Travis Heath on Psychotherapy as an Act of Rebellion

Travis Heath on Psychotherapy as an Act of Rebellion

by Lawrence Rubin
Join’s editor Lawrence Rubin in a fascinating conversation with clinician/educator/author Dr. Travis Heath as they deconstruct and rebuild the practice of psychotherapy. 


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An Act of Rebellion

Lawrence Rubin: Hi Travis, thanks for joining me today. I first became aware of you and your work after reading “Reimagining Narrative Therapy” that you co-edited with Tom Carlson and David Epston. There you said that therapy is, or at least should be, an act of rebellion? 
Travis Heath:
sometimes, usually unwittingly, therapy can become an act of reinforcing normative ways of being
I wrote that, huh? It’s always interesting to reflect on one’s own words. Should it be an act of rebellion? Maybe it shouldn’t be in every case. Yet, I think there could be therapeutic advantages to therapy being an act of rebellion. What I mean is that sometimes, usually unwittingly, therapy can become an act of reinforcing normative ways of being. What we might describe as “mentally healthy” may actually be a normative societal way of behaving. So then, an act of rebellion is when people move against the norm, right? To go against the status quo. And there could be — whether it be in therapy or elsewhere — immense therapeutic value when that rebellious act is consistent with who the person most knows themselves to be. Now, I’ll say that an act of rebellion for the sake of rebellion, like a contrarian act of rebellion around every turn, may not always useful. But one that is truly consistent with who a person is can have a positive impact on one’s mental health.
LR: And sometimes people come to therapy not sure of who they are, or which story is the one that is the healthiest for them to live by. Are you suggesting that for some people a therapeutic relationship allows them to rebel against norms that are oppressing them or holding them down?
a good question can open up a way of living that a person hadn’t articulated in a particular way before
I think a therapeutic relationship can help with that, although I don't know if that is enough alone. As someone who is informed by narrative ways of working, therapeutic questions are very important to me. Most of my questions are average at best and probably don’t lead to much change in people’s lives. But all I need is one really good question. Not one that I’ve conjured up, but one that just comes up quickly in the moment from the relationship I am having with the person that I just throw out there. A good question can open up a way of living that a person hadn’t articulated in a particular way before. Maybe they felt it somewhere or tried to imagine it, but now they’ve put words to a particular direction.
LR: This may be a tough one to pull out of your hat, but can you give me an example of a client that you recently worked with, or that stands out in memory, where you came up with the right question at the right time?
TH: Yeah, that’s a good question. I was working with a women-identified person in her 40s. In our culture, there are certain ideas about bodies — how they should look, and how bodies should and shouldn’t be shaped. I think this is especially so for women. That pressure seems to be increasing for those of us who are male-identified as well, but it’s been very tough for women for some time. She was really distressed when she came to me and was talking about eating peanut butter. Like, “I’m really distressed because I’m eating peanut butter.” And I remember saying to her, “Okay, I hear you and I want to understand what’s distressing about this?”  

I remember saying to her, “Can I share something with you? I eat peanut butter too sometimes.” And she kind of smiled, but added, “No, I mean I eat too much peanut butter.” And I said, “Okay, again, I hear you. Help me understand. What’s too much peanut butter?” She said, “Well, I might eat a spoonful or two spoonfuls of peanut butter.” And I said, “Hey, I won’t want to tell you how to eat or what you should or shouldn’t be eating. I’m just really trying to understand. And I wonder, is it possible that you could eat a spoonful or two spoonfuls of peanut butter and that might in some way be okay? Now, if you told me you ate the whole jar or something and you were doing this nightly, I would understand how that would be distressing. But do you suppose it might be okay that you eat a spoonful or two of peanut butter?”

it became an act of rebellion for her because she was resisting some of these discourses about food and about her body
With that question, she burst into tears. It was a simple question, not something you’d see in a textbook as an exemplar. But it was really just a question that in some small way, maybe larger than I initially realized, invited her to think about how she came to understand what’s too much peanut butter and what’s not enough peanut butter. The question was asking her to consider how she came to understand that eating peanut butter might begin to define her as not a good person. How did she come to understand that process? And we really had a session just about peanut butter, which sounds sort of wild, but it wasn’t initially an act of rebellion. It became an act of rebellion for her because she was resisting some of these discourses about food and about her body.

