In her 35 years as a therapist, Arlene Drake has never heard so many clients talking about the same issue. Week after week, they complain of panic attacks and insomnia because of President Trump. They're too anxious to concentrate at work. One woman's fear turned into intense, physical pain.
"It's just a nightmare," said Drake, who practices in West L.A.
Drake was trained not to reveal her personal beliefs, but now will agree with clients if they say they don't support Trump.
"If this were just another session, if this weren't such a big thing, if this weren't so evil, I wouldn't," she said. "But I have to stand for what I stand for and that does cross over into politics."
Therapists nationwide say they've been overwhelmed by the strong feelings triggered by one of the most divisive figures in modern political history.
Some patients who support Trump say they feel isolated because they can't share who they voted for in their workplace or home for fear of being harassed or called xenophobic or misogynistic. With few people to talk to freely, they turn to online forums and their therapists.
Opening up about voting for Trump has already stoked conflict with family and friends. One therapist mediated a case in which an adult son threatened to cut off his relationship with his parents because they voted for Trump.
Mental health professionals such as Drake have abandoned neutrality, while others are struggling to maintain it. Therapists on both sides of the political aisle are grappling with how to help patients affected by a national issue over which they have little control.
"This is so monumental because we are not in normal anymore," said Randi Gottlieb, a therapist who heads the L.A. chapter of the California Assn. of Marriage and Family Therapists. "It's putting into flux and questioning how do we practice, what is the best way to support the people we care for. We're beginning those conversations — we don't really have good answers."
Therapists say the last time so many people came to therapy wanting to talk about the same thing was after the Sept. 11 attacks. Trump has been a topic of discussion for months, even for people who see therapists for issues as seemingly unrelated as relationship troubles or eating disorders.
"I had a 10-year-old in my office who was talking about it," said Paul Puri, a psychiatrist in Brentwood.
Over the summer, William Doherty, a professor at the University of Minnesota and a therapist in St. Paul, published a manifesto online declaring Trump a unique threat to America's mental health. More than 3,800 therapists signed it.
Doherty wrote that Trump's campaign was creating widespread alienation and fear among Americans. Trump was normalizing behavior that therapists fight to reverse, including "the tendency to blame others in our lives for our personal fears and insecurities," he said, and "a kind of hyper-masculinity that is antithetical to the examined life and healthy relationships."
These issues haven't gone away now that Trump is president, Doherty said. He formed a group last month called Citizen Therapists for Democracy to consider issues raised by Trump's presidency. Therapists aren't accustomed to advising patients on how to handle this kind of "public stress," since psychotherapy has traditionally been limited to private lives and psychology, he said.
Among the unanswered questions for therapists: Can they validate clients' feelings without wading too far into politics? What's the best way to uphold and act on their personal values? How can they help people deal with something that's so pervasive and unpredictable?
"It's thrown therapists," Doherty said. "We're struggling with it because we've never dealt with it — and now we're forced to."
Mental health professionals have also debated whether to diagnose Trump himself. Though some have publicly done so, an ethical standard known as the Goldwater Rule prevents psychiatrists from diagnosing public figures without personally evaluating them.
In 1964, more than 1,000 psychiatrists said in a magazine survey that then-presidential GOP nominee Barry Goldwater was psychologically unfit to be president. It was an ethical misstep that might have eroded confidence in psychiatry, wrote Maria A. Oquendo, the head of the American Psychiatric Assn., in a statement last year reminding members to abide by the rule.
At the most recent board meeting of the L.A. County Psychological Assn. last month, therapists also discussed how to talk about Trump, especially with patients whose political beliefs might differ from their own. It turned into an hourlong discussion that Hillary Goldsher, a therapist on the board, described as "emotional, challenging, difficult."
But Goldsher, who practices in Beverly Hills, said that while she understands therapists' desire to condemn Trump, she thinks opening up could isolate some patients.
She wants clients to feel free from judgment, so she redirects them if they ask whom she voted for.
"You sign up for the notion that your goal as a therapist is to hold a safe space regardless of your own beliefs," she said.
Patients who feel overwhelmed by the new administration should set hard time limits for consuming the news, said Allen Wagner, a therapist in Mid-Wilshire who describes himself as "solution-focused." He tells people to delete Twitter and Facebook apps from their phones so they're not constantly tempted to check them.
Wagner has encouraged others to turn their anger or frustration into action by attending rallies or contacting their congressional representatives. One of his clients wrote thank-you letters to President Obama with her children.
"It makes them feel like it's not something they're watching, like a train wreck, and that there's some level of control," he said. "Maybe it doesn't change the larger narrative, but it makes them feel as though they're being authentic with themselves."
In many ways, the election has been more challenging for his conservative clients, who feel as though they can't tell their spouses, family members or friends that they voted for Trump, Wagner said. They fear being automatically labeled bigots or accused of electing a new Hitler, he said. They rely on secret Facebook groups to express their feelings.
"It's almost become irrational in terms of the anger people feel toward each other and the boxes they put each other in," he said. "I feel for the people on both sides."
Robert Puff, a psychologist in Newport Beach, said that many of his conservative patients were upset by the way Trump was portrayed by the media during the campaign. They dreaded the possibility of a Hillary Clinton presidency, especially after what they saw as "eight years of Obama oppression," he said.
Puff zeroed in on ways each client could increase happiness within his or her own life, regardless of the political landscape. Now his conservative clients are mostly relieved Trump is in office, he said.
"They're happy with what he's doing," he said.
Amy-Lee Goodman, a rape survivor who lives in Boston, said she broke down after watching a tape last year of Trump saying, in a vulgar way, that he could grab women by the crotch. She only felt more upset when he denied subsequent assault allegations, and then even more so after the election.
"I just had to turn off the news," said Goodman, 29. "It felt personal, like a personal assault against me, like this whole country had said what happened to me didn't matter, what happens to so many women doesn't matter."
Julia Hochstadt, who is Goodman's therapist, said many survivors of sexual violence had flashbacks and panic attacks because of the assault allegations against Trump during the campaign. Many saw their worst fear, not being believed, play out on the national stage, she said.
Even now, so many of Hochstadt's patients regularly talk about Trump that she's had to be extra careful not to get overwhelmed.
She spends less time scrolling through her Facebook news feed and watching the news. She's skipped a few recent episodes of the political thriller "Homeland," one of her favorite TV shows, because it feels too heavy at the end of the day.
"There are fewer and fewer places where you're not hearing people talk about this stuff," Hochstadt said. "I have to be ever diligent about carving out places for myself where I'm not talking about this, I'm not listening to this."
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