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What happens when mental health care becomes intertwined with prevailing political ideologies and biases?

• The rise of sociopolitical bias in mental health therapy
• The four levels of bias impacting therapists
• The incompatibility of patient-centered therapy with politically driven judgment
• The influence of activist-oriented norms in therapeutic contexts
• The role and objectives of the Open Therapy Institute
• Viewpoint diversity and the challenges faced by conservative therapists

Episode Transcript

John Tomasi: Andrew Hartz, welcome to Heterodox Out Loud.

Andrew Hartz: Thanks for having me.

John Tomasi: It's really a pleasure to have you here. You're the president and founder of the Open Therapy Institute. Which we'll be talking about as our main topic today. You're also a long-time Heterodox Academy member. You taught at Long Island University for a while. Can you tell us a bit about your connection at HXA?

Andrew Hartz: Well, I joined as a graduate student. And I remember learning about Heterodox Academy when I was a PhD student. And at the time I learned about it, you couldn't join unless you were actually a teaching faculty member. So I remember emailing saying, can graduate students join? Can PhD students join? How does this? And they said, not yet. And then I remember about six months later, they opened it up to PhD students. And that's when I joined.

John Tomasi: So it's really lovely to have you on the show. Tell us about the Open Therapy Institute. What problem is it meant to be addressing?

Andrew Hartz: So Open Therapy Institute is focused on socio-political bias in mental health care. So any way that basically political bias is impacting therapy, we want to address.

John Tomasi: So political bias, impacting therapy, can you give us examples of that?

Andrew Hartz: It really runs a spectrum. I kind of like to think about it as having like basically four levels of bias. One would be activist therapists, which do exist where they might explicitly think that they should bring their political ideology into sessions. And maybe proselytize to their patients or even reject patients from therapy if they don't have the right views. I'd say the next level of bias would be therapists who they're not doing that, but they have very strong political views. They're uncomfortable talking about certain topics. They might be very judgmental. They might be hostile to certain views. They might have rigid stereotypes. That would be like a very biased therapist. The next level of bias would be somebody who really means well, wants to be a really good therapist, but is maybe they don't know how to treat patients with different views. So like they don't understand things about different experiences and perspectives that patients might have. And what we want is to get to a place where therapists are skilled and knowledgeable, working with a wide variety of patients.

John Tomasi: So let me ask this a little more tightly, because what you just described seemed to me to be a description of the range of human types. There are people on the street, if I walked out here on 6th Ave, I might find people who fall into all those characterizations. But we're talking about people in a professionalized context. They're putting on their persona as therapist, and yet they're still falling into the categories you just described. There are people who, as therapists, when they walk in that room and switch into those professional norms. What I'm asking about them is, what are the professional norms of therapy? Are these people flouting the professional norms, or are these the professional norms?

Andrew Hartz: So, you know, for over half a century, the standard in mental health has been treatment should be patient-centered, should be focused on the patient's goals and values, and the therapist or the other provider should be attuned to the patient's values. Where things have gotten derailed, I think, in the past 10 years or so, it really comes, I think, for the people who are activist therapists, the way that they would probably frame it is, they're confronting racism. So, obviously, if you have a racist patient, you'd need to address that. That's totally reasonable. There's nothing biased about confronting racism. There's nothing biased about confronting sexism or homophobia. So, those are reasonable things for therapists to do. But their definition of what racism is and what sexism is, is more and more expansive. So, disagreeing with affirmative action policy, well, that's racism. Got to confront that in session. You know, voting for Donald Trump, that's racism. You know, your views on immigration, that's racism or sexism. So, the views get very expansive. And then, now, all of a sudden, the therapist is kind of using their role as a therapist to kind of weigh in on a wide range of ideological issues.

John Tomasi: Let me be sure I understand. So, how is patient-centered therapy compatible with responding to people's racism and sexism?

Andrew Hartz: I don't think that they're compatible. I think the field has drifted away.

John Tomasi: But I thought, I'm sorry, I don't mean to interrupt. But I thought you said that it's okay and reasonable for people to address people's sexism or racism.

Andrew Hartz: But the problem is that people are defining those terms so broadly now.

John Tomasi: But I'm asking about the core case.

