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Journal of Marital and Family Therapy 44(1): 19–31

doi: 10.1111/jmft.12244
© 2017 American Association for Marriage and Family Therapy

“BEING A THERAPIST DOESN’T EXCLUDE YOU FROM


REAL LIFE”: FAMILY THERAPISTS’ BELIEFS AND
BARRIERS TO POLITICAL ACTION
Lorien S. Jordan and Desiree M. Seponski
University of Georgia

A crucial and overlooked facet of social justice in family therapy is political and policy advo-
cacy. Family therapists have unique insight into how social policies and political discourse
shapes clients’ lives and the life of our profession. Such knowledge can inform policymakers
and political debate, yet few family therapists are trained to engage in political action. In this
randomized, national survey of licensed family therapists’ (N = 174), we explore beliefs
about and barriers to engagement in political and policy processes. The findings suggest that
there are significant barriers and uncertainties surrounding family therapists’ engagement,
including time, feelings of efficacy, and interest. Given these barriers we discuss practical
suggestions for clinicians and family therapy training programs.

Increased attention to social justice challenges family therapists to confront systemic inequali-
ties that affect clients’ well-being (D’Arrigo-Patrick, Hoff, Knudson-Martin, & Tuttle, 2016;
Imber-Black, 2011; McGeorge & Carlson, 2010; Seedall, Holtrop, & Parra-Cardona, 2014). While
justice-oriented research and practice are increasing, therapists’ engagement in policy and politics
remains overlooked. Given the consequences policies and politics have for therapists, their clients,
and their profession, neglecting policy is a significant issue (Waldegrave, 2009). Perhaps more sig-
nificant are the opportunities that family therapists miss to promote justice for families through
political advocacy (Avissar, 2016).
We, the authors, define social justice as seeking to reconcile the competing nature of freedom
and equality, improving access to resources, social participation, and interdependent self-determi-
nation (Crethar, Rivera, & Nash, 2008). In family therapy, therapists can apply these principles to
work toward social justice within therapy (D’Arrigo-Patrick et al., 2016; McGeorge & Carlson,
2010). We promote that therapists can push beyond the boundaries of therapy into the public
arena to transform the social politics that constrain well-being.
Family therapists might not perceive their work as a political exercise but, like others before
us, we argue the reverse is true (Seedall et al., 2014). Therapy is a policy-laden practice and
therapists must become aware of the ways in which “social policy and family therapy are bound-
ary-crossing activities” (Walker, 1988, p. 302). Family therapy proceeds against a backdrop of
overlapping policies that affect the ways we practice (West, Hinton, Grames, & Adams, 2013). At
the same time, therapists witness and gain specialized knowledge of the issues affecting clients and
communities. These issues include poverty, inadequate housing, food deficits, health disparities,
and inequities based on gender, sexuality, race, ethnicity, (dis)ability, and age—all of which are
mediated by policy and political systems (Waldegrave, 2009).
Despite the potential power family therapists hold in the public arena, efforts to encour-
age involvement in policy have been isolated (Davey & Watson, 2008; Twist, 2006;

Lorien S. Jordan, MFT, MA, LAMFT, University of Georgia. Desiree M. Seponski, PhD, LMFT, University
of Georgia.
The first author would like to express her deepest gratitude to Carl Johnson, LMFT for his ongoing mentorship,
support, and encouragement in policy advocacy. The authors also appreciate The Family Institute’s New Writers Fel-
lowship, Evan Imber-Black, and workshop participants for the careful reading, thoughtful comments, and generative
conversations about this manuscript.
Address correspondence to Lorien S. Jordan, University of Georgia, 163 Dawson Hall, Athens, Georgia 30602;
E-mail: lorien.jordan@fulbrightmail.org

January 2018 JOURNAL OF MARITAL AND FAMILY THERAPY 19


Waldegrave, 2009; Walker, 1988). No known studies have assessed family therapists’ beliefs
about political participation. The current paper is part of a larger study of family thera-
pists’ (N = 174) political participation and policy advocacy (Jordan & Seponski, 2017). Fol-
lowing a brief review of the impact of social policy on families and family therapy, we
present results from four close-ended survey questions, and the data resulting from two
open-ended questions. Through thematic analysis (Braun & Clarke, 2006), four themes
emerged which highlight participants’ feelings about engaging in political action and the bar-
riers they perceive as preventing action.

