Mental health, mental illness, insanity, wellbeing, distress, madness…

Hello, my name is Phil, and I don’t know what mental illness is.

Hello Phil.

I have an MSc in Counselling Psychology, work full time as a counsellor, and I don’t know what mental illness is. Neither do I know how it differs from mental health. I have a vague, felt sense of what these terms mean, but I don’t know.

Now admittedly, the ‘psychology’ aspect of my MSc wasn’t the kind that has lab rats and Big Brother body-language experts all that, but still, you’d think someone who’s qualified to work with people who are suffering from mental distress (there’s another ambiguous term to throw into the mix) might have a firmer grasp on such basic terms as ‘mental health’ and ‘mental illness’.

But I don’t. Neither do I really understand how ‘mental illness’ differs from ‘madness’ or ‘insanity’, or what place ‘wellbeing’ takes in relation to them.

Jens_Lehmann.jpg
A layperson [niche reference which doesn’t work in gender-neutral terms]
Sometimes I feel bad about this, and worry that I’m alone in my confusion – that I’ve missed the obvious distinction which everyone else was told about while I was in the toilet. But most of the time I think we’re all just operating in the dark. If you listen to people talk and write about any area of mental health there’s a real muddled mishmash of terms and attitudes which, to me, betrays a fundamental incoherence in the way that mental health/illness is understood both by the professional and the layperson.

Part of the problem is that the world of counselling is a bit scared of ‘proper’ mental illness – the kind we meant when, as politically-incorrect children we talked about people being ‘psychos’ or ‘mental’. We counsellors often shy away from a world we’re taught to see as too serious for our woolly skills (and too physical in cause). Some of us believe that we can help people with ‘proper’ mental illness deal with their problems, but the overriding discourse says that, at a certain point, we have to pass these people on to the big boys: the psychiatrists with the ability to prescribe and to section.

So there’s a whole big chunk of people who deal in mental health but feel they are not permitted to talk about the ‘real’ part, only the minor versions around the edges. And that in itself is symptomatic of the way that mental health and mental illness are (not) spoken about. We’re always banging on about destigmatising mental health issues but there’s a big stigma – a taboo – about deviating from this woolly, all-embracing, muddled approach to mental health [there’s the opposite taboo too, which I’ll deal with below].

There’s a taboo, in other words, about being clear about mental health and illness. A taboo which comes from a good place – not wanting to say something offensive about someone who is vulnerable – but whose effect is emphatically not good. By not speaking clearly we help no-one, in the long run, and we counsellors in particular make reduce our relevance and our stake in the argument to define what counts as mental health. In the interests of clarity, then, here are some of the things I’ve come across recently that have confused me:

Mental Health = Mental Illness?

met.pngA little while ago [ed. quite a while now, I’ve redrafted this many many times, and held off on pressing ‘Publish’ because breaking taboos is scary] there was a knife attack in Russell Square. Initially it was thought to be a terrorist attack, but the next day on the radio I heard your man from the police saying that it wasn’t terrorism what done it, it was a mental health problem.

I sat up at that phrase. Mental health?

Huh?

Without ever explicitly working it out, I think I’d always associated mental health with the softer end of the spectrum – the kind of thing we feel confident to deal with as counsellors: anxiety, distress, questions about purpose and meaning, that kind of thing. I’d linked it subconsciously with things like ‘wellbeing’ – with the everyday kind of things people mean when they say that 1 in 4 of us will experience mental health issues at some point in our lives. Stuff within the normal range of human experience. Not stuff that would lead you to kill a stranger with a knife.

sun.jpgThat kind of thing I always, unconsciously, thought of as mental illness. Mental illness which was seen, when I was young (and is still in the tabloid press) a kind of bogey-man; the kind of thing that the headline writers want you to think when they say ‘mental patients’ in front pages like the one on the right.

Mental illness = madness?

