Should providers remain neutral in mental health care? The war in Gaza has caused a split among therapists

Dr. Hayat Nadar, a Syrian licensed clinical psychologist in Uptown, warns his patients, “Don’t go to the hardware store for milk.”

It’s her response to the changing ways patients seek care since the war in Gaza. She says the people who come to her — from marginalized communities in the city and those who support Palestinians living in the region — are looking for someone who understands what they’ve been through from their own experience.

That way, “they don’t have to explain all their experiences and face resistance to what is reality for them,” he said.

As the war rages on with no end in sight, Chicago’s mental health providers are faced with the question of how best to treat patients who have suffered from violence. Some in the field view conflict neutrality as harmful to patients and say providers’ expertise has a place in therapy. Others argue that abandoning a sensitive but unbiased approach to care is at odds with how they are supposed to do their jobs.

“People want to know you’re a safe space,” said Anna Finkelstein, a Jewish clinical social worker in Skokie. “Being a therapist means being inclusive and helping marginalized populations.”

But according to the new way of thinking, “it’s like you have to pick a side. It goes against everything we’ve been taught.”

Finkelstein was trained in therapeutic neutrality, a concept that instructs her to remove herself from the session in order to better help the client. If the views are too deep, the provider may make a recommendation to someone else. But in recent months she has come under pressure to reveal her views on the war.

She also felt the professional impact of the change. In March, her name appeared on a list of “Zionist therapists” posted on a local Facebook group; the post said that health care providers should not refer patients to people on the list. She said she has never expressed her views on Israel publicly to avoid interference with her business. She believes she was singled out because of her “Jewish name.” She eventually found that she had received other clients who had seen her on the list.

Shayna Campbell, a Jewish licensed clinical professional counselor who practices with Finkelstein, said that “whether our views differ from the client’s or not, it should be about meeting their needs and being curious or empathetic about their perspective.”

Dr. Vale Wright, MD and senior director of health care innovation at the American Psychological Association, said that as mainstream health care moves away from psychoanalytic models where neutrality is the norm, more providers have been given the opportunity to use “ self-disclosure”.

For any practitioners trying to find a balance, Wright suggested consulting colleagues for advice, but providers should consider the best way to treat the patient on a case-by-case basis.

“There’s a lot going on in the world right now, so acknowledging that and saying, ‘I feel it too,’ can be helpful,” said Wright, a Villa Park resident. “The hard part is making sure the therapist doesn’t make it about themselves.”

Some recent studies have also criticized studies that ignore the effects of global conflicts.

“Health workers must be trained in structural competence to challenge the depoliticizing effects of medical neutrality in order to promote peace, health equity, and social justice,” wrote researchers Zwicka Orr and Mark Fleming in 2022 studies published in Global Public Health.

Nadar said that staying neutral, she said, could shift the blame for mental health issues caused by structural biases onto them.

“If I don’t acknowledge the systems in place that cause these feelings, I’m just saying the client is sick,” she said.

Evanston-based psychotherapist Nadia Greenspan, who spends summers working in trauma zones such as Rwanda, Serbia and Ukraine and has worked with patients from Gaza, said privilege can influence providers to view issues patients face as “ politics” to which they must be neutral.

“It’s not often that people of color, people who aren’t straight, or people who aren’t neurotypical talk about their lives and call it ‘politics,'” Greenspan said.

But Finkelstein and Campbell said the pressure to express their views pushed them and other Jews to retreat into their own communities.

“I never felt targeted or marginalized as a Jew until this year,” Finkelstein said.