Anti-Oppressive Listening in counselling and therapy: why it’s more important than degrees or methods

• by Sriram Ananth (sriram.writing@gmail.com)
• Blog: https://loveliberationstruggle.wordpress.com/

 

[Image citation: http://jessicamaccormackrmack.tumblr.com]

When I’m not writing lefty rants that no one reads or organizing in social justice movements that generally result in further self-marginalization, I work a day job that helps sustain those quixotic endeavors (not to mention paying off a mortgage, supporting a family, as well as buying beer and other staples). As day jobs go, it’s not too bad. I work as a trauma therapist and counsellor at a community health centre in a marginalized neighborhood in Toronto. I could do without the tedious bureaucracy and volumes of admin work, but then again I’m unlikely to a find a job in our current capitalist environment that doesn’t irritate and/or alienate me to some degree or the other. I work in a health industry that’s only marginally better than America’s, but likes to pretend it’s the pinnacle of civilized healthcare, which offers me an unending supply of institutional frustrations. My head has a constant metaphorical soreness from all the banging it does on the brick walls of a rapidly privatizing, over-medicalizing, quasi-Keynesian healthcare system that is getting dismantled by the less humane (but more brutally honest) elements of the political and economic elite.

I do, however, get to engage in a richly humanizing process of holistic therapy with a bunch of wonderful clients, while embarking on chaotic journeys of health and healing with them. It is undeniably the most fulfilling and inspiring part of my job. And it taught me the vital need for what I call anti-oppressive listening – engaging, caring, solidarity-based counselling that is always attentive to the way different structures of oppression manifest in our daily lives, more often than not in very traumatic ways.

I’ve been working in the field of public health as a counsellor, case manager, and educator for a number of years now in different parts of the US and Canada, and it boggles my mind how rare it is to find folks doing this, in a field where it ought to be the norm. I’m of the firm belief that the hyper-medicalization, privatization, and elitism lying at the heart of the medical industry is responsible for this lack of care and solidarity; at the cost of true health, happiness, and healing for those who need it.  More often than not, I actually have to bend, even break, rules and laws in order to provide basic care and support for my clients, especially when it comes to preventing already marginalized people from facing even greater marginalization. And there are many like me who face this problem. It’s really fucked up, trust me. Now, changing the healthcare system to make it truly egalitarian would require the kind of collective action and protracted mass organizing that changes the very oppressive foundational structures of our society, polity, and culture. Some might gently whisper that this is also known as a revolution, but let’s not get caught up in semantics here because I’m not even going there in this piece. As things get worse, we all have to either struggle together or die alone, and we can figure that out for ourselves.

However, in the meantime, to all who work and partake in the healthcare field, and especially pertaining to mental health, I would like to suggest anti oppressive listening as a way to provide a healing balm for the direct trauma inflicted by this system on the client, and the vicarious trauma it inflicts on the workers. It doesn’t change the oppressive nature of the system, but it at least creates a bubble of liberation for both parties that then provides that all-important seed of hope that individual and collective healing can indeed take place eventually. (I sometimes feel like hope is a complex carb akin to potatoes, rice, or wheat – it might not provide all the nutrients one needs, and occasionally gets treated shoddily by societies which have an abundance of food, but it keeps you going when nothing else is around.)

So what is anti-oppressive listening as it pertains to counselling and therapy? I’ve listed below a number of key elements (by no means an exhaustive list) that I think are crucial, and often sorely overlooked, in the field of mental health care that broadly constitute what I mean by anti-oppressive listening. It doesn’t matter what it’s called really, I just use that term because it provides a simple signifier.

