Frontiers in Mental Health

Introduction to OTI's new publication

The vision for this journal and the future of mental health care

By OTI Founder and President Andrew Hartz, Ph.D.

The following article appears as the introduction to the first issue of “Frontiers in Mental Health,” journal of the Open Therapy Institute. Download the full issue here.

The launch of this journal marks a pivotal moment in the history of mental health care. Countless clinical issues have been neglected because of socio-political biases in the field. As a result, an untold number of patients have received inferior care or been alienated from the profession. This is now changing. As we start documenting overlooked issues, we hope to spark conversations that can address biases, develop new interventions, improve mental health care, and even tackle problems in the larger society. This project can open an exciting new chapter in the future of this profession.

Scope of the Problem

The scope of the problem is immense. Socio-political bias has led to dozens of overlooked clinical populations, likely comprising many millions of patients. These are people whose concerns are left out of most research, ignored in most training progress, and who often have nowhere to turn to find skilled therapists. The issues include:

• People who self-censor or are otherwise impacted by censorship culture

• Issues related to therapy with conservatives or others with heterodox viewpoints

• People impacted by growing antisemitism after the 10/7 war crimes

• People impacted by hateful or aggressive DEI trainings

• People impacted by DEI-based job discrimination

• Issues related to political conflict in couples, families, and institutions

• Issues related to religious patients

• Masculinity issues in dating, couples, families, and young men

• Anti-male biases and aggression

• Culturally-skilled therapy for gunowners

• Gay men and lesbians who feel alienated by aspects of LGBT culture

• People who experience anti-white aggression and bias

• People of color who disagree with dominant “anti-racist” narratives

• Heterodox views about transgender issues

This is just the start of a much longer list—a list that will certainly grow as our scholarship expands—and on each issue, we need case studies, theoretical papers, surveys, literature reviews, and treatment interventions. We need these from every theoretical orientation, from cognitive-behavioral approaches to psychodynamic and humanistic approaches, including dialectical behavior therapy, acceptance and commitment therapy, and family systems theory. There are questions for each clinical issue about what contributes to it socially and psychologically, how people experience it, how it impacts symptoms, how it manifests in therapy, how therapists could respond better, what interventions help, and how to address it at the institutional and cultural levels. In short, there are hundreds of articles and studies needed for each topic.

Given the sheer number of overlooked issues, we’re beyond the need for general articles about why therapists should try to avoid bias. Instead, this is the time for scholars to drill down into specific topics and offer insights about how to improve care. For example, we need articles like these: “Bias against men in couples therapy from a structural family systems approach,” “Interventions that secular therapists can use with religious patients,” and “Psychodynamic techniques for developing a strong therapeutic alliance with conservative patients.” Scholars need to dig into specific clinical issues and avoid rehashing generic, abstract, or intellectual concerns.

Structure and Style of This Journal

The goal of this journal is to start outlining issues and perspectives in mental health that are overlooked because of socio-political bias. Because these topics typically have minimal academic literature, the focus is on starting conversations rather than trying to provide definitive answers. To best accomplish this goal, we’ve tried to follow seven principles so that the articles can be most useful and constructive.

Exploratory

At this point in time, most articles are happening at step one of the research cycle, which includes observation, theory, and hypothesis generation. Only after this work is done can we conduct studies and develop an evidence base. This means that much of what’s presented is speculative. Articles draw on observation, the academic literature, and clinical inference, but the new hypotheses they propose will require further study. In no article does the Open Therapy Institute take an official position. All viewpoints are those of the author alone. This is necessary because there simply isn’t enough evidence to take official stances on every issue. All we can do is highlight overlooked perspectives in the hope of furthering dialogue.

Succinct

Because so many patients are poorly served, there’s an urgent need to start these conversations now. However, robust literature reviews and empirical studies would take years (and substantial funding) to complete. With this in mind, we wanted scholarly articles that have academic rigor but don’t require the work of a 20,000-word literature review or a years-long empirical study. As a result, these articles are very short for academic articles—typically just 1,000 words. They’re dense with insights and information in the hope that each article can lead to considerable formal research later.

Accessible

We wanted these articles to be accessible to an educated lay reader. We minimized jargon and avoided an overly academic style so they could be read by non-professionals. Most therapists prefer reading articles written in an accessible style, anyway. This can make articles more impactful and sometimes more conceptually clear, too.

Useful

We want insights that are actually helpful to people—not overly philosophical, ivory tower observations but practical, clinically useful insights. We hope that this can demonstrate how powerful concepts from mental health can be and how they can address myriad problems of our current moment. This is especially important for those readers who might be concerned about useless academic navel-gazing or convoluted academic speak, which we tried to avoid at all costs.

Engaging

Articles are better absorbed when they’re interesting and touch on issues that have emotional resonance and relevance to the current times, as opposed to tedious summaries.

Courageous

We also wanted to prioritize courageous authors. Topics like anti-white aggression are third rail topics in contemporary politics, but this really makes no sense. Everyone should be able to understand that racial aggression toward anyone is wrong. People who’ve experienced anti-white hate are a severely underserved population, but they deserve care. Countless important topics like this are ignored because we have social conventions that prohibit needed conversations. To address issues like these, we need candid discussions that are warm, direct, and not overly vague or defensive. It takes courage to do this, but it’s very much needed in our current era.

Positive and Constructive

At all times, we want to maintain a tone that is warm, therapeutic, patient-centered, empathic, and dialectical. When addressing potentially controversial issues, we want to avoid aggressive, inflammatory language, ad hominem attacks, and other counterproductive rhetoric. The focus of every essay is on improving care for people who are poorly served. Never is it about settling scores, attacking others, or besting supposed enemies.

This Issue

Hopefully, this first issue, co-edited by Dr. Andrew Hartz and Dr. Val Thomas, comes close to these lofty aspirations. In it, we hope to introduce the reader to problems related to social justice activism that threaten the field and to explore ways we can most effectively respond. We also want to highlight the wide range of issues that need addressing, from bias in contemporary research to cultural challenges related to politicized culture and diversity, equity, and inclusion programs in particular. We also have articles on populations that are often poorly served, including men, religious patients, and people experiencing antisemitism. In future issues, we hope it will become even clearer how many issues need attention, but this is a start.

Applications

More than anything else, this journal is about planting seeds. Each article is a subfield that’s yet to be built. We hope each article leads to op-eds, training for therapists, public speaking, research proposals, books, clinical services, and resources for the public. It can help to foster a professional community of experts who can reform the field, even developing new programs, textbooks, and graduate course curricula.

We also hope that the template is copied by other fields. Every profession should have a publication highlighting issues and perspectives that are missing because of socio-political bias— from public health, business, and education to sociology, the arts, and the humanities. We hope, too, that the style, structure, and tone of the articles can be a model for talking about difficult subjects constructively.

In psychotherapy, the exploratory process usually generates unexpected insights. As people go into more depth, they often find unforeseen solutions, new ways of framing and responding to issues, and more information that helps them develop deeper understandings. The process itself can be healing. People become more comfortable speaking candidly about important topics, which helps them think more clearly and respond more effectively.

If mental health professionals apply this same process to contemporary issues that are impacting millions of people, it could be equally transformative—not just for mental health care but for the larger society. Here’s to beginning this work.