When we were children, the people we referred to as ‘mental’ were the same people we’d call ‘mad’. So is mental illness the same as madness? Is one a subset of the other? Clearly in The Sun’s mind ‘mental patients’ = ‘mental illness’ = ‘mental’ = ‘mad’, in the old-fashioned sense of the word. Mental patients are killers – the kind of people whose behaviour or thought is way beyond anything a normal person could understand. Where should we stand in relation to this running-together of madness and mental illness?

On the one hand, it’s pretty reprehensible, I think. It deliberately links all manner of mental illness with threats to your (children’s, granny’s) safety with no factual basis. It plays to an inaccurate picture in order to marginalise vulnerable people in order to sell papers.

But on the other hand, the everyday language notion of ‘mad’ or ‘insane’ is less obviously reprehensible. It is hard not to think of someone who deliberately stabs a stranger as insane, almost by definition. Their actions and thoughts are so far outside the normal range of human experience that they are ‘beyond’. So does ‘mad’ mean the same as ‘mentally ill’?

Clearly they’re not co-extensive – there’s people who we describe as suffering from a mental illness whom we wouldn’t want to say are mad. Those suffering from major depression, for example, I wouldn’t want to describe as mad, but I would want to describe as suffering from a mental illness. But there is a subset of those we define as mentally ill who would also be judge ‘mad’ in normal language: those suffering from paranoid schizophrenia, for example, or experiencing psychotic delusions.

A continuum?

We seem, then, to have a continuum which runs from wellbeing at the softest end (where “we all have mental health” [which, if I’m being really cynical, seems to mean we all have emotions], through mental health, which bleeds messily into mental illness, which at its extreme is madness – the kind you can get sectioned for.

Now it may be that the policeman who set this all off just misspoke: he meant mental illness (the type that is co-extensive with madness), but said mental health. But even if he did, his misspeaking betrays a muddledness which lies just under the surface of the way we talk about everything on the continuum.

This muddle is partly borne of the fact that it’s not at all clear who decides how it works or what standards should be applied along its length – there are no authoritative authorities to defer to. And it’s made worse by the many taboos and fears in this area, which mean that we all discuss the continuum in murky, euphemistic and underhand ways.

I’ve tried to get clearer in my mind by slotting the different parts of the continuum together:

  • At the softer end we have a focus on the societal causes, as in the myriad articles and reports focusing on the pressures on Young People from social media and schools and adverts and models and so on. You also see it in the articles which address the way that we organise our working lives, arguing that better mental health (sometimes ‘wellbeing’) could be encouraged through more humane working practices. Individuals are encouraged at this level to take responsibility for their mental wellbeing/health, by seeking out counselling or rearranging the furniture of their lives. Society around them is encouraged to make space for this, as their needs are, in some sense, normal.
  • As we move down the continuum we encounter those issues which counsellors typically feel justified in dealing with – relationship crises, mental distress (a very strange term which I see popping up more and more), obsessive behaviour, minor depression, PTS, generalised anxiety, that sort of thing. In all of these the individual is held to be capable of repairing themselves in the right relationship, though the doctor might need to be called to medicate if the intensity gets too high. Notice, though, how already the focus has switched from society to the individual. There’s much less written about how the workplace can change in order to support those dealing with OCD, for example. Instead the rhetoric here is all to do with destigmatising: these people are still normal; they’re just a bit out-of-sorts. They’re still held to be responsible for sorting themselves out, but they’ll need someone to support them through the process.
  • Further down the continuum you find mental illnesses of a kind that most counsellors are afraid to work with, and most friends and relatives might consider themselves unable to deal with alone. At this ‘harder’ end you find major depression, psychoses, personality disorders, PTSD – that kind of thing. These people are less ‘normal’, and less responsible for their situation. Neither society nor the individual is held to be in any way responsible for the cause or the solution. Instead the cause is defined as genetic or chemical, their distress is made private, and the treatment imposed.