I remember asking her, “Okay, so how often do you do this?” She said once or twice a month, so I said, “All right. Let’s just say that you stopped doing that. Do you then think your body would, over time, or maybe quickly, begin to conform to this body that you’ve been told you should have?” She really thought about that and said, “No, it probably wouldn’t.” “Well, what kind of acts of torture or anything else could you put your body through to make it look like these bodies you’re telling me would make you a good person?” In that moment, with that question and the questions and answers that followed, it was essentially about, “If I looked this way, I’d be a good person.” But she couldn’t initially articulate that. It was the question about “peanut butter” which enabled her to communicate those feelings of insecurity that she constantly experienced yet couldn’t ever explain. In that way, our conversation about eating, and even just existing in her body, became an act of rebellion against normative prescriptions of what society tells women is a good body.  
LR: You know, Travis, I would imagine at one level you were very aware that you weren’t really talking about a spoonful of peanut butter. Instead, you were creating a space in which she could really question the legitimacy of her rigid thinking, and maybe even dive more deeply into a conversation about self-worth, body image, and perhaps gender with its discontents. 
when people say “self” in front of anything — self-talk, self-esteem — I get skeptical
Lawrence, I might say it just a little bit differently. Not so much her own self-talk, but the talk of the culture that she had adopted and the cultural meaning of “self-talk.”. Because when people say “self” in front of anything — self-talk, self-esteem — I get skeptical. Self-talk isn’t really her talk, although it may feel like her talk because Lord knows how long that talk has been kicking around. But she didn’t come out of the womb with that talk. That talk came from someplace, and now it’s become a part of her. So, I think that this act of rebellion you’re talking about, when it is really shining, can help people see that and say, “Oh gosh, I didn’t come out of the womb with this. Actually, these aren’t my ideas.” Then that can lead to, “And I don’t even have to subscribe to these ideas,” which can be very liberating.  

Confessions of an Anti-Manualist

LR: So, you created a space in which she was given permission to rebel against certain language that has been forced on her or force-fed to her. Shifting gears a bit, has traditional therapy’s search for the grail of evidence-based techniques enhanced or diminished the craft of psychotherapy? 
TH: I like the question, and I think it’s an important one. Without trying to be too long-winded, I do think that historically the idea of “evidence-based techniques” came from a good place. By that, I mean hey, there was a time when psychotherapy was viewed in a certain kind of way—the work of charlatans. Hell, there were psychologists, not clinical psychologists, but there were psychologists — I think Cattell and some of those other folks — that weren’t necessarily huge fans of psychotherapy. And so, I think there was a time when it was important to show that there was some kind of scientific evidence base, that therapy wasn’t just akin to palm-reading. Maybe I shouldn’t dismiss that out of hand, but that’s a different conversation. The point being, there was a real reason for attempting to create psychotherapeutic techniques with evidence as their primary foundation.

at some point, this idea of evidence-based practice got tangled up with late capitalist ideas, and people discovered that you could sell a hell of a lot of workbooks
At some point, this idea of evidence-based practice got tangled up with late capitalist ideas, and people discovered that you could sell a hell of a lot of workbooks. You could also bring a hell of a lot of legitimacy to what you were doing, and it helped your personal brand that was tangled up with the brand of your therapy. That’s where I think it started to become problematic. So, the idea of having evidence is not necessarily bad. But when it’s done for these sorts of capitalist reasons, I become concerned about it.  

Now to your question of the art, if you will, of psychotherapy. I’ll share a quick story from a class I was teaching probably 10 years ago. It was an undergraduate intro to clinical and counseling class, and as we discussed I have never been too keen on these evidence-based models. So, I started the class by bringing in treatment manuals and handing them to everyone. “All right class let’s look these over. What do you think about them?” Most of the students, and I think this says a lot, were comforted by this. “Oh, great. I could do this. I could follow this script.”

Then one intrepid young woman who sat in the front of the class asked, “Well, what happens if you’re using this and it doesn’t work with someone?” And I said, “Well, okay, that leaves us at a bit of an impasse, doesn’t it? I personally don’t believe there are just two ways to do therapy. But let’s just look at two possibilities. So, one possibility is we use this manualized approach that we’re looking at. And it works to a certain degree for some people, maybe even most people. And you do a mediocre, good enough job, your whole career. And then, every now and again, you find someone it really doesn’t work for, and I guess you just abort mission. Or another option — it’s not the only other option — is that we learn how to do this on sort of a moment-to-moment basis. We’re really being in touch with the other person.” I said some other shit, too, but the students almost universally agreed that one sounds better, but it also sounds scarier. It sounds like a lot more work. And how do I know if I’m doing it right? They had all these questions, which were all very fair.

