advocacy, gen z,
and a shifting therapeutic alliance

jill king

Throughout my undergraduate career, I have spent a significant amount of time doing advocacy work. I have been able to apply psychological concepts to these advocacy efforts, my work being focused on mental health and disability. I believe my advocacy work to be interconnected with psychological concepts, which impacts dynamics within therapeutic alliances. We are seeing this more and more as Gen Z engages in advocacy movements.

Diversability, a community advocacy cooperative, put it well when they tweeted, “70% of Gen Zers are involved in a social or political cause, utilizing digital spaces and technology intuitively to advocate like never before” (2023). Advocating for your community and belief system has never been as accessible as it is today. I am proud to say my generation takes advantage of this opportunity.

Pew Research Center (2020) suggests that my generation, Gen Z, is likely to be a highly educated generation, with more of us pursuing advanced degrees. These factors together create an interesting dynamic in psychiatric spaces. Keeping in mind that Gen Z is also more likely to seek out mental healthcare and report mental health concerns (Bethune, 2019). When (if) our parents went to therapy, they were far less likely to be familiar with concepts brought up by mental health professionals.

Gen Z disability, patient, and mental health advocates are highly informed, we are coming into waiting rooms prepared. We aren’t just waiting, we are preparing. Gen Z is well informed due to personal advocacy work. They also tend to be more informed due to online communities and more readily available knowledge. There is a flip side to this dynamic to consider, because the internet is full of as much misinformation as well as valuable information. If a patient has more formal education, they may be able to suss out what is quality expertise. It is important to keep in mind that these online spaces do not substitute professional care.

Even though this cannot replace care from healthcare professionals, it enables patients to take a certain degree of autonomy within their care. Because of our formal education rates, genuine sources of aid and education can be found within patient communities. Within my own experiences as a chronic illness patient, being well informed about my own care has made sincere differences in how I advocate for quality care. 

There is an unfortunate necessity to fight for quality care within healthcare settings. Medical gaslighting, which refers to the subtle dismissal of patient concerns by healthcare professionals, is discussed often in these advocacy spaces. When healthcare providers dismiss a patient’s concerns or needs, it is in direct violation of their autonomy as the person living their experience. While more often discussed in chronic illness and disability spaces, patient autonomy is invaluable within mental healthcare as well. If a patient isn’t able to utilize self determination within therapeutic alliances, this can impact the efficacy and authenticity of care.

Within mental health care and counseling, we have seen transitions towards honoring this framework over time. Having spent the majority of my adolescent years in therapy, I have felt as though the most effective therapists have been those who have balanced the line between strictly being a coach versus being teammates. The more educated and driven I have become within the advocacy world, the more I have felt my identities as patient and advocate need to merge.

This preference of mine parallels shifts within the field itself, honoring lived experiences as well as validating and processing emotions as they come. Lawson-McConnell (2020)  reviews the history within the counseling profession of how therapists have aided patients in emotional processing. Their review found that we have transitioned from focusing on cognitive approaches, by way of cognitive behavioral therapy (CBT), to today relying more on developmental attachment focuses in the therapeutic alliance. The therapeutic alliance refers to the relationship between the therapist and their patient.

Advocacy spaces certainly have their criticisms of CBT, pointing out how shifting your perspective on marginalization does not aid the patient or the advocacy movements that aim to empower them. By honoring the frustrations and hopes that advocates value, there is a chance to both positively impact the patient-therapist dynamic to move towards beneficial clinical outcomes.

There are also movements to further humanize therapists within the therapeutic alliance, for example with potential-to-experience statements. Potential-to-experience statements are statements said by the therapist that acknowledge themselves in relation to the patient, which can include some forms of self-disclosure or recognizing similar feelings or struggles. Bar et al. (2020) conducted a pilot study examining this concept in practice. They found that the use of statements in therapy that acknowledge potential-to-experience within the therapeutic relationship had positive impacts on clinical outcomes. 

I feel that if therapists are consciously aware of both (1) these advocacy movements and (2) their patient’s relationship with them, the therapeutic alliance can be molded in useful ways. Zee & Bolger (2019)  separate and define social support by whether it is visible or invisible, citing needs for both in different scenarios and positive outcomes in wellbeing. Within the therapeutic relationship, we can utilize advocacy efforts and communities as invisible social supports that can work to aid the patient in achieving rises in wellbeing. 

Visibility of social support can vary, but we see positive impacts from both forms. For some patients or circumstances, more direct (visible) support can be overwhelming or cause more distress. Indirect (invisible) support can have positive effects especially when personal motivation is high. For further understanding, see Figure 1 from Zee & Bolger (2019). 

We see similar benefits when using client-centered perspectives. Another study, this time by Sumsion & Lenchucha (2009), examined the potential of client-centered perspectives within Occupational Therapy. By working alongside a patient’s larger support system, treatment outcomes were significantly enhanced. While this study leaned on their immediate support systems (in the form of family), I believe that by utilizing advocacy frameworks and the visible social supports found there, we may see similar positive outcomes.We can see these efforts being made in the nonprofit sector and through peer support movements, Project LETS being an example of this.

We have a unique opportunity within the counseling profession to take advantage of powerful work going on within society to aid our patients. Not only can we positively impact patients on an individual basis we also have a chance to employ cultural responsiveness in a powerful, revitalizing way. As a disability advocate and future therapist myself, I implore the field to take this into consideration.

Jill King is an undergraduate psychology student at Georgia Southern University. She is also a disability and mental health advocate. Jill is the co-founder and current president of the Students with Disabilities Advocacy Group at GSU, and she is also part of Mental Health America’s Youth Mental Health Leadership Council for 2022-2023. She has done research in health and social psychology and enjoys connecting her activism and lived experience with research. You can find Jill on Twitter @jill_gking, and she’s on Instagram by the same handle. Jill’s on LinkedIn, too, if you’d like to connect that way.

Leave a Reply

Your email address will not be published. Required fields are marked *