On this continuum, then, responsibility, agency, and normality are key factors. They are, in the way I’m picturing it, proportional to one another: the more ‘normal’ your experience, the more responsibility you have to sort it out yourself, and the more agency you are taken to have in doing this. The less normal your experience, the less you are seen as able to sort it out, and the less responsibility you are expected to take in doing so. In addition to this, you can add social responsibility, which is also proportional: if the individual’s needs are ‘normal’, we as a society are obliged to help them out in our everyday lives. If their needs are abnormal, we are under no such obligation.

The bleeding continuum

What seems to me to be happening now is that each part of the spectrum is bleeding into the other. The DSM-inspired hard end is encroaching on the softer middle and even the soft end, as the language of mental illness (symptoms, chemical causes, medical treatments, parity of esteem, little individual responsibility or agency) spills into the way we describe less-extreme forms of mental health issues. This comes largely from the ‘experts’ who have a vested interest in turning ever larger numbers of people into ijpatients, and use the DSM to achieve this. But it can also be seen in the way that us woolly liberals advocate for more and more expert mental health provision at all levels. While this is done from noble intentions, the effect is to imply that even lower-level problems need to be sorted out by experts, and that these problems are not the responsibility of the individual or the system they’re a part of. For example, the response to increasing levels of childhood depression has been to bring more mental health services (=, in many cases, more drugs) into schools, instead of encouraging us all to see these problems as ‘normal’ and so seeing society as responsible for changing the system that creates depression in children.

And then there’s the backlash to the hard end’s relentless march, as in this kind of headline, which seeks to reclaim mental illness as softer than the hard-end see it. They seek to limit the extent to which the common-person’s conception of mental health/illness is shaped by those at the extremes. Without wishing men.pngto get too deep into the oneupmanship of the ‘they’re not Muslims, they’re insane; they’re not insane, they’re men; they’re not men, they’re evil; they’re not evil, they’re let down by our cultural pessimism‘ Officer-Krupke bullshit, there’s an important re-balancing of the continuum away from the hard end here. Headlines like the one on the right argue that we need to push back at the definition of ‘madness=extreme mental illness’, so that those who are closer to the soft end don’t get infected by the fear created by headlines like the Sun’s.

That is, the soft end (woolly liberals) have argued successfully that lots of people at the soft end should be seen as mentally ill so that they can get treatment, and are now biting back at the hard-end because there’s a risk these people might be re-stigmatised by the focus on ‘mad’ people.  This rebalancing is vital (though it could all have been avoided if we’d come up with a different term for low-level mental illness in the first place), but because it’s being done with a sloppy attention to detail, it all ends up feeling confused and unhelpful.

ter.pngTake, for example, the article on the left. One bit of beef I have with headlines like these is that they focus an awful lot on stigma and an awful little on truth. In the call to stop calling terrorists mentally-ill (which was only done because they wanted to stop calling them religious), there’s very little interest in finding out if they actually are mentally ill. Regardless of stigma, if they are mentally ill, then failing to call them that is a regressive and unhelpful kind of self-censorship. In actual fact, the article concerned is quite well-argued: the author explains that there are many contributing factors to terrorism – that you need to take into account cultural, social, and individual purpose factors to understand how someone becomes a terrorist. In amongst all of this, though, he admits that mental health is a contributing factor, so clearly terrorism is in part a mental health issue, as well as a cultural issue, a social issue, and an individual issue. In his laudable desire to combat the way that mental illness is demonised by the tabloid press, he ends up openly contradicting himself and making an argument that will not change anyone’s mind. This kind of muddle will not help anyone, in the long run, and is intellectually dishonest.

More recently, articles concerning Donald Trump’s mental health have played the same back-and-forth game as ‘experts’ ‘diagnosed’ Trump with various conditions, and then were backlashed by those who argued it was wrong to equate evil/stupidity/meanness with mental illness. Neither side were particularly concerned with the truth of the matter: the experts wanted some official way to mark Trump’s idiocy, while the backlashers were scared that mental illness was getting yet another bogeyman added to their number. Truth, here as elsewhere, mattered little to either side, and so we ended up getting even more muddled.