So here goes, when I talk about anti-oppressive listening I mean:

1. Trauma and mental health issues in general are understood from a structural/institutional standpoint: I’m of the opinion that the majority of mental healthcare is done in this present system with an abominably shoddy, and often non-existent, understanding of the manner in which structures of oppression and the institutions that perpetuate them are at the root of so much violence, abuse, neglect, and hurt faced by people in general, with those in more marginalized socioeconomic positions facing a disproportionate brunt of it. (And forget about intersectionality, we’re light years away from that). Oh, and before you show me the mission statement of some health centre or the other, let me be the first to acknowledge that the language is often there in many institutions, but I’m talking about the practices. How can someone who has dealt with, say, trauma associated with transphobia in their home and society ever be expected to have a healing therapeutic relationship with a counsellor who doesn’t care about understanding or addressing that specific contour of oppression. Instead, they might be diagnosed with a plethora of “disorders” further contributing to humiliating stereotypes and thus even greater marginalization. The problem is that the healthcare worker is the so-called “expert” and might not want to showcase their lack of knowledge, and will opt for sterile, by-the-books therapy that often does nothing for the client. Instead, they could partner with their client in understanding the specific contours of oppression they’re going through, maybe learn together and *gasp* even be in solidarity with that client’s struggle and pain. The same goes for folks dealing with a racist immigration and criminal justice system, economic exploitation and poverty, patriarchy and misogyny, heteronormativity and queer-bashing, nationalism and religious fundamentalism, ableism and medical stereotyping, and all the other ways people are hurt in this world. In case you’re wondering who these people are, they’re you and me. Immigrants, the poor, women and female-identified folk, precariously placed workers, marginalized people of color, victims of the criminal justice system, people in abusive families and more. I would venture a guess that that’s the overwhelming majority of the people you and I know. But in addition to paying important attention to structural and institutional oppression, anti-oppressive listening…

2. Simultaneously honors the plethora of diverse individual experiences via solidarity: The above point on structural and institutional oppression always runs the risk of people then being “boxed” into a specific category (that’s what mission statements and funding proposals do, with the various minority “demographics” that need to be targeted in order for the healthcare system to sleep soundly at night, sans guilt). But if one is in true solidarity with any individual, then one knows that everybody’s experiences are unique and must be honored as such. This does another thing. People who go through oppression, violence, and abuse are not free of internalizing those oppressive norms themselves. None of us are. As a trauma counsellor who also happens to be a queer-identified, immigrant man of color, I see no shortage of various oppressive mindsets and ways of thinking in people who go through a lot of oppression themselves. A lot of it hurts me, and it’s important for me to acknowledge that hurt as opposed to ignore it under the façade of professionalism. I’m sure I have a lot of internalized crap I have to deal with too. The point being that when I’m in solidarity with that person, when we find a humanizing space for both of us, I can call someone out on their crap, they can call me out on mine, and we can still move forward together. But that can only happen if…

3. Care and compassion are core therapeutic values, as opposed to afterthoughts: I was in a mindfulness workshop with this rather lovely, warm-hearted individual called John Briere, who happens to be a psychiatrist associated with UCLA. Somewhere in the middle of what was the best professional development workshop I ever attended, he started a discussion on care and, while I can’t quote him exactly, he spoke about how the most important quality for any therapist or counsellor can never be taught: the ability to care. In my own, less erudite words, this translates to “show some fucking humanity.” He mentioned that often the people who provide the most healing conversations are rarely the medical practitioners who are supposed to, but instead regular, everyday people without counselling “skills” per se but just an innate sense of humanity and compassion. An increasing number of psychiatrists and physicians these days are glorified pill-pushers only interested in the professionalization of their positions, further embedding themselves within the industry, and frankly not being particularly caring or compassionate. Not all, but an alarmingly growing number. Please note that this is different than “compassion fatigue” which is a very real thing that can take over the purest of souls. What I’m talking about is professionally practiced and perpetually reproduced institutional callousness. I don’t blame them as individuals. I really don’t. As I mentioned earlier, the industry has converted ideas like care and compassion into afterthoughts, merely adorning the mission statements of hospitals, clinics, and health centres, as opposed to being core therapeutic values. But it’s always possible to buck that norm, and by doing that we ensure…