somewhere, usually early on in people’s formal training, without even realizing, without even really being presented it, they’re nudged to make the choice of one manualized treatment over another
My worry is that somewhere, usually early on in people’s formal training, without even realizing, without even really being presented it, they’re nudged to make the choice of one manualized treatment over another. They’re nudged to go down one of these pre-determined roads — and they’re sort of nudged often. And then if you’re trained in that way, it’s hard to put the genie back in the bottle. It’s not really that one way of doing therapy is superior, but if you’ve worked with enough people, you come to understand that you aren’t going to be able to take the same damn thing and apply it to everyone who walks through the door, or even most people.  
LR: So, would you say that you are an anti-manualist, or that you practice an anti-manualized form of therapy? I know Narrative Therapy is, by definition, an anti-manualized intervention.
there’s a certain soul to the way that I work. And there are patterns in how I work. I won’t deny that
I have never heard it put that way. I like the term. I accept the term. I don't know if I always live up to that as much as I could. I mean look, there are certainly patterns to my work. And people who know my work well and who have watched it behind mirrors or whatever they’ve done over the years, could point to patterns in my work. I don't know if patterns are manuals because I’m not necessarily adhering to a prescriptive one, two, three, four, this is the order of how you do things. But there’s a certain soul to the way that I work. And there are patterns in how I work. I won’t deny that. At one point, however many years ago, I said, “Well, I never do the same therapy twice.” That feels a little self-aggrandizing. Like why am I saying that? Yes, there are elements that overlap. So, to be an anti-manualist, yes. I like that idea. And, I have to acknowledge that not everything I do with every single person is completely new and creative. There are some patterns that you see.

De-Colonializing Therapy

LR: There are likely many clinicians in our audience who are really into manuals. It seems that once a therapy has an acronym, a workbook, and a “seal of approval” by some credentialing body, it becomes the stuff of grail. In this vein, and based on our conversation and my reading of your work, are we speaking about detraditionalizing therapy practice? 
TH: Thanks for asking these questions. To detraditionalize, for me, is something that if it doesn’t happen, then a therapy dies. But let’s get outside of therapy for a moment. I think almost anything dies. Maybe some of the folks who would frequent this interview may not be sports fans, so excuse the sports analogy, but I’m a big basketball fan — played basketball my whole life. And people will watch the modern NBA and they’ll say, “these guys shoot too many three-point shots. Back in my day, we never shot 30-foot shots.

for an approach to therapy to remain viable over the years, it must change and evolve
That may be true enough, but the game has to evolve. It must evolve. It cannot stay stagnant. Now, did it have to evolve in the way it did? Maybe not. But it must evolve, or it dies. And I think it’s the same with therapy. So, to detraditionalize, it’s not that we can’t do it with intention, we can. But I think for an approach to therapy to remain viable over the years, it must change and evolve. A lot of psychoanalytic psychodynamic approaches are probably misunderstood in the modern world. But the best practitioners I know who appreciate and look through that lens, they’re not doing the same shit Freud was doing. They might have taken some of those ideas and some of those cues, but they’ve detraditionalized them. In a way, they’ve modernized them. So, that’s the first thing I want to say. 

The second is, like in my work, I think traditionally there is a healer and a person to be healed. And then the person that’s the healer is somehow supposed to have the answers or write the prescription. And to meI’ll take a line from my mentor friend and colleague David Epston — a lot of Narrative Therapy is about elevating the knowledge of the other. And so much of my practice, and a part of it that I think is maybe detraditionalized, is not to rely on psychological knowledges, or psychiatric knowledges or descriptions, but to try to elevate the knowledge of the other.

there’s a whole ancestral presence that often comes with that person who sits in front of you
And the other doesn’t just include the person who’s in front of you. There’s a whole ancestral presence that often comes with that person who sits in front of you. Whether they realize it or not, it travels with them, it informs them with insider knowledge about how they may approach distress or problems that they’re up against in the world. And even so with therapists that would make the claim, “Well, I’m client-centered, I focus on the client.” Yes, but if you actually watch it unfold, it’s still based on a counseling prescription or a psychiatric or psychological prescription about how the session should go. It isn’t necessarily elevating the knowledge of the other. 