Stigma

Another area of much muddle is in the constant call for reducing stigma.

I wrote about stigma a little while ago. I’m not entirely sure stigma is a bad thing. And I think a big part of my problem with the anti-stigmatas is precisely the sliding scale I’ve been banging on about. I think stigma at the softer end is by-and-large a bad thing. The fear or shame which holds someone back from talking to their GP about minor depression or anxiety, for example, is helpful to no-one. In the middle of the scale it’s less clear: stigma here has bad effects but might also provoke action (for example, the person who seeks professional help when they hear voices, in part because they know that if they told their friends they’d probably not understand). And at the furthest reaches, it’s hard to imagine why a society wouldn’t want to say that madness is not a good way to be, and society saying that it’s not a good way to be will, in someone who feels that way, induce a feeling of stigma.

When we talk about reducing stigma we’re almost always aiming our comments at the vast majority of the 1in4 who will experience a mental health issue this year. The vast majority of them are experiencing more-intense forms of the problems that everybody face: stress becomes free-floating anxiety, feeling down becomes depression, comfort eating becomes an eating disorder. These are the things that we don’t want to stigmatise, but the reasoning is wrong: we shouldn’t, as is so often argued, destigmatise them because they’re analogous to physical illness, we should destigmatise them because they’re part of the normal picture of human life – just a more extreme version. They should be destigmatised because that’s a more caring and humane way to approach them, and one which will benefit all of us as we change society to make them less likely to happen.

The other side of mental illness – personality disorders, or ‘madness’ as folk psychology knows it – is a different case. Here, we should aim to destigmatise to the extent that this helps people who are suffering take less personal, moral responsibility for their problems. But we should also make clear that these experiences are outside of the normal expectations of human life. These are like physical illnesses. But with this de-agenting (to reduce stigma) we also strip away humanity. These are high stakes to play with, and the bleeding of the analogy-with-physical-illness argument into the lower levels of mental illness is not helpful: applying the same reasoning to the 1in4 is silly and harmful and confusing.

In fact, this misplaced analogy risks stigmatising normal experience, by putting it within the purview of mental health rather than putting the responsibility on the individual and on society to make conditions more amenable to a good life. For example, one reason that someone with low-level mental health issues may feel more stigma in coming forward to seek support is precisely because higher-level mental health issues have been destigmatised and put in the same category as theirs. The same person may previously have sought changes within their relationships and habits (i.e. taken agency and responsibility for themselves) but will now be encouraged instead to privatise their distress, rendering it the responsibility not of society but of professionals.

Enough

I starting writing this six months ago, and have struggled to come up with anything coherent. I apologise for this. If you’ve made it this far, thank you for your patience.

Normally I can’t stand it when people publish things that are unedited or confused or badly-argued, and then apologise for them. It’s better not to put them up at all, until you’ve done a decent job.

But in this instance I’m making an exception, because I’ve spent months sporadically trying to put this into shape and I just can’t: partly this is because I don’t have the intellectual chops I used to, but I think it also reflects the muddledness inherent in the subject matter. It’s so confused there’s nothing to do but be confused. I don’t have a pithy conclusion, but I do feel this is really important. The only way out of the muddle, I think, is to talk openly and honestly about what we all make of mental health / wellbeing / illness / madness and try to come to a better understanding of how we, as a society, want to understand them.

South Asians and their taboos

Waiting by passport control for my South Asian partner [for that is her title], I came across an article on the BBC news website last week about South Asian attitudes to mental illness. Normally I’d skim-read an article like this before passing on to something juicier or fluffier, but having just returned to UK connectivity I was (I’m ashamed to say) hungry for digital content of any texture, so read it properly.

