In her forthcoming book, "Decolonizing Therapy: Oppression, Historical Trauma and Politicizing Your Practice," Jennifer Mullan holds her profession to account.
A longtime psychologist and counselor at New Jersey City University, the 45-year-old Garden State native had grown frustrated with being able to provide care only on a small scale. Her work was burning her out, and she was overwhelmed by the fact that, for every person she could help, countless more were struggling.
Instead of trying to reform people’s access to therapy, Mullan set out to reform therapy as a whole.
She began to focus on asking therapists to assess how they conduct their practices and to steep themselves in social justice theory to consider whether their work might effectively hurt clients. She wants therapists to acknowledge that the task they are up against is Sisyphean in the absence of structural change. People often talk about how they are working with a therapist; Mullan is giving therapists homework, too.
An estimated one in five U.S. adults lives with a mental illness of some kind — some 58 million people, according to the National Institute of Mental Health. As a result, an industry already worth nearly $80 billion in 2022 is expected to surpass $105 billion by 2029.
The majority of people seeking mental health support opt for outpatient services such as online or in-person appointments—if they can find support. A 2021 survey by the American Psychological Association found that 65% of therapists said they were at capacity and could not take on new patients.
Matters are tougher for those trying to find therapists who look like them and might better relate to their issues, such as people of color, immigrants and members of the LGBTQ community. More than 80% of the psychology workforce in the US consisted of White people in 2021, according to APA data, and 69% were female. This can put such members of minorities as Black men at disadvantage should they seek help. Simply put, the therapy sector isn’t built for them.
Mullan’s breaking point came when she realized she was mainly triaging people’s mental health crises without addressing the root issues of how poverty, culture and generational trauma can impact a person’s resources and day-to-day life — and how medical, judicial and political systems go on to fail them.
“I loved my clients. I loved the people I served,” she says. But the reality that therapy grew out of European traditions, with predominately White professionals using the same baseline for most clients, didn’t sit well with her.
Mullan says many therapists see their work as apolitical and neutral, and she wants them to do some advance work so patients don’t feel the need to give their doctors a cultural education before seeking solutions. “My colleagues had really good intentions, but I did not feel that we were educated for the nature of the work that we were asked to do in a society that was, without a doubt, crumbling,” she says.
In 2019, she founded Decolonizing Therapy, an organization dedicated to providing training and workshops for therapists, nonprofits and professional associations.
She asks attendees to regard therapy through political factors that might cause someone to need it and to consider socioeconomic factors, such as institutionalized racism or belonging to a cultural minority in an unaccommodating society, that could stand in patients’ way. Her book is slated for publication in November.
Mullan’s book differs from many mental health books on offer because it’s directed toward therapists rather than patients. She initially balked when her publisher suggested she create a book to educate practitioners, but came to see it as an opportunity to address people she says are at risk of hurting patients more than they help them.
“This is a call to action for the helpers — for the therapists to take responsibility and accountability and to look at the ways in which therapy is not neutral,” says Mullan. “It can’t be apolitical.”
She calls for a reassessment of the often-prohibitive payment models that dissuade some people from seeking mental assistance. Therapy can cost from $50 to more than $300 per session, according to Bankrate, and not all therapists accept patients’ insurance — if they even have it. While such services as TalkSpace Inc. and Teladoc Health Inc.’s BetterHelp offer text and video-call therapy, many people can’t afford to spend $240 or more monthly on care.
“You realize: Wow, I am on an assembly line,” says Mullan of her eventual realization that even though she worked with people experiencing homelessness and incarceration, her work did nothing to address the systems that might trap them. “Almost always, we are asked to remain apolitical, neutral, not involved in the conversation — just be there for others.”
“I started to realize that this is part of a bigger structure and system,” she continues. “Although we have very good intentions, we are part of a larger systemic problem.”
Throughout "Decolonizing Therapy" (Norton Professional Books, $44; out on Nov. 7), she asks therapists to think critically and politically about their practices, from how their payment models impact who they work with to how advice or feedback they give will affect how those clients trust them.
Mullan also emphasizes what she calls a holistic approach to therapy that validates clients’ heritage by respecting such Indigenous beliefs as shamanism, curanderismo (traditional healing) and other therapeutic modalities. She stresses group therapy and other resources extending beyond the private-session model.
Such resources could include support that might be found in a running club, a meetup at a coffee shop or places like barbershops. A 2021 study from the University of Pennsylvania found that giving barbers anti-violence and sexual-health training helped their clients in Black communities better manage their emotional and sexual health.
Honoring rage and grief are two topics she discusses in detail on a popular Instagram page with more than 188,000 followers. The account experienced a striking surge in popularity in summer 2020 after the murder of George Floyd, a Black man, by a White police officer.
Mullan hopes people will maintain that energy to prioritize both mental health and activism three years later.
“It is not a trend, and I don't think that activism is a trend either,” she says. “There were activists prior to the pandemic — prior to social media blowing up — and many of us will continue to be activists till the day that we die.”
Social media can serve as a tool to make mental-health support more accessible, particularly if people lack the funds to pay regularly for a therapist. Yet, while social media can help people name what they’re feeling, Mullan worries about the risks posed by self-diagnosis without being able to receive care — much as Googling symptoms for a presumed cold might lead someone to find on WebMD that they’ve contracted bubonic plague.
“It’s important that people understand that looking at a set of symptoms or a few slides online does not denote that they have that issue,” she says. “They still need personal support.”
The ultimate point of her work, Mullan says, is for clients to feel as if therapy was built with them in mind. This requires therapists to educate themselves about experiences that extend beyond their own lives and to acknowledge that a 45-minute or hour-long session can’t offer a one-size-fits-all solution in a world that stresses people in so many disparate ways.
“I care about us, and sometimes we’ve got to wake up, and sometimes waking up means being uncomfortable,” she says. “My book is a love letter to therapists — to younger me, who thought that I wasn’t enough, who thought that I was the problem, who felt that I could be doing self-care differently.”
In reality, she continues, to truly help patients, “I needed to allow more of who I was to come out and to be more authentic.”
