I like this RSA video:
The video attacks the whole logic of positive thinking that's inherent in cognitive behavioural therapy (CBT), which trains a person how to challenge negative thoughts and feelings and how to develop positive thinking and action. This has been much associated with Richard Layard and was a new Labour fad, but it's a prevalent line of thought for the political right.
The argument for CBT is a simple one: if you're depressed because, for example, you're unemployed you've just got to develop a positive frame of mind, accept that a job on minimum wage is all you can aspire to and you're going to lose your home, family, hopes and reasonable aspirations forever, but that the positive frame of mind will make all these things seem entirely reasonable.
Candidly, that's akin to brain washing. That situation is not at all right and the only reasonable feeling anyone should have when faced with such a prospect is anger - which will inevitably turn into depression sometimes.
What's really insidious about CBT is the demand that such anger and depression be suppressed when both are sure signs something is really wrong and that real change is demanded, and that a policy of passive acceptance is completely the wrong reaction.
Get angry, I say.
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Positive Thinking and the pernicious Biopsychosocial model are all part of the authoritarian justification of the Welfare reform bill. Illness is redefined:
‘… disease is the only objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour — ‘all the things people say and do that express and communicate their feelings of being unwell’ (p39). The degree of illness behaviour is dependent not upon an underlying pathology but on ‘individual attitudes and beliefs’, as well as ‘the social context and culture in which it occurs’. Halligan and Wade are more explicit: ‘Personal choice plays an important part in the genesis or maintenance of illness’.’
http://think-left.org/2012/08/08/positive-thinking-is-a-convenient-tool-for-controlling-the-minds-of-the-masses/
This view, that illnesses such as ME/CFS, are some form of psychologically ‘wanting’ to be ill, has left the 250k sufferers without any sort of medical help or research since the late 1980s. It is beyond a scandal that such a profoundly debilitating condition has been so defined, in order to preserve the profits of the health insurance companies like Unum.
Agrred, wholeheartedly
Great video. Interestingly I’d been pondering something similar very recently. A major value behind neo-liberalism is that we all have control over our own destiny, so if we work hard enough or put our minds to it we can achieve what we want. If you believe that it also conveniently allows you to blame the victims, ignore any kind of injustice, and be free to tread on other people to achieve our goals. Plainly not everyone is in control of their own destiny, and not everyone can have a job if the sums say there are not enough jobs to go around…
Bang on Matt
It’s all a really rather nasty mind game to ensure that it’s all the victims fault
I’ve thought a lot about this one, Richard. I don’t think you’ve accurately represented CBT or perhaps represented an element as a whole. Trying to reply in the space available is difficult but I’ll give it a go. Firstly, I do agree about the Positive Thinking approach. It is not about reality and is directive. But there is more to CBT.
CBT has its place and is good in challenging unhelpful beliefs. Some people will generalize one bad experience and it becomes a pattern. There are thought patterns e.g. black and white thinking, which is only recognising two possibilities and ignoring others, which can contribute to a person’s difficulties. Many people have found CBT useful but many have not. There is no one method which suits all people.
CBT appeals to people who commission mental services. They have often done science since they were 14 and choosing their GCSE or O level courses. These people often do not rate the importance of emotional literacy. Ideas which can be represented as scientific carry greater kudos. There was a lot of evidence for the usefulness of CBT because it was widely researched by universities. However, further research has shown it is no better in outcomes than other methods. (Summary in the BACP British Association for Counselling and Psychotherapy June 2011 issue of their Therapy Today) What makes the most difference is the quality of the relationship between the client/patient and the therapist.
The National Institute for Clinical Excellence recommend CBT as the treatment of choice. They have also introduced the Increased Access to Psychological Therapies IAPTS which is a step in the right direction. I have helped deliver IAPTS courses having to use CBT methodology and there is considerable room for improvement. I am trying to open up a dialogue with the local health authority in my area about other methods. While I support your stand on the NHS, this is one area where the private sector, in my case a local counselling service, could make a positive and different contribution to the local mental health services-largely because we can be less ideological and bureaucratic.