POLICIES, THE FAMILY, AND FAMILY THERAPISTS

Policies are standards and rules created to inform decisions in multiple aspects of daily life,
from political systems to family systems (Gray, Collett van Rooyen, Rennie, & Gaha, 2002). Public
policies encompass and regulate nearly all areas of human behavior. A subset of public policies, so-
cial policies, are the laws meant to benefit citizens’ welfare and well-being (Haynes & Mickelson,
2009). It is important to attend to policies on all levels, because the decisions of policymakers influ-
ence both the formation and well-being of all families in our society (Letiecq, Anderson, & Joseph,
2013). While social policies are developed to protect and benefit families, they can have the oppo-
site effect (Letiecq et al., 2013).
Policymakers use a definition of family developed for the United States Census in the 1930s to
describe a family’s structure and potential needs (Bogenschneider, 2014). According to this defini-
tion, a family is a group of two or more people who reside in the same house and are related by
birth, marriage, or adoption (Bogenschneider, 2014). Since it was first adopted, this definition of
family has not been updated to reflect the country’s diversification and changing cultural values
(Letiecq et al., 2013). Defining families by such a narrow description promotes a singular family
form as the ideal while delegitimizing differently structured families (Twist, 2006). Unsurprisingly,
policies based on outdated definitions privilege some and disadvantage others. These policies pro-
vide differing “levels of opportunity, social capital, cultural capital, luck, access to education, and
discrimination” (Letiecq et al., 2013, p. 31).
There is also a subtle socially constructive process that occurs within political discourse (Sch-
neider & Ingram, 1993; Twist, 2006). Through portrayals, social policies created to protect and
benefit certain populations convey cultural meanings about those populations which can be
destructive, isolating, and stereotyping (Schneider & Ingram, 1993). Dialogue about policy posi-
tions certain people as pitiful (e.g., people with disabilities), deserving (e.g., widows of the mili-
tary), or contemptible (e.g., prison populations). The most significant, complex, and harmful
constructions occur when political discourse exists around intersections of class, gender, race, and
ability, seen in the dehumanizing stereotype of single mothers who receive TANF benefits as “wel-
fare queens” (Schneider & Ingram, 1993).
Sociopolitics can also negatively influence psychological well-being. As seen in the 2016
federal elections, a sphere of distrust, contempt, and division developed (Pew Research Cen-
ter, 2016) which created s significant source of stress for Americans (APA, 2017). The
increased use of suicide hotlines, antisexual assault hotlines, and mental health services has
also been noted (Burnett-Zeigler, 2016). Alongside feelings of anxiety and depression, the
campaign and surrounding politics have been blamed for the dissolution of relationships
(Morgan, 2016). To date, the relational effect of last year’s campaign cycle is mostly anecdo-
tal. However, families report being ideologically torn with bitter rhetoric separating friends
and family (Morgan, 2016; Whitesides, 2017). Families are also being physically separated as
new and extreme immigration measures are implemented suddenly and without warning
(Guerra, 2017). Families and communities are also experiencing increased fear, violence, and
exclusion due to the rise of targeted hate groups (Potock, 2017).
The current political climate and the constructive properties of policies clearly have profound
effects for families. Therapists are not immune to these discourses, and are influenced in the beliefs
held about people and the goals of family therapy. Family therapists must become aware of subtle
political influences and proactive in the politics of our communities to promote health and justice.
To do otherwise is to ignore the systems in which our clients are grounded.

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Family Therapists, Policy, and Political Action
Previous attempts to engage family therapy professionals in policy discussions (Davey & Wat-
son, 2008; Twist, 2006; Waldegrave, 2009; Walker, 1988) have been largely neglected. Orienting
family systems-thinking toward social justice requires therapists to view well-being in the context
of family, culture, and larger sociopolitical systems (Beitin & Allen, 2005). If we do not overtly
acknowledge the role that policies have in these systems, we overlook a significant part of our
clients’ lives and our work with clients (Avissar, 2016). Family therapy that is focused on
equitable access to resources, social participation, and interdependent self-determination “require
[s] direct involvement in the formation and modification of social policy” (Figueira-McDonough,
1993, p. 180).
Finding little data on political involvement in family therapy, we oriented the current study
toward discovery. We felt it was important to more deeply understand if therapists believe that
they have a political role and obstacles they experience in participation. With this knowledge, we
can understand if this is a topic of interest to therapists and where to direct training efforts. For
this study, we conceptualize direct involvement with policy as policy participation, the actions
taken to influence creation, adoption, and evaluation of policies (Gray et al., 2002). Politics and
policy go hand-in-hand as policies are created in political institutions through political processes.
Political participation denotes the activities and actions taken to influence decision makers and the
public about differing policies (Haynes & Mickelson, 2009).

METHODS

To learn more about therapists’ political engagement, we conducted a national survey of 174
family therapists. The survey asked questions about the specific actions that therapists took to
engage in political systems (Jordan & Seponski, 2017). The written responses from two open-ended
questions presented an unexpected opportunity to explore participants’ beliefs to and barriers in
political engagement. Through a detailed thematic analysis (Braun & Clarke, 2006) four themes
emerged. While we acknowledge that these data are preliminary to providing rich, in-depth under-
standing, it provides pathways for future research of the complex nature of therapists’ political
involvements.