It was interesting enough, and had a picture of Monty Panesar at the top, which I liked. It reminded me of a simpler time in English sport, before we got good at things. But there was something in the tone of the article that made me uncomfortable.

It wasn’t the premise of the piece: the question “Why do many South Asians regard mental illness as taboo?” is a very interesting one. The way that different communities regard mental health and illness is a fascinating and important subject for public policy and private understanding. My partner and I often struggle to understand each others’ preconceptions about mental health, which are partly the products of our different cultural upbringings. Encountering assumptions that are foreign to one’s own helps one to become better aware of their contingency and arbitrariness.

South Asians – “a particular problem”

What troubled me was the way that ‘regarding mental illness as taboo’ was equated in the article with ‘wrong’, or, at the very least, ‘a big problem’. For example, the Professor man describes the large role that shame plays in South Asian cultures, and tells us that South Asians do not consider mental illness to be a medical issue, instead holding “superstitious belief[s] that there is something they did in their previous life and they’re being punished”. Later in the article a report is cited which found that mental illness issues were rarely spoken about or allowed out of the house because of fears around the status of the family, and worries about arranged marriages being called off.

The implication of these various statements is, to my mind, clear: South Asian communities are doing mental health badly. We as readers are invited to conclude with the article that it is wrong for shame to play such a large role in their culture, and for mental illness to be considered a moral rather than a medical issue. It is wrong that family status and arranged marriages are put before individual mental health.

The flip-side of them doing it wrong, of course, being that we (read: middle-class, western, mainly white) do it right. We’ve got the right balance of shame and openness, and have moved beyond primitive notions of moral responsibility to a much more sophisticated medical model (or, if we haven’t, we’re certainly working towards it through constant de-stigmatisation and medicalisation). Further, we hold – correctly, mind – the needs of the individual higher than the needs of the community.

I don’t necessarily disagree with the above arguments (I do). My problem lies with the way that the arguments are (not) made, and the way that this allows a degree of unthinking racism to be smuggled past the reader.

This may sound extreme. Read the article, see how racist it feels. Maybe it doesn’t. It didn’t to me when I read it. But that, I think, is because the article and hundreds of others like it doesn’t make its arguments explicit. If they’re held up to the light you can see how contentious the article is, but to avoid any controversy they’re smuggled through the back door, in unspoken assumptions.

The enthymeme

Hiding the most important parts of your argument in assumptions you don’t spell out is a classic philosophy trick, called an enthymeme. What are the enthymemes at work in the article? One of the main arguments being hushed through is that medicalising mental illness is a good thing. Another is that it is bad for a community to use shame to regulate itself. A third is that the needs of individuals should have precedence over the needs of family or community. There are others, especially once you get to the report, but lets stick with those three.

I’ve written before about my various beef with the first assumption, so won’t go into it much here. Suffice it to say that I think medicalisation is not obviously a good thing. At the very least, it risks narrowing the narratives available to individuals to explain and own their troubles, potentially disempowering and harming them.

But what of enthymemes two and three? Is shame a bad thing for a community to use to regulate itself? Should the needs of the individual be put above the needs of the group?

Shame

It’s easy for us to look down on shame, especially when we find it in other cultures, as it seems such an old-fashioned and anti-fun emotion. But unless you’re Carl Rogers (and I sincerely hope you’re not) there are some pretty good reasons to think that shame is essential for humans to live with one another.

For example, just off the top of my head, shame is one of the primary forces that stops me from becoming addicted to computer games. I know these are a drain on my life and cause my arthritis to flare up in ways that have terrible knock-on consequences for my physical and mental health. But it is not this knowledge that motivates me to stop – it’s the shame of being caught.

Shame is also a primary tool in the education of children. Much of the work of growing up is working out how to negotiate the balance between one’s bodily desires and the desires of others. It is shame, in the first instance, that helps a child to regulate their needs, as they seek approval from significant care-givers, and try to avoid losing this. Later on you might dress the shame up with rational argument but ultimately it’s the shame that does the work.