4. The client’s health, happiness, and liberation become the focus as opposed to specific therapeutic models, clinical methods, and health industry rulebooks: During a case conferencing meeting at a major hospital in Toronto, I made the suggestion that many of our clients who were dealing with different forms of marginalization like poverty and homelessness needed that to be addressed before any kind of focused therapy could be conducted. It was fairly simple reasoning in my mind. If I’m homeless and wondering where my next meal is coming from, I am not very likely to be interested in talking about any abuse I might have faced, because there are more immediate concerns at hand, such as being homeless and wondering where my next meal is coming from. A top psychiatrist in the hospital had suggested that I run a CBT (that’s Cognitive Behavioral Therapy) group for all my homeless clients in order to help them get “healthy coping skills” to deal with their homelessness. I wondered out loud if maybe a list of subsidized housing providers, emergency shelters, and food banks might be more appropriate, which didn’t go down well. I’m not exaggerating here and this is one among countless such experiences I’ve had with the healthcare system. This might seem like a contrived example, but it is indicative of how too many healthcare practitioners are obsessed with fancy therapeutic models and clinical methods that often display a breathtaking severance from reality. Don’t mistake me. I’m not saying skills are unimportant. Indeed, I have successfully employed and continue to employ various forms of CBT for a number of my clients, many of whom are homeless or precariously housed, but only when they are ready for it and not when I determine they are ready for it. People might wonder when to do what. It’s actually pretty simple. Just focus on the client’s actual health, happiness, and liberation by listening to what they need, as opposed to what fancy-ass skill you can deploy in order to prove what a gifted therapist you are. That, however, requires a shift in the way we perceive of healthcare and with anti-oppressive listening…

5. Holistic care is preferred over just focusing on a single symptom of a more deep-rooted health issue: The increasing professionalization and rigidity in roles within the healthcare system has resulted in most practitioners relegating the idea of holistic care to nothing more than a platitude. Holistic care is a form of healing that “considers the whole person — body, mind, spirit, and emotions — in the quest for optimal health and wellness” (according to WebMD anyway). Holistic care understands that one’s health doesn’t exist in a vacuum but as part of an intricate universe that defines a person’s life as a whole. Physical health practitioners can paper over scant attention to holistic care more often than mental health practitioners can. Most folks going to a physician are going for a specific problem, a sore throat, a stomach bug, a pimple on one’s ass, whatever. Physical health practitioners can get away without thinking holistically. It’s still shoddy medical practice. A practitioner treating someone for diabetes might learn that their client is impoverished and can’t afford good vegetables, in which case their marginalization and poverty has a direct impact on their diabetes care. A good practitioner will not just ask them to eat more vegetables but try and direct them to resources or make referrals that help them do so (and not just punt, like so very many practitioners do). With mental healthcare, it becomes even more pertinent. A non-holistic approach by mental health practitioners is just downright asinine. For example, If someone is coming in for help with their panic attacks, and during the course of counselling one learns that they faced intense sexual abuse as a child and are also currently at risk of being abused at home, it’s not enough to just go through some grounding exercises and call it a day. There is a need to address those far more deep-rooted and equally pressing issues, whether it be providing resources or shifting the focus of the therapy. Nothing illustrates the need for holistic care better than addictions counselling which then means that…

