"Therapy is Ableism" and Other Reckless Assumptions

Apr 10

Another day, another illiberal thread in some therapist networking group that frightens me about the direction our field is going. When I voice a different opinion, a moderator gets tagged, confronts me on my supposed -ism’s and my “defensiveness.” My motives, tone and word choice don’t seem to count. The underlying assumption is that any heterodox opinion is automatically incorrect, uneducated, biased, and defensive, whereas any opinion that upholds the “correct” narrative must be correct, unbiased, and driven by proper motivations. It’s become quite black-and-white, with very little room for viewpoint diversity or constructive disagreement.

I respond because I am genuinely concerned. I do not feel defensive, only exasperated. I am confident in my years of experience building excellent relationships with clients, watching them transform, and hearing heart-warming feedback. I think my clients' and my own experiences are far greater estimations of my character and my skill as a therapist than what some stranger on Facebook thinks because of three sentences I wrote. I wonder what therapist is actually so insecure that a situation like this could make them feel defensive? They'd have to be pretty inexperienced, unsuccessful, or thin-skinned. But telling me I'm just being defensive is a very convenient way to dismiss what I'm saying.

My colleagues also love to suggest that anyone with a divergent viewpoint obviously needs further training, or as they like to call it, “education,” before we “harm” even more people with our supposed ignorance. No one here is looking at anyone’s actual training, years of experience in the field, or track record. My commentary usually applies integrated knowledge of relevant factors toward unpacking whatever the dilemma is about, often interweaving an understanding of the possible roles played by family systems, secondary gain, learned helplessness, child development, or social incentives, for instance. I say this not to be defensive, but because I wonder what’s happened to my colleagues. Have they forgotten these concepts, or did they never learn them?

But enough of my exasperation. Let's get into what happened.

Here is the original post:

“A parent has asked for an assessment only, as therapy is ableism. The parent says reasonable adjustments and equipment are ok but therapy is not acceptable. The type of therapy proposed would only support the child to cope with their own dysregulation but would not seek to change behavior unless it was harmful. For example a child who was head banging harshly and hurting themselves would be stopped and redirected to use a different method of stimulation that would not be harmful but would allow the seeking behavior to be fulfilled. Do you think this is ableism?”

A chorus of therapists chimed in: yes, therapy is ableism.

There was a lot of support for the parent’s perspective. Mind you, the above information is all we were provided. We don’t know who the parent or child is, what their previous experiences have been, or what their aims are. This child could be four or ten, mildly autistic or severely learning disabled. The family could be rich or poor, black or white or Asian or Latino, white collar or blue. The parent could be a marathon runner or in a wheelchair. Last night’s dinner could have been filet mignon or Maruchan ramen. The parent could be emotionally stable, or falling apart at the seams. They could have had one depressive episode in their life, or been struggling with chronic PTSD since they were their child’s age. But you know what we can’t rule out? That the parent has a personality disorder and we’re looking at a case of Munchausen syndrome by proxy.

Alright, let’s pick this situation apart.

The parent needs an assessment, presumably of Autism Spectrum Disorder or another neurodevelopmental disorder. They want this assessment so that the school will make certain accommodations for the child, but they don’t want anyone to help their child with their own behaviors - not even a therapist who specializes in children with neurodevelopmental disorders. If the parent needs an assessment, they probably don’t have one already. This would mean the child has no official diagnosis yet, although the parent probably has one in mind. Perhaps their pediatrician or teacher has suggested that it’s probably autism but that the child needs a full neuropsychological assessment from an appropriate specialist. Now the parent wants the therapist to play a very specific role: write a formal diagnosis of the condition, so that the parent can request accommodations from the school.

The parent has already…

Insulted the therapist by making a negative generalization about the therapist’s entire line of work.
Assumed they know what it is the therapist does.
Assumed they know what’s going on with the child just as well as any therapist ever could.
Assumed they know what kind of treatment from adults will be best for the child.
Assumed they can tell the therapist how to do their job.

Imagine being a parent whose child bangs their head against the wall, and deciding you don’t want any help or advice from another adult who has extensive experience with this behavior.

You don’t even want to take a break from your child for an hour and leave them in the hands of one of the most highly qualified people you could possibly leave them with, while you go get a breath of fresh air. Nor would you want to be there with your child to make sure you approve of the treatment being provided. How do you live like that?

Do you have any adult friends or relatives who are good influences? Are there any outside perspectives that you would welcome? Have you read a book or watched any informative videos about the condition you believe your child has?

Do you allow your child to be with any other adults?

How do you reconcile your conscience with certainty that you are doing the right thing for your child?

I have never known a good parent to maintain an unquestioning confidence about their own parenting. Part of being a good parent is that you mess up and regret it, and you chronically worry about whether or not you’re doing it right. And part of being a parent of a child with a disability is that you are exhausted and want all the help you can get and are obsessed with trying to figure it all out. What kind of parent who feels genuinely frightened for their head-banging child is certain that the best way to handle things is on their own?

What kind of modifications could the school possibly make without any behavioral intervention for the child? Build a padded room? Is that what the parent does at home? Do they follow their child into the bathroom to make sure they don’t hurt themselves in there?

What kind of future does this parent imagine for their child? What kind of future do they want to help mold and shape? The outlook seems grim to me.

I can’t even.

This is so sad.

I understand wanting to give others the benefit of the doubt.

That’s admirable, and I try to do so myself in many situations. But by assuming that the parent must have come to this conclusion for respectable reasons, we might be missing something key here. At worst, we might be enabling abuse and neglect.

We have responsibilities...

To protect children. To take time when conducting a thoughtful bio-psycho-social assessment, and evaluate the possible roles that family dynamics could play in the child’s condition. To recommend a treatment plan based on our findings, informed by our training and industry best practices. To own our expertise while we listen to families — these are not mutually exclusive, and in fact, the best professional behavior involves doing both simultaneously.

Of course, providing good care means that if a client or caregiver has a negative association with therapy, we take time to listen, hear their story, understand their concerns, and build rapport. Maybe the parent doesn’t want therapy for their child because they were mistreated by therapists. I know I have been; it’s not uncommon. And we have to take time and appropriate steps to help that heal, just like I’m talking to a therapist right now about how hard it is for me to talk to a therapist. But it’s equally possible that the parent has never had therapy before, or that they had a good therapist who lovingly confronted them in a way they didn’t want to hear. We can’t know.

There’s major bias here that these supposedly neurodiversity-affirming therapists can’t see in themselves because they are too busy pointing the “bias!” finger at everyone else (like me). It’s a bias toward a particular worldview, and all one has to do to trigger the bias is use a word ending in “ism.” The assumption is that any accusation of an “ism” is inherently correct, and should be accommodated as such. That’s awfully convenient for those with ulterior motives. It’s ripe for manipulation. It’s as volatile as a sociopathically sadistic vixen during the #metoo era, who is always just one step away from incarcerating an unsuspecting man for rape just for kicks, while actual rape survivors suffer from victim guilt and their assailants go free.