The Gentrification of Social Work: Why a “Political Mental Health” Must be Public

My family’s been in Greenpoint, Brooklyn for over three generations. We’re a big, loud, tough working-class New York family: the kind that’ll have you crying with laughter one minute and ducking a punch the next. My father always swore to get us out of Brooklyn in the 80s, so my immediate family lived there until the socio-economic conditions shifted enough to allow my dad to hustle us into the middle class. But Brooklyn never really left us. With all our family holidays there and a generational family history, being “Brooklynese” is at the core of our family identity.

When I moved back to Greenpoint during college, I watched the neighborhood gentrify. Families who had long lived there were being priced out or dying, while “hipsters from Ohio” (as Brooklynites called them) acted like they’d just “discovered” the place. I felt a mix of anger, disbelief, and sadness as I watched the community transform, with long-time establishments and residents treated like “cool props” in the gentrifier’s “authentic NYC experience.”

I also felt shame knowing I was unwillingly participating in the economic gentrification of my family’s neighborhood. I was a middle-class (admittedly hipster-ish) student at a liberal arts school in Manhattan, whereas my family, who had never left, were working class. I regularly spent time with my family and had a different relationship to the area than others who had moved there (after all, I was born there), but because gentrification is an economic process, I was still part of it by default.

Similar complex feelings resurfaced when I transitioned from clinical social work (after being thoroughly burnt out from years of serving poor and working-class communities in New York City) into private practice as a psychotherapist working with mostly middle-class individuals. The shift was a sort of cultural and professional whiplash for me, as I had originally become a social worker to serve a different population.

What struck me most was the unsettling sense that I was participating in another form of gentrification, this time within the social work profession. A report to the National Association of Social Workers stated that 65% of social workers are in private practice. Although data related to this are notably unclear due to the profession’s lack of cohesion and comprehensive records, what is irrefutable is that the field has undergone a profound transformation in its mission and practice since its origins in the Settlement House and Charity movements, which at that time emerged in response to the poverty created by industrial urbanization.

Although social work today may seem far removed from its origins, one could argue that it still fulfills an underlying, yet undeclared, mission: providing professional advancement and opportunities for white, middle-class women; who were referred to as “the New Woman” of the Progressive Era. Considering social work’s historical alignment with capital (and its role in the social management of the poor, control of labor supply, as well as containing social unrest) its current orientation toward privatized, middle-class–focused services is a historically and structurally inevitable development. According to Roland Meinert, if you want to understand the prevailing social order at any given time, all one needs to do is look to the social work profession; this is because the profession is subject to perpetuating the status quo, given its market-based alignment, dependence on (private and public) funding, and institutional affiliations with the state.

To my knowledge, however, in most parts of the world, social workers (quite logically) do not provide psychotherapy to the affluent in private practice, but rather social services/case management to vulnerable, underserved populations. But the creation of the social work profession in the United States has been distinct: emerging and developing within a specific context, market-driven economy, and shifting political and cultural conditions. As such, certain branches of social work (most notably psychiatric social work) in pursuit of ‘professional prestige’ aligned themselves with the medical establishment, psychiatry, and the American conservative ego-psychological interpretation of psychoanalysis (unlike, say, the “Political Freudians,” Freudo-Marxists, or the social focus of the “revolutionism” of analysts in Europe; for a brief review see How Red Vienna Revolutionized Sigmund Freud).

These institutional alignments helped certain branches of social work rid themselves of the stigmatizing association with the poor by cultivating a new middle-class clientele and, as such, better “legitimize” the profession. This was professionally ‘necessary,’ given that the question of whether social work was a real profession had been ongoing since its inception. Needless to say, McCarthyism and the ensuing Red Scare further reinforced this shift toward an “individual-focused” clinical practice, aligning with the medical establishment at the expense of community services or a broader mission of social reform. And later, further changes, stemming from the shift away from welfarism towards neoliberalism, laid the groundwork for the privatization of social services and the current gentrification of the profession, in particular due to its increased focus on psychotherapy at the expense of social reform.

The shifts in the social work profession have and are having far-reaching consequences beyond the breakdown of the field. In The End of Social Work, Chris Maylea states: “The reality is that a toothless, depoliticized social work serves the agenda of the right, providing an ineffective cover for inequality while failing to address it.” In addition, because social workers are the largest group of mental health practitioners in the United States, the license’s influence on the delivery of psychotherapy is significant. One could also suggest that increased use of the social work licensure may be contributing, in some ways, to the changes in how psychotherapy skills are defined and used, in addition to the ongoing deskilling of the mental health profession.

Consider the structure of the Master of Social Work (MSW), which is a two-year degree in social work and not a degree in psychotherapy or mental health treatment, meaning it provides limited clinical and psychotherapeutic preparation. Historically, most social work clinicians recognized this gap between clinical practice and theoretical education and sought to close it through years of fieldwork with diverse populations in a variety of settings, post-graduate psychotherapy training, and/or rigorous clinical supervision. Before the shift towards neoliberal managerialism in social work, agencies typically provided rigorous clinical training and higher-quality clinical supervision. These shifts in management and funding have broken down the clinical supervisory relationship in community health settings. Historically stronger preparation (included training and supervision) was standard practice for social workers engaged in clinical case management work or community psychotherapy clinics, and/or transitioning into providing psychotherapy in private practice.

