What’s political about practice?

Therapy is never just private work.
What shows up between a clinician and a client is shaped by laws, institutions, distribution of resources, and social meanings about race, gender, class, sexuality, and desire. When we don’t name those forces, clinical choices — what we notice, what we diagnose, how we interpret behaviour, whether we advocate — are quietly governed by the status quo.

That’s why practice is political.

What that looks like in everyday work

• Material conditions & policy. Clients’ distress is often bound up with housing, income, criminalization, or health-policy decisions. A safety plan or a behavioural activation sheet only goes so far when structural barriers remain.
  (See client vignettes in On Being a Politicized Practitioner).

• Identity and power. Race, gender, sexuality, immigration status, and disability change how people are treated — by services, by employers, and by the law — and they change how clinicians’ reactions (countertransference) show up.

• Diagnosis, language, and pathologizing. Labels carry moral and political weight. Who’s described as “difficult” or “noncompliant”? Who is assumed to be making bad choices? These are decisions with political consequences.

• Transference & countertransference as political work.
  A client’s anger at government policy, a family’s shame about sexuality, or a coworker’s microaggression are clinical material and political signals — they shape what is safe to say, how power is enacted in the room, and what we must hold as clinicians.

• Workplace culture & ethics. Clinical practice exists inside organizations that hire, fire, fund, and set scope-of-practice rules. Ethical practice often requires reading those organizational politics and acting accordingly.

Why it matters
Naming the political dimensions of care improves clinical accuracy, protects clients from retraumatizing practices, and helps clinicians make ethical choices that don’t reproduce harm. It makes therapy safer and more useful for the people most affected by injustice.

How I work with this question
I help clinicians and organizations translate political clarity into clinical craft: reflective supervision about countertransference, case formulations that include systems and policy factors, interventions that hold both symptom relief and structural realities, and team-level assessments that produce safer services.