Sample and Recruitment


For this study, we aimed for a broad perspective on family therapists and political participa-
tion. To sample a wide pool of possible participants, we compiled a comprehensive list of licensed
marriage and family therapists from the public information available from all fifty states’ licensing
boards. The names of each therapist were entered into an excel document, given a random number,
and sorted in ascending order. We then mailed the survey, a stamped return envelope, and an
informed consent letter to each of the first 500 candidates. A reminder postcard was sent 2 weeks
after the survey. A lottery incentive was provided, with one in every 25 respondents randomly
selected to receive a $25 Amazon gift card, for a total of seven incentives. The final response rate
was 34.8% (N = 174), a rate consistent with previous studies of family therapists (Dattilio,
Kazantzis, Shinkfield, & Carr, 2011). Our university’s institutional review board approved this
study.
Majorities of the participants identified themselves as women (n = 126, 72.4%), White
(n = 151, 86.8%), and heterosexual (n = 164, 94.3%). Their ages ranged from 28 to 82, with a
mean of 50.74 (SD = 14.41). Most worked in private practice (n = 113, 64.9%), were fully licensed
MFTs (n = 166, 95.4%), and held master’s degrees (n = 126, 72.4%). They represented 38 states.
More than half reported belonging to AAMFT (n = 106, 60.9%). The sample was largely homoge-
nous, mirroring the demographics of AAMFT’s (2012) membership in 2012. See the supplemental
file online for detailed demographic and state information.

Survey
The survey included questions on demographic data, political participation, and therapists’
beliefs and barriers in political and policy advocacy (Survey available in online version of this
manuscript). Questions on the activities therapists engaged in were developed by Gray et al.’s

January 2018 JOURNAL OF MARITAL AND FAMILY THERAPY 21


(2002) study of social workers’ political engagement. Four questions on therapists’ impediments to
policy and political activity and beliefs about engaging in activity were also included, and devel-
oped from the social work literature (Rocha, Poe, & Thomas, 2010). In this paper, we specifically
report on the data obtained from these four items, which focused on beliefs (“Do you believe that
therapists have a role in policy or political processes?,” and “Do you believe therapists should dis-
cuss political/policy issues with client?”), knowledge (“Do you feel that you have the appropriate
knowledge to participate in the policy or political process?”), and barriers (“What are barriers to
your participation in the policy process?”). In addition to the closed-ended survey questions, we
included two open-ended questions. These questions were: (1) “Please list particular policy/politi-
cal issues in which you are especially interested either personally or professionally,” and (2) “Please
add any further comments you have about therapist political involvement.”

Analyses
A six-phase process of thematic analysis (Braun & Clarke, 2006) was used to code partici-
pants’ responses to the open-ended questions (Piercy et al., 2016). First, the open-response data
were entered into MAXQDA (Kuckartz, 2001) and read through multiple times, with initial
thoughts and impressions of the data carefully noted. In the second phase, we generated initial
codes by identifying meaningful units of text relevant to the topics of beliefs and barriers. Third,
we grouped the codes into categories based on similarity in the creation of provisional themes. In
the fourth phase, we reviewed the similarities and differences between and across the themes to
refine them. Fifth, we named, defined, and compiled the themes with supporting codes to illustrate
the essence of each. In the final phase, our analysis concluded with the written report (Piercy et al.,
2016).
Coding in thematic analysis can be inductive or deductive, and theme development can be
semantic or latent (Braun & Clarke, 2006). In the current study, we employed an inductive and
latent approach, generating our themes “from the bottom up.” An inductive approach is a process
of coding in which the data are not fitted into preconceived codes, but the process is instead driven
by the data themselves (Piercy et al., 2016). By interpreting themes on the latent level, we
attempted to go beyond explicit description of the data to theorize underlying meanings within
them. Our inductive analysis resulted in the four themes described below.
We were further interested in how the themes corresponded to the numerical data from the
four closed-ended questions described above. We entered that data into SPSS v23 (IBM Corp.,
2014), which was screened by an independent reviewer for entry errors. We then reviewed descrip-
tive statistics for frequencies of barriers, and beliefs, and compared the results to the results of the
thematic analysis.

RESULTS

The open-ended questions elicited 67 discrete responses regarding therapists’ beliefs about
political participation and the barriers they experience to acting. The themes that emerged were
aligned with responses to four of the close-ended questions that were focused on beliefs and barri-
ers. The results from the closed-ended questions are arranged by theme and displayed in Table 1.
In the following sections, we report on the emergent themes and results from the close-ended
questions.

