Transcription
Hello and welcome to Competencies in Civil Discourse, a show in which we talk about the importance of civil discourse in a free and civil society. I am your host, Eric Smith, a former professor of rhetoric and a current research fellow here at the KO Institute. Today's guest is a friend of mine, but that's not why he's on the show. Andrew Hartz is a clinical psychologist, a writer, and founder of the Open Therapy Institute, which is basically what happens when you take mental health and free speech and have them procreate. That's how I like to see it. Anyway, he's on a mission to make sure that therapy doesn't turn into an ideological echo chamber, and he's not afraid to ask the tough questions like, what happens if our thoughts and feelings don't have to be a political act, right? So, I'm happy to have him on the show today. Thank you, Andrew.
Thanks for having me. Fantastic. So, we met a few years ago and I remember you telling me about the state of uh talk therapy uh in the country and I was absolutely floored. Um, obviously these issues prompted you to co-found the Open Therapy Institute, and it's a pretty impressive institute so far. We'll get into that a little bit later, but I was wondering if you could tell the audience what you told me about the state of therapy today.
Yeah. Um, some of the practices that are common in mental I mean, I think the same thing that's happening in in mental health is what's happening in other professions like medicine, law, education. You see this across the professions, but um, basically there's there's a movement towards overtly, you know, deliberately uh politicizing psychotherapy sessions. Um, and this ranges from everything like calling out patients for their white privilege to trying to dismantle gender to trying to queer the therapeutic space. Uh and often these interventions and ideologies aren't disclosed at the beginning of treatment. They're kind of brought in. Um, so I saw things from patients being asked to leave treatment because of their political views to uh uh uh one when one training uh training institute where I was, a patient said that she hated a patient of hers just because he was a white male, not because of anything he said or did. And of course, the response among the the therapists there was that her feelings made total sense, and she was brave and courageous for expressing them. So, so you get you're getting more, I think, of very aggressive, often really with hateful overtones um ideologies really permeating psychotherapy. I I would I would say that even though those ideologies are um very uh influential and they've had a big impact on academia, I don't think they're the most common among professionals. It might be 10% to 25, 30% of therapists who actually adhere to these. They tend to be younger. Um, but there are other biases that still come into psychotherapeutic practice. I think a lot of therapists are often misattuned around sociopolitical issues. They make assumptions. They avoid topics. They have judgments. Uh and so I think that the problem of bias in mental health care really goes far beyond uh just these ex just the more extreme stuff, which is very concerning.
Very interesting. Sad but interesting. Um, the good news about all of this is that it prompted you to co-found the Open Therapy Institute. Tell us a little bit more about the Open Therapy Institute.
Well, when I was in training and I was kind of experiencing this over politicization, um, I noticed like it was incredibly stressful because disagreeing with these ideologies felt really dangerous. You know, uh, I was definitely worried about retribution for even asking questions about these ideologies. And it was really important to me that throughout my training, I was in psychoanalysis, pretty common for therapists, and I had a space where, luckily, I had somebody where I could talk through what I was experiencing and think about how I wanted to respond to these very challenging situations. Um, I started to recognize through patients I was seeing that I wasn't the only person, you know, experiencing this. There were people who had analogous experiences who were actors, and they were working in theater, or they were writers, or they were uh working at a law firm. Um, and they were having the same types of political ideologies come into their work and impact them. And I thought, where do they go to get support? Because if they just looked a random therapist online, is that going to be somebody who's going to understand their experience, who's going to want to help, who's going to be able to help, or is it going to be somebody who's going to judge them for having the reactions that they had and maybe even attack them and recreate the same problems that they're having? So, I didn't even know where to find a therapist who would be good for any of these patients. Um, and so that was really the impetus behind the Open Therapy Institute. It's like, what are all the different issues people are experiencing around the country where they might have a hard time finding a therapist because of bias, where therapists might not be doing a good job because of bias? How can we start to document those issues and train therapists to work on those issues so that we have a really robust professional network that can help all these patients that can't find somebody. So, it was really trying to build a robust professional community that could do all the work where people couldn't find a therapist. Um, and uh, and so that that was really when uh when we started writing about creating the Open Therapy Institute and starting to write articles and get things moving.