Andrew Hartz: Yeah, no. I think for the people who practice what I would call like an activist-oriented or social justice-oriented psychotherapy, that's what their rationalization looks like. So, they would rationalize it as, we are still basically being patient-centered. We're not really being biased. We're just addressing racism. I think that's how they would describe it. The problem is exactly what you're saying, which is that it's very easy, once you bring that into therapy sessions, it's very easy to stop being patient-centered and for it to be a slippery slope to disagreeing about every political issue that exists.

John Tomasi: So, is there a space in therapy for moral judgment of your patient's views? Moral judgment of a person has a view about women, for example, and a role in society. Yeah. Is there space there for that in a healthy therapeutic relationship in your view?

Andrew Hartz: There could be. I mean, imagine like a very narcissistic patient who is being very aggressive towards women. And, or, you know, or it could be a narcissistic woman who's very aggressive towards men. But, but there might be a way to say, you know, that worldview and that stance is creating problems for this patient and that being candid about that is reasonable. So, goals of their own, for example, to have a long-term relationship or to have healthy relationships with their children. Goals of their own might be thwarted by things and thought ideation and patterns that they have. Yeah. Or even just like feeling grounded or emotion dysregulation stuff or why aren't people getting along with me or what? Like it would probably, if they're, if they're acting in like a pervasively aggressive way towards people, it probably is impacting their life negatively.

John Tomasi: So let's, thanks for that background for me. That's, that's helpful. It's helpful to me. So let's, let's move now to the Open Therapy Institute and what you're seeing out there. What kinds of, can you give us some examples of, of therapeutic interventions or experiences that have come to your attention that motivate your work?

Andrew Hartz: Yeah. I mean, increasingly, I mean, especially in professional bodies and in a lot of training programs, students, therapy students are taught that every therapy needs to broach race and issues like white privilege. Every, every therapy needs to conceptualize the patient and therapist as privileged or oppressed, based on certain demographic categories. often they're taught to think about race in terms of a very, or gender in terms of these very preordained scripts where the black patient is their chief problem in life is racism from white people. And they have a whole set of beliefs and values that are shaped from that. And the therapist needs to view them in a particular way. So, so I'd say these ideologies are really intensely coming into training and a lot of those ideologies are explicitly advocated by professional bodies in the field.

John Tomasi: Can you give specific examples? Are there particular cases that stick out in your mind? Of like, therapists actually doing this?

Andrew Hartz: Yeah.

John Tomasi: A therapeutic, a therapeutic, experiences of patients where they're getting this kind of care.

Andrew Hartz: Yeah. We, you know, we were emailed weekly by patients, you know, several times a week by patients looking for a therapist to report things like this. And it really does.

John Tomasi: Give an example.

Andrew Hartz: So one, like, so I wrote, I wrote an op-ed about that had one example where I was at a clinic where a patient said that, he disagreed with, affirmative action. And, and, and I guess, the, the situation was he didn't get a fellowship. This is a Jewish patient, as I remember. yes, it was a Jewish patient and, and didn't get a fellowship, which he felt was because of, affirmative action policies and the response to the, so we discussed this case in a case conference that was probably, probably two or three dozen people with, you know, social workers, psychiatrists, everybody in the field. And there was an apparent consensus that the patient was, racist for having this view. And that because of that, the patient needed to be referred out and seen elsewhere that the, the, the, the therapist who was a woman of color couldn't be expected to see such a racist patient. they're not.

John Tomasi: I'm sorry, don't you catch that?

Andrew Hartz: Sure, sure.

John Tomasi: So that the, the therapist professionally should not be expected to deal with a patient with those kinds of concerns.

Andrew Hartz: Yeah. And it, it, it, it exactly shows the slippery slope of the racism thing that I was talking about earlier, where it's like, yeah, if you were a, if you were a black therapist and you're treating a patient who's, an actual white supremacist, who is bombarding you with hostility for your race the entire time, you actually wouldn't be expected to do that. But on the other hand, having a fairly run of the mill opinion about affirmative action, but probably a majoritarian opinion is a totally different thing. And there's this conflating of the two that can, lead them to really, really mistreat patients.

John Tomasi: That's fascinating. So how widespread is this, is this phenomenon and, and, and is it, is it geographically, does it arise in different, in red states and blue states differently? Just how, how widespread is this, this, this issue?

