When Fear Is Rational: Therapy in an Actively Harmful World

There are therapy training programs and continuing education courses that explicitly and implicitly teach clinicians to distrust their clients’ fears. This framework is often presented as more clinically rigorous as they focus on helping the client identify cognitive distortions, challenge catastrophic thinking, and reduce anxiety by correcting inaccurate beliefs. 

However this approach relies heavily on a singular assumption that the fear itself is unfounded. 

This assumption is not neutral. And in the current social and political climate, it is increasingly dangerous. 

What does therapy look like for someone who is terrified of a real and present threat? What does care look like when fear is not imagined, exaggerated, or distorted, but rational, evidence based, and grounded in lived experience?

These are not theoretical questions. This is the present condition of mental health care in the United States. 

In real time, many therapists are supporting clients who are navigating active harm. Some clinicians are helping people safety plan for encounters with federal agents. Others are supporting families facing deportation, surveillance, legislative erasure, or other state sanctioned violence. At the same time, there are therapists telling clients that these fears are hyperbolic, unfounded, or products anxiety, coaching them to ignore what their bodies, histories, and communities are telling them. 

I want to be very clear: when a therapist dismisses justified fear, that is not treatment. That is gaslighting and dangerous.

For years, many of us, especially those who work primarily with Black, Queer, immigrant, and marginalized communities, have argued for the necessity of an equitable, social justice informed lens in therapeutic practice. We have witnessed firsthand the psychological toll of policing, legislation, surveillance, and state power on individuals and families. We have the data. We also have the scares, emotional, financial, and professional, to show what happens when you name these realities within a fear that insists on maintaining the idea that therapy is and should be “neutral.”

Therapy has never been neutral nor unbiased.

The dominant models of mental healthcare were developed within paradigms that center white, cisgender, heterosexual, middle class experiences as the default. What is labeled “neutral” is simply what’s familiar to those with the most power. When therapists insist on neutrality without interrogating whose reality that neutrality serves, they inadvertently reinforce a paradigm that excludes vast portions of the human experience. 

To borrow from feminist theory: the personal is political. Therapy does not occur outside of social context. It never has. 

We can see this clearly when we look at a diagnosis like eating disorders. Anorexia and bulimia do not emerge in a  vacuum. They are directly connected to fatphobia, patriarchy, racism, and capitalism. Systems that assign moral and social value to thinness. People who internalize the social rule that thin bodies are safer, more worthy, and more loveable often develop disordered eating as a survival strategy. 

And their conclusions aren’t “wrong.”

Our society materially rewards thinness. That is not a cognitive distortion. It is a social fact. Any therapeutic approach that treats disordered eating without naming these conditions risks individualizing fault when the responsibility for debunking a harmful belief system is the responsibility of the collective. 

The same logic applies to children’s mental health. Rising rates of anxiety are often attributed to screen time or a deficit in their resilience, while the broader conditions of the modern childhood experiences remain unaddressed. Children are practicing lockdown drills in schools that are not protected by meaningful policy change. They are required to engage with technology and social media platforms as part of their daily education, even as these platforms are known to exacerbate anxiety. These are political decisions with psychological consequences. 

And then there’s now. 

People are scared. And their fears are valid. 

We are collectively living within dynamics that mirror an abusive relationship. There are real consequences for noncompliance. There is surveillance, punishment, and threat of force. Some people cope by aligning themselves closely with power, insisting that everything is fine, and that compliance will keep them safe. This mirrors the “golden child” dynamic in abusive families, where proximity to power becomes a survival strategy. 

Others are labeled hysterical, dramatic, or irrational for naming the danger. 

Therapy that tells people to ignore this reality, to override their fear rather than understand it, doesn’t foster healing. It fosters dissociation. 

I don’t claim to have all the answers for what ethical therapy looks like in the midst of collective trauma. But I am certain about where we must begin: Honesty. Validation. Refusal to deny what is plainly visible. 

I will not coach clients into doubting their own perception of reality. I will not ask them to override what their eyes see, their ears hear, and their nervous systems register. 

There is a therapeutic concept called radical acceptance, which refers to the practice of fully acknowledging reality, including what is painful and beyond our control. Radical acceptance is not resignation. It is clarity. 

Accepting that we are living under oppressive conditions is terrifying. It hurts. It shatters illusions of safety. But it also creates the possibility for grounded action. When we stop expending energy on denial, we can begin asking better questions: How do we protect ourselves? How do we organize? Who can we trust? Where do we invest our time, care, and resources?

This becomes the work. Not eliminating fear, but learning how to move with it.

Therapy aligned with social justice is not about preaching or prescribing beliefs. It is about practicing with integrity, accuracy, and respect for lived reality. It is about refusing to individualize harm that is collective and resisting the urge to gaslight people into believing their experiences are imaginary. 

Sustainable mental health requires more than thought-challenging. It requires attention to the conditions people live under, the systems they navigate, and the truths they are already carrying. 

Anything less is not neutrality. It is complicity.