Today, however, many MSW graduates are increasingly opening private practices immediately after completing their degrees. Consequently, many are ill-prepared for clinical work, often substituting theoretical depth and experience with clinical language drawn from a patchwork of psychotherapeutic approaches, alongside “social justice” rhetoric acquired during their master’s programs. This rhetoric frequently manifests as decontextualized activist buzzwords and language, and, in contemporary contexts shaped by social media and performative identitarianism or “wokeism” (see Vivek Chibber’s definition of wokeism).

It has long been recognized and known (perhaps not often spoken about) that the social work degree has functioned for some professionals as a pathway or licensure loophole to provide psychotherapy to more affluent clients rather than as a means of serving marginalized communities. But if this backdoor route to private practice with the affluent is an open secret, why does a profession that prides itself on “social justice” avoid confronting such an obvious contradiction? The hypocrisy is difficult to ignore: a field that speaks of economic equity and advocacy remains silent about the structures and changes within its own profession that privilege affluent communities/professionals while sidelining the communities it claims to serve.

This is no longer a marginal trend, but rather becoming a structural feature of the profession, with significant ethical, material, and broader implications for the field. As social work increasingly evolves into a quick pathway into private psychotherapy for the middle classes (rather than primarily a profession serving underserved communities), it affects both the availability and quality of services for vulnerable populations. In addition, it is shaping the broader mental health field by impacting the training and theoretical orientation of a new generation of mental health professionals, who are increasingly tending towards the adoption of rhetorical, atheoretical, and/or decontextualized clinical approaches or modalities. This leaves gaps that are often replaced by consumerist logic, digital algorithms, or quick attempts at acquiring marketable therapy techniques (at two-day trainings) at for-profit CEU educational institutions.

What distinguishes the current therapeutic turn, however, is its adoption of a “justice-oriented” or “social” discourse, yet one increasingly disconnected from the reality of the poor and working classes. Many of the very social workers who might once have critiqued this shift towards individualization and privatization are now participating in these very shifts often under the banner of a reframed, “woke” aesthetic. This brings up questions that need to be explored: how do we make sense of a profession based on “social justice” ideals that is increasingly orienting itself toward the very socioeconomic strata it claims to critique? And what does that reveal about the structural and ideological function of social work and the broader mental health profession within a market economy, as well as the larger “social justice” career apparatus, especially when it is neither rooted in the public sector nor oriented toward strengthening it?

Rather than a larger professional focus on expanding access to mental health care for low-income communities, social workers are increasingly channeling the profession’s ethical rhetoric into private practice and lifestyle-oriented activism and self-improvement. Meanwhile, the material and economic realities of mental health care (especially those facing community agencies, funded by federal money and Medicaid) are mostly ignored.

For instance, even licensed social workers in private practice are drastically underpaid by insurance companies, making it increasingly financially unsustainable for clinicians to accept coverage—especially amid the personal costs of private health insurance, office rentals, cost of living, etc. Additionally, many newly graduated practitioners (despite limited experience) now charge out-of-pocket fees comparable to seasoned clinicians. As a result of these compounding issues, psychotherapy (as provided by social workers even in private practice) is becoming an increasingly elite, non-accessible service. And if these trends continue, quality (maybe even non-quality) psychotherapy will soon mostly become accessible only to the wealthy, excluding even the insured and middle classes.

This accelerated shift of the profession toward private practice is occurring alongside a broader turn toward authoritarianism, austerity, weakening of labor and environmental protections, attacks on marginalized communities, dismantling of public institutions, cuts to social safety-net programs and public funding, and the intensification of wealth concentration, processes that further marginalize and underserve the very communities social work was originally intended to serve. Thus, without confronting these structural conditions, calls to “politicize” or “decolonize” mental health at this juncture remain symbolic, serving middle-class careerism more than calls for justice or equity. Moreover, these abstract “radical” calls often promote the creation of new psychotherapy models for niche markets (signaling perhaps unconsciously that our social problems can be solved not only individually, but also via market integration) while overlooking the ideological functions of “therapy culture” for capital.

In the end, what emerges is a (largely unspoken about) contradiction: a profession once rooted in providing social services to the poor and vulnerable, increasingly reproduces the very structures of exclusion it set out to challenge, dressed now in the language of “social justice” and therapeutic comfort. The privatization and commodification of “social justice” values and the appropriation of the language of oppression are reshaping psychotherapy into a practice that increasingly obscures, rather than confronts, the material realities of marginalized and working-class communities.