Andrew Hartz: Yeah. I, I, I would guess that there, it is different in different regions, although I don't know of any data supporting that. I, I think, you know, maybe less recently, but definitely in the past 10 years, if you were on a therapist list serve, like therapists have these email lists where they will look for a therapist for a particular patient. And there were lots of people who would openly say they would not see a Trump voter. They'd actually say that. Say that proudly. I mean, and, and lots of people said, but even, and recently, I mean, there was a news story in Chicago. There was a group of therapists who said they wouldn't treat a Zionist patient and they actually identified therapists who they suspected of Zionism and said they wouldn't refer any patients to therapists who were suspected of being Zionists. So there is this, there's definitely a influential wing of the therapeutic world that is pretty, pretty strongly behind these ideas.

John Tomasi: So I'm just fascinated by that because as you know, from your involvement with the heterodox academy, one of our main ideas is that the university is in some sense, a special place separated from the ordinary run of politics, a place where people can go and put their guard, put their guards down. Join in conversations with one another with humility, recognizing the things they don't know and want to learn, speaking openly about their weaknesses. But all of that depends upon the forces of politics, of ordinary politics, not washing over the walls of the university and covering up the campus. But I think in many disciplines, many professions, that's the case, or it should be the case, that same ideal that this professional area, say in law, for example, or in medicine, or in therapy, that if politics washes, it's allowed to wash over the walls. So now you have doctors making decisions about their patients based on their political views, what treatments they get them, whether they see them at all. Or you have lawyers saying, I won't take clients of these different categories, or I think no one should take a client of that type. That's just a destruction of the profession. But in psychotherapy, what do you see there? It sounds like that washing over, is there anything pushing back against that washing over? Professional norms, for example?

Andrew Hartz: Just to kind of underline your point first about how damaging that worldview is, I mean, I think the bias has to get pretty bad before you get leaders of professional associations advocating this type of, what I would say is extremely politicized approaches. So all the other layers of bias that I mentioned at the beginning, I think they've been there for a while, and they've really ossified into something else. To me, when you're kicking people out of therapy for majoritarian political views, that's a canary in the coal mine, that the bias situation has gotten much more severe. The therapeutic relationship is very intimate. It's very personal. You really have to be open and curious and empathic to people with a wide range of views. You can't kind of just fake it or not have knowledge or have real hostility and do good work. So I think it's the tip of the iceberg, of this huge iceberg of bias, and I think there's a lot more under the water.

John Tomasi: What's the pushback like?

Andrew Hartz: Therapists are very scared to speak out about these issues. And the biggest fear is that if they talk about problems in the field, they will not get referred patients. They're worried about other things. They don't want to lose their – they don't want to lose friends. They don't want to be attacked. They don't want to get sued by patients. If they find out you're a conservative or you have a conservative view, then maybe somebody will file a complaint with your licensing board or something. So they tend to have fears like this. I don't know how common those things actually are, but therapists are very worried about them.

John Tomasi: But isn't there an official body that sets professional norms, states professional norms? Isn't there – or is there a group that says therapy is a specialized place? It's not the place for you to do political campaigning or other kinds of moralized – are there leaders in the field who remind people of what the ideals are professionally? What the ideals are being not observed and being observed in the breach rather than being supported and reinforced? Is that the way therapy works?

Andrew Hartz: I mean, it's probably the way it should work. But, you know, I don't – a lot of the professional bodies are some of the most politicized parts of the field. I mean, the APA, there's the Association for Social Workers, for Counselors. There's university training programs. There's psychoanalytic training programs. I mean, so many of these have gotten really aggressively politicized. And it's actually running the risk of kind of death spiraling because people don't want to enter the field to go through a graduate program that's very intensely politicized and hostile to them. So if you're not on board with these ideas, the idea of spending three to six years in graduate school having to self-censor and feeling attacked, it makes people say, I'm not going to enter the field. And so it could – it's kind of already reached a very radical point. But I think it has the potential to just kind of continue to spiral.

John Tomasi: It's fascinating. And so now tell us about the Open Therapy Institute.