Therapists’ Personal Philosophies on Policy Participation


The four close-ended items included two questions about the participants’ beliefs about politi-
cal engagement. The sample appeared to be split in their beliefs about the type of role therapists
should have. Participants largely agreed that therapists have a political role (n = 150, 86.2%),
however, they overwhelmingly agreed that therapists should not discuss political issues with their
clients (n = 162, 93.1%). Two themes emerged from the open-ended responses on the topic of
beliefs, the theme a philosophy of democracy and the second theme a philosophy of neutrality. The
two themes can help explain the beliefs expressed in the close-ended questions.
Theme 1: Philosophy of Democracy. In the survey, we provided a definition of policy pro-
cesses and asked participants if they believed that therapists have a role in those processes. The

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Table 1
Emergent Themes Developed from Open-Ended Questions Relative to the Results from
Close-Ended Questions

Response to survey
item
Emergent theme/survey item Yes No

Theme 1: Philosophy of democracy (beliefs of participatory and civic responsibility)


Item: Do you believe therapists have a role in political and 150 (86.2%) 24 (13.8%)
policy processes?
Theme 2: Philosophy of neutrality (therapeutic boundaries and client protection)
Item: Do you believe therapists should discuss political/policy 12 (6.8%) 162 (93.1%)
issues with clients?
Theme 3: External barriers (environmental impediments to participation)
Item: What might be some barriers to your participation in the policy process?
Time 147 (84.5%)
Legal concerns 42 (24.1%)
Workplace pressure 14 (8.0%)
Theme 4: Internal barriers (personal impediments to participation)
Item: What might be some barriers to your participation in the policy process?
Interest 68 (39.1%)
Knowledge 73 (42.0%)
Feelings of ineffectiveness 53 (30.5%)

overwhelming agreement to this concept (n = 150, 86.2%) aligned with the first theme to emerge
from our analysis. The theme, a philosophy of democracy, reflects the belief that citizens in a democ-
racy have a responsibility to that democracy. Civic responsibility is a foundational aspect of a
democratic republic and includes accountability to the collective good (Thompson, 2015).
Accountability ran throughout the responses, as shown here:
To me, democracy is participation, being informed, speaking out and listening, influenc-
ing systems when appropriate, and managing and making the best of it when the tide
flows in a direction that I believe is a mistake.
Participants stressed the importance of not overlooking or avoiding responsibility to commu-
nity and country. Echoed in many responses, one participant strongly voiced the role of the thera-
pist in civic responsibility, writing, “Being a therapist does not exclude you from ‘real’ life.”
Respondents shared similar ideas about the continued role that therapists, as citizens, share and
the ways their therapeutic work can inform political engagement. One participant said, “Participa-
tion in the political process should be based on being a citizen and informed by our work as thera-
pists.” Another said that being a therapist is one aspect of identity that can influence our politics,
writing, “Some positions you may take on issues will be influenced by the role of the therapist, but
also by religion, gender, race, SES, etc.” Another felt that therapists should use their status in the
community to engage in advocacy, stating, “[We should] use our platform and knowledge to sup-
port government in restoring basic care.”
Other participants lamented the decline of civic responsibility, with responses centered on the
belief that political action is no longer a common value in the United States. As one participant
stated, “We are all citizens of the United States, who have the duty/right to participate in our
democracy. That very salient point has been lost over the years by citizens at large.” This partici-
pant’s notion that political engagement is both a right and a duty signifies that the right to partici-
pate politically is governed by our obligation to perform the actions defined by that right

January 2018 JOURNAL OF MARITAL AND FAMILY THERAPY 23


(Thompson, 2015). The right to democracy is also a duty and a commitment to making changes in
our communities and working for rights of others, as highlighted in this comment:
True democracy does not mean manipulating others to gain votes, get your own agenda,
or in any way reducing the ability of others to have as much of a voice as I wish to have.
We definitely have an imperfect union, and it’s everyone’s job to make it better for every-
one in the US and the world.
Theme 2: Philosophy of Neutrality. A close-ended question in the survey asked if the partici-
pants believed in engaging in political discussion with clients, to which participants agreed that
they should not (93.1%). The desire to not discuss politics with clients can be explained by our sec-
ond theme, a philosophy of neutrality. In this theme, responses indicated that political interests
should not be an aspect of therapy or the therapist.
Common in the theme of neutrality was the idea that a therapists’ identity is an unbiased and
objective one. As an ideological stance, respondents reported a responsibility to clients and their
professional lives; setting therapeutic neutrality above civic responsibility. Ideas of the neutral
therapist are reflected in the comment “Being political is an appearance of overstepping bound-
aries,” indicating a desire not to interject in clients’ lives. Another respondent felt, similarly, that
the role of the therapist is not in political advocacy but in the provision of therapy alone, writing,
“We should be MFT experts, not political action committee experts.” Protecting the client was also
relevant to one participant, who said, “I don’t automatically assume I know what is right for every-
one.” By contrast, the response “I think it is important to remain unbiased when it comes to poli-
tics, especially in my town” focuses on protecting professional identity and reputation of the
therapist. Professional identity was salient in a comment by another respondent, who suggested
that involvement in politics would risk “offending clients, reducing client load, and affecting
peers.”
The idea of neutrality further extended to beliefs about the role of therapists’ professional
organizations. According to one statement, “AAMFT [should] not [become] associated with
trendy news topics because AAMFT needs to bridge all political perspectives.” The response
implies that professional organizations like AAMFT make political stands at the risk of isolating
dissenting political beliefs. Also discussed were the terms in which participants believe therapists
can appropriately address political topics. Respondents suggested that therapists can be political
in their efforts to safeguard the profession. As one participant remarked that family therapists
should “work for the good of the profession, not take political stands on issues that do not relate
to right to scope of practice.”