LR: You said something earlier, and I don’t necessarily want to skip around too much, but it seems like we’re entering a cross-conversation about multiculturalism. When we talk about “elevating the other,”, are we getting at your ideas about working with “the other,” and what you have referred to as “decolonializing” psychotherapy?
TH: The phrase I’ve liked most recently is “anti-colonialize.” De-colonialize is fine, but I don’t like post-colonial, because post-colonial implies that somehow, we’ve moved past colonial logic, which we haven’t. Anti-colonial to me just seems like a little bit of a stricter stance against past, present, and future colonial logic and colonial attempts at living. So, I’ll start with that. But de-colonial is fine. I like that word, too.

You’ve heard me use the phrase “colonial logic,” but I’d like to weave in yet another term here: “multicultural.” If we look at the term “multicultural,” and a multicultural approach to therapy or counseling, often what that is saying is, “Hey, those of you from non-European descent, you can come, we welcome you. You can come and heal in these Eurocentric mediums of healing.” On the surface of it, that’s a nice offer. But it doesn’t make a ton of sense. And really what it’s doing is replicating colonial logic in that, “Hey, these European ways of being, behaving, and these European standards of living, these are the right standards. And we’re going to help you through therapy live up to these standards and these ways of being.”

To me, an anti-colonial approach would seek to first try to find the colonial logic that’s at play. And nobody bats a thousand at that, I would argue. But because it’s so embedded in the culture, we don’t think to critique it, although that has been happening more in the last couple of years. Anti-colonial, then, talks about culturally democratic approaches to therapy. A friend of mine, Makungu Akinyela in Georgia, has a type of therapy called “Testimony Therapy” which he equates to being next of kin to narrative therapy and African-centered therapy approaches. He says that a culturally democratic approach is to invite people to speak on behalf of their own healing.

a culturally democratic practice seems important because people are allowed to speak on behalf of their own healing...through the cultural knowledges that they have come up with
And so, if we hope to practice an anti-colonial approach, which to me is like the big umbrella term, then
a culturally democratic practice seems important because people are allowed to speak on behalf of their own healing. Speak in their mother tongues. Speak through the cultural knowledges that they have come up with.

One thing about psychiatry and psychology, if we’re not careful, is we can get a little too big for our britches. We can think that healing’s only taken place in the last century-and-a-half, or whatever it’s been. No, it’s like, hey, come on, you think just because we’ve now labeled these things as depression or anxiety or PTSD, people haven’t been up against these things throughout time? 
LR: Like we invented these afflictions.
TH: Right. And did these people with depression and anxiety all just curl up in a ball and not live their lives? No, people have experience with healing. And they have knowledge about healing. It doesn’t have to exist in a Eurocentric way. And often what therapists are doing — almost always unwittingly — when they’re reproducing colonial logics in their practice is recolonizing people. And often the therapist doesn’t realize this is happening, nor does the client. And yet, this process is playing out. It’s assimilation. We talk about, should people assimilate when coming to a new country…Well, really that’s what therapy has often been doing, again unwittingly. I don’t think this has been done with malice.
LR: This is psychiatric assimilation.
TH: Right, exactly. And so traditional therapy reproduces this colonial logic, which then sometimes — again, completely unwittingly almost always — is reproducing internalized racism where people might already experience feelings of inferiority. It doesn’t always have to be around race, of course. It could be any number of other factors. So, I hope that there’s some justice to your question.
LR: So, traditional multicultural counseling, if I’m hearing you right, is, “Sure, come into my session, wear your native garb, let me learn a couple of buzzwords that are unique to your culture. And sure, tell me your story. But in the end, I’m going to lay some ACT on you.”
TH: Yeah. And again, almost never is this done with malice. But that’s some of the demanding work I think we have to do. And another thing is like, okay, I am of mixed racial background. I have the blood of the colonizer and the colonized that runs through me, which is a complicated place.

if we are reproducing traditional Eurocentric ways of doing therapy, then we are a de facto White
One of my colleagues out here in San Diego now, Vid Zamani, he was the first one I heard say that if we are reproducing traditional Eurocentric ways of doing therapy, then we are a de facto White. And I really appreciated that, because it was like, well, just because of my own background, that doesn’t make me immune from practicing colonial logic. And he said, of course, that makes total sense.

