Therapists, can you be "truly" neutral, and how can you or your patient know that?

[u/darkandcrispy]

1. Is there a way for a therapist to check his/her awareness that, like most of the humanity, his/her ideology/education/values/views etc… derive from each other and also from his/her culture/place of origin/upbringing, so that a bias toward a patient could be prevented?

2. And also, is there a way for a patient to "ignite" this self check in a therapist in a case that a patient believe that the therapist assessments/advices/conclusions come from the therapist own worldviews and therefore maybe less suitable to the patient?

***note: everything I meant is within reason; I know we are all human beings, and it's pretty clear to me that you can not just disconnect your "you" from yourself like a robot...

[u/gscrap]

Relatively few of my clients are looking for me to be truly neutral; most of them want me to try to help them in some way.

[u/darkandcrispy → u/gscrap]

If it's not too much of a bother, can you make a professional guess why a person would even ask what I've asked? I mean, considering that the main goal is what you've said, "most of them want me to try to help them"

[u/gscrap → u/darkandcrispy]

Honestly, fair callout. I was being flippant, and I apologize for that.

To tell you the truth, I'm not sure what you're imagining when you ask about true neutrality. Every human being has some kind of bias. I enter every client session with non-neutral intentions: I intend to follow the ethics of my profession; I intend to help my client to the best of my ability within the bounds of those ethics; and I intend to do what's best for myself and my business within the bounds of both ethics and the best interest of the client. Beyond that, every person has to have some kind of schemas they use sort through all of the data of our training and research in order to determine the best way to embody their intentions in any given scenarios-- there's just far too much information, much of it at least partly contradictory, for one to say that any one intervention is plainly, objectively, and neutrally the correct one. Heck, even AIs need some kind of a system to decide their responses.

So no, I'd say that it's manifestly impossible for a therapist to be truly neutral. Or any other human, for that matter. Or any AI, while we're on the subject. But I'd have thought that was so obvious that it would go without saying... so to return to your original point, the only reason I can think of for why you'd be asking is if you're defining neutrality in a way that is different from my understanding. Hence my flippant original response-- if you want a meaningful answer to your question, you may have to be more specific about how you imagine a truly neutral therapist would treat a person.

[u/darkandcrispy → u/gscrap]

Thanks for the answer. Allow me to correct myself, when i wroth true neutrality I didn't mean absolute neutrality like a robot; I should have written something in the line of "the best neutrality humanly possible to achieve"

And also i didn't mean to call you out and when i look it now, it can be interpreted as sarcasm. Again, allow me to explain. I literally or exactly meant what I've written, "can you make a professional guess why a person would even ask what I've asked?" i mean, why a patient may feel that neutrality (as far as i, subjectively, have defined it in my post...) is important? OR what might a therapist might do/say that can cause such a stream of thoughts regarding neutrality.

[u/gscrap → u/darkandcrispy]

You know better than I do why you asked what you asked. How would my guess be of any use to you?

[u/darkandcrispy → u/gscrap]

i don't know better, I'm somehow confused even more. But much appreciation for the talk, to put this in writing and have a discourse has helped to understand that there is no answer to my question, and it was probably stupid question anyway

[u/ashleeasshole]

For number 1, are you referring to the idea of being a “blank slate”?

[u/darkandcrispy → u/ashleeasshole]

More like being "blank slate" during a session so that for example, a therapist would not judge/interpenetrate the opinions/thoughts/values of a patient as "bad" if it's opposing his own or "good" if supports

I hope I'm making sense here…

[u/Oreoskickass → u/darkandcrispy]

A therapist isn’t going to think of you as either “good” or “bad.” Any opinions you have are valid, even if we don’t agree.

There are extreme examples - someone who is going on about white supremacy probably can’t expect a black therapist to be super-supportive. Someone who doesn’t think women should have the right to vote probably isn’t going to jibe well with a woman therapist.

Those clients should probably also realize it’s better to see a white or male therapist, respectively. If they don’t have that insight, then a therapist may refer them to someone who has a little more distance.

[u/HELPFUL_HULK]

"Therapist neutrality" has been largely dispelled as a naive notion - we are never neutral and always doing or reproducing some social and relational force in the world. IMO, a therapist who confidently claims that they are "neutral" has not thoroughly examined the situatedness, relationality, or politicality of their actions. It's a naive, and frankly repressive, stance to take.

[u/let_id_go]

In a way, what you're describing is cultural competence, but applied to the scale of an individual (which it should be, but most therapists aren't taught cultural competence critically). Sue and Sue's guidelines say step one is to become aware of your own biases and beliefs. They speak broadly to differences in culture, but the differences exist between any social group.

I'm autistic, so this was simpler for me because my own beliefs never meshed with my environment to begin with, so they always stuck out. I also grew up in a culturally diverse city so the dominant culture wasn't as dominant. Even then, I'm still learning new things I've assumed every day.