Yes. I want to talk about those articles a little bit later. Uh, but I want to emphasize the, I don't know, disbelief I have. I believe you, but I'm just floored by the fact that this is going on. It sounds like people need therapy to deal with their therapist, and that is not a good place to be.
I'm the graduate, the graduate students, that's often really true. They, the graduate students uh in the mental health fields, a lot of them, if they have a single heterodox viewpoint, it can be really challenging to get through these strident programs. But I, I cut you off.
Oh, well, I, I was just going to say how impressed I am with the fact that you created an institute, an alternative place to deal with these things. It's hard to fix what has been broken regarding um, the um, political ideologies that are affecting so many institutions, right? So many fields. But uh, you didn't do that. You created another space to do this. And I, I find that very impressive. But I also want to ask, because I may want to do something like this with academia. How did you go about creating the Open Therapy Institute? Was it easy?
And do it with you? Uh, no. I mean, and I, I had a bunch of really fortuitous things happen. I mean, I don't want to uh, you know, understate how many things, you know, I got some really, I got some op-eds on this topic placed in the Wall Street Journal. We got connected to some donors early on. We were able to recruit a remarkably talented faculty. I mean, if you look at the people who are on our editorial board for our journal, it's, you know, multiple people from Harvard, Yale, Columbia, NYU, and a lot of people kind of came out of the woodwork, just to be honest. I, I would get emails from incredibly prestigious named people who just wanted to help. Um, and so, uh, we got a ton of support all the way around. I think there was a real hunger for it. I, I worked really hard to, I, I do think that it's a problem. I'll say this, that a lot of the concern with bias in institutions tends to be structured in a reactive, negative way. It tends to be, we don't like the social justice stuff or the woke stuff. This is why they're wrong and attacking it. And it's not, this is all the issues they're missing. This, it's not building new things, saying there are all these blind spots and things that are being neglected, let's build stuff that can do the work they're not doing and seeing the opening that's opened up by that. I think, like a good example of another space where I think this is really desperately needed is the arts. You know, there's so much great literature, writing, theater, you know, uh, you know, film, and like places where people could do really creative stuff uh from an open perspective, and it could be great art. And it's, it's often instead of fostering and cultivating those new spaces, so much of the response tends to be attacking the old spaces. It's negative and reactive. And I think the same's been true in academia. If you kind of look at how people are phrasing framing the problems, it's so much, these are all the things we hate about how academia is run, and let's attack it. And it isn't as much, how do we create the new institutions that are really going to foster sustainable change? So OTI was really, I really prioritized that this is a positive project. We're going to outline every issue and perspective blind spot and taboo that is being missed by the field. And we're going to, and that is a huge gap in the literature, multiple gaps in the literature, a huge research project just to outline each one of these areas. And it's about gender and race and religion and sexuality, and it's about uh, you know, all these self-censorship and cancel culture and abortion and guns, and there's just so many interesting issues that are have a poor or very biased literature. If we build this new literature, we have a really exciting, creating, creative intellectual project to build that's really useful and interesting and that really, it's attractive to people. It's attractive to scholars to kind of come together on an interesting, needed project and to build that as opposed to just continuing to critique what's bad about the current system.
Uh, yes, I understand. What you're saying about uh, you know, not just countering or fighting fire with fire, as it were, with these issues, but excessive neutrality isn't good either, right?
Yeah, no, I'm not, I'm not saying those critiques aren't warranted or that they shouldn't happen, but the, but the uh, but having a good research program and research project is really animating to get people to actually fill in and correct the specific gaps. Be, I think there's a danger, danger that things get too one-note where, especially in our field, like every article would be, therapists shouldn't be activists, therapists shouldn't be social justice, you know, therapists shouldn't be biased or whatever it is. And we just kind of keep rehitting that note as opposed to saying, look at all these blind spots and neglected populations and issues and the nuances of them, and they're, they're, they're more detailed than people think. Like, how might the role of the father be underappreciated in a family therapy context? You know, there's biases that can come in there where that's a whole area of literature that's really rich and interesting, and we can write about that, and that actually is a critique of the biases in the field implicitly and maybe even explicitly. But it's not, it's not just rehashing. I think it's getting off the one note of just saying we don't want therapists to be biased, which needs to be said, and we're going to keep saying that, but, um, but looking towards all the work that needs to be done that's often really interesting and very much needed.