6. Harm reduction and reason are upheld when dealing with substance use issues as opposed to punitive morality. (Also, the health and healing powers of weed is made clear): If someone has been referred to counselling for alcohol dependency, the insular mode of operating for so many addictions programs focuses all efforts on the addiction per se. In reality it’s more important to focus on addressing the pain and hurt this person is going through that has them self-medicate with alcohol in order to escape it. Alcoholism here needs to be seen not as a vice or a sin, but as a painful coping mechanism that innumerable marginalized people turn to in order to deal with their pain. Looking at it this way opens one’s mind up to possibilities that might actually be salubrious in the long run, even those with a bad rap, such as the increasing discoveries around cannabis and its healing properties. This doesn’t mean I’m advocating some kind of ill-conceived stoner therapy (though I do imagine a rich field of health science blossoming a few decades from now). All I’m saying is that it’s important to find ways of reducing harm, including a program of moderation while slowly building resiliency in order to deal with pain utilizing healthier coping mechanisms. It is hard fucking work, let me tell you. Compassion fatigue can set in with alarming regularity. But punitive morality does not work. It is the bastion of those who dehumanize our brothers and sisters who cope with a plethora of addictions issues. It is the status quo of people too lazy or scared to understand the chaos, complexities, and equal parts tragedy and triumph of real holistic addictions counselling. If only all those sad souls would seek out reason and rationality (or just smoke a damn joint), they might even be convinced that…

7. The obscene power differential between client and worker can be replaced with (though never eliminated by) solidarity: I hate the fact that there is a power differential between me and my clients, where I’m in a certain position of authority in relation to them. It’s a disgusting part of the healthcare system, consistent with the way power and authority are just taken as a given in our societies across the board. I’m also not stupid enough to think that anything I can do as an individual can make it disappear. However, I do believe strongly enough in the liberating qualities of solidarity and mutual care for one another to know that it’s possible to reduce the influence of that power differential in our therapeutic relationship. One might ask how it can be done. For starters, I think it needs to be acknowledged, said out loud, and stated with clarity, so the client knows that their counsellor is at least aware or making efforts to understand a very dehumanizing power imbalance. The rest will follow based on where both parties are at in their lives. The important thing is to not hide behind the power differential, but stand in front of it and try to figure out with your client how to work around it. Because ultimately we want a situation and a therapeutic relationship that…

8. Humanizes both client and therapist (where the therapist’s personal struggles and battles with mental health become a point of solidarity as opposed to a professional weakness): I have moderate PTSD from a stint as a human rights worker in 2002 resisting violent religious fascists in India. I had a brief but perilous period of grief-induced alcoholism after I lost my younger brother days before his 18^th birthday in 2004. I have a plethora of mental health issues that I deal with on a regular basis, including occasional depression, traumatic nightmares, and sporadic insomnia. But it’s all good, because I’m also so very happy with my life that I wouldn’t trade it in for anyone else’s. I often disclose all this to my clients, something that is not exactly encouraged in my field as it makes me look like I have fallibilities and weaknesses (frowned upon by medical professionals used to being seen as right all the time). Yes, I do have a number of fallibilities and weaknesses, and I’d rather let my clients know about it than hide it from them because it humanizes me and makes them realize that what they’re going through is not any more abnormal than what I have dealt with and continue to deal with. We become comrades embarking on a journey of healing. And that’s a beautiful thing.

There are so many other aspects to anti-oppressive listening and I would love to hear from others about this. As I sign off, I feel compelled to say that I’m not suggesting anti-oppressive listening as some kind of “solution” or all-encompassing panacea. There are innumerable things that individuals can do to make this system truly egalitarian. But having worked in the field of public health in the US and Canada for quite a few years now, I am of the firm opinion that the healthcare system doesn’t actually give a crap about a person’s health, happiness, and liberation, but is primarily at the service of big pharmaceutical and insurance companies. It is a callous and uncaring system, but one tiny way to subvert it and move towards something more egalitarian is actually changing the way the system wants us to think and relate with each other. Anti-oppressive listening (or whatever you want to call it) might not be a bad idea. At the very least it’s a tiny, likely insignificant, moment of subversion against an oppressive institution. As we await some dangerous times ahead for those of us who believe in equality and justice, we need to hold on to those rare moments and spaces where love and solidarity exist despite structural pressures that seek to constantly deny their existence. I’ll always count that as a win (plus, it gets me out of bed on Mondays with a reasonably low level of irritability).