Roe v. Wade and Therapeutic Duty

If you want a therapist to start talking and never stop, ask them about movie portrayals of therapy. (Asking about working with insurance companies will also work. But we are going to stick with Hollywood for today.)

There seem to be two options for therapists in the movies: the Freud-like couch, where the patient does all of the talking, a long monologue at the silent, stoic therapist who may jot some notes, but otherwise might as well be a rock, usually seated in a very expensive-looking chair. This therapist is usually portrayed as male. The second option feels almost completely opposite: they are usually female. They are wearing a lot of flowing layers (scarves, shawls, big skirts), maybe funky glasses, and are a stereotype of the 1960s hippie. God forbid this latter example is also playing a sex therapist! Then there is a lot of art pieces that look like vulvas.

So which is it? Perhaps obviously, there is a happy middle for most of us. We can be professional and warm, appreciate a nice chair and funky glasses. But we all make choices about how much of ourselves we show our clients. This is in an effort to ensure that the therapy hour is about the client, and not the therapist. It works to allow our clients to hold different beliefs, opinions, and identities from our own, and not feel restricted in sharing them with us.

I know that last part has always been a challenging part of practice for me, and acutely so since 2016.

As a sex therapist with specialized training in sex therapy with queer and transgender people, you might guess that a good percentage of my clients are very liberal. You would be correct. But not all of my clients align politically left. I have witnessed similar clinical outcomes with people regardless of their political inclinations and religious affiliations. And I want to be a therapist who welcomes all. Being “affirming and inclusive” is used by many in my field to express their acceptance and celebration of LGBTQ+ community and other marginalized groups. And, inclusive means being, well, inclusive. Of everyone. And it is something I take seriously. Research shows that folks from conservative backgrounds might experience higher than average sexual dysfunction. 

We are coming up on a month since the SCOTUS decision of Dobbs versus Jackson Women's Health Organization, which overturned Roe versus Wade, rescinding federal protection of abortion and sending the decision back to the states. As a sex therapist in Indiana, I and my colleagues immediately braced for impact. Our state legislature called a special session, to start July 25th, which will likely ban abortion in our state with few exceptions. To support reproductive choice is considered politically “liberal.” So what does a therapist who wishes to be accessible to all do?

On August 13th, my practice, seek&summon, will sponsor a table at a fundraiser for our state's abortion fund. I mulled this decision over, cognizant of the impact my overt display would have on potential and current clients. And then I wrote the check. I believe support of bodily autonomy and health care access is what my profession's code of ethics calls me to do, and I believe there is room for healthy, therapeutic dialogue with my clients who have questions, should they desire it. Reproductive freedom is about abortion, but it is also about my clients who utilize contraception; gender-affirming hormone therapy; those who require assistive technology to become pregnant such as IVF and surrogacy; those who use medications for unrelated ailments who will now find it challenging to access their needed pharmaceutical care because those meds might also be used to induce a miscarriage; and access to a supportive adoption system that feels less like an exploitative industry.

Maybe this puts me closer toward the therapist wearing 6 shawls, 2 scarves, and glasses on my face as well as perched on top of my head—and I will admit that as a sex therapist, I do indeed have vulva-inspired art. But we are living in a time--and I would argue, we always are--where it is a matter of clinical safety for clients to know if their therapist supports their bodily autonomy. As access to abortion care and potentially other reproductive and health care needs becomes almost impossible, I'll take the wacky therapist trope over the neutral rock if it means that my clients know that I will give them evidence-based information and help them meet their health care needs. I am proud to signal that publicly, and invite all therapists to consider their duty in an increasingly precarious time for our clients who hold oppressed identities.