But if we’re not careful, then what happens is in the field’s attempt to diversify—sure, we might look diversified on the surface, but our practices aren’t that diversified—we’re still practicing the same colonial logics. The practice really isn’t changing, even if superficially the people doing the practice look different.   
LR: So, until the psychotherapist recognizes that they are colonializing their clients, until the traditional colonializing psychotherapist rebels against their own inherited narratives of what psychotherapy is, they will continue to colonialize their clients. And colonialize the psyches of their clients. 
TH: Yes. And this is, I’ve found, a largely unpopular idea. Especially among folks who have been doing this for a while. I’ll share this story that I think drives home your point. I was doing a job interview. Not for the institution I’m currently at, but for a past institution. I was doing a presentation that talked about some of this stuff that we’re talking about now. And when I got to the end of it, a dude says to me — an older white man in his 60s, “Hey, I’m going to throw you a softball question.” And right away I was like, okay, yeah, what’s this guy up to? And then he says, “Well, what am I supposed to do when you tell my students that I am practicing a therapy that’s colonizing folks?” And I thought about it for about five seconds, and then respectfully I said, “Well, if I can share something with you, I can guarantee you I’m practicing in colonizing ways. And in fact, I can guarantee you I’m doing it in ways I’m not yet aware of. So, in that sense, I wouldn’t be asking you to do anything that I am not practicing myself.” But I found that there are folks that are resistant to the fact that their work could be colonizing at all. 

Communities of Care

LR: In the context of this thing called multicultural practice and colonization, what do you mean when you talk about the dignification of the client? I think that was your word. 
TH: No, it’s David Epston’s word, although I might have used it. What’s interesting about that, Lawrence, is that I met David in 2015, so that’s seven or so years ago. I had been out of graduate school a good six, seven years at that point. I had been practicing in the community for the same amount of time. I had been a university professor for seven or eight years. I had been around this a minute, and I had never — and I mean literally never — heard a person use the word “dignity” regarding clients in therapy. I was taken aback by the word the first time I heard it in this context. Dignification is even a little better than dignity.

when we engage in dignification and people can feel that they have dignity, that helps to open additional stories in their lives
When someone’s up against something, some kind of distress — I’ve worked with a decent number of people in the criminal legal system — they are often stripped of their dignity. And so, dignification is really an effort to afford the person that dignity within the conversation. And
when we engage in dignification and people can feel that they have dignity, that helps to open additional stories in their lives. And maybe those stories were already there, but if they don’t feel as though they have dignity, then those stories are inaccessible to us. Even if they’re there someplace.

I noticed this with people in the penal system—it doesn’t happen after one meeting and could actually take months — but when they really started to feel dignity, and that they were living a life with dignity, and respected as a person with dignity, we would start to see a turning point in what we were doing. Because there aren’t many systems that are practicing un-dignification more than the criminal legal system. And so, it was actually a great place for me to see that juxtaposition of when people are afforded dignity. And these probation officers would ask me, “Hey, how did you get this young man to take responsibility for his actions?” And I said, “Well, first by never mentioning the term ‘personal responsibility.’ That’s probably not a great way to go, even if that’s what you’re hoping for. And secondarily, by taking them seriously. Treating them with dignity. Listening to their ideas. Taking that insider knowledge they have and really using it as something that could move us forward in a way that would make sense in their lives.
LR: Your dislike of the notion of “personal responsibility” brings me to something you said about the difference between self-care and communities of care. What is that difference? 
TH: Well, it depends. What’s the goal? If the goal is to make money and sell lots of products, then we’re not moving in the wrong direction at all. I think Ronald Purser is the dude’s name, he wrote the book “McMindfulness.” He articulates this as well as anybody I’ve heard. It’s worth the read. 

Look, self-care is another one of those things I feel like came from a good place. And when I talk about my issues with self-care, I preface it by saying, if you want to take a bubble bath, that could be lovely. If you want to watch a movie or do whatever, great. I’m not against that. Where I find this to be problematic, and our field has done this as much as any that I’ve seen, is a student, for example, in a master’s or doctoral training program in our field starts struggling. And often the response by those in charge has been, “Well, are you doing your self-care? What are you doing to take care of yourself?” But then you look at a PhD student. They come here, work 18 hours a day, doing all their school stuff. We don’t pay them enough to survive, we give them a small stipend. Now they have to go work another job. But we remind them “please don’t forget to take care of yourself.”

we outsource the responsibility for the oppressiveness of the system and then turn around and say, “It’s your responsibility”
Essentially and systemically,
we outsource the responsibility for the oppressiveness of the system and then turn around and say, “It’s your responsibility.” As opposed to a community of care — and this is something I try to think about in my role as chair now of an academic department — which is, “Okay, if we have faculty that are drowning or students that are drowning, what are we doing to do to help, rather than lay the responsibility on the student to adapt to a system that is rather oppressive?” So, do we need to scale back some of what we’re requiring? Do we need to change the ways that the system operates? What can we be doing, other than once a school year bringing puppies in? “Hey, that’s lovely.” Or they’ll have a little massage chair set up. Fine.

