In some cases, fear of social repercussions creates a new type of isolation and anxiety that makes it hard for my patients to process their emotional responses to events, even with some of the closest people in their lives. One of my patients, for instance, has a transgender daughter. As she walks this journey with her, she often complains to me that she must put up a false front to the outside world. “To express anything short of joy that my kid is trans makes me look unsupportive and risks criticism, or worse. I only feel safe telling you all my complicated feelings. I love my kid and will defend her to the ends of the earth, but I need time to process this change and come to accept it.” Her legitimate concerns that others will hear her struggle as unsupportive have led her to distance herself from friends and relatives, and delete her social media presence.

Another patient, a faculty member at a university, went through a brutal tenure review because he held a conservative viewpoint that differed from his colleagues. This experience brought him into therapy because he wasn’t sleeping and was afraid of losing his job. He was vulnerable and worried about being misunderstood, so before he would trust me with the details of his situation, he spent many sessions making sure my leanings on issues related to his field wouldn’t affect my view of him. “I don’t understand how they can espouse academic freedom when they expect me to toe a line that is the opposite of that,” he told me. I reassured him that I was there to offer him the help he needed regardless of my own views, and that there was no political line he had to toe in our sessions. Giving him the room to speak openly about his beliefs was critical to his ability to continue to function at his job.