Andrew Hartz: So the Open Therapy Institute – so I think one of the things that was on our mind when we were founding the Open Therapy Institute was not limiting the discussion to just the most extreme forms of bias. We do want to talk about those. They are really important. They're happening more than people probably could imagine. But we wanted to talk about the other forms of bias too, the way that therapists might make assumptions about patients, you know, that could be pathologizing. Oh, you're a Trump voter. It means you're a narcissist or it means you're dumb or whatever or other biases that they might have. This group's privileged or this group's, you know, always a victim or something. And we wanted to actually think about what are all the different ways – what are all the different issues in mental health where bias manifests, where things might not get addressed and talked about that could come up in sessions? What are all the different ways that bias might manifest? It could be, you know, a faith-based issue. It could be around religion. The field is very secular, very atheistic field. I think maybe – I think I saw something that's most atheistic profession, which kind of surprised me. But most patients aren't. So there's a big gap. And a lot of – like when I was in graduate school and I did my PhD, I didn't have a single lecture on religion.

John Tomasi: Fascinating.

Andrew Hartz: So most therapists that I know in New York don't ask about religion in intake. They don't ask. So it's – and then if it did come up, I think a lot of them have the assumption that being culturally competent around religion means being nice about it. So you're nice to them. But you don't know anything about it. You don't engage them with it. You don't have faith-based interventions or suggestions. You don't bring it into your formulation. You don't have any thoughts about it. And so I think that's an example of the type of bias that's happening around other things. And it could be politics. It could be self-censorship. It could be masculinity issues. It could be racial issues. We had somebody who's giving a talk in a couple months who's talking about gun owners. You know, what are – there's a history in mental health of pathologizing guns and gun ownership. Gun owners know this. They're very mistrustful to the mental health profession. They're worried that they're going to get reported and red flagged. And so gun owners who need therapy are often very mistrustful of the field. And that's true for dozens and dozens of populations like that.

John Tomasi: And with gun ownership, does that happen historically because of the connection between gun ownership and successful suicide? That's one of the arguments against gun ownership is that – it's a complicated issue, but one of the arguments is that if you have a gun in the house and are having suicidal thoughts, there's some evidence showing that there's a higher likelihood that you actually will successfully kill yourself.

Andrew Hartz: Yes.

John Tomasi: Is that the roots of that?

Andrew Hartz: I mean, that's all the more reason why we have to have excellent mental health care for gun owners. And we have to have a great relationship with gun owners so that they get treatment and so that we reduce those numbers. I mean, like, we should have great trainings so that gun owners get superb mental health that's culturally attuned. And that means, you know, they have a gun for safety reasons or they have a gun because they like to hunt or they like the antique or whatever it is. Like, you can be curious about that. You can be warm about that. Of course, you need to prioritize safety. If there is suicide risk, you need to address that in an assertive way, the way you would with another patient. But we should have a much better relationship with gun owners than we do.

John Tomasi: And on the religion topic as well, it fascinates me and it surprises me deeply because I would think that in a therapeutic context, understanding people's deep connections to the world, how they see themselves, the world, how they situate themselves in the universe, how they root the importance or unimportance of their life. Religious people have those resources in a way that are distinctive. And it seems like such an obvious opportunity for therapeutic connection and drawing people through.

Andrew Hartz: Exactly. And for interventions. I mean, there's a lot of research. And look, I'm a big meditation supporter. There's a lot of research on meditation. And I think that's great. I'm a big fan of it. Compared to prayer, I mean, the focus of the field on meditation. Meditation versus prayer is very stark. But they're similar. And there's a lot of benefits to prayer and thinking about prayerful meditations and faith-based meditations. And it's just clearly addressed much less, I think, obviously because of the secular bias in the field.

John Tomasi: It's fascinating. And can I just ask you to think about, to talk with us a bit about how you see the broader cultural moment. Because I would say that with Donald Trump's presidency and the whole Trump phenomenon, we hear about Trump derangement syndrome, which is a therapeutic, quasi-therapeutic term. Right, right. But also just the polarization that a figure like Donald Trump sort of generates. Also with the DEI trainings now in workplaces, which talk about different kinds of racial responsibilities and toxic masculinity. There are a lot of forces and ideals out in our society that people are encountering that seem to put some groups on the defensive. So there's maybe a greater need for, there's a therapeutic moment perhaps. Does that seem right to you or how do you see that?

Andrew Hartz: I mean, if you go back 15 years, if a patient came in and wanted to talk about politics every week, that would have been diagnostic. It's like, what are you avoiding? What is this about? Why are we talking about politics every week? It's not abnormal anymore. It's clearly on people's minds a lot. I think it's a source of a lot of distress for people. When people, you know, Trump derangement syndrome is obviously like a pejorative term.

John Tomasi: Yes.