I can’t help but feel the same complexity of feelings as I witness the mission and commitment of the social work profession undergoing a similar process of gentrification, just like my family’s neighborhood in Brooklyn. Fast forward to the present day, and the Greenpoint my family knew has all but disappeared—a symbolic reminder of the likely erasure of the very communities social work is meant to serve. Watching social work become a boutique profession (notably with the rise of ‘boutique psychotherapy individual and group practices’ often staffed by hip, attractive young social workers) feels like an upside-down world that no one wants to talk about, and a lot like watching Greenpoint streets transform: once familiar, replaced by high-end sushi restaurants, hip bookstores, and tattoo parlors. Similarly, in this process, the very communities whose oppression and lived experiences “give meaning” to social work’s mission are rendered symbolic, paralleling the way long-term residents in gentrifying neighborhoods are objectified as props for the gentrifier’s “urban experience.”

These patterns mirror broader cultural trends that intersect, which urgently needs to be discussed within the field. Namely, the same middle-and upper-class individuals who gentrify neighborhoods are often those performing “wokeness” and are highly invested in mental-health and “trauma culture.” As such, these discourses do not simply reflect concern; they perform socio-economic functions. As Catherine Liu argues: “Trauma culture destroys the political and historical ground on which to form a critique of capitalism. Since the end of the Cold War, it has worked tirelessly under the guise of progressive politics to depoliticize the public sphere.”

Furthermore, these same career professionals ultimately dominate the discourse of “social justice” within their professional spheres. Meanwhile, those experiencing social and economic injustice become invisible, reduced to discursive objects within a professionalized, commodified, and careerist “politics” of empathy, trauma, and “social justice.” What emerges is a profound tension between a class of individuals who dominate the language of oppression and those who experience it.

Much like gentrifiers who believe they are “helping” a neighborhood by bringing organic produce and “little free libraries,” many social workers in private practice hope they, too, are advancing “social justice,” often either unaware of the sociopolitical and economic processes they are part of.  At the opposite end are those in private practice who are more concerned with the social work license rather than the social work mission. What we need now is not another wave of performative “politicized” Instagram accounts or books, or the continued “mental health-ing” of everything, or the proliferation of new “liberatory” models of mental health care, or calls to abolish existing psychotherapeutic institutions.

The task before psychotherapy and social work at this historic moment is not symbolic radicalization or decolonial rebranding, nor for the dissemination of more niche online content creation; rather, a more strategic and reality-oriented politicization of psychotherapy, which under the current conditions in the United States, means to prioritize making psychotherapy accessible to all who need it, and practiced well by highly-trained clinicians. Achieving this requires accessible, high-quality clinical training for clinicians and a renewed commitment to public systems of education and universal health care, supported by policies of economic redistribution.

It is pertinent to note that not all psychotherapies are liberatory in nature. Some approaches (particularly those oriented toward behavioral control, coping, or measurable “results”) tend to reproduce dominant ideologies and subjects that merely “adjust.” In contrast, psychoanalytic and psychodynamic depth therapies are unique countercultural practices capable of transforming that which dominant ideology represses, as Carlos Padrón argues possessing an inherent political potentiality. Yet this potentiality cannot be realized without a congruent public orientation, lest these practices be absorbed by capital, serving to reproduce the very market-shaped subjectivities they claim to resist.

Though not a socialist, Freud himself was a self-described social democrat, who expressed concerns about the limited treatment success of psychoanalysis; he argued that it was “not the fault of therapy but rather of social institutions.” His observation that psychological well-being is dependent on social and economic structures that promote health remains valid, as they must be central to any conceptualization of a “political” mental health. Yet the contemporary therapeutic discourse has expanded far beyond anything Freud could have imagined or likely would have ever wanted for Psychoanalysis to later influence. In fact, Freud worried explicitly about America’s interpretation of psychoanalysis; he hated America and dismissively called it “Dollaria.”

Freud’s fears were prescient: psychoanalytic theories and later evolutions from it have long since been absorbed into a broader therapeutic culture industry, in which psychological language circulates as a consumable good, detached from its original philosophical, countercultural, and social praxis. In this way, the current therapeutic and “social justice” marketing of psychotherapy represents a distortion of Freud’s original theories and practice, shaped by the very social and economic forces he cautioned against that could ail us.

Arguably, what most defines our era is the combination of increasingly distorted social and theoretical realities and a massive upward transfer of wealth; distortions that reinforce one another in consequential ways as the discourses that shape our understanding of the world (in this case, on mental health) also help naturalize and cover up the very inequalities they arise from.

Just as parts of Brooklyn and other communities have been reshaped by gentrification, social work (and the mental health field), too, is undergoing its own form of gentrification. Only by reorienting not only the social work profession, but also broader mental health professions toward the public domain, by demanding investment in public infrastructures of health (while simultaneously critiquing its discursive and ideological function), can we realize psychotherapy’s political potential as a dialectical practice of liberation from the societal forces that make people psychologically and physically ill. But without a strategic focus on the public sphere, “mental health” cannot be “politicized” nor “liberatory”; it will merely continue to be gentrified.