Clinician and client political values in culturally-competent psychotherapy

The ways in which client and therapist political values affect the therapeutic process has been a neglected factor in clinical practice, with many clinicians committing “culturally-competent malpractice” in this area (Redding, 2020).  A client’s sociopolitical values (“SPVs”) are often central to their identity and can affect their relationships, including their relationship with the therapist. Likewise, the therapist’s values can affect their understanding of and empathy for the client, and can influence for better or worse case conceptualization, diagnoses, and therapeutic choices.

Many issues of concern to clients directly or indirectly implicate SPVs, including child-rearing practices, abortion, lifestyle choices, sexuality, and issues around personal responsibility, to name but a few, and increasingly nowadays clients are experiencing family and relationship conflicts over political issues.  A recent survey (see Redding, 2020) of therapists and clients found that client SVPs often arose in therapy, but that clinician and client SVPs often differed.  Clients reported that it was helpful to them to raise such issues in therapy, and therapists likewise reported that it was helpful for case conceptualization and tailoring treatment to know about the client’s SPVs.  Half of therapists said that their political beliefs influenced how they practiced psychotherapy, and 23% identified the client’s political preferences as being among the top three demographic and cultural factors that affect them the most when working with clients who are different from them.

Thus, understanding a client’s sociopolitical values can be useful for tailoring therapy to client needs and concerns, and a congruence between therapist and client values may enhance the therapeutic relationship.  But a lack of value congruence need not be detrimental if the therapist is open to and respectful of the client’s values, and considers those values in appropriate ways to leverage positive therapeutic outcomes.

How Can Clinicians Be Socio-politically Competent with Clients (see Redding, 2020)?

  • Clinicians should engage in ongoing introspection about how their SPVs may play out in the therapy room, particularly with clients whose SPVs are antithetical to their own.
  • Consider whether the clinician holds implicit or explicit biases against the client, as a function of the client’s SPVs, and the steps can be taken to minimize such biases and their impact on the therapeutic relationship.
  • Consider whether the clinician understands the clients’ values, appropriately modifying treatment to be consistent with client values and goals.
  • Consider how clients’ SPVs, clinician SPVs and the interplay between the two, influence case conceptualization and therapeutic goals and choices.
  • Understand how clients’ value systems shape their behavior and life choices, and how they affect their work, family, and social relationships.

How Can the Profession Become More Socio-politically Competent (see Redding, 2020)?

  • Incorporate into the ethical codes a prohibition against discrimination based on client SVPs.
  • Include SVPs among the list of factors to be considered in multicultural practice guidelines, and incorporate training on cultural awareness about diverse sociopolitical groups into multicultural education in graduate and clinical training programs.
  • Develop evidence-based best practices for working with socio-politically diverse clients.
  • Encourage those of diverse sociopolitical backgrounds and values to enter the profession, particularly political and religious conservatives, who are vastly underrepresented in the mental health professions.

Reference/Target Source

Redding, R.E.  (2020).  Sociopolitical values: The neglected factor in culturally-competent psychotherapy.  In L.T. Benuto, M.P. Duckworth, A. Masuda, & W. O’Donohue (Eds.), Prejudice, stigma, privilege, and oppression:  A behavioral health handbook (pp. 427-445).  New York: Springer. Link to Full Text Chapter.

Discussion Questions

  1. How are your preferred therapeutic approaches and choices influenced by your own sociopolitical values, and how might you modify those approaches to better fit with the values of different clients?
  2. Do you understand and empathize with clients’ sociopolitical values and understand how those values influence their behavior, relationships, life choices, and presenting problems?
  3. Do you hold implicit or explicit biases against the socio-political “Other” client, and how might those biases impact the therapeutic alliance, case conceptualization, diagnosis, and treatment planning?
  4. Do you experience countertransference with socio-politically different clients?  Do you unknowingly commit microaggressions against such clients?

About the Author

Richard E. Redding, J.D., Ph.D., is Professor of Psychology and Education, and the Ronald D. Rotunda Distinguished Professor of Jurisprudence, at Chapman University.  He previously was a professor at Villanova University and the University of Virginia.  He is a fellow of the American Psychological Association and the Association for Psychological Science, and Founder of the Open Inquiry in Behavioral Science group, dedicated to promoting sociopolitical and intellectual diversity in the science and profession of psychology.  Dr. Redding can be contacted at redding@chapman.edu.

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