Therapists Can Be Warm, Helpful and Wise, but Not Neutral

With guest co-authors, Daniel Frost and Chelsea Johnson

A bummed-out client is complaining to his therapist about his children. Specifically, he is feeling burdened by the demands of his two young sons and wants to transfer full custody to their mother. He admits he is focused on other things and is looking for ways of paying the least child support possible.

His therapist is in a tricky situation. She wants to support her client, but his goals are likely damaging to the well-being of his sons. Should she lean back, reflect his feelings, and explore the consequences of this decision in a nonjudgmental way? Should she challenge his choice, and if so, is she imposing her value judgments, or undermining his self-determination?

The Impossibility of Therapist Neutrality

These are common dilemmas in therapy and highlight the issue of therapist neutrality. Neutrality is a therapeutic idea that has its roots in the medical model and the aspiration to be objective and scientific. Even though its existence has largely been refuted, it still surfaces in the ways therapists are trained. For example, there is a spoken or unspoken push to set aside bias when assessing, diagnosing, and treating problems. This sterile approach may be well-meaning in its attempt to avoid being moralistic or preachy. However, when dealing with typical therapeutic issues involving relationships and happiness, therapy is a human interaction and cannot be neutral.

Even the idea therapists “should” be neutral is a value judgment about how therapists “ought” to act ... thus violating neutrality. And this is hardly the only judgment therapists make. Every comment made, question asked, or challenge posed, springs from opinions and values. Clinical theories and interventions were created by people with ideas about what is helpful. Therapists also invoke an extensive repertoire of values and principles in session, including autonomy, empathy, compassion, equality, assertiveness, empowerment, self-esteem, interpersonal connection, and so on. Therapists are hardly neutral on these matters.

The Importance of Responsibility

Therapists can no more escape value-driven interactions than they can escape being human. And that is how it should be. People come to therapy to engage with a caring person who can hear them, struggle with them, and walk with them in paths they both agree on. Therapists are a caring lot—but the aspiration to “help” presupposes an understanding of how to be helpful. The process of sorting through these complex decisions cannot happen when therapists avoid the very topics that will help their clients grow.

For instance, clients often share moral dilemmas they are wrestling with. These situations address responsibility and integrity, particularly in circumstances that involve the well-being of others. Many therapeutic approaches indirectly address this. For example, there is a focus on value identification and congruence in Acceptance and Commitment Therapy or Dialectical Behavior Therapy, and attention to relational health in couple and family therapy. Attempted agnosticism about values just means the therapist is unaware of what values they are promoting or reinforcing. Rather, it is helpful to identify the values at play in session and invite clients to reflect on these and act in ways to increase moral engagement with others and pursue individual growth.

John Bradshaw says that “reclaiming virtue” is the key to psychological healing, and that therapists “have more to offer than symptom reduction.” As William Doherty explains, “psychotherapy must promote moral responsibility” because nothing short of commitment to the good is enough to redeem life’s suffering. Indeed, seeking to make moral choices and find meaning in relationships can give clients the means to metabolize and make sense of pain, rather than merely manage it. According to Viktor Frankl, “suffering ceases to be suffering at the moment it finds a meaning.”

Admittedly, engaging with questions of moral integrity is difficult. It may be easier for a therapist to feign neutrality than to wrestle with one’s values and the moral issues at play in a session. Let’s return to the case of the struggling father. If the therapist helped this man avoid his responsibility to his children, it might reduce both of their anxiety (temporarily) but would likely bring problems for the children, and for the father. It would reinforce a pattern of life in which responsibilities can be cheaply discarded. Avoidance will not prepare him to engage in deeply connected relationships, a value which most therapists agree is critical. If, however, the therapist discusses the needs of the children and the father’s obligations to parent them, it might bring discomfort to the father in the form of his increased accountability, but it will likely lead to healthier outcomes. In either decision, neutrality is not possible, but in the second version, the father is more likely to grow as a person.

Therapists often seek to offer what Carl Rogers called “unconditional regard”—unwavering interest, compassion, and validation of worth (all of which are non-neutral positions). This is likely useful but inadequate. If, for example, our therapist simply validated this father’s desire to seek his own dreams while abandoning his children, his specific goal would be reinforced to the exclusion of the boys’ well-being. Rather, therapists should go beyond basic validation and integrate Rogers’ additional focus on being accountable to one’s growth potential. As Rogers said: “The process of the good life is not, I am convinced, a life for the faint-hearted. It involves the stretching and growing of becoming more and more of one’s potentialities.” A neutral reflection is not always enough to help clients stretch and grow.

G.K. Chesteron once said that “the mere pursuit of health always leads to something unhealthy.” Therapists who pretend to be neutral when issues of moral integrity are being violated are forfeiting important conversations clients need. And pretending to be neutral only places the value of avoidance above the value of addressing complex issues. Conversations in therapy are rich, meaningful, and full of moral complexity. Neutrality is not possible for therapists, and feigning it does not serve clients.

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