National Nurses United has a message for the White House: “ICE messed with the wrong profession.” After intensive-care nurse Alex Pretti was killed in Minneapolis last month, the union’s members called U.S. Customs and Immigration Enforcement a “fascist, terrorizing, and lawless paramilitary force violently enforcing a white supremacist agenda.” In another statement, the union called federal immigration enforcement agencies one of America’s “top public health threats,” adding to a string of similar declarations it made about racism, climate change, and Israeli “apartheid.”
The helping professions—occupations like therapy, social work, and nursing—have increasingly drifted from their traditional roles as carers and embraced social-justice advocacy. These fields have long leaned left and female, but the skew has recently intensified, following broader trends in academia. Progressives now vastly outnumber conservatives, creating an echo chamber that has radicalized a segment of the workforce.
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One reason for the change is the work of Derald Wing Sue, a psychologist whose racialist theories upended his field. His ideology captured professional organizations and accreditation bodies and changed the character of the helping professions.
Sue’s influence began to take hold in the late twentieth century, as patient populations became more racially and ethnically diverse. Therapists faced new challenges that demanded new competencies, and Sue filled the vacuum. His seminal 1981 text, Counseling the Culturally Diverse, established him as a leading figure in the emerging field of “multicultural counseling.”
His book was less concerned with the practical difficulties of cross-cultural therapy than with its premises. Sue argued that conventional mental-health models, rooted in the values and beliefs of “White Western Eurocentric culture,” wrongly cast individuals as autonomous agents responsible for their condition. Such assumptions were allegedly “oppressive and discriminating toward clients of color,” whose psychological and behavioral problems Sue attributed to “systemic factors” such as “stereotypes, prejudice, discrimination, and oppression.” The counselor’s role, he believed, was not merely to treat the individual but to eradicate structural oppression.
Sue later popularized the concept of “microaggressions”: “slights, snubs, or insults” that target “marginalized” people. Such covert bias, he insisted, is “many times over more problematic, damaging, and injurious to persons of color than overt racist acts.” This unfalsifiable construct made Sue an interpretive authority on “microaggressions”—and carved out a lucrative niche for such “experts” in education and consulting.
Research now suggests that microaggression trainings may heighten people’s perceptions of racism in ambiguous situations. After Scott Lilienfeld warned of these risks in 2017 and called for a moratorium on such trainings pending evidence of benefit, Sue blithely dismissed him: “those with power,” Sue quipped, “enjoy the luxury of waiting for proof.”
Meantime, Sue argued in Counseling the Culturally Diverse, minorities were being harmed by “White institutions.” He rejected “colorblindness,” denounced policies that “claim to ‘treat everyone the same,’” and classified the suggestion that unequal outcomes might reflect factors beyond prejudice as a category of microaggressions labeled the “Myth of Meritocracy.” Instead of individual change, he advocated “social therapy,” in which helping professionals pursue institutional reform.
Minorities, in Sue’s scheme, possess little agency, while whites enjoy the “power to define reality” as a result of their “privilege.” He compared whites with “fish in water,” oblivious to how their “Whiteness . . . intrudes and disadvantages people of color.”
These radical premises formed the basis of “multicultural counseling.” Sue argued that, to become “culturally competent,” white counselors needed to confront their complicity in perpetuating racism, acknowledge their “unearned privilege,” and develop an “antiracist White identity.”
In time, Sue’s theories infected professional counseling and psychological organizations. By 1994, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) had begun integrating his “multicultural competencies” into its training requirements. The American Psychological Association followed suit in 2002, publishing multicultural guidelines coauthored by Sue. Twelve years later, the American Counseling Association Code of Ethics required educators to “infuse material related to multiculturalism/diversity into all courses and workshops,” and subsequently adopted the Multicultural and Social Justice Counseling Competencies, built explicitly on Sue’s original 1992 standards. CACREP updated its standards again in 2024 to reaffirm that “diversity, equity, and inclusion . . . are integral to counselor preparation and should be infused throughout the curriculum,” and to require instruction in “theories and models of multicultural counseling, social justice, and advocacy.”
Social work embraced similar principles. The 1993 National Association of Social Workers Code of Ethics introduced “social justice,” which was elevated to a core professional value in 1996. In 2008, immigration status, sexual orientation, and gender identity were added to its nondiscrimination commitments. NASW then published Standards and Indicators for Cultural Competence in Social Work Practice in 2015, invoking Sue’s language, and issued a 2021 revision clarifying expectations for “cultural competence.”
Today, accredited university social work programs must embed “anti-racism, diversity, equity, and inclusion” across curricula. Students learn to recognize their “positionality, power, and privilege,” confront oppression, and “advocate at all system levels” to reduce “inequities,” aided by Sue’s widely assigned Multicultural Social Work Practice.
Nursing may seem a less obvious target for Sue’s influence. Yet the field enthusiastically embraced his brand of racialism. Accreditation is aligned with the American Nurses Association’s Code of Ethics for Nurses, a document that calls racism a “public health crisis”; tasks nurses with “dismantl[ing] structural barriers to a good and healthy society”; and calls on nurses to “condemn all forms of oppression” and oppose “voter suppression.”
Ethical codes are blends of enforceable rules and aspirational ideals. But for students, “multicultural competence” requirements are nonnegotiable. In counseling, psychology, social work, and nursing education, trainees are judged as much on ideological alignment as on clinical skill.
Professional psychology graduate programs, for example, consider “gatekeeping”—the “initial and ongoing academic, skill, and dispositional assessment of students’ competency for professional practice”—an ethical duty. Faculty are empowered to monitor students’ compliance with ethical standards and to pursue “remediation” or “termination as appropriate” when they resist dominant orthodoxies.
Roger Scruton observed that human beings are shaped through the giving and receiving of social recognition. The pursuit of recognition is among the most powerful human drives; threats of rejection and ostracism are existential. It’s little wonder, then, that so many students in helping fields align their beliefs with progressive norms.
In higher education, helping-professional programs often consider white students like Alex Pretti inherently “privileged.” Such students are told that their lives “must become a ‘have to’ in being constantly vigilant to manifestations of bias in both [themselves] and the people around you [them],” and that “dealing with racism means a personal commitment to action,” as Sue instructed in Counseling the Culturally Diverse. In response, some white students attempt to demonstrate their moral bona fides through “antiracist” activism.
A generation of counselors, social workers, and nurses have been influenced by Sue’s racialist theories. If accreditation bodies and professional organizations change course, some counselors, social workers, and nurses would, too. But as National Nurses United’s comments after Pretti’s death suggest, change may be a long way off.
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