Andrew Hartz: I think there is something that people are actually seeing, which I do think happens on both sides of the spectrum, where people get very emotionally dysregulated around politics. And I think often lose their grip on reality testing, start to believe things that aren't implausible. They can become paranoid. They can damage their relationships in a severe way. People are noticing a certain type of pathologies that's related to politics that they're seeing more for sure. And I think the DEI trainings, I mean, it brings politics into the workplace, into school. A lot of those trainings have a lot of hostility. I've been to trainings personally that were overflowing with hostility towards certain demographic groups in certain parts of the country. There's just more and more ways that people are impacted by these ideologies. It affects dating. It affects their family and their relationship with their kids and their parents. And it's shocking. I'll tell you, one thing that's shocking is how many patients think they're not supposed to talk about politics and therapy. That they think they have a responsibility as a patient not to do that. That they're not supposed to. And they think that about religion, too. Some think they're not supposed to talk about religion, too. A lot of them do. And that's what therapists actually have to do a little bit of work to open up. That if those are things that are on your mind that are impacting you, it's okay. It's probably good. It's probably necessary to talk about those at least a little bit. But a lot of people think they're not supposed to. And they self-censor. And they probably underestimate how much the entire therapeutic process can be derailed when you're self-censoring parts of your life like that.

John Tomasi: I read someplace, maybe on your website, that you created the Institute to Address Polarization in Mental Health Care. Is that a formulation that is familiar to you?

Andrew Hartz: I don't think I framed it that way. But I'm curious where you're going with this.

John Tomasi: Well, from what you just said, that strikes me as an accurate account of that line I just mentioned about addressing polarization. Polarization is something that I think can have the effect of creating loneliness for people, creating dysregulation, as you talked about. Feelings of extremist thinking. It's the end of the world if Harris wins or it's the end of the world if Trump wins. The end of our society, the end of America, as we know it, both sides, it seems to use that kind of rhetoric. It's Hitler coming or it's communists coming, the Marxists are coming. So there's kind of this extreme thinking happening in a polarized society. And I would think that in cases of polarization, there's perhaps a greater need for therapy and a special kind of need for people who are feeling lonely, feeling beat up at work, trying to understand what their role is in a society with a very complex and, in many ways, horrible racial history. What does it mean to live in that society and still be the person you are and have an appropriate understanding of, are you responsible for all of this? Are you a good person? How do you live your life? How should you move through the world? I mean, I gather those are triggers for the need for therapy. And then we're talking about when they get therapy, they don't actually get the responses that they might be getting.

Andrew Hartz: Well, I mean, I think you and I were talking earlier about how over with all the kind of like political chaos that's happened over the past decade in particular. And, you know, I feel really strongly that tools from psychology and maybe clinical psychology in particular can really be indispensable at diffusing tensions, fostering dialogue, helping people understand, helping people repair, helping systems become more, more functional. And I think it's been a huge missed opportunity that the field hasn't done more work to foster that. You know, in terms of polarization, like I would say the country is very polarized and people are feeling that. The mental health field, I think, is less polarized because there's just one pole. There's there is no counterpoint. It you do find there are individual therapists who are right wing and do things that I would consider unethical politicizing sessions. They exist and they say crazy stuff, too. There's definitely some of that. But I think like psychology professors are 17 to one liberal to conservative. I think therapists are 90, 92, 93 percent liberal to conservative. The conservatives tend to not write articles, not speak about it, not teach about it, be in the closet about it, self-censor, you know. So viewpoint diversity is a massive issue. It's a massive issue and there's only it's very unequal. And so there's the issues that tend to get ignored and the perspectives that tend to get ignored are almost always on the center and on the right.

John Tomasi: Are there other systematic biases in the profession that might be related to, for example, socioeconomic class?

Andrew Hartz: Do we know about that or gender? Oh, well, is there gender for gender for sure? Because the field is really female dominated. And I think it's 80 percent of therapists are women. That gap is getting bigger. And I'm actually having second thoughts if it's exactly 80 percent, but it's something in that ballpark. Child therapists, it's even more extremely geared towards women. And men's issues are often really mishandled. I mean, the place where I see it, I'm particularly concerned about it is couples therapy. I'm very concerned about biases against men in couples therapy that so many couples therapists are women. They don't understand men's issues. They might pathologize men as being more aggressive, as being less supportive, as being more narcissistic. They might undervalue men's needs in relationships. And it shows there are all of these subtle ways that bias can come into sessions. It's not always like the big sledgehammer of explicitly politicizing a session. It could just be like a tendency to stereotype men as the bad guy in the relationship.

