Is Therapeutic Neutrality a Thing of the Past?

How can therapists avoid imposing our values in a world so deeply divided over what constitutes the acceptable range of human expression?

Therapy Twitter (X 🙄) is popping off again about neutrality & not imposing our values on our clients. How are we going to square this with the reality that so many therapists are imposing gender ideology onto vulnerable young people & pushing them down a path of lifelong medicalization? And how can I, as a therapist, remain “neutral” about something so unconscionable? 

Is it time to explore the concept of "neutrality within limits?" What precisely are the limits to therapeutic neutrality?

Some things about ourselves we cannot help but to give away: by our mannerisms, style of dress, facial expressions, office decor or virtual backgrounds... 

Our values, too, reveal themselves in all manner of ways. Therapists are constantly faced with ethical dilemmas in which it is difficult to conceal our biases, or perhaps morally questionable to do so. 

Example: a patient is considering leaving her husband for a man she has fallen in love with. Our views on marriage & romantic love cannot help but to influence how we approach her dilemma. A therapist with more traditional, conservative values is likely to emphasize loyalty to the marriage covenant over pursuit of individual liberty, whereas a progressive, thrice-divorced hopeless romantic therapist may subtly encourage the patient's decision to jump ship. This is likely to occur even in a context in which the therapist strives to keep the bulk of her opinions & judgments to herself. 

So, too, a therapist who himself was abandoned by his wife for a man she fell in love with, if faced with a patient in this situation, is going to have difficulty managing his countertransference. At what point does it become a problem that interferes with effective therapy? 

And what about our biases regarding health? The art of psychotherapy has increasingly been fused with the healthcare system & been re-termed not only "mental health" but also "behavioral health." This indicates that the public sees it as our job to encourage healthy behaviors... 

If a patient engages behaviors we know based on research are not conducive to good health, but frames them as supportive of her individual freedom of expression, do we subtly join in celebrating her freedom & individuality, or subtly encourage her to rethink the wisdom in these? 

I posit an idea: that the lovely, aspirational ideal of true therapeutic neutrality can only exist in a relatively stable culture, held in place by well established norms & expectations taken for granted by most people. Why? 

Because only within such a container — a society in which we mostly agree on the boundaries to what constitutes basically acceptable human behavior within some normative range — can there exist enough freedom to play with choices that can be viewed as equally morally acceptable. 

Think of this like good parenting. A good parent establishes clear, consistent limits, within which children are free to play, explore, & dabble.

They offer equally acceptable choices: would you like broccoli or green beans for your vegetable tonight? 

This kind of family environment forms the basis for secure attachment & lays the foundation for healthy adult social & occupational functioning. It allows children the security to grow up confident in their decision making abilities, & able to trust themselves & others. 

Sadly, many of us did not grow up in such optimal environments for growth. And, in parallel, it is my belief that we do not presently live in a society with adequate stability as described above. We don't agree on what the boundaries are, & what the normative, healthy range is. 

So in a world fraught with culture wars, in which we are radically divided on the moral acceptability of many crucial issues, what constitutes therapeutic neutrality? And what are the boundaries of the sandbox within which patients are free to play? Therapists disagree. 

The field of Marriage & Family Therapy — which is the type of license I hold — originated during a time that the average Westerner was married by the age of 30.

We live in a radically different world today. 

This started off as a post thread on X. Read & share that here.