“There is no such thing as a trauma expert. Sure, they have fancy degrees, but they basically do the same thing as my co-counsellor. Why should I pay $200 a session to get something I’m getting for free from my peers? Therapy is a patriarchal, top-down model that’s part of the problem, not the solution.”
And thus the conversation was over, between my friend and me, five years ago. She had been involved in re-evaluative counseling (RC) for a few months at that point, and was in the process of getting her bachelors in psychology. (Full disclosure: I have no direct personal experience with RC in an official setting. Many of my friends have been involved, and I’ve developed opinions about it purely on that basis.)
My own privileged social location and upbringing had led me in something of the opposite direction: there are specialists and experts who devote their lives to studying their craft, and they deserve their hefty fees because they’ve honed a skill that really makes a difference. After all, as someone who’d myself tried to open a boutique private practice charging similarly high rates for alternative care, it was important to me to believe the myth of the expert lest I fall into cognitive dissonance—or worse, the dreaded imposter syndrome.
Rethinking Trauma Treatment: New Research on Non-Specialist Care Delivery
There was nonetheless something beautiful about imagining a much flatter social hierarchy and more grassroots healing work. From co-counselling groups to all the “____ Anonymous” 12-step meetings out there, could it not be that we are meant as a species to comfort and heal each other on an even field? To listen deeply to one another, hold space and give gentle advice?
Sure, your friend might not be a brain surgeon, but couldn’t they help you change a bandage? What, then, is the psychological equivalent?
And if all you need is a bandage changed, why go to a brain surgeon anyway? If you don’t have “real trauma” (or if you can’t afford a real trauma therapist to tell you that you have trauma), what harm is there in letting your friend have a look?
In Denmark, where I’ve made my home for the past two years, there is also a significant shortage of labor in the healthcare sector. This is a deeply complicated issue that touches on the sustainability of the welfare state, Denmark’s hotly debated immigration policies, and the respect and salary due to highly-educated professionals versus less-well-educated professionals. Should “routine” healthcare tasks be passed off to less skilled workers, or better yet, volunteers? At what point do those volunteers take on more than is good for them, meaning they need more education and more pay? At what point do they take on more than is good for the patient?
Ethical Considerations for Modern Psychotherapists in a Changing Landscape
In the U.K., psychotherapeutic professions are not so regulated as in the U.S. This means anyone can call themselves a therapist. Accreditation and professional registration is entirely voluntary, putting the burden of discovery on the client. The controversy over this has recently flared up again prompted surely in part by the extraordinarily high demand for mental health treatment, and the concern that the introduction of new regulations could further reduce the number of available practitioners.
A study published March 3, 2025, in Nature Medicine seems relevant here. In it, researchers determined that nonspecialists (in this context, nurses and midwives) were equally capable of delivering effective psychotherapeutic interventions as mental health professionals, regardless whether they were delivered in person or via telemedicine. For a mental health care system that is buckling under unprecedented demand, the news that there is another labor pool that can effectively help is welcome indeed.
(As a side note, I can only imagine this is also welcome news for the population receiving care, namely perinatal mothers. But the focus of studies tends to linger there only in a quantified, abstract way.)
Evidence-Based Approaches to Expanding Mental Health Access Without Compromising Quality
But it calls to mind another recently published study from PLOS Mental Health that indicated that responses from ChatGPT were preferred to those from human therapists, as rated by clients in terms of empathy and helpfulness. Much has been made of how this advance in technology is now poised to at least supplement, if not altogether replace mental health care professionals in many contexts. Notably, AI-based (and, by plausible extension, para- and pseudo-professional) solutions may have the greatest potential to increase mental health care access in economically disadvantaged communities and communities of color, where cost and availability are often prohibitive barriers to care. Unfortunately, providing this kind of ‘second tier’ care only exacerbates the existing inequity in care.
I admit: I cherish the feeling of hope that comes from seeing a new technology help people, and I personally find it easy to give the benefit of the doubt to the people behind the mental health startups that are flooding into the yawning chasm of a marketplace that is the global population’s desperate need for mental health help. (Cynically, we might see that need as another manufactured export, or a result of manufactured exports from the U.S. — but genuine suffering is clearly there, as is a genuine desire to help.)
Continuing Education for Therapists: Integrating Traditional Expertise with Emerging Models
Similarly, I actually roll my eyes a little at the news from Nature Medicine that nurses and midwives can “do psychotherapy” effectively — after all, how could it not be helpful to receive compassion from a caregiver, whoever they may be?
And yet, I find myself unwilling to discard my respect for experts and their craft entirely on the basis of utilitarianism and the promise of mass-produced solutions. I do believe there are professionals out there who are vastly more qualified than I am, for example, in helping someone heal from trauma. And I don’t just think it’s because I’m old-fashioned: I believe in the effectiveness of skills mastered over time through practice. I believe in the benefit of having a living lineage of knowledge. And I am as deeply skeptical of commoditized and exploitative solutions to uniquely individual struggles as I am concerned about the insidious ways they get used to reinforce systemic oppression.
Join Trauma Wisdom Circle
Learn from THE experts redefining Trauma Care today with practical, actionable tools you can trust, held within a dynamic and supportive community of your peers.
Learn from pioneers and top emerging voices in trauma therapy education.
Join monthly live meetings and group discussions.
Access a growing library of expert-led on demand trainings.
Embrace new ideas, challenge outdated practices, evolve with your peers.
Client-Centered Practice: Lessons from Peer Support and Technology Innovations
I don’t have a one-size-fits-all answer. And I belong to a tradition that discourages me from hastily replacing a good question with an answer, in any case. It’s in that spirit that I’ll conclude with a story:
A couple of years ago I had a conversation with a marketing mentor of mine, in which I was trying to decide whether or not a certain tactic was appropriate. I began by saying, “well, if I imagine myself on the receiving end of this…” and he interrupted to say, “isn’t that always our job? To put ourselves in others’ shoes and empathize with how it would feel to be them? Isn’t that the only way to be effective, not to mention to have integrity? Any sentence that starts with ‘if I were my customer’ is pointing you down the right path.”
I’ve tried to take his words to heart. I know that marketing might seem a world away from therapy, but in reality they are two of the professions that most require compassion and empathy for their effectiveness. So I would ask: if you were a client (and you have doubtless been someone’s client before), what would be important to you about the mental health care that you receive?
Perhaps sitting with this question can lead us on the road to a practical compassion that is broad enough to encompass the suffering of clients, the struggles of their providers, and the interests of the healthcare system they both find themselves living with.
I´d enjoy and appreciate hearing your thoughts on these important issues, and warmly welcome comments on this article here.
Kind regards,
Ian