I know it’s unfashionable to say this, but shame does a huge amount of work in western as well as South Asian communities, as it should do. It has huge limitations, and a lot of the work that gets done in therapy is aimed at undoing unhelpful feelings of shame. But the point at which shame ceases to be useful and becomes harmful is not an obvious one, and criticising the South Asians for having a different way of drawing that line to westerners is not a useful response.

What would be useful is if the article had made clear its assumption that we’ve got the right line in the liberal West. At least that way the reader would be invited to question this, and understand the wider relevance of shame within a community.

Individual vs family

In the absence of such clarity, how might we find out how much shame is the right amount? Well, a simple way to do this would be to look at its effects: who gets hurt, who gets helped? In the article there is much focus on the harmful effects of shame on individuals, and an acknowledgement that this is often done because of the perceived needs of the family or group. The voices we hear are those individuals who have been harmed by shame, and rightly so – their voices need to be heard.

The voices that are not heard, though, are the voices of families and groups who have been helped to stay together by shame. And because of this we are not able to explore, within the article, whether or not the trade-off the South Asian communities have arrived at is a good one. As an article on a western website, the author expects us to unthinkingly accept that the any sacrifice required of an individual in the name of family or group is wrong, problematic, or backwards. But is this so?

Every culture balances the needs of the individual and the group in various ways. Obviously. Middle-class white Britain, for example, has embraced a kind of individualistic liberalism over the past 50 years which holds that family is very important so long as the individual chooses to be a part of it. We generally look up to people who sacrifice some of their own happiness to help their families (because family is important), but we do not look down on those who do not (because it was their choice). In other words, family is a good thing if and only if the individual wants it to be. In all things the individual is the final arbiter where any good is concerned.

The picture is different, I think, outside of that middle-class white bubble, but let’s not get into that now. As a white middle-class Brit, I am grateful for the freedom which individualism brings. It’s allowed me to make choices which have aimed at my individual flourishing, regardless of family or social expectations. But I also regret that some of my needs were placed higher than those of my family. For example, I was not required to visit my Grandfather when he was living in an old people’s home and, being a somewhat emotionally awkward twenty-something, didn’t choose to visit him. I regret my choices then and I regret that I didn’t belong to a culture in which my actions would have been shameful.

I regret, too, that it is not shameful for me to avoid ever talking to my neighbours, as this kind of shame would make me a better, more connected, happier human being. Without the societal expectation that I commit to something I don’t want to do, I find myself unable and unwilling to step out of my individual comfort zone and become a better person.

Ok Phil, but why spend so long pedantically tackling a pretty bland article?

Well, while the article itself may be bland, the trend it is a part of is not.

This article, like so many others we read every week about mental illness, unthinkingly holds that mental illness is a neutral object, capable of being observed free of any cultural baggage.

Mental illness is not a thing

But mental illness is not a thing. It does not exist. It cannot be treated as an object which is the same in one community as it is in another. In this respect it is not like physical illness. It is a cultural construct, as your man Foucault spent a huge chunk of his life riffing about (see this for a short, typically blinkered description of Foucault and the anti-psychiatrists). Our conception of mental illness is connected with many other aspects of our culture, including personal motivation, family structures, rituals, habits and so on. Medicalising mental health fits with Western materialistic (not in the hippy sense) individualism, but it doesn’t necessarily fit with a more collectivist culture.

By adopting a Western conception of mental illness, South Asian cultures would probably gain something (lower suicide rates, lower incidences of anxiety or whatever you’re measuring – that kind of thing) but also probably lose something. It might be that they lose something insignificant, but it might also be that they lose something of deep importance. We don’t know, because the article does not address this, and, by refusing to fess up to its enthymemes, tries to stop us from addressing it.