I was talking to someone this morning, and the language that she used was so passive. We say, “I’m experiencing burnout.” And my thought about that is, no, you’re being burned out. That’s not the same thing. It’s about experiencing burnout versus being burned out. Our systems are burning us out. And so,  if our systems are burning us out and we’re asking people to handle this individually while the system that’s doing this for its own gain takes no responsibility, well, then this is just going to keep repeating.

And I’ll come full circle to say that I think, not individual people, necessarily, but folks with something to sell don’t mind that. Because if the person is continually being burned out, guess what? They’re going to consume more of the product that we want. So, the system is actually set up beautifully for making money. I don’t necessarily think it’s set up good for quote-unquote “mental health.” 
LR: So, in a sense, graduate trainees, like therapy clients, are typically colonized and oppressed by structures of authority. What do you mean when you say that therapy — and graduate education in the context of this conversation — should be an act of shared humanness?
TH: Yeah, I think again, the culture that we’re in is so ruggedly individualist, that often the human experience gets defined solely within the individual. And I worry about that. And to me, therapy at its best is shared humanness. I used to do this early on when I was a therapist. I came up for my first master’s class in 2002 with all these journals under my arm. I was going to save the world by going into these communities in South Los Angeles. And it didn’t take me long to figure out that shit wasn’t going to work, and I had to do something else. I learned that quickly.

therapy at its best is shared humanness
The way I think about the shared humanness now is, we can’t be doing what we’re doing right now in this conversation without shared humanness. The same goes for a therapeutic conversation. When there is shared humanness and it comes together, something exponential is possible. But I would not be able to say everything I’m saying today during our time together without your questions. Your question takes me somewhere that I couldn’t have gone just by myself. Maybe I could have generally gone there, but something about your questions and the give–and-take transports us there. And the shared humanness in therapy is exactly the same. You bring these two people together. And what we could each accomplish on our own could be fine, or even good. But what we can accomplish in this shared human way is exponential.    

Wholehearted Therapy

LR: Very similar to what Irvin Yalom refers to as the here-and-now—that the therapeutic relationship is lived in the moment the fruits of psychotherapy grow from the back and forth. Is this related to what you describe as “wholehearted therapy practice?” And what does a therapist look like when they’re practicing halfhearted therapy?
wholehearted therapy is bringing all of yourself to the practice
I think halfhearted therapy, or quarterhearted, or two-thirdshearted could happen for a lot of different reasons. But to me, wholehearted therapy is bringing all of yourself to the practice. One of our students asked a fair question just a couple of weeks ago; “How do I know how to be in therapy relative to how and who I am out in the world?” They asked it a little differently, but basically what they were asking was based on their feeling, “I don't know how to not bring all of who I am into the room.”

And so, I think halfhearted therapy can happen when we think that there are parts of us that somehow can’t come into the room. Now, what I’m not saying is that there are certain topics we might not talk about in the room. Now, I would even question some of those and whether they are truly off limits, and I do frequently. But obviously there would be some topics that would be off-limits for us. Therapists could decide that. But I’m not so much talking about the topics of discussion. I’m talking about how much of themselves that they’re bringing. And I fear that therapists are often taught not to bring important parts of themselves.

With regard to halfhearted therapy, they could be doing therapy in a system in which they’re chronically underpaid and overworked, and their spirits are just really sucked dry. And then they just don’t have that spirit to bring. In no way would I blame the therapist for that. But if I think about the times when I’ve engaged in halfhearted or quarterhearted, or however much hearted therapy practice, it’s often been for those reasons. Now, earlier on in my career, it was because I was asking myself, well, can I be this in the room? And of course, that’s a ludicrous question, because I am this. So, one way or another, the person that I’m in conversation with starts to deduce that anyway.
LR: In the recently released “Reimagining Narrative Therapy Through Practice, Stories, and Autoethnography,” you wrote a chapter entitled, “Maybe We Are Okay: Contemporary Narrative Therapy in the Time of Trump,” in which you narrated the therapeutic interaction you had with a person whose political views, specifically, their Republican views, clashed very dramatically with your Democratic views. So much so that the conversations about who you voted for 2016 became part of the therapeutic relationship. And in that relationship, you nicely demonstrated how you can disagree with someone’s political views, but still respect them as a person. Was that an example of wholehearted practice?
I noticed a lot of my colleagues saying something like, “Well, if Trump came to therapy, would you work with him?
It was interesting how that chapter came about. You know how therapists can get together and start talking in between seeing clients. Well, I noticed a lot of my colleagues saying something like, “Well, if Trump came to therapy, would you work with him?” I didn’t say anything when my colleagues were saying, “NO, I would never do that! Who could do that?” But then, I thought about it, and I was like, yeah, I think I’d work with him. I don't know if he’d want to work with me. Maybe he’d tell me to get lost, but I think I’d try.

