Coercion, The State of Missouri, and Psychotherapy

The Missouri Attorney General’s order to block transgender medical care is expressly using our profession to justify the oppression of transgender people in Missouri. The order uses the language of psychological therapy. It cites “mental health comorbidities” and requires a specific number of therapy sessions and psychological evaluations as a precursor to medical care.

Instead of using outright criminalization or physical coercion, the State is calling upon us to understand transgender people as “sick” and in need of psychological treatment. 

There is a long standing critique of our profession to which I am particularly sensitive. That is, we mis-diagnose people’s problems because we use the wrong level of analysis. Instead of understanding the social and cultural problems (the systems of oppression) that lead to psychological issues, we locate the problem within the individual and then pathologize and treat them.

If we allow the State of Missouri (or any other proxy authoritarian system of belief) to define our work with clients, then the State becomes the de facto arbiter of “mental health.” If we are working to help people conform to a broken system then we are part of the problem. 

At its best, psychotherapy is an exercise in freedom: It creates relationships in which people can be understood and become their authentic selves; It allows a space and time where people’s lives are validated and cherished; and, ultimately, it un-shackles the individual from internalized conflicts that limit them from living their lives.

I want our transgender siblings to know that we hold that space for them, that we are not going to participate in the pathologizing of their experience, and that we love and support them.

Jeremy Duke LPC