Perceived Barriers to Participation


In addition to beliefs about therapists’ political involvement, responses to the open-ended
questions focused on the barriers that our participants have experienced in advocacy work. The
two themes that emerged were external barriers and internal barriers. These themes were highly
reflective of the results from the close-ended question on barriers (see Table 1). In the following we
describe the themes, while also presenting the results from the close-ended questions.
Theme 3: External Barriers. The theme of external barriers reflects the environmental factors
that can prevent advocacy work. Time, legality, and workplace issues were the external barriers
included in the close-ended survey question, and indicated in the written responses. For partici-
pants, time (n = 147, 84.5%) was the number one obstacle that impeded engagement in policy and
political efforts. Participants referred to the issue of time as constraints occurring from competing
demands of daily life. These ranged from time spent on the job to the demands of parenthood,
expressed by one participant: “I have little time, [and] I spend most of my time with a 2-year-old.
Unless it is on Disney, I don’t see it.”
Although workplace pressure was the least-reported barrier in the closed-ended results
(n = 14, 8%), the open-ended responses often described issues surrounding work settings. The par-
ticipants described the pressure they felt in their work settings as being nonsupportive of their
involvement in political matters. Commonly described was the belief that work in faith-based orga-
nizations creates barriers, seen in one statement “Leadership at the church I serve may not support

24 JOURNAL OF MARITAL AND FAMILY THERAPY January 2018


my involvement.” While other participants worried about isolating themselves or their colleagues,
seen in the statement: “[I’d] be discriminated against by colleagues.”
Legality was a concern highlighted by a minority of participants in the results of the closed-
ended question (n = 42, 24.1%). Legal problems can arise from lobbying on behalf of a nonprofit
institution or as a government employee (Rocha et al., 2010). Participants did not generally report
concerns about legal challenges in written responses. However, an unexpected result was the issue
of citizenship itself. Some respondents wrote that they were not able to fully engage in the system
in which they live, work, and study due to their immigration status. In thematic analysis, it is not
uncommon to highlight significant but infrequent codes (Braun & Clarke, 2006). We felt it was
important to amplify these participants’ concerns as our profession continues to attract interna-
tional students. One respondent wrote, “Immigration law has been challenging and disadvantaging
for those who pursue higher education. I do not have the right to vote.” The issue of citizenship
and immigration remains an important reminder of the exclusion that non-native therapists and
clients can encounter from full participation in our society.
Theme 4: Internal Barriers. The theme, internal barriers, describes participants’ personal
aspects that obstruct active participation. In the close-ended survey questions, internal barriers
included, knowledge, interest, and efficacy, which were mirrored in written responses. Not having
knowledge was the second most cited barrier among the closed-ended questions (n = 73, 42%). In
written responses, a lack of knowledge was referred to in written responses as a failing of our train-
ing programs, as one participant wrote, “many therapists are a-political, which needs to be
addressed in their professional education programs.” While a lack of knowledge can result from
external forces such as a lack of training, it becomes part of inner experience. This is felt in the
responses of participants who wrote that they did not have the knowledge of the influence of policy
on the profession, as seen in the comments: “This has raised my personal awareness, and I may
want to expand my knowledge and interest into policy issues that are/could be important to me”
and “I was shocked to learn how our profession is significantly impacted by state and national pol-
itics.” A deeper reading of the responses points to the possibility that a lack of knowledge about
political identity of family therapy can create a lack of interest. Disinterest was noted by 68 partici-
pants (39.1%) as a barrier in response to the close-ended question, and also emerged as an internal
barrier in the written responses. One participant noted, “I am [un]interested in politics. Other than
voting at elections I spend little time with this.” Another remarked, “Politics bore me and don’t
concern me,” showing a disconnect between the overt and covert politics inherent in therapy.
In the close-ended results 53 participants (30.5%) acknowledged feeling ineffective in political
engagement. In written responses, the feelings if inefficacy were linked to advocacy within ineffec-
tive systems. One participant wrote, “I suppose I get discouraged with the policies and procedures
of government.” Discouragement with ineffective political processes was noted by another partici-
pant, who wrote,
By the time lobbyists make headway and laws are enacted, politicians add addendums
that make no sense and can make a new law without benefit. I am not trying to be cynical,
just frustrated.
A challenging issue of feeling ineffective is the possibility for it to discourage future political
engagement, when one’s work does not come to fruition.

