they know how I vote, how I feel about book banning or the pronoun “they,” but failure to actually explore these issues can lead to misunderstandings. Every patient I saw the day after Donald Trump was elected sat in my waiting room crying. They felt safe, assuming everyone had a similar response to the outcome. In fact, I know I have some patients who voted for Trump and who hold many conservative beliefs.

Increasingly, I find myself in a delicate dance with patients about what is acceptable to say or to ask. Early on in treatment, patients will often curse and then quickly apologize. I assure them that it’s fine with me if they use profane language, and I use it, too, if I sense it is not offensive to the patient. If patients use language that I find offensive, I may challenge them to examine this choice. It can be as simple as referring to grown women as girls or something more dramatic, such as slurs that evoke harmful stereotypes.

Not surprisingly, when patients are speaking freely, they may voice many beliefs which I don’t share. Keeping the focus on the clinical material is critical, but it cannot be divorced from the current culture. I am thinking of one patient in particular who was very angry with his employer, a white woman like myself. As a white man, he felt discriminated against and resented the perceived preferential treatment others were receiving at his company. He accused me of not being able to understand his outrage because as a woman, I must have benefited from similar inclusive policies. Working to maintain respect for one another and keep the focus on his treatment rather than debating the issues of the day was a true challenge for me. There were times that I worried his unbridled anger might be turned against me and hurt my professional reputation.

Agreement is never the goal of therapy, and yet not agreeing with people now feels much riskier. In particular, the discomfort that comes from disagreement extends to fear when there is a true risk that holding a different stance can lead to being “canceled.” For therapists it may come not merely in dropping out of treatment but in the form of bad reviews on social media or complaints raised with therapists’ employers, or, most dramatically, as a threat of malpractice.

The nuanced, complex work of a therapy relationship naturally has ups and downs over time. Having patients leave a session unhappy, or even angry, might be a consequence of treatment, but not necessarily a sign of bad therapy. But if the therapist or patient is biting her tongue in fear of retribution of some kind, it can impede doing our best work. In a related format, we have seen the unfortunate impact of this dynamic in academia, where untenured faculty, consciously or not, give higher grades to students in hopes of getting better course evaluations and saving their jobs.

To mitigate the impact of cancel culture on therapy, I suggest naming it as a real issue early on in the treatment. It may come up because of a patient’s worry about something in their life, such as speaking out within a friend group, or because of how they vet the therapist on certain issues. If either the clinician or the patient find themselves holding back from speaking openly, this needs to be aired out. Certainly, a neutral stance is not always warranted, and true violations of others’ rights deserve some form of consequence. But for that to happen productively, it is best if it can be an in-person conversation without veiled threats.

In the case mentioned above, I set very clear boundaries around the difference between blowing off steam and making personal attacks. I supported my patient’s need to vent his anger and listened carefully to the root of his hurt feelings. At the same time, there were professional boundaries that needed to be respected if we were to continue to work together. I presented this not as a threat, but as a teachable moment. If I couldn’t feel safe in the room, I couldn’t help him.

To reiterate, the antidote to cancel culture is trust. By establishing trust in the therapy relationship, or any relationship for that matter, the opportunity for understanding improves. People are more willing to listen when they feel heard. Opinions may not change, and feelings may still get hurt, but if the relationship has established enough trust, then we can learn from each other and deepen our connections rather than sever them.

File under: The Art of Psychotherapy, Musings and Reflections