Alarm bells have been ringing loudly for some time about the incursion of critical social justice into the therapeutic professions. But it doesn’t seem that many clinical psychologists or other mental health professionals are listening. In some ways that’s understandable. Who knows what ‘critical social justice’ actually means? It doesn’t trip easily off the tongue, does it? On the other hand, most people understand what is meant by ‘social justice’. If you’re working in a profession dedicated to helping others, then you are likely to want fairness and equality for all. Community psychologists, for example, aim to help people who are disadvantaged by identifying underlying social issues that contribute to their difficulties and taking action to change these. So, what’s all the fuss about critical social justice (CSJ)?
CSJ theory combines Marxist thought with postmodern concepts of knowledge, power, and discourses. Its aim is to eliminate prejudice and discrimination by changing society through social justice activism. People are categorised according to their ‘identity group’. Those in the majority group are viewed as ‘oppressors’, while those in minority groups are seen as ‘oppressed’. Intersectionality is a CSJ method by which minorities are further divided into sub-categories, according to their degree of marginalisation.
CSJ considers Western science and notions of the individual as ‘problematic’. Both are thought to be embedded in oppressive societal power systems such as ‘White supremacy’ and ‘patriarchy’. To dismantle those power systems, curricula have to be ‘decolonised’, removing any scientific research that is deemed too Western Educated Industrialised Rich and Democratic or ‘WEIRD’.
CSJ activism has gained traction in recent years due, in part, to the popularity of books such as How to Be an Anti-Racist by Ibram X. Kendi and White Fragility by Robin DiAngelo. While Kendi calls for present and future discrimination to overcome racism, DiAngelo claims that all White people are inherently racist and talks disparagingly of ‘White women’s tears’. These authors are proponents of critical race theory, one of many CSJ theories, and one which attracts a great deal of controversy both in the US, where it originated and here in the UK.
CSJ and critical race theory are widespread in the US and embedded in the American Psychological Association. In Canada the accrediting boards for graduate clinical psychology training programs are now planning to refuse to accredit university clinical programmes unless they have a ‘social justice’ orientation. The British Psychological Society(BPS) has also adopted a CSJ agenda and this is reflected in its magazine The Psychologist. Their commitment accelerated following the death of George Floyd and the Black Lives Matter protests in 2020. The BPS now follows the ‘anti-racist’ agenda advocated by Ibram X. Kendi and has adopted the terminology of Robin DiAngelo.
All of this has happened at great speed and without any meaningful discussion or consideration of the consequences for clinical psychology and, more importantly, for those people that clinical psychologists serve. Attempts to initiate debate have been met with hostility and accusations of bigotry and racism. It is hard to comprehend how this can be happening in a profession that prides itself on engaging in reasoned, respectful debate, listening, compassion, and reflection.
What does this mean for the future of clinical psychology? Two articles by US researchers provide some insight into what therapeutic work, based on a CSJ approach, might look like. The first, ‘Talking With white Clients About Race’, describes ‘how to connect race and racism to the client’s explicit goals for therapy’. The author deliberately uses a lower case ‘w’ for ‘white’ in the title to symbolically diminish the power and privilege inherent in the word.
In a similar vein, the second article, ‘White Supremacy and Counseling: A Critical-Conceptual Framework’, enthuses about putting social justice ‘at the center of all our work, including our work with White people’. The authors recommend ‘rejecting racial progress narratives’ and ‘centering White supremacy as a key problem for the field of counseling psychology and allied helping professions.’
The prospect of clients seeking help for mental health problems and being confronted by a psychologist-activist who decides to ‘cure’ them of racism, or any other ‘ism’ is a troubling one that is surely deserving of discussion and debate before ideas like this are embedded in clinical training courses.
Training psychologists to reflect on their own ‘White privilege’ is one thing. Training them to reflect on their clients’ ‘privilege’ and to discriminate against them on the basis of immutable characteristics, such as skin colour is quite another. What happens when you’re assessing a white, male, working-class client on benefits? Do you categorise him as an ‘oppressor’ based on his skin colour and sex – even though he is disadvantaged? Do you suggest he attributes his problems to racism and sexism and help him see the error of his ways?
Psychologists are expected to maintain clients’ dignity and autonomy, to be non-judgemental and non-discriminatory and to keep their own beliefs, values and opinions out of the therapy room. Both the Health Care Professions Council and The BPS’s standards of conduct make this clear.
However, in one notable case, relating to gender identity, CSJ beliefs and values have found their way into the therapy room with troubling consequences. The recent Cass Review Interim Report on the Gender Identity Development Service (GIDS) at the Tavistock & Portman NHS Foundation Trust highlights the risks to young people with gender dysphoria of professionals unquestioningly adopting a ‘gender-affirming’ approach. This approach is underpinned by CSJ Theory. The report states that at GIDS: ‘Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.’