DISCUSSION

Although a handful of authors have written about the importance of and need for political
and policy involvement by therapists, this was the first study to explore the beliefs that family ther-
apists hold about policy work. We were encouraged by the results, which indicated that the major-
ity of our participants felt therapists do have a role in policy processes. Participants related that as
citizens of a democracy, they have certain responsibilities for supporting their communities. Other
participants expressed reservations about political engagement as possibly detrimental to their
duty as therapists to remain unbiased. We also received clarity on what impediments participants
encountered when engaging in political action. The responses underlined the need for the family

January 2018 JOURNAL OF MARITAL AND FAMILY THERAPY 25


therapy profession to embrace a political identity in order to enhance training to encourage thera-
pists’ awareness of the impact of social policy.
Participants who supported political advocacy as a matter of democratic civic responsibility
also noted the declining value of civic and political engagement in our country. Civic responsibility
is considered a bedrock of functioning democracies, as people must be critically and actively
involved in their own governance (Van Camp & Baugh, 2016). Civic engagement is multidimen-
sional and includes having the skills, knowledge, and commitment to improve the social condition
of one’s community. Historically, the teaching of citizenship and democratic participation was the
responsibility of schools (Hepburn, 2013). As education standards have changed, civics and demo-
cratic participation have been abandoned and presumed to be taught in the family. The reduction
in civic education contributes to the waning of public knowledge and skills for civic responsibility
along with decreased democratic participation (Van Camp & Baugh, 2016). Political knowledge
increasingly comes from social media, which is troubling given the rise of “fake news” (Hepburn,
2013). A lack of accurate knowledge about current events and ways to engage in political systems
can create negative perceptions of politics and feelings of inefficacy (Rocha et al., 2010), reinforc-
ing detachment from politics (Pew Research Center, 2016).
Political detachment was evidenced in the current sample, with 39% reporting no interest in
politics. Therapists’ political disinterest is troubling for two reasons. First, it shows the potential
disconnect that therapists might have from the reciprocal nature of policy and therapeutic practice.
If family therapists are genuinely concerned about the future of their field and want to gain access
to broader populations, they must accept the role of policy in the profession (Heisler & Bagalman,
2015). Similarly, to promote principles of social justice, therapists must be aware of the sociopoliti-
cal identities of therapists and clients (Letiecq et al., 2013; Twist, 2006; Waldegrave, 2009). A lack
of interest in politics can be attributed to the indifference and irrelevance that often occurs with les-
ser degrees of critical consciousness. Critical consciousness is the growing awareness of the link
between the personal and the political (Hern andez, Almeida, & Vecchio, 2005), and in this case the
political impact of policy on clients. Critical consciousness is often less cultivated in people from
socially dominant groups, and it is possible that the overwhelming homogeneity of our partici-
pants led to an expression of disinterest as a barrier to political action (Hern andez et al., 2005;
Swank & Fahs, 2013).
Our participants also noted the need for therapists to protect the therapeutic relationship by
maintaining boundaries as an unbiased person. Therapeutic neutrality considers therapy to be best
achieved when only therapeutic expertise, not the values of the therapist, is employed (Fife & Whit-
ing, 2007). Therapists who adopt a value-neutral stance appear to believe that having a political
ideology and being clinically impartial are contradictory (Haynes & Mickelson, 2009). They might
believe that neutrality even requires down-playing one’s public and political positions (Avissar,
2016). The value of neutrality in session can also be linked to an ethical objection against therapists
pushing agendas (D’Arrigo-Patrick et al., 2016). Nonetheless, the therapist-as-person is a political
being and sociopolitical beliefs permeate clinical practice, whether consciously or not on the part
of the therapist (Avissar, 2016). If therapists ignore their political selves, they run the risk of fur-
ther marginalizing or disenfranchising their clients.
Our participants overwhelmingly reported that they do not engage in political discussion with
clients. While there are many possible reasons for this, therapeutic neutrality appears to be the
clearest. The polarizing arguments that surround politics might discourage therapists from engag-
ing their clients’ political selves. To do so would open therapists to the anger, hurt, and despair
their clients might feel (Avissar, 2016). As with other topics, such as finances (Lowrance, 2011),
when therapists are not trained to openly bring the topics into the therapy they might believe they
are taboo or irrelevant (Avissar, 2016).
Avoiding discussion of clients’ political commitments and the political discourses in which
they live dislocates clients from their world (Avissar, 2016). The political lives of clients give thera-
pists glimpses into the values, meanings, motivations, concerns, and beliefs that clients hold.
Encouraging family therapists to engage their clients’ political selves would require clear distinc-
tions to be drawn between ethical and unethical behaviors. Without such distinctions, uncertainty
would remain about where family therapists should draw the ethical line in political advocacy.
Even without clear ethical guidelines, some actions are appropriate for encouraging clients’