John Tomasi: Fascinating. As you were speaking just then, I was thinking about parallels with teaching. But in teaching, we're trying to help people think. We want to impart to them a body of knowledge so that they can think for themselves. We want to give them tools so they're able to find their own direction. And at HXA, we're often charting the various biases that have been implicit or even explicit in the way teaching has occurred in America. So, for example, 50 years ago, there were very few black professors, very few women professors. And that affected the way people would interact. And now we've done much better to integrate and be more inclusive in those dimensions. But there's new forms of bias and collective group thinking that have been occurring that are very damaging for teaching. And therapy seems to have some of the similar kind of patterns going on. It's fascinating. There's a professional in the room, as with a student or a therapist, and then there's a student or a patient. I'm interested in how that relationship, there's parallels between those two sets of relationships. I wonder if you could just tell us a little bit more. There's a big report I know you've been working on at the Open Therapy Institute. But just tell us a bit more about the institute itself first. Who are you? Who's involved with it? Is it a membership network? How do you operate so far?

Andrew Hartz: Yeah. I'm sorry.

John Tomasi: When did you just start it? What year?

Andrew Hartz: We started in 2024. We founded this year.

John Tomasi: I didn't realize you had just begun.

Andrew Hartz: We announced in 2023 that we were starting. We officially got incorporated in January.

John Tomasi: Oh, fantastic. Congratulations.

Andrew Hartz: Thank you.

John Tomasi: I did not realize it was that new of a venture. I thought it was two or three years.

Andrew Hartz: It's taken, you know, it takes a while to get the team together and get everything moving. I, we, we, we have such a superb team of, faculty and therapists, from around the country.

John Tomasi: And, what's the model? Is it a membership organization? What, how does, how do you, how do you work? Okay. Or how will you work? What's your vision?

Andrew Hartz: We are trying, maybe I'll kind of like tell you the sequence. So we have this report. We're trying to document issues that are overlooked because of sociopolitical bias. Any of the issues we were talking about, self-censorship, cancel culture, gender. And then we do continuing ed trainings for therapists that are accredited, that therapists can take to get their continuing ed credits. and those therapists can also become members of a network. It's just open to therapists and we have a monthly peer consultation group. We'll probably add and do more peer consultation groups for therapists there too. So the focus is research and training and supporting therapists.

John Tomasi: And did you, did you need to get accreditation, be able to provide these courses?

Andrew Hartz: Yes, we did.

John Tomasi: Was that a complicated process? You started in January and you already have it?

Andrew Hartz: We already have it. We got it. it sounds, it was fairly smooth. It was, yeah, I think, yeah, no, no, big issues. I think we were worried about potentially being politically targeted, but you know, we have like Ivy league faculty giving talks on underserved populations and we have an incredibly diverse group of people like politically, racially, religiously, are Heterodox Academy members part of your core? Yes. Yes. Yeah. Yeah. It was a lot of people that came out of it were connections from Heterodox Academy. So Mike Strambler was a Heterodox Academy writing fellow, Sally Satel, Pamela Paresky, who we, who we talked about Camilo Ortiz. we had, so our initial group was like mostly Heterodox Academy people. Interesting.

John Tomasi: And so go on, tell us more about, tell us more about you.

Andrew Hartz: So it's, so the, the, the, the main, I think, I do think we were talking like long, how does this problem get fixed in mental health? I mean, I do think long-term the problem is going to be through the market. The supply of therapists is not meeting the demand. I think there's a market-based solution where they get paid more because of the supply demand mismatch. It attracts more therapists to do this work and that the private sector can be an engine for correcting this problem. But for that to happen, there has to be a way for therapists to actually get trained on these issues that they've never had training on. That's why we want to do the report, outlining all these issues, trainings on these issues, and then the, the groups for members where they can talk through and support each other as they, they learn this new material.

John Tomasi: So that's working on the supply side, supplying, supplying therapists who are trained in these ways to see these biases, to be aware of them, sort of thinking about ways they can provide better, better therapeutic opportunities for people. On the demand side, I wonder, do you work there as well? Because I would, I would guess if a lot of patients aren't really quite aware of how off things are, they go to a therapist and they start getting effectively told that their moral views are wrong and their political views are suspect and they don't, they're there to speak now in therapy. Is there a demand issue or people, are people, is there a market from the demand side?