Well, that sounds like a rhetorically sound tactic you have there. Um, instead of saying don't think this, you're saying consider thinking this, right? Um, which is a pretty um positive alternative to what's been going on lately, not just in your field, but in society at large. Um, in an article you wrote called "The Path Forward: Our Strategy for Confronting Sociopolitical Biases in Mental Health Care," you argue that the field must begin producing the research, trainings, and conversations that have been systematically avoided. Right?
Yes. Exactly. Yes. And I, I asked that question because you seem to be touching on it with your last statement. Could you elaborate further on what topics are being avoided?
Yeah. Uh, for sure. I mean, I, I think, you know, political, right now in 2025, political issues are incredibly psychologically charged for people. I mean, and you can think about it. People are losing jobs, swift, um, changing careers, moving cities, cutting out family members, getting divorced. This is like, people are charged on these issues, and we, as a society, uh, that most people have a very poor ability to talk about these in a nuanced way, in a mature way. And so the, the types of things that people feel really, really strongly about but can't talk about, that's the type of thing therapists are interested in, you know, and maybe at a different time, that might have been sex or something else or family or something. It's this. And so I'm, any issue that raises the blood pressure, I am interested in as a clinical issue because those are those are the types of issues that are going to lead to cognitive distortions, defense mechanisms, emotion dysregulation, interpersonal problems, and symptoms. So, like a, a good example of of symptoms here, Dean McCay is a senior adviser at the Open Therapy Institute. He's at Fordham. He's an OCD researcher. And he's noticed a new form of OCD that's come into being related to cancel culture. And it's where people have repetitive intrusive thoughts, obsessions of, what if I say or do something that's going to get me canceled? And they think about it a lot. And then they sometimes have rituals associated with it, going into their social media or their email or their text messages and combing through everything and deleting even the slightest risk of anything. Uh, and so you can see how something like OCD is being shaped by the sociopolitical context, whatever the most charged issues are. And you can imagine the same thing for people with social anxiety, for people with depression, for people with substance use disorders. These issues are really active for people. Uh, so another example of an issue that's like this would be abortion. Uh, you know, abortion is an issue that raises the blood pressure. Just mentioning it for a lot of people, it raises the blood pressure. That's evidence that that means something to people. And for a lot of women, their experiences and their stories about an abortion are not one-sided. The political debate, the women's stories are always one-sided, but the nuances of the relationships they're in and the feelings they have. And it's not uncommon to feel guilt or regret or loss or whatever it might be. And that messiness, the emotional messiness in the individual diversity of responses and complexity, it makes therapists uncomfortable to explore. It makes patients uncomfortable to explore. But those feelings can be really powerful and they can be related to whatever symptoms somebody might be coming into. So, we had trainings on uh, doing better therapy with gun owners. Ways that therapists might be misattuned to religious patients. Here, religious patients is a great example because a lot of therapists don't ask about religion on the intake. Yeah. And, you know, we were a very religious country. It's very important to people. But that sends a signal, which a lot of patients have, which is, you're not supposed to talk about religion in therapy. Of course, that's not true. You should talk about whatever you feel you feel, but they make that assumption. Um, you know, I want to say one other thing related to all of these populations, all of these issues, where do they go to find a therapist? That's the question. They, they're stabbing in the dark. They go online thinking, ah, this person based on their photo or their bio seems like maybe they'll get me or whatever, or they give up and they avoid treatment. And I think this is an important point for KO also, because that's true, the issues in mental health are true in medicine, they're true in education, they're true in the arts, where there's these, this huge gaps where nothing exists, and there's an opportunity to build new institutions, and even new private sector sector institutions, even new new for-profit institutions. And I think that people who are concerned about these issues, uh, I, I really hope there's a pivot that happens away from the just critiquing thing towards actually building businesses, building organizations, and building institutions that can actually affect uh, enduring change. Because, you know, if we could have a, a for-profit mental health provider that's that's filling this gap uh in services, it could be immensely profitable and it could help millions of people. And the same thing's true in the arts and education and medicine and every other field. They all need new institutions, and a lot of them could be for-profit and profitable. Um, and uh, so, so hopefully there's an entrepreneurial spark that accompanies the needed, the needed change here.