How can you be sure, when you see a young person with gender dysphoria, that you haven’t missed something when you immediately ‘affirm’ them as gender dysphoric rather than adopting an exploratory approach? What if they have autism or a history of childhood abuse?
And what of the ways of thinking that CSJ encourages? How helpful is it for people from minority groups to hear they are ‘oppressed’ victims who are unable to escape from racism? What happens over time if people learn to look for microaggressions in every social encounter? How can it be right that racial slurs are aimed at people from minority groups who do not agree with this worldview? It is essential that Clinical Psychologists engage with these aspects of CSJ and consider their consequences.
Psychologist Jonathan Haidt and his co-author Greg Lukianoff propose that thinking styles such as ‘mind-reading’, ‘emotional reasoning’ and ‘all or nothing thinking’, all of which occur frequently in CSJ, are associated with depression and anxiety. This, they say, is like a form of ‘reverse cognitive behaviour therapy’ (CBT). Haidt also points out that even psychotherapy can be viewed as a microaggression if it challenges a client’s view of the world and so undermines their ‘lived experience’. In fact, CBT has been described by CSJ proponents as ‘epistemic violence’, ‘his master’s tools’ and suggestions made that it be ‘dismantled’.
CBT itself falls into the category of ‘WEIRD’ science, as do other evidence-based psychotherapies. A recent article in the BMJ Global Health raises concerns about the potential harm of ‘decolonisation’ in undermining confidence in scientific knowledge. ‘Decolonisation’ may have serious implications for evidence-based psychotherapies at a time when they are most needed, following a pandemic and a rise in prevalence of depression and anxiety.
There is also the question of the ‘scientist practitioner’ model. The role of the Clinical Psychologist is described by NHS England as one in which “you will draw on your scientific knowledge to bring about positive change”. It continues: “you’ll work in partnership with service users to design and implement interventions to overcome their condition or improve their quality of life”.
This means adopting a scientific approach to clinical work, carrying out a detailed assessment of a client’s difficulties and using the best evidence-based treatments available to help them recover. And yet, if you view the role of the Clinical Psychologist through the CSJ lens, all this is turned on its head. How can you be a scientist practitioner if you reject the notion of scientific enquiry and view it as ‘WEIRD’? How do you find out whether or not your intervention has been successful if you’re not allowed to measure outcomes because this perpetuates the power structures of ‘Whiteness’?
Why, when for many years clinical psychologists have carefully avoided categorisation and diagnostic labelling in favour of using scales of measurement, are they now happy to put people into boxes, labelling them ‘Black’, ‘White’, ‘privileged’, or ‘victimised’? This is dangerously close to ‘good’ or ‘bad’. Whatever happened to the principle of ‘First, do no harm’?
Finally, there is the question of ‘victim blaming’. This is an accusation that is often levelled at those of us who prefer to focus on helping individuals address their psychological problems, rather than seeking to alleviate their ‘oppression’ through activism. I worked as a Clinical Psychologist in an inner-city hospital for many years, where much of my time was spent advocating for clients who had problems with their health, their housing and, often, asylum claims. They came from many different countries and cultures. Some were diagnosed with HIV, others were receiving palliative care.
Liaison with community organisations, local support groups and Citizens Advice Bureaux was a regular part of my job, ensuring those individuals received the help they needed. At times I found it frustrating that I could not improve their social circumstances, but I always remembered the wise words of Professor Michael Berger, emeritus professor of psychology at Royal Holloway – ‘Know your limits.’ I was not a social worker or a housing officer, or a political activist. I was a Clinical Psychologist.
With a broad-ranging assessment, incorporating a client’s social and economic circumstances and their cultural and religious beliefs it is possible to create a formulation, in collaboration with clients, that encompasses a range of interventions at different levels. Your work need not be limited to managing thoughts or mood. On many occasions I would help a client understand they were not to blame for their situation and how societal and cultural factors played a part in maintaining their difficulties. Nonetheless, it was still possible to help them find ways of feeling better by listening carefully, understanding and connecting them with like-minded people in their own communities or support groups. There is never a ‘one-size fits all’ solution to people’s problems. I fear, though, that for CSJ the only solution is to engineer changes in society through its politically driven brand of social justice activism.
So, what to do? A few months ago, I wrote to the Health Care Professions Council (HCPC) raising questions about the extent to which the CSJ worldview and values are compatible with their standards of professional and ethical conduct. The HCPC is an evidence-based regulator. They are keen to investigate my concerns. However, mine cannot be a lone voice on this issue. If, after reading this, you share those concerns, please contact the HCPC yourself and let them know. From what I have learned about critical social justice, it is more likely to lead to division, grievance, resentment and victimhood than to equality and fairness for all. What kind of social justice is that? There’s a very critical difference.
Carole Sherwood, DClinPsy is a clinical psychologist who worked in the NHS and private practice.