26 JOURNAL OF MARITAL AND FAMILY THERAPY January 2018


political self-determination. Actions such as responding to clients when they open political discus-
sions, encouraging clients to pay attention to who their legislators are and how they vote, and pro-
viding information about organizations and how to contact elected officials and attend council
meetings are all noncoercive ways to encourage clients’ voices in the policy process. For further
ideas, we point readers to articles that discuss therapist’s advocacy with clients (Gehart & Lucas,
2007; Rome, Hoechstetter, & Wolf-Branigin, 2010).
We conducted the current survey before the campaign cycle and federal elections of 2016.
During that time, the United States has become politically galvanized. People, regardless of politi-
cal views, are channeling their disappointment, fear, and anger into purposeful action (Pew
Research Center, 2016). This renewed political interest has created an opportunity for the family
therapy profession to engage in political discussion, reflection, and action. Therapists, students,
and professors must have a conception of who they are sociopolitically. They must understand the
contexts in which they teach, practice, learn, and administer. They should critically question their
knowledge and how it might be connected to political discourses. At the same time, the importance
and difficulty of obtaining accurate information are clear (Balmas, 2014). Websites such as Factch-
eck (www.factcheck.org) and Politifact (www.politifact.com) are resources for checking the verac-
ity of news items. The potential for building awareness and linking the personal, professional, and
political is close at hand. As a profession, therapists have an opportunity to engage in critical dis-
cussions of the harsh political realities of the divisions in our country, the reemergence of overt
exclusionary tactics and hate groups, and the disintegration of hard-won protections.

DEVELOPING A POLITICALLY ORIENTED PROFESSION

Increasing family therapists’ involvement in policy processes is easier said than done. It is one
thing to make a case for direct political and policy involvement and another altogether to prepare
therapists for such work. Our analysis provided insight into some of the barriers family therapists
face to engaging in policy advocacy and political action. Knowing more about these barriers will
help us create strategies for the development of a policy-oriented profession. These strategies are
discussed below for both students and clinicians.

Where Training Programs Can Begin


We recognize that family therapy training programs carry a heavy responsibility and must
accommodate many competing stakeholders (Bernal, 2009; Nelson & Smock, 2005). Therefore,
the following suggestions are not meant to overburden already busy schedules but to be incorpo-
rated into current coursework and class discussions. An important first step is for training pro-
grams to support professors’ development of political awareness. Faculty members can
collaborate with family therapists and family scientists who are already engaged in political work
to learn more about action and advocacy. Instructors can raise their awareness through recogniz-
ing the range of political systems they work in. From academia, professional organizations, and
state licensing boards policies guide these institutions. Professors can act intentionally in their
interactions with these systems, involving student discussion and evaluation of current policies.
Many professors engage in other forms of civic participation by voting, testifying in commit-
tee hearings, campaigning, lobbying, and protesting. These actions should not be considered sepa-
rate from professional life, but should instead be discussed openly with students. Faculty modeling
signals to students that these actions are a part of the life of the therapist and the life of the profes-
sion. Bringing institutional and social action into class discussions can raise students’ awareness
and expand their interest in developing the political aspects of their therapeutic selves. Political dis-
cussion requires interpersonal commitments to listening, understanding, and valuing different per-
spectives while challenging and critiquing the status quo (McGeorge & Carlson, 2010). Faculty
members can model respectful debate in their classrooms around the role of policy in sociopolitical
history, psychological oppression, power and privilege (Letiecq et al., 2013).
The area of greatest improvement in our development of a politically oriented profession is
intentional training. Training programs can revise curricula to incorporate concepts and ideas of
policy and political advocacy. All courses can include readings about the constructive power
of policies on family development and well-being, for example, articles on family leave or

January 2018 JOURNAL OF MARITAL AND FAMILY THERAPY 27


immigration policies. Teaching about specific political and policy processes goes beyond assigning
and discussing articles. Faculty members can invite guest speakers to classes and encourage stu-
dents to attend political events such as committee hearings and town halls. One valuable resource
is local nonprofit organizations’ “Lobby Days,” where students can experience political interaction
with legislators and lobbyists. Piercy and Sprenkle (1983) gave an early outline of the aspects of
developing students’ understanding of the legislative process. Their suggestions went beyond read-
ing to include classroom simulations of the creation and evaluation of legislative bills and testifying
before legislative subcommittees (Piercy & Sprenkle, 1983). We outline further possible teaching
strategies in a curriculum available in the online version of this article.