CBT is, I think, ‘left brain’-logical conscious thoughts. . So sometimes we hear, ‘I understand now, but don’t feel any better.’ To succeed one needs to integrate the emotional or ‘right brain’ aspects
Paul Gilbert’s Compassion Focused therapy adds to CBT by recognising and working with that emotion which the religious writer Karen Armstrong argues is at the heart of all the major religions-compassion. It is part of the methodology. Obviously, other methods do also.
One other writer who is interesting is Oliver James.one of whose books is called ‘Affluenza.’ He argues that the neo-liberal economic system causes more mental illness than that of, say Denmark.
Lastly, I do think there is some truth in the proposition that many therapists focus on the individual and don’t give enough importance to the social context. The pathology is also in the system-and on that we can agree.
I think brief solution focussed therapy vastly more useful….give it a look
It-solution focussed therapy- is useful if the problem is recent or limited in extent. Some folk present with current issues which are fueled by previous events-some of which are below the level of consciousness, and there it is not more useful.
Monoculture CBT is what is offered in my area (with a few exceptions) and I hoping to arrange a conference where we can present good evidence that it needs to be broadened.
Good luck!
Richard I don’t want to take up your blog space on an issue which is not central to the good work you do. But it is possible you might find Paul Hoggett’s bit (second part of the passage below) interesting. To me it sums up a lot of what is wrong with public services today.
This is very well described by Professor Paul Hoggett at the University of the West of England. He is a qualified psychotherapist as well as Professor of Social Policy and Director of the Centre for Psycho-Social Studies at UWE. He has twenty years’ experience of researching welfare change and the politics of community life for the ESRC, the European Social Research Council, the Home Office and European Foundation.
In the British journal of Psychotherapy in 2010, in the course of an article in which he is talking about the ‘perverse social defence’, he describes the new model of government provision of public services. He calls them ‘neo-liberal’, a term used elsewhere and cites a range of sources. I help to deliver EAPs (Employee Assistance Programmes )and talk to other counsellors who do this sort of work and there is much that is recognisable. I have family members in nursing and education and one sees evidence of what Hogget says.
So sorry for the length but it repays reading.
“To try and summarize, the essential strategy was to divest government of the responsibility for service delivery by devolving delivery to an array of semi-autonomous ‘cost and performance’ centres or externalise delivery entirely to the private and voluntary sectors. Allocation of state resources became increasingly tied to how well these cost centres —hospitals, universities etc.- appeared to be performing according to an array of indicators. In this way, it was argued, competition could be introduced within the service delivery sector and costs pushed down and, in theory at least, government could be relieved of operational responsibilities freeing it up to focus on policy making, standard setting and performance monitoring. This was the ‘audit explosion.’”
He offers a simple summary “what was recordable and measurable became what was good.’
He continues with examples across the board of care plans, lesson plans and policemen spending 43% of their time in stations and only 17% on patrol.
“Increased proceduralization ensured that, where face-to-face work did occur, the encounter was itself highly regulated and subject to standardized behavioural repertoires. In some areas of professional practice, such as working with offenders, the very concept of the professional who carried a personalised case load has almost disappeared altogether as the offenders became the objects of a programme of standardized, off the shelf, intervention packages such as CBT and Anger Management, undertaken by a team of human service ‘technicians’. What progressively disappears is the idea of an encounter between two separate subjectivities in which the client/user is recognised as a unique locus of experience, a subject to be understood rather an object to be acted upon via a re-skilling and re-programming.”
In plain English he is saying that the danger is that human beings become objects of an instructional programme, he calls it ‘instrumental relationship’. The person to person relationship can get diminished by the regulatory and operating structure. I am not saying this is the case but in the framework in which we operate, it remains a clear and present danger.
I think this a accurate description
Much is reflected in what I write in the Courageous State
Re the one to one relationship: cuts will destroy this in the NHS, not least in general practice where it is vital
I think the perceptions are sound