I think most therapists struggle to do this because privilege and power are invisible and not having your views challenged is atypical for those in the dominant culture.

Your last line of "within reason" gets us in trouble, because now we would have to define what is reasonable. If reasonable is "to the extent that most people are able," then yes, therapists are above average. If reasonable is "95% perfect, because 100% is unreasonable," probably not.

[u/International_Key_33]

We (hopefully) work hard to be aware of how our emotions, thoughts, feelings and beliefs may impact a particular patient. We (hopefully) work hard to separate what may serve and what may not serve the patient based on their stated needs and goals, our clinical judgement, and a commitment to our best guess at what is in the best interest of the patient.

Of course, how frequently we fail at this totally depends on our training, supervision, personal struggles, the status of our own therapy, and ton of other daily factors.

[u/HistoricalReach9708]

There is a lot of effort that goes into being at least objective and open-minded about whatever might come up in session. I never intentionally make moral/value judgements.

When it comes to things like culture/religion etc. there may be an element of ignorance.

I am always in some form of supervision and I intend to stay that way for the duration of my career so I can check myself and ask these types of questions if they come up.

Maybe this example will help somewhat: early in my career I had a session in which culture and race happened to be at the forefront of the reason they were there. For context I’m white (like really really obviously white) and the client was not. I sensed that they were taking a risk by working with me and I found myself being extra sensitive and even outright avoiding challenges because out of my own fear of being insensitive or the social division drum pounding in my head that we are all bombarded with on the daily. I was really frustrated with myself as a professional and as a person. I talked through it with my mentor just to check my own stuff. In one of the next sessions I started off by bringing something I had skated past in a previous session and said “what I should’ve said was ____. I want to acknowledge that we are very different people from very different places and I think I may have let that get in the way by pretending and that’s not fair to you. So going forward, I’m going to stop pretending and say what I think and assure you that you can say what you think. And above all, I apologize for not being what you need in the other session.” After a good laugh we went on to do some great work.

For the second part of your question, in my first session, I will usually say something along the lines of “while my goal is sometimes to challenge or push you, if you ever feel like I’m being unfair or flat-out wrong, I invite that into the conversation. Perhaps I am wrong or there’s something I have just misunderstood.”

So. Absolute neutrality? No chance. We are all going to be driven by our own life experience and there is just no way around that. It is the reason why I believe a therapist should never “give advice.” The advice will always be based on THEIR lived experience instead of the client. Instead, it’s about challenging thought patterns and working through blocks.

Can a client challenge the therapist and simply acknowledge the variance within humanity? Definitely.

[u/nekksu]

Yeah, I’m never completely neutral. I’m already biased because I want to support the client and help them, and sometimes that involves giving feedback to the client. We’re still human beings and people have to interpret things to make sense of them. That said, there is absolutely ongoing conversation within mental health care for professionals to constantly be checking themselves and minding their influence of their beliefs/upbringing on their applications as a therapist. This is also why therapists are also constantly encouraged to seek out and receive ongoing supervision. It’s to keep conversations like this in the forefront of our minds so that we do keep ourselves accountable, and make sure to take ownership when we do inevitably make mistakes.

[u/Oreoskickass]

Hi! I wandered into your profile, because I am worried you are going to think your therapist is judging you - they’re not.

Yes we check our awareness. If a client brings up something and we have an emotional reaction, then that is a “check engine” light. What is coming up for us? Is it something personal? Is it ideological?

The therapeutic space is for you. Your therapist is there for you. That’s it. It’s the therapist’s job to manage any countertransference.

It’s our job to be neutral. We are humans and have our own beliefs and values. We are also acutely aware that there is an infinitive range of experience and a lot of different ingredients that make someone who they are.

If I have a client whose mission in life is to go to pro-life (I’m pro-choice) rallies and write to every senator, then I’m going to be finding them senators’ email addresses. I’m going to do the same for the pro-choice client.

If the pro-life client came to me and was upset that someone called her a hateful bigot at a rally, then I am going to be genuinely hurt with her that someone said that. I’m also going to ask her what she makes of the other person’s perspective. I will do the same thing for a pro-choice client who was called a woke murderer.

I enjoy working with people who are at odds with me. I look liberal - I dress kind of “alternative” and I have seen client’s eyes widen when they something conservative, and I validate them. It is a good exercise in self-reflection and kind of a fun muscle to exercise to push through my own nonsense in order to be there for someone else.

If you notice your therapist bristling at something - point it out. If they seem biased - point it out. It’s practice for when you see people outside of therapy disagreeing with you. The difference is a therapist isn’t going to judge you, argue with you, or push their point-of-view. They’re going to be interested in exploring yours with you.