I just attended the Evolution of Psychotherapy Conference in Anaheim, California. This event occurs every four years and is the world’s largest psychotherapy conference, with over 7,500 attendees coming from all over the globe to learn from the most well-known and influential psychotherapists today.

This was my third time attending and yet I was still eagerly anticipating it because of my positive experiences in the past. The first time I went in 2009 was very influential for me as a therapist. It was there that I first heard Daniel Siegel speak (multiple times) and his Interpersonal Neurobiology approach to understanding the human experience still centers my perspective today.

As was the case with each previous conference, while listening to different speakers and experts share their wisdom, beyond the specific topics of each session, an organic “meta” theme emerged. This is not by intentional design from the conference coordinators, but perhaps reflecting the real-time insights of a field that is presently immersed in the lived experience of people – a sociological manifestation of multiple discovery.

Eight years ago that emerging idea was the importance of being self-aware and how our beliefs shape our behavior, just anticipating the expansion of the practice of mindfulness from Buddhism and therapy into the mainstream.

Four years ago the idea was the importance of human connection in a world that is becoming more and more influenced by a Western perspective that esteems individualism, and more and more personally isolated despite technology and globalism.

This year that emergent theme was the importance of bringing out into the open and to the center that which we as people (and as therapists) have previously kept to the margins or in the shadows. Having kept these things hidden, we have subconsciously told our clients “what is important to you, is not important to me.”

The consequence of this historical ineptitude is that about two-thirds of people never come back to therapy after the first session, even when all other barriers have been removed. In fact, more people prefer their psychics and spiritual advisers to therapists, physicians, and friends for help. And they find them more helpful. Scott Miller, director and founder of the International Center for Clinical Excellence dropped these humbling facts on us. His research also tells us why — because psychics and spiritual advisers don’t judge people for their spiritual beliefs about the whys of the Universe, form quicker and better therapeutic alliances, and give more helpful immediate advice in the context of their clients’ worldview. They validate more of the person’s whole identity than therapists, physicians, and friends.

So what are the parts of a person’s self-identity that therapists routinely ignore and trivialize, either unintentionally or deliberately? Gender, sexuality, culture, race, and spirituality/religion. If you are a therapist, you know this is true. I was convicted when I heard this too.

In the only talk that focused on gender and sexual identity, Marilyn Yalom spoke on the history of women, which for the most part is a history of invisibility, powerlessness, and forced compromise – until the past century. She talked about our assumptions of “traditional” masculinity and femininity as being challenged by changing gender roles in an increasing egalitarian society and the positive impact of inclusion of the LGBTQI community as part of the larger human community. In summarizing this fairly recent history and the trajectory we are on, she posed a question that was both challenging and optimistic:

“It was a time when women were becoming more like men. Will the 21st century be when men become more like women?”

Esther Perel took the baton from Marilyn Yalom, and much like my first exposure to Daniel Siegel, I attended almost every session where she spoke. In the context of being an effective therapist, she wove in the necessity of understanding the impact of gender and culture to form a therapeutic alliance built on validation and trust – and these were just the off-hand remarks she would make while talking about her areas of expertise in relationships and sexuality. The scarcity of these types of remarks from other speakers probably contributed to the frequency in which her statements were met with applause.

And speaking of the unspeakable, in her final talk of the conference she asked the large audience of mental health professionals a more personal question: “How many of you have been impacted by infidelity? Either as a child in a family where there was infidelity, as a partner, as the “other person,” or as a confidant where someone came to you for support?” Almost all hands were raised, which in a simple way normalized the prevalence of infidelity as part of our universal shared human experience. The fact that her book The State of Affairs – Rethinking Infidelity shot to the top of the New York Times Bestsellers list within one week also tells you that this isn’t the behavior of psychopaths or deviants, but everyday people. And so, Esther Perel made it not only possible, but she made the case that it was imperative that we talk about things we don’t typically talk about in therapy – gendered experiences, culture and race, sexuality and infidelity.

In addition to being an expert on relationships and sexuality, Esther Perel is an immigrant who speaks and practices in seven languages. One of the screening questions she asks her clients is “have you ever left or have you always stayed?” because “if you’ve ever left, then you know that there is more than one way to do things.” This was the first time in the conference where anyone addressed a multicultural worldview, and to be honest, after this was pointed out to me, I couldn’t unsee the complete lack of diversity in the faculty. And if it wasn’t clear enough, on that same panel, Asian American Psychologist Derald Wing Sue, the only faculty member of color at the conference stated bluntly:

“Is this the Evolution of Psychotherapy or the Evolution of White Psychotherapy?”

Whereas Scott Miller pointed out that two-thirds of people in general don’t return to therapy after their first session, Dr. Sue said that number is 75% for people of color. His decades of research have in part focused on the impact of the more subtle forms of prejudice, whether that be racial, gender, sexual identity or ability.