It seems like you are in the center of a wheel with spokes that lead to education, the arts, and and other fields. You're the salient field in this culture war, if I can use that term. I know not everybody loves it, but you know what I'm talking about, right?
Yeah. Well, thanks. Thanks. I mean, I, I would think so because I, maybe that's, I mean, I think I'm always, maybe people always think whatever they're doing is the most important thing, but because you need a place, I would think people need a place that's confidential where they can get their head screwed on straight about what do they think, what do they feel comfortable saying publicly, and not what do they want to do. You need some type of support often for that or a connection to some type of community to get the ball rolling on any of these things. When people are self-censoring, it usually means they're isolated. And when they're isolated and self-censoring, their thoughts aren't clearly formulated. And it's really hard to connect to others and take action on anything. So the dialogue, having open dialogue and some support and connection to other people, I, I think has to be a first step. Uh, often it, it is for people.
Yes. Uh, this is civil discourse gold you're giving us right now. It's, it's, I, I know it's uh, important to your field, but I think it's important to discourse at large to think about these things. I really appreciate that you're doing it. I do want to talk about the overlooked populations uh you mentioned in the journal you have called Frontiers in Mental Health. We'll get to that a little bit later on. Um, but I want to talk about these overlooked populations. Um, I've gathered that they're conservatives, um, religious uh patients, men and boys. Um, yes, people who experience anti-white bias and disagree with DEI. That's the uh obvious one, I think. And individuals impacted by anti-semitism. Yes. Can you elaborate on that more? Not just that population, but the populations in general. Did I leave one out?
Yeah. Oh, yeah. And I, you did, you of course you did, because we're just starting to map these. We're, we're finding more. I mean, even just the OCD, I mean, if I didn't know Dean McCay and, you know, he did a, he did a poll that's going to come out in our next journal. He has an article. He asked people on the OCD list serve he was on, I think it's 137 people or something. He, he asked, "Have you seen this form of OCD that's focused on cancel culture?" And he got, I might, I might be getting some of the wording wrong of the question, but the, the central point is true. He, he asked, and he, he got 137 responses, or some, most of the people on the list have responded. Everyone had at least one patient, and some people reported up to 12. So, this is a, this is an. So, and, and I wouldn't even know necessarily about that population because I'm not an OCD specialist, uh, if it weren't for Dean. Now, I think there's analogous stuff across the board on all of these issues for with the men's issues. I mean, and couples therapy is a huge thing where I think men are often the more, in a heterosexual couple, the male is often the more resistant to the couples therapy. And there's a sense that they're going to, their needs are going to be diminished. They're going to be emasculated, and, uh, and, and it's not really going to serve them well. And I think those fears are not misplaced. Those are not unreasonable fears that the field, and you talk to couples therapists, and they're confident that they've never read an article on men's issues or bias against men. They've never had a training on it. They're confident they have no biases, and they're misunderstanding men left and right. Uh, I, I think they're devaluing male emotional labor. They're devaluing male male needs. Uh, the woman is often in the driver's seat in terms of making decisions for the direction of the couple. And there's just a lot of things that are happening implicitly or explicitly in the couple's therapist. I'll even say, and it goes as bad in the couple's therapy question, you can have a therapist who practices from a feminist theoretical perspective and doesn't disclose that anywhere in her materials. Yeah. And you think you're just seeing a regular therapist, and it turns out she's operating from a feminist or queer theory perspective, and her goal is to queer the relationship or dismantle the patriarchy, and she doesn't disclose that at the beginning. You know, I think that's unethical, uh, personally, but it's, it definitely happens. Now, so that's just, so you pick any of these issues, just couples therapy, just OCD, just, and, and you see there's a lot to be said about each population. And with most of these, uh, most of these issues, I think again, there's some activist therapists who are doing, I think, deliberately politicized work that I think is unethical. Most therapists I think have, I think it's over 90% of therapists lean left. So, it's an incredibly left-leaning profession. Yes. And the, the large majority of them though, I think, don't want to be biased, think they're not biased, but have enormous blind spots. They don't know about these issues. They're misattuned left and right. They've never made an effort to learn about these issues, and they handle things poorly all the time, and they're oblivious. Um, and I think the percentage that are really actively attuned on these and educated about them is small, partly just because the literature doesn't exist. The trainings don't exist. A, the A lot of the trainings that we've done at OTI, there's never been a training on that topic before. We, we, we had a whole workshop on the mental health cost of self-censorship. How does it impact people? How to treat it? I don't know of any other uh talk anywhere, continuing ed talk anywhere that's been on that on that topic. So, how, how skilled could a therapist be if they've never read an article and never done a training on on it? Right. Right.
