Back in February, we asked our social media followers about an issue dominating the cultural conversation: conspiracy theories. We wanted to know if conspiracy theories—which might be considered a dangerous kind of delusion—were showing up in the consulting room and how therapists were handling them. Boy, did that generate some buzz! Trying to fit every response in the pages of this magazine would be, well, practically delusional of us. But in the spirit of continuing the conversation and highlighting the range of viewpoints, we’ve collected some of our most popular ones here.

When my clients talk excitedly about political conspiracy theories and fears, my mind wanders to the stages of early childhood development. I’m reminded of a preschooler having a tantrum.

In that moment of overwhelm, there’s little cognition to mitigate the child’s feelings. I consider what a parent’s options are at these times: wait for the storm to pass; get pulled down into the child’s vortex; or ideally, help the child integrate thought with those primitive feelings.

After a tantrum, parents can help children build in cognition by processing the experience, reflecting on the effectiveness of a tantrum versus words, and discussing the logical rationale for the limit that was set—such as no cookie before dinner.

Therapists help clients build skills to maintain this kind of cognitive reality testing even under stress, and face the world with flexible coping options.

We might also encourage them to take a broader view of their subject, to evaluate themselves and the world better. Within a therapeutic relationship, I may gently share my opinion about how the media affects us at a primitive emotional level, dragging us into its vortex of panic and catastrophic thinking. This often leads us to abandon our critical analytical skills—ultimately stirring up our fight-or-flight response.

When clients tell me about conspiracy theories, I consider why they’d take therapy time to focus on them. Are the feelings overwhelming? Are they looking for reality testing? Comfort? Or help understanding their experience?

Focusing on the process, not the content, affords me the critical distance to contemplate how best to help. Often, I’ll describe how the media can manipulate us, and then question whether the situation is as dire as social media can make us feel.

After acknowledging their fear and anger, I’ll try to help my clients use evaluative thinking skills to mitigate extreme feelings.

“Is it actually so black-and-white?” I’ll inquire. “Or, as with most things, is it grayer than we might assume?”

I’ll also ask, “Does it even make sense for us to feel it this intensely? Especially when we aren’t in a position to do anything about it?”

My ultimate goal is to help my clients recognize extreme feelings, then add in reflection, evaluation, and increased reality testing so that they can have more rational control over their experiences and choices.

Julia L. Mayer, Psy.D.
Swarthmore, PA

I’d venture to guess that most therapists weren’t trained to work with conspiracy theorists. After all, who could’ve anticipated that we’d be living in a post-truth era, ushered in by a president who normalized conspiracy theories? Remarkably, a significant percentage of Americans believe that COVID is a hoax and President Biden stole the election.

In clinical encounters, we typically have a deep understanding of the conditions we treat, like depression and anxiety. I think having a better grasp of the conspiratorial mindset would be similarly helpful. Ultimately, we’re all vulnerable to believing conspiracies. For most of our evolutionary history, humans lived in small groups as hunter-gatherers, in which our ancestors had to fend off various threats. They worried not only about predators, but clashes with other tribes. The paranoiac tendency to scan the environment for potential threats would’ve promoted survival. Thus, being suspicious conferred an adaptive advantage. In keeping with this evolutionary logic, studies show that conspiracy theorists tend to have greater levels of paranoia and suspiciousness than others.

So how can we best work with conspiracy theorists in the therapy room? It seems to me that we can do this by treating the root of the problem: fears about living in an uncertain world. Fostering a positive therapeutic alliance and empathizing with their fears can help assuage anxiety. And being a consistent figure in their lives, one who’s curious about what they think and feel, can help build trust. Instead of challenging their views directly, which would likely play into a suspicion that you’re not to be trusted, it might be more helpful to mirror them and repeat their words back in a nonjudgmental manner, thereby encouraging insight into their beliefs.

As clinicians, we can help combat conspiratorial thinking outside the therapy room by raising awareness. We’re hardwired to rely on heuristics and patterns for survival, but in our modern world, social media often flood us with misinformation, overwhelming us when we’re trying to make sense of things that can be confusing and scary. While we can work with our clients to help them feel safer and more secure, it’ll take impactful policy to address the problem fully. As America confronts the increasing challenges of political division and a changing social landscape, this is more important than ever.

Vinita Mehta, PhD
Washington, DC

We know that our brains are predisposed to seek order, to create patterns out of ambiguous stimuli. Just think about how often we see faces in tree bark and animals in clouds, and engage in superstitious behaviors! Perhaps we shouldn’t be surprised that when people feel vulnerable, they’re drawn to belief systems and conspiracy theories that enable them to revise reality. Not only do they provide a sense of control, but comfort in feeling like they belong to a group of people who have privileged information. It doesn’t help that in our media-rich world, it’s quite easy to ignore information we don’t agree with and amplify the things we want to believe.

When clients expound conspiracy theories in the consulting room, I focus less on what they believe and more on the personal and behavioral implications of the beliefs. Is believing these theories causing them to lose family or friends? If so, does that bother them? Do these beliefs help them cope with a fear of change or feeling out of control? If so, are there ways I can help them develop more effective strategies for addressing those concerns?

Conspiracy theories can reflect wishful thinking because they provide an alternative to a disappointing reality. Our role as therapists is to help people find clarity and function more effectively, not make them see the world as we do. The exception, of course, is if these beliefs pose a serious threat to clients or others. The good news is that, conspiracy theory or not, the fact that clients are engaging in therapy indicates that they recognize that something in their lives needs to change.

Mary McNaughton-Cassill, PhD
San Antonio, TX

As therapists, we don’t choose the topics we discuss in therapy. Frankly, I don’t care what my client’s stance is on conspiracy theories unless that thinking is a danger to themselves or others. I don’t care if I’m working with science-deniers, antivaxxers, Trump loyalists, or far-left liberals. Rather than what we’re discussing, I’m interested in why we’re discussing it. I’m interested in the context of the topic and its relevance to the decision to seek therapy. If I cared about whether my clients’ views were informed or not, where would I draw the line? Politics? Social issues? History? The list is endless!

Wondering whether I should confront clients’ “misinformation” with “real information” suggests that I know something they don’t, and that something is wrong with their assessment. In truth, I’m probably more knowledgeable than they are about certain things, but making the determination about what’s true and false is a fine line for therapists to cross, and prioritizing my own views over my clients’ views isn’t something I believe is helpful to the work. If asked about my personal stance, I’ll engage. Otherwise, I try not to bend my clients’ will to my own thinking. A curious inquiry may naturally shift perspectives just the same.

Larry Laveman, LCSW, BCD
Solana Beach, CA