Nancy McWilliams against the “industrialization” of mental health care

In this video, psychologist Nancy McWilliams critiques how psychotherapy has been framed in much of popular culture, what she describes as “the commodification of therapy.” She discusses the idea that therapists are not “technicians” applying modalities, but that what matters is our ability to enter into meaningful relationships with complex human beings in a process of change. “We have to keep a sensibility alive that involves respect for individual subjectivity, individual suffering, the complexity of things, [and] the humility involved in approaching things as if we don’t know the answer.”

While simple solutions are great when they work, most people don’t need therapy to arrive at those decisions. In the face of complex problems, psychodynamic therapy engages us in a process of radical candor, in which we gain awareness of unconscious motives and increase our capacity to think about what is difficult and know what is painful. Some might call this insight, or when it’s more about being able to feel, increased emotional experiencing/tolerance of emotion.

I like to think of McWilliams’ work alongside the work of lawyer, writer, and activist Dean Spade, who has called for “radical discernment” about the solutions being presented in social movement organizing. In both situations, there is an interest in questioning the ways in which the frame for understanding how change happens is being set, and wondering if that is sufficient to achieve real, meaningful transformation. When change seems impossible—sometimes this is because we’re not asking questions about structure and framing, not because we’re asking for too much.