Therapy in the Age of Individualism

Is it working?

“I’ve chosen myself.” -Kim Kardashian

Photo by Jared Rice on Unsplash

As I waited to board my plane, I glanced at the latest cover of Vogue magazine at the airport newsstand. Poised confidently was the self-made billionaire and pop culture icon Kim Kardashian, with the caption “I’ve chosen myself” written in bold font across a vibrant cover.

Regardless of your personal opinion of Kim K, it is indisputable that she stands as a prominent focal point in pop culture, with hundreds of millions of individuals choosing to follow and update themselves on her every move. This celebrity fascination is nothing new; we are long accustomed to celebrities and their corresponding messages shaping societal norms as we absorb them in grocery checkout lines, while watching television, or perusing social media. Nothing about Kim K on the cover of another magazine was particularly shocking or noteworthy to me, nor am I here to comment on the influence of particular celebrities on social norms.

In order to become a marriage and family therapist, I was trained to view the world systemically, which is a fancy way of saying that I’m interested in understanding the ways that parts relate to the whole, and vice versa. As mental health clinicians, we are taught to orient ourselves with increased awareness in any given culture and to constantly strive to enhance our competency by identifying our own cultural blind spots.

A thought that occurred to me as I looked at the cover of Kim Kardashian, one that has plagued me since, is the reality that there are dozens of my fellow colleagues—other therapists—who unquestionably affirm, promote, or applaud the declaration: I choose myself.

I get it. It sounds nice. It even foreshadows the instructions to “place the oxygen mask on yourself first” that my flight attendant will give when I board this flight with my child. If I don’t place my mask on first, I’ll be unable to assist my child in getting the oxygen she will need. Choose yourself. Got it. Great!

But, as a result of my training (and beyond the literal application of oxygen masks on planes) I must ask: what does it really mean to choose yourself? What does it mean to be a Self (yes, capital S, in the Jungian sense)? A Self that exists completely separate from our relationships with others? Is there such a thing as a world of properly balanced, atomized selves operating independently? Selves whose interests are best served in the endless pursuit of developing more Selfhood? In a time of increasing societal polarization, loneliness, relational breakdowns, anxiety, depression, and suicide; is the therapeutic message we want to emphasize really to keep choosing yourself? Is this helping?

The therapeutic literature of the 60s and 70s aimed largely to rescue a person’s sense of “self” from constrictive parts of traditional culture. Descriptions of enmeshment, codependency, boundaries, and authenticity developed over time in the psychoanalytic industry as people worked to heal from personal harm caused by overly prescriptive systems that failed to allow for individual expression. The promotion of the authentic Self shifted culture in revolutionary ways, and therapists played their role in this shift: for better and worse.

Therapists like to imagine that we remain completely values-neutral in work with clients. To impose our own personal values on a client is unethical, and rightly so. Clients do not seek treatment in order to learn how to live according to their therapist’s belief system. A therapist attempting to impose their personal values on a client is in serious breach of ethical and legal obligations. If you’re seeing a therapist who operates this way, it’s time to get a new therapist.

In order to honor our ethical principles, therapists cannot afford to pretend that we are not heavily influenced by the very culture we are embedded within. Dr. William Doherty makes a brilliant observation in his book The Ethical Lives of Clients: Transcending Self-Interest in Psychotherapy. He argues that any therapist who “claims to be value-free in work with clients is to be under the influence of the mainstream value orientation of one’s culture” (Doherty, 2021).

Whether therapists recognize this or not, most people seek therapy as a form of ethical and moral consultation. They want to know, and have explicitly hired us to help them sort through some of life’s greatest challenges. How best to live? What makes healthy relationships? Why am I not happy? Should I stay in my marriage? How should I parent my difficult child? How do I cope with my aging parents? Is this sexual behavior okay? Do I tell the truth about this secret I’ve been keeping? In a modern, secularized world, therapists often replace pastors, coaches, and/or spiritual guides for ethical consultation. It’s more common to hear “My therapist said…” in conversations now more than ever.

In modern Western/American culture, our mainstream value orientation is described by Doherty as a system centered on the “individualist, consumer self” at the top of a hierarchy, a self whose interactions have become increasingly “transactional” (Doherty, 2021). Relationships, institutions, and traditions exist to serve the actualization of the self. Consequently, if/and/when they fail in their service of selfhood, the self should feel free to dispose of what’s “no longer working for me.” In this pursuit, the concept of moral obligations to others and relational commitments are delegitimized whenever they conflict with selfhood.

Doherty explains that therapists often “challenge clients to privilege their immediate self-interest over relational commitments. This looks like neutrality, but it’s a heavily value-laden stance, one the therapist is usually not conscious of holding in an individualistic culture” (Doherty, 2021). This is an understandable error on the part of many good therapists, as we often work one-on-one with clients. As such, we can only treat the person in the room and our focus is to help mitigate personal harm in a client’s life. Naturally, as we work within their internal world, we can inadvertently become aligned in a unidimensional perspective. Too often, therapists fail to substantially explore the additional ethical stakeholders in many of our clients’ ethical dilemmas: children, partners, parents, etc.

Doherty argues that the pendulum has swung too far in therapy in the direction of this consumer-self-transaction value system. He quotes the prominent, existential psychologist Rollo May, whose early writings criticized inauthentic living due to social roles and obligations. May had begun to reevaluate the role psychotherapy and therapists have played in this pendulum swing by the 1990s:

“We in America have become a society devoted to the individual self. The danger is that psychotherapy becomes a self-concern, fitting...a new kind of client...the narcissistic personality...We have made therapy a new kind of cult, a method in which we hire someone to act as a guide to our successes and happiness. Rarely does one speak of duty to one’s society. Almost everyone undergoing therapy is concerned with individual gain, and the psychotherapist is hired to assist in this endeavor” (May, 1991).

I believe May’s assessment in the 90s has proven its point in the two decades since. I would further argue that a deeper understanding of our increasingly poor mental health outcomes will involve taking a hard look at an embedded value system that promotes this “consumer self.” Clinical psychologist Sue Johnson, best known for her psychological expertise on bonding, attachment, and adult relationships, reminds us that “we cannot shape what we do not understand.” Attachment theory teaches that our very concept of selfhood arises first in relationship to others; in this sense, there is no “I” without a “We” (Johnson, 2008).

Doherty proposes a therapeutic antidote to our increasingly individualistic value system that instead articulates the importance of the “relational self”: a self-oriented towards relational commitments and connection. He emphasizes that this is a more radical shift than it may seem because most people agree that we need and desire relationships. The conceptual shift involves seeing that relationships “are not just voluntary bonds that we take on or discard but inherent to the very concept of self” (Doherty, 2021).

As such, I see my role as a marriage and family therapist to promote the examination and integration of selfhood into a larger relational framework in which the self ultimately exists. Connection and commitment are vital to the formation of selfhood. It’s a value system bias I will strive to make explicit to my clients, not as an imposition but as a way of providing informed consent.

I will offer invitations to explore the ongoing tension between our relational self versus our consumer self when dilemmas arise. I will not pretend to be values-neutral in this effort, and I believe therapists can engage their clients in a more meaningful, substantial, and exploratory level of personal freedom; a freedom to open a conversation about what it really means when we affirm something as seemingly positive as “I choose myself.”

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References

Doherty, W. (2021). The Ethical Lives of Clients: Transcending Self-Interest in Psychotherapy. American Psychological Association.

Johnson, S. (2008). Hold Me Tight: Seven Conversations for a Lifetime of Love. Little, Brown and Company.

May, R. (1991). The Cry for Myth. W.W. Norton & Company.

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