Ethical Practice in Crisis: Supporting Vulnerable Clients in Today’s Political Reality

Feb 25, 2025

As therapists, many of us are witnessing unprecedented challenges facing our clients from marginalized communities. Recent policies targeting immigrants, women’s reproductive rights, LGBTQ+ individuals (particularly transgender people), and efforts to restrict education about racial history have created a mental health crisis that demands our attention and action.

These are not abstract political issues but concrete realities affecting our clients’ daily lives, safety, and mental health.

Case Example: When Politics and Therapy Collide

Elena, a 19-year-old college student, recently started therapy for depression and anxiety. She’s struggling with the fear that her reproductive rights could be taken away and worries about safety as a queer woman in an increasingly hostile environment. Her therapist, while compassionate, avoids discussing these fears, saying, “I try to keep politics out of the therapy room.”

Without validation, Elena feels unheard, begins doubting herself, and ultimately stops therapy, feeling even more isolated.

This case raises an important question: When systemic issues are directly impacting a client’s mental health, is “neutrality” an ethical stance?

The Current Crisis

Policies affecting mental health have real consequences for our clients:

🔹 Immigrant communities face increased deportations, family separations, and detention.
🔹 Women are experiencing restricted access to reproductive healthcare.
🔹 Transgender individuals are seeing their healthcare access and legal protections eroded.
🔹 Black communities and other people of color face efforts to restrict education about historical racism.

For many clients, these are not just abstract concerns but lived experiences affecting their mental health.

The Challenge: Can Therapists "Set Aside" Their Politics?

Many therapists aim to keep personal beliefs separate from their work. But when political policies actively harm clients, can a therapist truly provide safe, affirming care while supporting those policies?

Consider policies that:

🔸 Detain asylum seekers in inhumane conditions—including reports of neglect, abuse, and family separations in U.S. immigration detention centers.
🔸 Restrict bodily autonomy—limiting abortion access, contraception, and reproductive healthcare, disproportionately harming low-income individuals and people of color.
🔸 Deny gender-affirming care—criminalizing medical providers, forcibly detransitioning youth, and even threatening to remove trans kids from affirming parents.
🔸 Erase racial and historical education—banning books, restricting discussions on systemic racism, and silencing marginalized voices in schools.
🔸 Increase state surveillance and policing—criminalizing homelessness, restricting protest rights, and escalating police violence against Black and Indigenous communities.
🔸 Attack LGBTQ+ rights—pushing policies that ban trans people from public life, deny marriage equality, and target queer youth in schools and sports.

These policies aren’t just political ideologies—they are systemic acts of harm.

If a therapist supports these policies, clients from affected communities will feel unsafe, unseen, and even retraumatized in therapy. The power dynamic in therapy already requires trust—if a client knows their therapist fundamentally does not support their right to exist safely, therapy cannot be a place of healing.

Therapy is supposed to be a space of safety, not another site of harm. A therapist cannot claim to be neutral when the policies they support directly endanger their clients.

What Defines a Safe Therapeutic Space?

Effective therapy relies on trust, empathy, and cultural responsiveness. But when a therapist’s personal convictions contradict a client’s identity, wellbeing, or lived experience, can they truly offer affirming care?

A truly safe and effective therapeutic space allows clients to:

✔ Share openly without fear of judgment
✔ Feel respected and understood
✔ Trust that their wellbeing is the priority
✔ Have their identities, experiences, and values validated

While therapists don’t need to share a client’s beliefs or identity, their ability to provide nonjudgmental, ethical care can be compromised if:

Their personal convictions prevent them from validating a client’s identity (e.g., refusing to affirm a transgender client’s gender).
They minimize or dismiss systemic oppression that impacts the client’s mental health (e.g., downplaying racism, homophobia, or sexism).
Their advice or interventions are shaped by personal moral views rather than evidence-based practice (e.g., discouraging reproductive choices based on religious beliefs).

Ethical therapy requires cultural humility, self-awareness, and the ability to separate personal ideology from professional responsibility. When that line is blurred, the client’s wellbeing is at risk.

When Political and Religious Beliefs Impact Therapy

We must acknowledge that not all differences between therapist and client create barriers to good therapy—but some do.

✅ When Political and Religious Beliefs Don’t Interfere

Some therapists effectively:

✔ Keep personal beliefs separate from their practice
✔ Develop genuine empathy across differences
✔ Create safe environments despite personal views

This works best when:

The therapist maintains strong professional boundaries
Their beliefs are held with flexibility rather than rigidity
The presenting issues don’t directly clash with areas of value difference

⚠️ When Therapists Think They’re Neutral But Aren’t

In other cases:

The therapist genuinely wants to help all clients
Unconscious biases show up in subtle ways (microaggressions, invalidation, or avoidance)
Clients sense judgment but may not directly address it
The therapeutic relationship suffers

For example, a therapist who claims to “love all people” but subtly discourages a queer client from pursuing gender-affirming care may be unaware of how their bias is shaping their guidance.

❌ When Ethical Lines Are Crossed

Sometimes:

Personal beliefs directly interfere with evidence-based care
Clinical judgments are influenced by moral or religious views rather than best practices
The therapist expresses disapproval of client choices or identities

This is where ethical violations occur—if a therapist refuses to affirm a transgender client’s identity or promotes conversion therapy, they are actively harming their client.

🔄 When Referrals Are the Best Option

Many therapists choose to:

✔ Specialize in working with clients who share similar values
✔ Refer cases where significant conflicts might arise
✔ Be transparent about their approach and specialties

Ethical therapists recognize when they may not be the best fit for a client and offer referrals rather than causing harm through bias or judgment.

Best Practices for Navigating Differences

✔ Practice cultural humility – Recognize the limits of your understanding and be willing to learn from clients.
✔ Seek diverse supervision – Regular consultation with colleagues from different backgrounds helps identify blind spots.
✔ Consider your limitations – Be honest about areas where your values might interfere with providing the best care.
✔ Be transparent when appropriate – Clients deserve to know factors that might affect their treatment.
✔ Focus on common humanity – Look for universal experiences that connect us beyond our differences.
✔ Examine how the policies you support may harm or invalidate your clients.

A Call to Professional Integrity

We cannot claim to serve all clients ethically while supporting policies that directly harm them. This isn’t about partisan politics—it’s about human dignity, evidence-based practice, and professional ethics.

We Want to Hear from You

💡 How do you approach these ethical dilemmas in your practice? What challenges have you faced when navigating personal beliefs and client care?

The Curious Therapist

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