My gut feeling is that the price for adopting a western conception of mental illness would be pretty high. It might include the loss of established truths and norms which provide comfort and security, the loosening of family ties built through expectation and rituals of respect, and the diluting of cultural identity. Whether or not this is a good bargain is not clear, and not answerable by those, like myself, who are not a direct part of the South Asian cultures in question. And neither is it answerable by those who adopt an unthinking scientism where mental health is concerned. The ‘truth’ about mental health is ultimately not purely a physical one, but a cultural one too.

The South Asians who are quoted in the article are, to my mind, the only saving grace of the article, as they are arguing from within that their culture can and should change. These are important voices to hear. What’s missing in this article is the other side – the voices of those South Asians who value the traditional role that shame plays, for example, or who feel that the Western conception of mental health would not fit with their community in other ways. Their voices are unthinkingly erased from this account, because of the assumption that this is not a cultural issue but one of straightforward scientific misunderstanding.

Stripped of its ‘neutral’ surface dressing, an article like this which tells South Asians that they’re bad at mental health is straightforward cultural imperialism which borders on racism. That we don’t recognise it as such is testament to the power that the medicalised, individualised conception of mental illness has amongst us today. It’s become so much a part of our cultural furniture that we don’t even know it’s there.

What’s needed instead of one-sided dismissives is a genuine discussion about the broader cultural context of mental health – one which acknowledges that those on both sides of any cultural divide can learn from each other. Slating the South Asians isn’t good for them because it’s racist and plays into a stereotype of backwardness and rigid hierarchy and anti-science. But it’s not good for ‘us’ either, as it stops us from gaining insight into ourselves, and ideas from others.

Ultimately articles like this constrain rather than enable understanding. They are fundamentally conservative, and, under the cloak of ‘helping backwards Others’, serve mainly to bolster our own sense of right, preventing us from ever asking the question of the place mental health holds in our own culture: is it as good as all that? And that’s a shame.

Footsoldiers or Connoisseurs

(Paper presented at the Keele Counselling Conference on 7/5/16)

When the opportunity to present at the conference came up, my first thought was: what’s the point? Why bother? I’ve got nothing important to say and even if I did it wouldn’t change anything anyway.

For anyone who knows me and knows how passionate I am about counselling and about education and research, that would’ve come as something of a shock; I’m normally the first to jump at opportunities like this. And it shocked me as well. The more I dwelt on this shock and the negativity, the more I thought that I did have something I wanted to say: not to talk about my research, but to tell the story of doing the research – the story which ended with me feeling so negative and dis-empowered.

We’ll hear a lot of positive and inspirational things this weekend about creative research. My paper is going to sound very negative next to them, but I hope this negativity can serve a useful purpose. I hope that my story of isolation will resonate with others’ experiences, and highlight the danger that faces us when we, as practitioners, are separated from the knowledge creators. I also hope that the journey I’ve been on may gesture towards a different way to think about ourselves as professionals, and about what knowledge in counselling could mean.

Research, Knowledge and Fear

I’m going to start, then, with a very brief description of my Masters dissertation. My plan was to investigate my own identity as a white, heterosexual, middle-class man; to look at the privileges that this conferred and how I often failed to acknowledge or engage with these. I wanted to challenge my insider safety and security by involving others in the process – others who didn’t belong to the groups I belong to – others who could challenge and change me.

Fearing that any established method I chose would merely repeat and reinforce my privilege, I adopted an anti-methodological methodology. I hoped to ‘meet’ my participants, in Buber’s sense, with as few technical or power-full impediments as possible. So I sought dialogue – meeting – with Others, with no pre-set method at all except to engage and to keep on engaging. I had no criteria guiding the research except those which emerged in discussion and debate. I was the author and took responsibility for the work, but was not in complete control at any stage.

What did this look like in practical terms? Well, it meant holding an initial dialogue between myself and my participants which focused on identity (but was otherwise unstructured). Following this, both my participants and I would reflect on the transcript of that discussion and engage in further dialogue about these reflections, both via email and in person. This process would continue, spiralling hermeneutically towards a better, richer understanding of our encounters. The work would evolve in dialogue with my participants, rather than being an analysis of this dialogue.

