The therapeutic relationship between client and therapist as well as the therapy space are thought of as very specific spaces, separated from the rest of our relationships or the environments we navigate.

It is true that these spaces are meant to feel safe enough for us to explore and address difficulties in ways that are not possible elsewhere, and they are constrained by certain boundaries such as confidentiality. A therapeutic relationship is not meant to be like a friendship, but it is important to remember that this space and our work cannot be separated from the social context in which we live. It is embedded in this social context and in many ways, it is influenced by it as well.

Let’s talk about why the social context needs to be taken into account in therapeutic work.

 

Social determinants of mental health

It is a well-known fact by now that social and environmental factors have an effect on people’s mental health and can increase the risk of suffering from mental illness or distress. In fact, this report from the World Health Organisation  states:

“Certain population subgroups are at higher risk of mental disorders because of greater exposure and vulnerability to unfavourable social, economic, and environmental circumstances, interrelated with gender. Disadvantage starts before birth and accumulates throughout life.”

It is of course, important to explore the impact of individual trauma, adversity, and problematic relational patterns in therapy to help address our psychological and emotional distress. However, we must not forget to also include what social, economic or environmental factors might have had an impact on how we feel about ourselves, others, and the world.

We are social creatures, made to live and grow in community and we can be deeply affected by factors that impact our experience in this society such as poverty, racism or discrimination of any kind, gender violence, forced migration (even if forced by economic realities), etc. This, even in cases when these adverse social situations are in our past and not part of our present anymore, the lingering effects can still impact on our mental wellbeing and our relationships today.

Therapy should also provide a space in which, not only intra- and inter-personal dynamics are explored and addressed, but also social, structural and even historical dynamics (in the case of intergenerational trauma for example).

I would even argue that even when we don’t consider that our lives were affected by adverse social situations, for example, if we have lived comfortably, there are other social factors that may also impact on our psychological and emotional wellbeing. These might be tied to certain social norms or expectations that we feel we have been subjected to and that might create pressure to perform or to be a certain way. In these cases, our lives can feel inauthentic or we can suffer from a lack of agency or meaning which can be addressed in therapy.

Like previously noted, we don’t ned to be under adverse social situations right now to seek support. Anyone can go through adverse situations at any point in their lifetime and for some, these will have lingering impacts on how they think and feel and therapy can come in handy to address these issues if they are having a negative effect on a person’s life.

 

Adversity and trauma

One of the ways in which we can make the link between social realities such as poverty, sexism, racism, discrimination, etc, and mental health is by understanding how these increase the level of a person’s or a group’s vulnerability and limit their sense of empowerment and agency.

The way we understand trauma in general is usually linked to these two elements as well. A traumatic situation is one in which we feel the threat of violence upon ourselves or someone else, and we have little to no control or power to protect ourselves or the target. If no appropriate support in processing these events is received, the sensation of fear and vulnerability may stay with us for much longer than the traumatic events last, creating distress and other symptoms.

This is not to say that all socially adverse situations can or should be qualified as trauma, but I do believe that drawing similarities here can be useful to understand the impact they can have on our mental health.

Another avenue for exploration in therapy is how social situations may foster shame and self-blame in people. One way our society deals with social violence and inequalities is to adopt a hyper-individualistic perspective and blame people for their situations. However, these situations were not a choice. These blaming messages tend to get internalised and people can feel shame or blame themselves for what is happening to them.

It might be useful to place responsibilities where they belong and at the same time recover a sense of agency to, as much as possible, make the best of what we have and not let the rest impact on how we feel about ourselves. Therapy can help with this.

 

The therapeutic relationship in context

One last point I’d like to make is that if people are affected by past and present social situation, so is the therapist. In turn, our work and the therapeutic relationship will also be affected.

My approach to therapy considers that the therapist, being a human with their own set of experiences, cannot (and should not try to) be a neutral mirror for the client. We as therapists, come with our knowledge, our baggage and our full selves and we can use this to connect with the client and to help. We will always hold some similarities and some differences with our client’s and their experience. Knowing this and acknowledging it is essential for a healthy and trustworthy therapeutic relationship.

When working with the impact of social situations on people’s lives the therapist must be open to receive and hold experiences and perspective that can be wildly different from their own. In this, it is important that they remain open to accepting their limitations if they do not understand where the client is coming from, and address this appropriately.

 

Recommendation:

If you are looking for a therapist and you think you might want to explore your experience with social and structural issues it might be a good idea to open the subject from the get go and ask some direct questions about:

• The therapist experience in working with these issues
• Their perspective on how social situations impact on people’s mental health
• Their way of working with this or what they propose as direction for the work

And gauge the responses noticing how they feel for you. This is a good indicator to know if the therapist will be a good fit to work with you and what you wish to bring to the space.

As a counsellor, I am here to help. If you believe the social context has had an impact on your mental health or your well-being, Contact me to discuss how I can support you.