Andrew Hartz: yeah, I mean, there is a poll and I don't have the specific data on it, but there is a, and I hope we'll tweet about this soon, but there was a national poll that was done recently that I think it was 38% of the country is concerned about therapist bias. So the word is getting out. It's amazing. it's the word is getting out that this is an issue. I think when people actually learn how bad it's gotten and they actually see what these professional bodies are saying and writing, I think that number could double. it's a real issue. the, I do think patients have some misconceptions, like they, they don't talk about politics because they're worried about judgment. So they'll just hide it. If they have a concern about, you know, bias against men or affirmative action or something, they'll just self-censor around that issue or they just won't talk about their religion. even if, even if these are things or experiences that are really on their minds, causing a lot of psychological discomfort, they still won't speak about them. Some, or they, or they just are not even not speaking about them. They won't even look for a therapist. They won't even go because they're all woke or they're all, you know, and, and so I think a lot of people are, are losing confidence in the field. if you do want to find a therapist and you're like, okay, I care about, I'm going to want to talk about some of these. Issues because they're impacting me. Maybe I'm a student and I'm, I'm feeling attacked for my beliefs. I'd really like to talk to a therapist who knows something about this or where I can be open about this. Where do you go? You know, I mean, you, you kind of like you're, you're going on psychology today, taking a stab in the dark. Okay. This person's profile doesn't seem too political. we'll, we'll, we'll check this one. If you go to psychology today, looking for a therapist, this is true. The last time I checked, at least a majority of therapists in New York, right after their name, it's their pronouns. The first thing after their name is pronouns. Now, I think I know a lot of therapists who do that. And a lot of them, they either they're required to do that from their work, or maybe they feel like I'm being inclusive. This is an inclusive thing to do there for the most part, totally oblivious that it's sending a signal to a lot of patients that they adhere to a whole constellation of ideologies that the patient doesn't adhere to. And it, but it, it sends a message to a lot of patients where they look for a therapist and everyone's got their pronouns and they think therapy isn't for me.

John Tomasi: tell us about the report. You've been working on this sort of a large scale report. Just tell us what's, what's in it. What's the, what, what's the objective for the report?

Andrew Hartz: So the report was to document issues and perspectives that are under addressed because of sociopolitical bias. So we identified, I mean, we've already kind of talked about a lot of these, but we've identified like, 50 issues for this first report. Every issue has tons of clinical questions that aren't answered. So if you just take the issue of self-censorship, like what in society contributes to it? How do institutions foster it? How do people experience it? How does it come into therapy? How do therapists respond poorly? How could they respond better? What interventions could help from different theoretical perspectives? What reforms of institutions could change things? How does it impact group dynamics? There's so much just on that issue. And we don't have case studies, lit reviews, theoretical papers. We don't have, interventions that we can test. and we could look at those from like, what do those come from a behavioral perspective, from a psychoanalytic perspective? I'll give you one example from, from one of our talks is there was a behaviorist and he was talking about the idea, in one of our workshops about doing a behavioral experiment. With self-censorship, like try asking a question and see what happens and just, and you start to do these behavioral experiment. Maybe it's not the, maybe it's not what you think, but kind of the systematic approach to doing behavior experiments to confirm or disconfirm your beliefs about what would happen if you spoke up. So, I mean, these interventions, we can develop lots of interventions that are effective for different people, just on that one issue. But the same that's true there is also true for racial issues, gender issues, trans, sexuality, politics, cancel culture. So, every one of these issues has dozens and dozens of topics that need to be addressed. So, we're starting with just 50. we're doing really short articles. They're about 1,000 to 1,500 words each, very dense, just to kind of get the conversation started on what interventions for self-censorship look like. How do masculinity issues come into couples therapy? What are specific issues that young men might be facing? What are, what are racial issues at the workplace that might be under addressed? So, we're just trying to document those issues. I think the main thing that I would want to say that is the pitch to Heterodox Academy on this is, I really think every discipline in academia could write a report like this. public health, education, sociology, humanities, every department could write a report on this.

John Tomasi: And I'm going to make sure I understand your suggestion because I'll be talking about it with a team.

Andrew Hartz: Okay.