Where Therapists Can Begin


Advocacy begins with looking inward and reflecting on the reasons one wants to become
involved (McGeorge & Carlson, 2010). Therapists can reflexively consider who their political role
models were, what messages they received from their families about politics, and who in their
social networks are politically active. Therapists can also take the opportunity to learn more about
the role that policy plays in constructing families (Letiecq et al., 2013). Beyond reflection, there are
many ways therapists can contribute to political action and social policy. Clinicians can join inter-
est groups and local grassroots efforts. They can join their clinical organizations’ advocacy net-
works and sit on their boards.
Becoming active in community interest groups is another step toward political advocacy.
Town halls, council meetings, and school board meetings provide opportunities to connect to peo-
ple in one’s area who have advocacy knowledge and skills. Simply showing up to meetings gives
insight into the roles one can play and the actions needed. Meetings provide excellent opportunities
to connect with like-minded people and create relationships with key policymakers. Moving still
further into the political world, therapists can volunteer with campaigns and work on policymak-
ers’ task-forces. Nurturing relationships with elected officials simultaneously gives policymakers a
link to their constituents and therapists a voice in the political system.
Political giving is one activity requiring little time that substantially supports candidates and
issues. Political action committees (PACs) pool contributions to donate for or against legislation,
initiatives, and candidates (Brunell, 2005). By giving to a PAC, clinicians can maximize their finan-
cial contributions in focused efforts to bring about policy changes. Other activities that require
small outputs of time include testifying in committee meetings and making statements to the
media, though these require background information to be effective. We suggest that interested
clinicians consider the provided curriculum in the online version of this paper for self-study.

LIMITATIONS AND FUTURE RESEARCH

Our study is an exploratory first step toward understanding the family therapists’ perceptions
about becoming politically oriented. While a response rate of 34.8% is respectable for mailed sur-
veys, our findings should be generalized with caution. Because it was a self-selected sample, there is
no way to know how those who did not respond would answer. The participants who did respond
might have an interest in policy and political issues that is not representative of family therapists.
The questions on barriers and beliefs were limited and the answers to them should be considered
relative rather than absolute. The sample’s homogeneity might have skewed the results about bar-
riers to political action. Previous research has discussed the complex relationships that can exist
between political action and social location. Future research should sample a diverse range of fam-
ily therapists to better represent the obstacles that might arise from membership in historically and
currently disenfranchised or marginalized communities (Swank & Fahs, 2013).
Further research could produce a finessed measure to explore the boundaries and underlying
values of a policy orientation. This research could identify the factors that influence participation
and motivate family therapists toward political action. While we can make assumptions about why
some therapists are politically active and others not, further studies could give us unique insights
into the differences between politically active and nonactive therapists. Finally, one area for explo-
ration is the role therapists take to encourage client activism while monitoring the line between
empowerment and coercion.

28 JOURNAL OF MARITAL AND FAMILY THERAPY January 2018


CONCLUSION

As a profession, family therapy can make significant contributions to social policy. A minority
of authors have called for family therapists to become politically active. Other authors advocating
for community action have eschewed therapist policy involvement as an elitist and disempowering
slippery slope (Doherty & Carroll, 2002). As with any work seeking to represent people’s needs, we
must be aware of the fine line walked when engaging in political action and the risk of extending
colonizing discourses (Bermúdez, Muruthi, & Jordan, 2016). However, therapists cannot be pas-
sive. Any attempt to empower clients without personal accountability implies it is the responsibil-
ity of the marginalized to change systems of oppression. Therapists’ commitment to advocacy in
political systems embraces the belief that “oppressors and oppressed must join together to fight for
social justice” (Beitin & Allen, 2005, p. 31).
The current paper comes at a time when the country is fraught with derision, disappoint-
ment, fear, and anger (Pew Research Center, 2016). Fact is hard to discern from fiction (Bal-
mas, 2014), access to political leaders is proving difficult (Pew Research Center, 2016), and
measures to exclude dialogues on justice and inclusivity are being brought forth (Mitchell-
Yellin, 2017). At no time in the history of our profession has it been more important that we
become accountable to our communities. We have a responsibility to promote the welfare of
our clients and ourselves by becoming personally involved in political processes. By sharing
our unique expertise with policymakers and engaging in in-session activism with clients, “we
must try to achieve a situation in which the work is political always, already—not unusually,
not exceptionally, not only when it is done by mavericks, but when it is done in an everyday
way by every therapist” (Samuels, 2006, p. 16). Moving into the public arena might be overtly
political, but not doing so is covertly political (Avissar, 2016). Incorporating a social justice
stance requires acting with our clients and within the public arena to influence broad social,
organizational, and personal change. As a profession, it is time we decide whether we will enter
the political fray.

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SUPPORTING INFORMATION

Additional Supporting Information may be found in the online version of this article:

Data S1. Demographic and background information.


Data S2. Curricular introduction to policy, politics, legislation, and civic responsibility.
Data S3. The political participation of marriage and family therapists.

January 2018 JOURNAL OF MARITAL AND FAMILY THERAPY 31