I just remember how outraged they were. And when they asked the question of how I would do that, I would say, “Well, I haven’t worked with Trump, but I’ve worked with plenty of people who have views that are very different than mine.” So, that was the inspiration for this, to try to explain shit to myself. Even after writing the chapter, I’m not sure I understand how I always engage in this work. But, to go back to bringing one’s full self into the room, we didn’t get deeper into the party politics in that chapter. But if we happened to in our sessions, I wasn’t super-enthused about voting for Hillary. I felt like a lot of people — like I have to decide between two people that I’m not really enthused about. Okay, I’ll take the one that I’m a little more enthused about. I’ll engage in a minimization-of-harm vote, is kind of how I felt.

But clearly, in the chapter you’re describing, my client and I voted for different people. When that moment came up, the question was, “Do I talk about it or do I not?” And the thing about that is, okay, I could decide not to talk about it. I could decide to do the thing as, “Oh, that’s an interesting question. I wonder why you’re asking?” But she knew. She had a sense of this, of who I voted for. And I’ve heard people say this kind of thing who haven’t read the chapter, but have said, “Well, you know, you’ve got to be careful. You’re pressing your political views on them.” But I disagree. What I’m doing in therapy is I’m simply showing up as I am, and she can show up as she is. And then we have to figure out how that meshes, and how we do the work together that we’ve been charged with doing with one another.

what I’m doing in therapy is I’m simply showing up as I am
And that doesn’t require me being neutral. And by the way, I’m not neutral. It’s just a matter of whether I admit I’m not. I’ve seen a lot of discourse around this lately about neutrality and people debating what it means and all this kind of stuff. But to me, it’s an impossibility. We are not neutral. And so rather than try and pretend as though I am — not unsolicited would I share such a thing, but when it works its way into the session — when she brings this up, it’s like okay, let’s talk about the shit that we’re not supposed to talk about. Let’s talk about religion. Let’s talk about politics. To me, therapy seems like a great place to do that. And not just in the sense of me just passively listening or looking for pathology in the patient and how they talk about this. But rather, let’s have an actual conversation with two wholehearted human beings about the thing that we’re not supposed to have a conversation.
LR: In a sense, you are co-rebelling against the mandates of traditional therapy with a client by self-disclosing and by being fully present.  
TH: And neither of us has to change our political party. Although for me, I’m not that enamored with the Democratic Party, either. But I’m not sure I have a party that represents my interests, to be honest. I certainly wouldn’t say I’m an Independent. That has its own set of connotations. But I don’t feel like I have a party that represents my interests. And I didn’t say that explicitly. At least I don’t recall saying that in my work with her. But perhaps it came out. Perhaps this is more complicated than we give it credit for.

probably these last two or three years, I’ve constantly been on the lookout in my therapeutic work for people with binaries
And to me, probably these last two or three years, I’ve constantly been on the lookout in my therapeutic work for people with binaries. Because our culture relies so heavily on them. And I often find that when people bring those up, that’s at the root of something that they’re really struggling with. And it’s built into our language, Lawrence. We say, “Well, I need to hear both sides of the story.” And to me I’m like, I’d like to hear all the sides of the story that I could hear. I’d like to hear many sides of the story. I found that often people are thrust into these binaries, and it almost feels like there’s not another option. So part of my job is to have these discussions and then look outside of those binaries for what could be there. And I don’t think therapists do this on purpose, or clients do it on purpose. It seems to be a real cultural thing.  
LR: I used to joke with my classes — sorta — by saying, “There are two types of people in the world. Those who believe there are two types of people in the world, and those who don’t.” Does this wholeheartedness, the kind you described in your work with this particular client involve what you refer to as “radical respect?”
TH: I can tell you the story about where that term came from. I don't know if we mentioned it in the book, but it came from Art Frank, a brilliant writer. He’s not a therapist but when he would read transcripts of sessions or watched sessions, he said, “When I see David [Epston] practicing, Tom [Stone Carlson] practicing, what I see is radical respect.” And so that term actually came from someone outside of the therapeutic community altogether, which I think is worth noting.

narrative therapy hold this deep respect for people and why...they’re living through the stories that they are
I think part of what he’s getting at is there is that no matter where the person moves, no matter where they might take the conversation, no matter what the stories are that they might wish to live through, or that are living through them, that
narrative therapy endeavors — it isn’t always successful — but endeavors to hold this deep respect for people and why they are behaving the way they are. Why they’re living through the stories that they are. Why they’re feeling the way they are. And that radical respect then to me promotes curiosity. 

