When to Challenge and When to Affirm: The Epistemic Role of A Therapist

I have recently delved into the idea of epistemology: The science of knowing and its various forms of (epistemic), injustice and justice.

It relates to what I find myself often writing about concerning the resulting harm or privilege: who’s knowledge is trusted, valued, understood and accepted as legitimate, or rather silenced and ignored – especially in context of identity, rank and power in settings like healthcare, organisational life and society.

Terminology can be ‘knowing power’

Ironically, discovering this terminology and how to apply it is demonstrative of the results of epistemic justice and injustice in action.

In my case, coming to the terminology late did not stop my ability to now notice, understand and explore ‘knower’ privilege and prejudice as an observable phenomenon and personally relevant experience.

But perhaps earlier in my life due to a lack of experience, not knowing it may have disadvantaged my ability to make sense of further ideas beyond personal context.

As an aside, I feel genuinely gratified when I discover there are names and labels which endorse things I have described in layman’s terms; discovered through experience.

Epistemic justice, injustice and the resulting privilege or harm, so completely relates to writing and identity as a writer too. Regarding whether one chooses to be or gets positioned by others as (a credible) one.

Who gets to ‘know’ in the therapy room?

I’ve since been thinking about what the most helpful or effective epistemic role, or mediator of knowledge is for a therapist considering my experiences both in and out of the client chair and my own intersectional identity.

We all posses a multitude of characteristics, experiences and identities markers that arm us with advantage in some scenarios and places, and may hold us back in others. This is also relevant outside of the consulting room.

As therapists, whether or not we always acknowledge it, and however collaboratively and human-human we may approach things in the room, there is a real power imbalance between client and clinician.

In terms of who is positioned as expert and who, layman, in the seat of client, we are potentially vulnerable and exposed, while in the therapist chair we may feel these things privately but are also both container and guide. Therapists are positioned in this situation ‘to know’ and for our words to hold weight.

What happens when someone has less privilege to ‘know?’

Concerning ‘knowing’ experientially and otherwise, epistemic injustice and the resulting harm is a specific disempowerment risk potentially experienced by anyone encountering a situation beyond their familiarity or expertise. But it is especially more risky for anyone in this circumstance andbelonging to a minority identity or group.

The risk comes directly from something you can’t often control: not being part of the majority. The harm results from the potential for your experiences, views and expertise to be discounted as invalid due to being different from those of the majority’s.

The resulting injury can be on many levels: personally you may feel the impact as a sense of low self esteem and worth, circumstantially you may experience barriers to success, and relationally you may experience a sense of less credibility or value in comparison to others.

The majority sets what’s seen as normal knowledge

In situations like the Cass report and its significant reverberations; the ‘deficit’ or ‘illness models of neurodivergence, and the well-documented dismissive healthcare experiences of people of colour; there are publicly explored or researched patterns concerning how majority perspectives and experiences influenced them.

These fit with a pattern of majority experiences inaccurately informing the baseline upon which to judge or understand the minority ones.

Evidence suggests that in these situations, each minority group’s knowledge or testimony was either discounted completely, downplayed, or reframed instead; as bias, subjectivity, or overreacting.

Perhaps in these real-life scenarios the idea of objectivity got conflated with majority knowledge.

With structural inequality operating this way, the burden of proof will naturally fall on the minority to prove their experience as valid according to the language and metrics of the majority’s structure.

But those methods may already be designed in ways that hide rather than clarify minorities experience in the first place.

In the fields of social and political philosophy hegemony is the terminology that describes how when a majority controls systems, they also control the worldview and what is seen as standard, neutral, normal and common.

By default the minority perspective then gets positioned within this structure as ‘the exception to the rule’- creating the ‘knowing and experiencing’ injustices I have just talked about.

To me this seems a bit of an absurd error, like a fish (assuming for this comparison, that we as humans are a marginalised or less informed group) telling a human air does not exist because the fish can’t see it. But it is one rooted in the distribution of power.

When is it helpful to validate or challenge?

This gets me onto my point about when it could be helpful to affirm or challenge in therapy.

I therefore don’t think there is a clear binary and I wonder if there are many interim options available to the therapist or helper before doing either? In my experience affirming too early might land as disingenuous, and challenging too early might unintentionally be received as invalidating or threatening – especially if too early means ‘uninformed’.

I have been increasingly more aware as a therapist, to be less worried about sometimes going ‘off-model’, and to remind myself to step back and question when I may be seeing (or subtly ignoring) a client’s unusual, uncommon, cultural, social, health, or spiritual etc. experience through the biased, distorting lens of hegemony – even considering my own intersectional identity.

This may apply subtly to a myriad of situations far beyond those I’ve named. I wonder if it actually may expand to any situation or identity factor where we are not accustomed to or familiar with experiencing because we often assume our knowledge as clinicians, citizens, and humans is common sense or standard?

So perhaps the epistemic role of a therapist then lays in learning the person in front of you in relation to their context, to be able to help?

Perhaps rather than only affirming or challenging it is valuable to know when to hold back, when to pitch in, when to curiously explore, or outwardly admit we don’t always know from experience, expertise or otherwise?

I have been wondering if perhaps my pull to challenge or explain could be paused more often, especially if I recognise that my knowledge and even the therapy models I use themselves may sometimes, in some situations, risk being disempowering, or even silencing.

Perhaps when we allow the words, concepts and knowledge we are given by each other to expand what we know… the exchange of words and concepts, could help us collectively understand the litany of human experiences and each other more widely?