Uploaded August 2026 | Updated September 2026, 2 weeks ago
What if therapy's job isn't to patch you up and send you back into the machine? Julie Tilsen — a longtime narrative therapist with a PhD in social construction and an emphasis in queer and cultural studies — joins Travis Heath to talk about her new book, Personal Responsibility, Inc.: How Psychotherapy Turns Society's Problems Into Yours.
They trace Julie's two decades of work in trans-affirmative therapy (and why "affirmative care" is a lower bar than it sounds), the neoliberal language reshaping how clients describe their own suffering, and what it might mean to be responsible to each other rather than just to ourselves. Along the way: George Floyd Square, Rebecca Solnit on hope, and why Julie gives her book royalties away. A conversation about what we owe each other, and what therapy too often lets us forget.
Topics & questions covered (timestamps approximate)
(01:39) Julie's background: a PhD in social construction with an emphasis in queer studies and cultural studies, and years teaching in the University of Minnesota's youth studies program
(02:51) Looking back at a 2005 conference workshop on trans-affirmative therapy that drew nearly 100 attendees — unusual for the time
(05:14) Where the field stands now on trans-affirmative care, and the researchers and practitioners doing the real work
(07:47) The parallel between "anti-racist" becoming a label people claim and "trans affirmative" becoming a label people claim — without the practice behind it
(08:27) "Show me the money": what actual allyship requires versus performative affirmation
(10:22) The four-year origin story of Personal Responsibility, Inc. — noticing how clients' language around diagnosis, regulation, and "executive functioning" was shifting
(15:52) Defining neoliberalism ("NL" for short) and how psychotherapy can unintentionally turn social problems into personal ones
(18:34) The "battlefield of neoliberalism": when self-care and regulation become about getting people back to functioning rather than asking what they're functioning for
(19:16) Why the language of "coping" doesn't quite capture it, and who is culturally expected to "stay regulated"
(20:53) Personal responsibility, reframed: "You're not a therapist, you're an un-therapist"
(25:16) Julie coins "co-responsibility" live, mid-conversation
(25:42) Why the people most eager to demand personal responsibility of others rarely apply it to themselves
(26:59) "The time of the unstory" — diagnostic labels replacing narrative, and the limits of blaming social media for it
(29:07) A concrete practice: inviting clients to describe their experience as if they'd never heard the diagnostic term for it
(35:00) A client's "buzzing" body, a tornado-siren metaphor, and how the conversation shifted from individual dysregulation to community and connection
(39:22) What to do when systemic critique feels too big to act on: shifting from "control" to "what matters"
(40:53) Rebecca Solnit on hope, certainty, and why uncertainty can hold more possibility than false confidence
(42:09) Julie's supervision philosophy: "I don't want you to be certain. I want you to have confidence."
(44:43) The closing challenge: how do you critique neoliberal capitalism while selling a book on Amazon?
(45:29) Julie's answer: donating book royalties to agencies serving queer and trans youth
(46:13) Travis's answer: radical sliding-scale fees and trying to be in "the best relationship possible" with these systems
(49:51) Is Julie done writing books? "I'm tired. I'm tired."
What if therapy's job isn't to patch you up and send you back into the machine? Julie Tilsen — a longtime narrative therapist with a PhD in social construction and an emphasis in queer and cultural studies — joins Travis Heath to talk about her new book, Personal Responsibility, Inc.: How Psychotherapy Turns Society's Problems Into Yours.
They trace Julie's two decades of work in trans-affirmative therapy (and why "affirmative care" is a lower bar than it sounds), the neoliberal language reshaping how clients describe their own suffering, and what it might mean to be responsible to each other rather than just to ourselves. Along the way: George Floyd Square, Rebecca Solnit on hope, and why Julie gives her book royalties away. A conversation about what we owe each other, and what therapy too often lets us forget.
Topics & questions covered (timestamps approximate)
(01:39) Julie's background: a PhD in social construction with an emphasis in queer studies and cultural studies, and years teaching in the University of Minnesota's youth studies program
(02:51) Looking back at a 2005 conference workshop on trans-affirmative therapy that drew nearly 100 attendees — unusual for the time
(05:14) Where the field stands now on trans-affirmative care, and the researchers and practitioners doing the real work
(07:47) The parallel between "anti-racist" becoming a label people claim and "trans affirmative" becoming a label people claim — without the practice behind it
(08:27) "Show me the money": what actual allyship requires versus performative affirmation
(10:22) The four-year origin story of Personal Responsibility, Inc. — noticing how clients' language around diagnosis, regulation, and "executive functioning" was shifting
(15:52) Defining neoliberalism ("NL" for short) and how psychotherapy can unintentionally turn social problems into personal ones
(18:34) The "battlefield of neoliberalism": when self-care and regulation become about getting people back to functioning rather than asking what they're functioning for
(19:16) Why the language of "coping" doesn't quite capture it, and who is culturally expected to "stay regulated"
(20:53) Personal responsibility, reframed: "You're not a therapist, you're an un-therapist"
(25:16) Julie coins "co-responsibility" live, mid-conversation
(25:42) Why the people most eager to demand personal responsibility of others rarely apply it to themselves
(26:59) "The time of the unstory" — diagnostic labels replacing narrative, and the limits of blaming social media for it
(29:07) A concrete practice: inviting clients to describe their experience as if they'd never heard the diagnostic term for it
(35:00) A client's "buzzing" body, a tornado-siren metaphor, and how the conversation shifted from individual dysregulation to community and connection
(39:22) What to do when systemic critique feels too big to act on: shifting from "control" to "what matters"
(40:53) Rebecca Solnit on hope, certainty, and why uncertainty can hold more possibility than false confidence
(42:09) Julie's supervision philosophy: "I don't want you to be certain. I want you to have confidence."
(44:43) The closing challenge: how do you critique neoliberal capitalism while selling a book on Amazon?
(45:29) Julie's answer: donating book royalties to agencies serving queer and trans youth
(46:13) Travis's answer: radical sliding-scale fees and trying to be in "the best relationship possible" with these systems
(49:51) Is Julie done writing books? "I'm tired. I'm tired."