Um, I have colleagues in my field who refuse to read anything they think they're going to disagree with, which means that you're not a real academic if you're not reading a substantial amount of the literature in your field. So, I mean, it's, it's um, not surprising, sad, but not surprising that that's also happening in other fields like yours. But you mentioned literature and um, the literature that's being uh, neglected or ignored or not written. You have a journal associated with the Open Therapy Institute called Frontiers in Mental Health. What kinds of authors and articles can we find in there?
So, uh, they're all related to mental health. They're written by mental health professionals. Um, any issue uh that is under addressed because of sociopolitical bias, we're interested in. And we're really trying to, you know, the first issue in some ways was more, more of a general issue, but we're really interested in getting into the into the details, the clinical details, and really kind of narrowing in to to show uh, be, because I think that when you go, when you focus in more specifically into these clinical issues, you really see the complexity of what's happening. Take for example, somebody who loses a job because of a, a joke they told or a tweet they had. Okay. Um, every time that actually happens, when you do therapy with a person who's had that experience, you realize this is a whole person. They had a whole work life, they had a whole personal life and a whole history. And this could have been somebody who was very passive and bullied at work, or it could have been somebody who was kind of obnoxious, and that played a role in how the cancellation played off. Maybe, maybe they did make some mistakes at work. Maybe they, maybe they're a harsh, maybe the professor is a very harsh grader and, uh, that made some enemies, and then those grad students got revenge when they had an unpopular tweet. So, there's all this, and I, I just, as an example, I know, uh, somebody who had a, a vicious cancellation campaign waged against him, and it was waged mostly by women. I don't know if the charges were mostly about sexism, totally exonerated on everything. Um, turned out early in his life, he was told by his mother that she had tried to have an abortion of him when he, she was pregnant with him, and it failed, and then she ended up having him. So he learned that fact when he was a young child, and it was kind of this foundational myth for his life was that he was unwanted, and this sense that his mom tried to kill him. Okay. And so then the cancellation campaign echoes with this kind of central paradigm that he's had in his mind from a young age of the women, you know, trying to kill him, trying to destroy him symbolically through this cancellation campaign. So, you really get a sense when you hear people's real stories and the details involved, the psychological meanings and complexity and messiness that goes into each one of these. Um, they're all the stories are like that. They're all, they're all have these twists and turns and nuances and meanings. And, uh, I think in the national discourse, that's lost because their people are so flattened as it's just like, they made a tweet and then got fired, and it's like, there's not the sense of like the real way that they, that these things get enacted, um, which has a lot more complexity to it. So, I think that we, we, we want to really unpack, uh, you know, what's, what's censorship really like? I mean, the people who self-censor, some of them are incredibly anxious people, and they, they probably have social anxiety. You know, there are plenty of people who have social anxiety. Now, cancel culture's around, and their self-censorship in a way becomes a lot harder to deal with because what had been clearly, they just don't, they're terrified of any social judgments. Now it has this political reality to it of, oh, what if I say the wrong thing and it gets, so it's, it, it kind of adds this, um, uh, adds this additional challenge to speaking up and overcoming the social anxiety because it's got this political piece to it. So, just, just the more detail you get, the more you recognize how, how complex these issues are, and definitely they impact people.
