Mental health awareness month seems like a great time to ask odd questions. Or so I thought as I walked into my therapist’s office. I sat down in my usual comfy chair and grabbed a fidget off the coffee table. I took a deep breath and as I exhaled, l looked him in the eye and said, “I’m Cleopatra.” Not I like the idea of Cleopatra or that I see myself in her, but that I am her. What’s more, I said, I was upset about my Mark Antony. My therapist said nothing. He just peered at me over his glasses with one eyebrow slightly raised. Then he quietly put his pen down and frowned.
Ok, so none of this really happened. It’s just a thought experiment. But it’s one that lets me ask, if I did say that what would the counselor’s role be? Would it be to help me through my sorrow about Antony, to disavow me of my delusion, or perhaps some combination of both?
At a minimum, if I had made such a declaration, we can probably all agree that my therapist would be right to be worried. By almost anyone’s definition, such a statement would suggest that I have lost touch with reality.
We would know I’ve lost touch because, when it comes to Cleopatra, we have a clear and shared sense of what’s real, what’s not, and how to tell the difference between the two. And, based on that, no one in their right mind should believe me.
But this example works largely because the difference between what’s real and what’s not is, for all intents and purposes, self-evident. To just about everyone.
This question of what’s obviously true and what’s not turns out to be considerably more complicated on other topics—especially when it comes to those that are politicized. The therapist’s couch is not exempt from questions around race, identity, inequality, and fairness—to name but a few.
So, what does my claim to being Cleopatra have to do with any of this? Imagine a different example. Let’s say that instead I walked into my therapist’s office and said: I’m feeling left out of my social group. I’m pretty sure it’s because I told them I don’t think George Floyd was murdered because he was Black. They now know I believe it to be just bad policing that doesn’t have all that much to do with race.
Now, what would my counselor’s role be?
It’s worth bearing in mind that therapists are predominantly liberal—here’s data from 2016 on psychiatrists—and there’s an active debate about whether they should keep politics out of the clinical setting at all. (One recent article suggests many have decided not to.)
This combines with a national political divide that has resulted in two distinct versions of reality. (The Durham report either damned the FBI beyond any reasonable doubt or was it a giant nothingburger. Pick one.)
Taken together, these factors suggest that there’s a world where my therapist is just as convinced that I’m deluded about George Floyd’s murder as I was about being Cleopatra.
To be clear, I’m not a therapist. (Although I’ve probably been in more than my share of sessions as a client.) In other words, I’m not coming at this question from the position of a mental health practitioner. I am coming at it from the position of someone concerned about the way we think and communicate, especially on heated issues. In particular, I worry about the way certainty—the Certainty Trap, if you will—drives us to draw unwarranted conclusions and then judge people who disagree.
This is made more complicated by the fact that there’s much to worry about when it comes to mental health. There’s AI’s impact on loneliness, the mental health crisis among teenage girls, and the rising levels of depression—reaching 10 percent among adults and 20 percent among adolescents and young adults. We take solace where we can find it. Whether it’s through exposure to birds and their songs or kids simply leaning on one another for support.
But individual therapy remains the gold standard for many. In 2019, anywhere from nine to 11 percent of US adults, depending on the age considered, reported seeing a counselor or therapist in the last 12 months. This means the question of what happens in those counseling sessions is an important one.
Going back for the moment to my example relating to George Floyd. Is the therapist’s role to talk me through the social isolation I’m experiencing? Or is it to convince me that Floyd’s murder was, in fact, racially driven—thereby facilitating my reinstatement with my social circle? If you think this question sounds far-fetched—that people aren’t so convinced of their beliefs that we might see such an outcome, you might want to consider the following example.
I recently found myself in conversation with an adjunct professor of counseling, who also has a clinical practice, in Chicago. She’d reached out because she was deeply concerned about the ideological commitments she was observing among many of her students. More specifically, she was worried about how those commitments could relate to the treatment of the students’ future patients.
In one of her classes, she required the students to watch a documentary about mental health that centered around the stories of two women: one Latina and one Black. The assignment was to come up with a tentative diagnosis and treatment plan, based on what the women revealed in the documentary. The instructor shared that a number of the students in the class proposed plans that started and ended with talking to the women about the racism that had shaped their (the clients’) lives.
The students, most likely, prioritized a desire to communicate to the women that their difficulties weren’t their fault. That they could be traced to systemic forces that conspired to keep them down. This was the students’ certainty.
The surprised and dismayed instructor asked the class why they would assume that racism played a central role in what these women were experiencing. After all, neither had said anything about racism in their narratives. The future counselors didn’t respond.
They were so convinced of, in this case, the role and impact of race, that they didn’t step back to consider whether there might be another possible answer. This tunnel vision has obvious implications for the patients—namely, the counselor might fail to get to the root of their real challenges. But it has broader ramifications too.
Let’s go back for a moment to our divided political world, with two versions of reality. If counselors are predominantly liberal, and they believe their worldview is correct in the same way it’s correct to say I’m not Cleopatra, then we have a potential problem. After all, what’s to stop them from treating, even with the best of intentions, anyone who doesn’t align with that view as simply needing to be convinced to get on board? Another way of asking this is, what’s to prevent conservative—or, simply, non-progressive—views from being seen as a de facto sign of mental illness? To be sure, some practitioners have themselves begun to raise similar questions.
Ultimately, it’s because I’m a believer in the power of counseling that it matters to me that people get the help they need. And the reality is that what the person needs may or may not align with the political values of the therapist. So, unless the goal is to pathologize any political view that’s not progressive, the certainty must be left at home.
Please note that much of the writing on this Substack is either derived from or is related to the manuscript, The Certainty Trap (unpublished). For inquiries about the manuscript, please reach out to me directly.
I really appreciated this article and the nuanced take on mental health practices. Certainty can delude those with the best intentions in any profession, having wide ramifications for those seeking professional services. Thank you for writing this, Ilana!
https://www.scientificamerican.com/article/the-problem-with-implicit-bias-training/