John Tomasi: So, you're suggesting sort of a landscape analysis of what the patterns of bias are field by field. Is that what you mean?

Andrew Hartz: I, I think it's drilling down into specific issues. So, if you identify what are, you know, and, and a lot of this, it's, it's all a work in process. So, sometimes somebody comes up with an idea, we never thought of it, but then it's like, oh, that's a good point. I never thought about how that issue would come up. Like what? Here's it. Here's one. Polyamory. I, as a therapist, I see more and more people who identify they're practicing polyamory. What is this about? How does it impact them? You know, there's questions. And I think often the sociopolitical bias in the mental health field is you always have to be approving and affirming. And you can't really think clinically about maybe this has some other, maybe this is a reaction to trauma. Maybe this is an avoidance of intimacy, or maybe this is something else. Like, so new things are constantly being suggested by scholars to us that we'd never considered. But 50 topics is nothing. Like we could do, we could come up with hundreds and hundreds, and I think every department could.

John Tomasi: And we're coming down to the end of our conversation. What's the opportunity in front of you? It just seems like there's an incredible, on the downside, there's a really bad situation with therapy. How do you see the opportunity? Do you see yourself more as creating an alternative to standard therapy, or are you trying to change what standard therapy is? How much are you reformers, and how much are you, I'll put it this way, how much of you are HXA, reforming an existing institution from within, and how much of you are UATX, building a separate institution elsewhere? How do you see your role? That's really, can I ask it that way? Yeah, yeah, yeah. We love UATX, but I'm just curious. Yeah, yeah. How do you see it?

Andrew Hartz: I think, I mean, the opportunity really is tremendous. There's so much fascinating work that I think can really help people. And actually, when we write about it, and it gets hopefully disseminated into the larger culture, it has a cultural impact too. We are probably more like the University of Austin model, if I have to just pick one. And the reason is, I think it's really hard to think about how to reform some of these existing institutions. I would ideally like training on working with diverse viewpoints, training on working with, maybe we would call them, patients who are underserved because of sociopolitical bias, training on how to treat those populations. I would like that to be required in every therapist training program in the country, from master's level to PhD level. I would like that to exist. We need to do the report first. Hopefully, that becomes a book. Then we can get a textbook. Hopefully, we can get a curriculum. This is the step of how we get there. But we want to cultivate a team of faculty that have expertise in different issues. Oh, this is our masculinity with young men person. This is our faith-based interventions person. And we get these different specialists really being experts on this, doing talks and writing articles on it. And then we start to have something that looks like a faculty that can actually do this work. But changing the system from within would take a long time to get those programs established.

John Tomasi: The challenge of changing the system from the change from within strategy is always try to, if the powers that be within don't see the problem as a problem, then it's very hard to get traction to make things start to happen. In the academy, at HXA, we think that in the last year of now, there's much more of a recognition because the public opinions focus on the universities and some of the dysfunctions at universities. There's an opportunity, a special opportunity now for that. I'm not hearing you say that there's something similar in therapy or am I missing that? Is there, you're saying a lot of, there's a widespread understanding that there's something wrong with therapeutic models as they currently exist or current therapeutic practices as they currently exist, I gather. But that watershed moment hasn't, you're not going to have the presidents, like the college presidents up there on trial for all the world to see, okay, something's really gone wrong with this organization. Is there any kind of moment like that? Can you imagine a moment like that?

Andrew Hartz: Well, the transgender stuff is probably where a lot of this starts and where people start to become aware of sociopolitical bias. Because, you know, when I was in graduate school, like I remember when it was kind of rolled out that you were supposed to be affirming. And I was like, I'm not seeing any studies that, I'm not seeing any randomized control trials here. Can we see, can I see a longitudinal randomized control trial that this therapeutic intervention is actually better? And people in the field, I knew lots of psychologists and psychiatrists who had the same questions and were afraid to ask. And meanwhile, it's announced to the public that there's this broad consensus in mental health care. Now it's actually coming out that, no, we don't have longitudinal randomized control trials. And lots of people got surgeries and regret it or were impacted by it, including kids. That's a place where people can start to think more about how sociopolitical bias is impacting mental health. And then maybe they can start to see it. Oh, there's analogous issues also.

John Tomasi: That's fascinating. I wish you well with the Open Therapy Institute. It's really a pleasure to have you here at the Segal Center. Thanks for all the work you do.

Andrew Hartz: Thanks for having me.