July 25th, 2023

Gatekeeping Mental Health Spaces

Sometimes I can keep on a topic for more than a minute, so this blog is kind of a continuation of last week’s blog about terminology. It was a rambly (shock) post about language, and the nuance needed to create understanding, as well as the parameters needed to keep language helpful without being misused. This is going to be another nuanced topic, because it turns out that life isn’t super black and white, so we have to be able to explore the gray spaces. So, let’s take a look at gatekeeping in the mental health space. 

So, gatekeeping in our modern, online culture is usually referencing the idea that one person or a group is saying some other person or group isn’t welcome in a space. Something to the effect of vegetarians are just failed vegans. Like, all squares are rectangles, but not all rectangles are squares, and if squares and rectangles got all upset at each other and tried to create some sort of social hierarchy around it. A common example I use is that in order to lead an AA meeting you need to have gone through AA (AA isn’t a fair example, they’re a little culty and gatekeeping is baked in). It would be like someone with anxiety saying that anyone who works with anxiety should also have anxiety. And like, nah, that isn’t how it works. I would almost argue it’s the opposite. For example, if you’re divorced you absolutely can work with couples, but while you’re actively divorcing, you gotta be super aware and be careful you’re not carrying your own shit into session. I’ll use myself as an example, being raised fundamentalist is super helpful for my clients who come from a similar background, as I often know what words or phrases they use without needing to explain it. But this can also create problems, as the reliance on assuming there is mutual understanding could lead to things to get skipped. And while I was working through the hardest parts of deconstruction and my own religious trauma, I was not seeing clients about that. And I still maintain my own work in therapy to make sure I’m not bringing my own shit into session. So, shared life experience is helpful, but certainly not necessary. And we as therapists need to be careful to say, “how dare Kevin say he sees clients with abc when Kevin never experienced that himself,” because in some cases, that therapist who doesn’t have the lived experience may have done a lot of work to gain an understanding and appreciation of the topic at hand, and be super helpful. Or, conversely, that therapist without the lived experience might just be a great fit, and still be able to provide great therapy. Or, again, that therapist could be the only person in the area, and having some knowledge and appropriate humility and openness to learn will still be a good experience for a client. We certainly don’t want clients to not get treatment because some professional doesn’t have a certain lived experience.

All that being said. We absolutely have to be careful and speak out about therapists who are seeing clients outside of their scope of practice. Bad therapy is harmful. So, while sharing a lived experience or a particular identity or diagnosis is not necessary, we still need to make sure that professionals are being professional and referring clients who are outside their scope. As much as I don’t want a client to seek help because there are limited resources in their area, just going to see any old therapist, and sticking with that therapist when it isn’t helpful, is actively harmful. I don’t think all my neurodiverse folks need to see a neurodiverse therapist, but I do think my neurodiverse folks need to see a therapist who is well-trained in how to work with neurodiversity, and knows what to look for in the first place. I don’t think clients with trauma need to see a therapist who lived through the same trauma, but a traumatized client does need to see a therapist who is trauma-informed. And that is an important distinction. I don’t even think lived experience is enough to inherently mean scope of practice, although it certainly could be in some contexts. Ultimately, I think therapists need to be savvy with their own limitations, and need to be aware of what their actual scope of practice is, because our graduate training is pretty bare bones in just covering the basics. Continuing education and additional certification is going to help most professionals have a good idea of what they are qualified for, but there are plenty of therapists I know, or clients who have told me horror stories, or therapists out there thinking that because they have a license it means they are fit to see any and everyone. 

I also think clients need to be supported in finding a good therapist. We need to support people as they advocate for themselves in a complicated field, and to normalize the experience of shopping around and potentially having multiple professionals for different issues (wouldn’t universal healthcare be grand!?!?). If therapy consistently isn’t helpful, and you’ve raised that concern to your therapist, find a new therapist. If you have a very specific thing to work on, find a specialist. For years I’ve called out therapists with no couples training doing couples work, but that doesn’t inherently mean every couples therapist is going to be a good fit for every couple. Hence, the nuance. I hope in all this mess of words I made my point. 

Find a therapist who has the expertise needed. Therapists, make sure clients you are taking on are within your scope of practice. Everyone, stop going online and offering brief platitudes about complex topics and thinking you’ve helped somehow.