How Therapists Can Drive Systemic Change: Tackling Systemic Issues in Mental Health Through Advocacy
Dr. Lisa Marie Bobby is a licensed psychologist, licensed marriage and family therapist, board-certified coach, AAMFT clinical supervisor, host of the Love, Happiness, and Success Podcast and founder of Growing Self.
As therapists, we spend so much of our time sitting face-to-face with clients – listening deeply, supporting healing, and helping people create meaningful change in their lives. But every one of those lives is also shaped by something bigger: the systems they live within. And if we want our work to be truly transformative, we can’t stop at the therapy room door.
Therapists are uniquely positioned to be advocates for systemic change in mental health. We see, up close, how social systems, access barriers, and policy gaps affect our clients every day. When those systems fail, people fall through the cracks – and we feel it too.
In this episode of Love, Happiness, and Success for Therapists, I had the privilege of talking with Gino Titus-Luciano, licensed mental health counselor, nationally certified counselor, and CEO of Kokua Mental Health & Wellness Group. As president of the Hawaii Counselors Association, Gino has spent his career advocating for systemic change and expanding access to care through systemic advocacy – from shaping telehealth legislation to supporting the next generation of clinicians.
Seeing Beyond the Individual: Why a Systemic Lens Matters
Gino and I talked about something many of us experience in the field: the frustration of watching clients stabilize just enough to “graduate” from a program while knowing they still need more support. It’s painful to see potential progress cut short by policy limits, funding gaps, or rigid program structures.
As Gino shared, “It’s not just fixing symptoms of a problem, but really trying to address the core of the sickness.”
This is where systemic advocacy begins – in the moment a therapist recognizes that an individual’s pain isn’t just personal, it’s structural. By zooming out, we can start to see how the system itself needs healing, too.
This aligns with the ACA Advocacy Competencies, which offer a framework for counselors to address systemic issues in mental health through both individual and collective action. As Toporek, Lewis, and Crethar (2009) describe, effective advocacy begins with recognizing when a client’s challenges are rooted in larger structural inequities.
For more on this perspective, see Why Therapists Need to Grow Too and Uncovering Blindspots: Cultural Competence in Therapy.
You’re There
For Them.
We’re Here
For YOU.
Craving community, consultation, private practice support and learning experiences that help you grow personally and professionally?
From Frustration to Action: Systemic Advocacy in Practice
One of the most inspiring parts of our conversation was hearing about Gino’s work expanding telehealth access in Hawaii. He helped pass a bill that allows audio-only telehealth sessions. It was a small policy change, but it made a huge difference for clients living in remote or under-resourced communities.
It’s a powerful reminder that systemic change doesn’t always mean sweeping reform. Sometimes it’s one thoughtful adjustment that dramatically improves access to care.
Gino is also leading systemic advocacy around funding models that support paid internships and equitable training opportunities. He sees how supporting early-career clinicians directly impacts the nationwide therapist shortage. “If we could fund training in a way that’s sustainable,” he says, “we’d not only improve care for clients – we’d help therapists stay in the profession.”
Research supports this approach. Waite, Diab, and Adefisoye (2022) found that expanding telehealth options improves satisfaction and outcomes for clients. Removing systemic issues in mental health, like transportation or technology barriers, helps more people access the care they need.
If you’re reflecting on this connection between policy and practice, you might enjoy Is It Time to Rethink the Medical Model in Therapy? and Why Therapists Need to Be Leaders.
Healing the System From Within
We often talk about systemic issues in mental health in terms of legislation or policy. Yet systemic advocacy also starts inside the profession itself.
Gino and I reflected on how many therapists, especially those in private practice, struggle with isolation, burnout, and the slow erosion of community connection. Without colleagues to consult with, supervision to rely on, or peers to challenge our thinking, our work can start to feel heavy and disconnected.
That’s one reason I created The Growth Collective for Therapists. It’s a professional home for clinicians who want connection, consultation, and support to build sustainable, satisfying careers. We can’t advocate for systemic change in the world if we’re depleted ourselves.
If this resonates, you may appreciate Don’t Go It Alone! Therapist Isolation and How to Build Community and Finding Your Niche as a Therapist.
A Call to Engage: Systemic Change Starts With Us
Advocacy doesn’t always mean marching on Capitol Hill or writing legislation. Sometimes it looks like joining your state counseling association, mentoring new clinicians, or starting a conversation about equity in your workplace.
It’s about staying engaged – in community, in dialogue, and in curiosity about how systems shape the lives of our clients and colleagues. As therapists, we are both witnesses and participants in those systems. When we choose to stay connected and use our voices, we become part of the solution.
For more ideas on the evolving role of therapists, read The Future of Therapy in the Age of AI and AI, Ethics, and Therapy: What Every Clinician Needs to Know Right Now.
If this conversation inspires you to take the next step in your own advocacy or connection, I’d love for you to explore The Growth Collective For Therapists. It’s a space to recharge, grow, and rediscover your “why” together.
You’re there for your clients. Let us be here for you.
Join The Growth Collective for Therapists!
xoxo,
Dr. Lisa Marie Bobby
Resources:
Toporek, R. L., Lewis, J. A., & Crethar, H. C. (2009). Promoting systemic change through the ACA Advocacy Competencies. Journal of Counseling & Development, 87(3), 260–268. https://doi.org/10.1002/j.1556-6678.2009.tb00105.x
Ratts, M. J., Toporek, R. L., & Lewis, J. A. (2007). The ACA Advocacy Competencies: A social justice framework for counselors. Journal of Counseling & Development, 85(4), 387–392. https://doi.org/10.1002/j.1556-6678.2007.tb00609.x
Waite, M. R., Diab, S., & Adefisoye, J. (2022). Virtual behavioral health treatment satisfaction and outcomes across time. Journal of Patient-Centered Research and Reviews, 9(3), 158–165. https://doi.org/10.17294/2330-0698.1918
Subscribe, Share & Follow
The Love, Happiness & Success
For Therapists Podcast