Yeah. I, I, I know a handful of people who have expressed uh suicidal thoughts because of cancellation attempts. I know of at least two people who have committed suicide um because of these cancellation attempts. Uh, so personally, that, you know, personally? No, I know of them. I know people who knew them. Yeah. I didn't know them personally. Um, but nevertheless, you're doing very important work. You're, you're literally saving lives in my opinion, right, by by having this institute and having this journal. Um, what I want to ask now, because we're coming to the end of the episode, is how are you doing? How has this affected you uh before the institute, during the institute? How are you getting through this stuff personally?
Yeah, that's an interesting qu. It's interesting you talked about suicide because I have a, I have a, a story of someone as well who had these, uh, false accusations of sexual misconduct. And again, he was exonerated. This person was exonerated. They found text messages. A woman accused him of raping her. And then they found in the trial text messages that she sent where she admitted to making it up. And he actually sued her for defamation and won. So she, he was in the right on this, but the accusations still lingered and continued to affect his life to the point where he had a hard time getting a job. And, this was, this was, uh, not a personal friend, but like you said, a friend of a friend, and ended up, uh, taking his own life. I, I, um, so I definitely see, uh, the, the gravity of how people are impacted. And if there's anything that we do, I hope it's to get the help towards all of these people that we can, uh, around the country. And I hope they know that we're a resource that they can contact us on our website. It's opentherapyinstitute.org. If it's anybody wants a therapist, please contact us. We have a, uh, 250 therapists around the country currently who are seeing people. So, we'd love to find somebody for you. And if anybody is a mental health professional or researcher, please become a member and, and, and see patients that we have. And we also have peer consultation groups and other resources. So, um, but in terms of, uh, how I'm doing, I, I, I, so far, you know, knock on wood, I feel like I'm surprisingly unscathed. I haven't gotten any hate mail. Maybe I've kind of flown under the radar, and that's what why this has happened. Or, uh, I, I, I also think I've been really careful, uh, to talk to make sure that I'm talking about issues in a patient-centered way. What we're doing is always about helping people who need a therapist to get effective care. And I think that's a hard thing to disagree with. Not to say, I, I'm sure people talk about me behind the my back and I've got negative, you know, I've got detractors, but I haven't had, Yeah, but I, I really haven't had that much direct antagonism. And I've also been really surprised, and this might be about the reframe of these projects, uh, away from just attacking the, the, the social justice stuff towards filling the gaps that are are there. Um, I, I know I have a lot of, I still have a lot of liberal friends. I have conservative and I have a pretty ideologically diverse social group. Um, and I'm always surprised at how even pretty far-left people really like the Open Therapy Institute and the work that it's doing. I think it's been something that even people who are fairly, uh, politically motivated, uh, end up, politically left, end up end up supporting. So, we've, we've actually managed to get a really diverse faculty that includes lots of liberals and conservatives, and I hope, I hope we can maintain that.
That is a very positive note to end on. Thank you. I was worried there, but you ended on a positive note, and, um, and that is fantastic. Andrew, thank you for talking to me and talking to the audience today about the very important work you're doing. You mentioned, uh, where we can find Open Therapy Institute online, right? Um, it's a.org, correct?
Yeah, open, opentherapyinstitute.org, and we have a Substack where we release articles from our journal. You can, all of our social media links are at the bottom of the page. We've got, uh, you know, all of them, X, Instagram, Facebook, LinkedIn. We're really, we really wanted to build our professional network. So, anybody in the mental health professions, please, please, please join. This is the only way we're going to affect change in the field. And, and anybody looking for a therapist is invited to reach out to us for free. It's a free service. We'll, we'll, we'll connect you to a to a therapist.
Thank you, Andrew. And thank you viewers for tuning in for this very important episode. Um, I am Eric Smith, and this is Competencies in Civil Discourse. If you are interested in rhetorical tactics, uh, strategies, or just theory, you can go to www.mmutualpersuasion.com. Have a good day.