When it comes to race, whereas Nazis marching in Charlottesville is an overt and highly visible display of prejudice and power, microaggressions are built on the “myth of colorblindness” which falsely asserts that since we are all human beings, that people of color are exaggerating their harmful experiences as being treated differently because of the color of their skin. As a result of this gaslighting, they are left with the psychological labor of trying to overcome self-doubt and unexpressed emotion while still explicitly dealing with the consequences of discrimination, but in isolation. When someone says #BlackLivesMatter and you respond with #AllLivesMatter, that’s a microaggression. If you have a hard time understanding why that’s bad, it’s because like Esther Perel says, “you’ve never left” which means that you are the one with the limited perspective.

In a packed ballroom with women, other therapists of color, LGBTQI therapists, and therapists with visible and invisible disabilities I was about as moved as I’ve ever been seeing a rare person that I relate to (an Asian American male in the mental health field) validate such a real experience for me and people I know. The emphatic nods and loud applause from others only further validated that Dr. Sue was speaking a necessary and hard truth about not only our field, but the world in which we live.

I heard from another attendee that at another session, Dr. Jeffrey Zeig (who is the person responsible for putting together the conference) was asked about the lack of diversity in the teaching faculty at the conference. Shockingly, he gave a very tone-deaf response saying:

“Well, I don’t see much diversity in this room.”

There were audible gasps. There’s your proof that microaggressions are real and that people of power and influence perpetuate them.

And what does this lack of diversity cost us? People would rather go see their psychics. Again, two-thirds of all people never come back to therapy, and seventy-five percent of people of color don’t get past the first session. That’s the shortcoming of therapists who don’t validate the unique worldview of women, people of color, LGBTQI and the specific hardships that these identity markers bring.

Therapists, who are disproportionately atheist, agnostic, and nonreligious compared to the general population, also can passively or sometimes actively trivialize a person’s spiritual or religious identity. I’m a spiritual person. I also need to do better in letting people know this.

When you take all these marginalized groups together as a whole, that’s most people that therapy fails. It doesn’t matter how many workshops teach the “art and science of psychotherapy” or which modality of treatment is best when people don’t trust you to know what it’s like to be them. Therapy will never work if you can’t get past the first session.

An Open Letter to Dr. Jeffrey Zeig:

When there is a lack of genetic diversity in biological evolution, you get disease and death. When a trait is best suited for changes in the present environment, the expression of those genes become the dominant variant because they contribute to the thriving of that species. So just like diversity is necessary for biological evolution to succeed, it is equally important for us as a field to get better at widening the perspective — beyond a Eurocentric White older male minority to include the rest of us who are in the majority.

So Dr. Zeig, I’m asking you to help us all to evolve and thrive, lest this conference go the way of the dinosaur. You sat on a stage with Sue Johnson and she said that though she admired Salvador Minuchin greatly, she didn’t appreciate his well-known provocative and challenging style in family therapy. She preferred connecting with – with emotion, with people. You on the other hand said that you felt it was important and necessary for people to be challenged, even if it makes them uncomfortable. Some embarassment might bring certain difficult truths to light and lead to real change. You also said that you thought it was masterful how Minuchin moved that father’s chair outside of the circle where the rest of the family and Minuchin, the therapist, were sitting. This was done to explicitly show that the “in” group had implicitly made the father an outsider, though obviously fathers are an important part of a family.

So since you love challenges and metaphor and imagery — imagine this. There’s a circle of chairs where the predominantly White, older, male, heterosexual faculty of the Evolution of Psychotherapy sit, facing inward and they are having a lively and engaging discussion on the amazingness of psychotherapy, while complementing each other on their contributions to this amazingness. You are part of this inner circle. And sitting outside of that circle of chairs are thousands of women, people of color, young people, persons with visible and invisible disabilities, people who identify as LGBTQI, people who are religious and spiritual. Those on the outside are excluded from your conversation.

Now do you see the diversity in the room? Or are you going to keep your chairs turned inward and only talk to those that look like you, think like you, believe like you? Are you going to be the therapist that works to bring everyone into the circle, or are you going to be the bouncer that only lets certain people into your exclusive ‘good ol’ boys’ club? How’s that for a challenge? Does that metaphor work for you?

If this conference is truly meant to be the Evolution of Psychotherapy and it doesn’t want to become extinct, it needs to adapt to a world that we openly acknowledge is still prejudiced, is steadfastly spiritual, and is becoming more feminine, more sexual, more colored, more multicultural, and more queer.

I am a therapist. I’m still learning. This conference has been an important part of my growth as a therapist. I believe therapy works. I just want to see it work for everyone.

You can see my thoughts evolving “live” during the conference on my twitter feed @mntlhealthiness #EvoAnaheim

I also share my thoughts on the Evolution of Psychotherapy Conference with my friend and colleague Dr. Martin Hsia on his podcast PsychRally, Episode 31 – How Much Is Psychotherapy Really Evolving? 

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