So, in the chapter that you were referencing, the Trump chapter as it’s getting to be called, I hope there were some examples of radical respect in there. I’ll give you an example from the chapter of my attempt at it. When I came to realize that by completely dismissing her perspective — which I don’t think I did, but I could have because I found a lot of things Trump did objectionable — I might have been engaging in some sort of erasure of her family. And that would have been highly disrespectful. And so even when it was something that I fundamentally disagree with, there was still a way I could practice respect. This was opposed to going, “Well, but you’re on the wrong side of history.” I also think radical respect is a feeling that both the therapist and client experience, sometimes without words.

Art Bochner talks about “evocative autoethnography” which is not about the therapist simply being a fly on the wall, but instead being moved by the client’s story, their narrative. Let’s say you were reading that chapter about me and the woman, and you had never seen either of us before, and then you see us walk out of a room. You’d know it was us. But the point is, that’s what we’re endeavoring with autoethnography. We get out of the world of jargon so both partners in the therapeutic moment can feel and experience it.  
LR: As we near the end of our time, Travis, I want you to know that I’ve had a lot of fun in this interview. Do you have any questions for me?
if therapy is really an act of rebellion, then there has to be something at stake, there has to be risk involved
No, but I will say one thing quickly, though. If therapy is really an act of rebellion, then there has to be something at stake, there has to be risk involved. It has to mean that you could be out of compliance in some way — with tradition, with certification standards, with accreditation expectations. And if we’re not doing anything, if what we’re doing is completely devoid of risk, or we’re afraid to take any of that, then we won’t move any of these things forward. And I know plenty of people who are, in their own ways, challenging these different systems. And this is not to knock the accrediting bodies. They have their role. But we have to take some of these risks. To detraditionalize, as we were talking about earlier. Risk is inevitable, right?
LR: On that note, I think I’m going to say goodbye. I thoroughly enjoyed this conversaiton, Travis. It reignites me.
TH: Stay in touch. Holler at me with whatever.


How does Dr. Heath’s description of his work resonate with your own therapeutic approach?

Which of his concepts strikes a particular chord with you and why?

How might you have worked with the client who struggled with peanut butter consumption?

How do you engage in radical respect with your own clients? Do you have difficulty doing so with a particular type of client?

Can you think of a client with whom you have worked, or continue to work, wholeheartedly or halfheartedly?

What about Narrative Therapy interests you and challenges you to learn more about the model?

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Travis Heath Travis Heath, PhD, is a licensed psychologist and has been in community practice for nearly two decades. His scholarship has included looking at shifting from a multicultural approach to counseling to one of cultural democracy that invites people to heal in mediums that are culturally near. Other writings have focused on the use of rap music in narrative therapy, working with persons entangled in the criminal injustice system in ways that maintain their dignity, narrative practice stories as pedagogy, and a co-created questioning practice called reunion questions. He is co-author, with David Epston and Tom Carlson, of the first book on Contemporary Narrative Therapy released in June 2022 entitled, “Reimagining Narrative Therapy Through Practice Stories and Autoethnography.” He has presented his work in 10 countries to date. 
Lawrence Rubin Lawrence ‘Larry’ Rubin, PhD, ABPP, is a Florida licensed psychologist, and registered play therapist. He currently teaches in the doctoral program in Psychology at Nova Southeastern University and retired Professor of Counselor Education at St. Thomas University. A board-certified diplomate in clinical child and adolescent psychology, he has published numerous book chapters and edited volumes in psychotherapy and popular culture including the Handbook of Medical Play Therapy and Child Life: Interventions in Clinical and Medical Settings and Diagnosis and Treatment Planning Skills: A Popular Culture Casebook Approach. Larry is the editor at

CE credits: 1.25

Learning Objectives:

  • create a list of therapeutic questions for several of your current clients
  • analyze and critique some of Travis Heath’s concepts like anti-colonial and shared humanness
  • apply several core principles of Narrative Therapy in your clinical work

Articles are not approved by Association of Social Work Boards (ASWB) for CE. See complete list of CE approvals here