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Elizabeth Wilkins-McKee, LCSW's avatar

Dr. Hoff, this is a critical discussion, and as a clinical social worker with nearly three decades in the field, my answer to whether Brown's work is "in keeping" with the field is a complex "yes and no."

Let's be clear: Dr. Brown is a Ph.D. social worker. Her foundational research on shame, vulnerability, empathy, and connection is the "bread and butter" of clinical practice. It’s a direct and valuable extension of social work's core "person-in-environment" perspective and our commitment to the "dignity and worth of the person." She gave accessible, research-backed language to concepts many of us have worked with for decades.

The problem is not the research; it's the application.

This "rebrand" isn't a therapist evolving; it's a consummate businesswoman solidifying her brand as a leadership consultant. Once she hit the talking circuit, it's hard to see how she remained *primarily* a psychotherapist in practice. This is an assumption, of course, but the demands of being a public figure are all-consuming. This shift places her work squarely at the center of the most significant debate in our field today: the blurring line between therapy and coaching.

The Therapy vs. Coaching Dilemma

As clinical social workers, we are licensed, regulated health professionals trained and legally authorized to diagnose and treat mental and emotional disorders. Our goal is healing. Corporate coaching is an unregulated industry focused on performance.

The ethical "gray area" here is dangerous. When a coach at BetterUp asks a manager to "rumble with vulnerability," what happens when the root of that manager's avoidance isn't a "skill gap" but undiagnosed complex trauma, social anxiety, or severe depression?

A clinician is trained to identify this, manage the risk, and provide treatment. A coach is not. At best, they are out of their depth; at worst, they risk causing real harm by pushing someone into an emotional space they are not equipped to handle, all under the guise of "leadership development."

This is the very "commodification" I find so troubling. It's not the future of therapy; it's a lucrative exit strategy from a broken, undervalued system. And to frame this as therapy's "future" erases the past. The idea that we are just now being "invited" to address "systems, organizations, and culture" is a striking omission of the entire history of social work. This is social work. Clinical social workers, as mandated by our codes of ethics (like the NASW's), have been doing this systems-level work long before it was fashionable.

I also must fundamentally challenge your core premise that "Therapy as a profession may be shrinking."

Where is the evidence for this? All available data, like from the Bureau of Labor Statistics, shows the exact opposite: "much faster than average" growth for our field. The profession isn't shrinking; the *demand* is exploding. My own practice, infused with ideas of justice and culture, is growing, not shrinking.

Care for maternal mental health - still we have a shortage.

Care for children - still we have a shortage.

Guess what? There is less money and less attention to mothers and children. While some of you may be focusing on other communities some of the most in need are still here, still needing care and this is care that cannot be done with AI empathy.

What is shrinking is the workforce's capacity to meet this demand. The "culture eating therapy alive" isn't AI; it is capitalism: burnout, low reimbursements, and administrative burdens. What is shrinking is the number of psychotherapists trained in clinic and psychiatric settings. What is increasing is people becoming licensed and opening up their own shop...but being most interested in the worried well and the all mighty dollar. (Making money is not wrong. Yes, the worried well need care too but I didn't get into this work for that.)

The Biological Reality: AI Cannot Co-Regulate

This brings me to your concern about AI "automating empathy." This isn't just a philosophical problem; it's a biological one.

Therapy is an embodied, relational experience. What happens on a biological level between humans is not, and cannot be, replicated by an AI.

Co-Regulation:When we are in a therapeutic relationship, our nervous systems attune. This is the essence of co-regulation, where one person's calm, regulated state can physiologically soothe another's dysregulated state. An AI has no nervous system. It cannot co-regulate.

Neurobiology:Brain imaging shows that human-to-human interaction activates specific neural networks that AI interaction does not, particularly the regions for **Theory of Mind** and the mirror neuron system. These are the biological underpinnings of empathy.

Neurochemistry: Genuine, trusted human connection releases a cascade of neurochemicals, most notably oxytocin. This "bonding hormone" builds the felt sense of safety. An AI cannot trigger this reciprocal, relational neurochemistry.

That biological dance of attunement is uniquely human. An AI can simulate a response, but it cannot *be* in a relationship. (And if a day comes when it *can* trigger that neurochemistry, we have a different set of problems and probably need to pull the plug.)

This pivot simply turns "healing" into a construct for those with the most power and money. What about healing as a messy, nonlinear, human right? What about just being okay with being average? What about connection as the real, biological foundation of care?

Dr. Hoff, therapy should always have been, and for many of us has been, about what happens when you "leave the room." But leaving the room means different things to you, I think, than to me. You seem to be championing a move to a different room: the corporate boardroom. For me, and for the social work tradition, it means taking the work into the systems of justice, community, and culture that shape our clients' lives.

Of course, in a short forum like this, both your post and my response are bound to be reductionist. I hope that's something we can both own.

With that said, and honestly, enough with Brené Brown. We've read the books. We can thank her for her contributions. But it’s time to move over. There are newer thinkers, and most especially, let's take the time to listen to thinkers who are not white. Let's intentionally listen to and highlight more BIPOC theorists and writers in our field.

If we don't, psychotherapy will continue to be a field about healing people in the image of what dominant white culture is comfortable with. Yuck. This is the history of the field.

That is the far more important work to be done. It just might not make as much money.

Maxine Taylor's avatar

I deeply resonate and loudly celebrate your identification of therapy moving into a larger “room” so to speak, because the goal of therapy (in my opinion) is learning the art of building bridges over personal disconnection and grief; the better we connect with ourselves and the areas we’ve been disconnected the more effective (in a non-corporate and icky way) we are at receiving true healing that likely can only come from community. Relational wounds need relational healing, and currently the workplace is the cornerstone of most adults’ lives. This is sustainable healing, and all the tools we can conceptualize “on the bridge” in therapy as we bravely look down into the chasm of our pain, can be truly integrated on a larger and more holistic level. Fantastic piece, thank you for articulating this!

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