So what happened? Well, it was a complex study, but one of the main threads that runs through the dissertation – and that I want to focus on today – is the way in which, after each dialogue, I would go away and try to understand what had occurred, and then share this attempt at understanding. And each time I shared this attempt at understanding, I would be told in response: “You’re trying to make this too clean, Phil – too final – too sensible”. I was told:  “You’re trying to understand it – to stand underneath it and justify and encompass it all”. And further, I was told that this movement was symptomatic of a privilege which seeks to encompass and erase difference.

As the piece developed, then, my participants were telling me that my goal of telling a clear story, or even of just plain understanding at all were themselves goals of a privilege which whitewashed and denied difference. I was invited instead to sit with the discord, to hear rather than understand; to allow the project to outgrow me.

I found this very difficult, and I shared these difficulties with my participants in a way which itself felt exposing and uncomfortable. But ultimately it was these moral and political criteria which led the writing of the dissertation. Ultimately I decided, in dialogue with my participants, that the moral and political imperative called upon me to include all of our voices, often uncommented upon, instead of rigorous analysis and clear explanation. I spent the majority of my allotted 20,000 words on these dialogues, and trusted to my reader that what mattered would come through in the writing.

The work was hugely worthwhile for me and, I hope, for my participants, and I don’t regret it. The learning I took away was of a moral, emotional and political nature, centring on what it means to be defined by others, and how unethical it can be to resist this. I have kept it with me and continue to learn from it.But the practical consequence of going off-piste in my research was that I got a much worse mark than I would have liked. This was the right mark, but the effect it had on me, which I hadn’t foreseen, was to feel excluded from academia.

And not only to feel excluded, but also, in a small way, to be excluded, as, without a distinction next to my name, I’m less likely to get funding for a PhD and, as I’m a counsellor, there’s certainly no way I can self-fund.

Now, this was my choice – I chose to write in a way which I knew risked getting a bad mark. But the feeling of being excluded from the bodies which create the knowledge that we as counsellors apply, set me in mind of other instances of alienation, and I realised that it’s something of a theme in my professional life.

Being a member of the BACP, for example, is for me an experience of having a distant, paternalistic instructor tell me what not to do. I feel I have very little voice in the body which represents me, and feel that it only represents the bland, quiet, profitable aspects of me.*

And this in turn set me in mind of another instance of isolation from my previous life as a teacher. Some years ago, while doing an MA in early years education, I conducted a piece of action research with my staff team. This research sought to raise our awareness of our interactions with young children and to reflect on these: to learn from the children and to learn how to learn from them. This was a fundamentally trusting, human, and relational piece of work, in which we all had a voice. And it paid great dividends, opening up new avenues of practical knowledge which would not have been accessible without this relational method. It was fundamentally lived, practical knowledge – it’s not the sort of thing that an outsider observing could have discovered. But not only did this knowledge not spread beyond us, it was soon overturned and negated by more official forms of knowledge: by initiatives backed up by extremely dubious but extremely evidence-focused research.

We had been encouraged to find our own practical knowledge, but were effectively told soon afterwards: “This is local, specific and not really proper knowledge. Our large scale studies are more important – they are more true”. In the years which followed this I found myself becoming more and more isolated from the sources of knowledge-creation in education, and, at the same time (because I was required to see and interact with my students in terms of this evidence-based ‘knowledge’), more and more isolated from the children in front of me. Eventually, the gap became too large and, reluctantly, I left.

The Risk to Counselling

Is this really a risk though? Do my own personal experiences really illustrate something larger? I don’t think counselling will ever end up where teaching has. For one thing counselling is much more private an enterprise, and a less political issue than teaching, and it has, at present, no statutory authorities. But I do think it’s worth considering what can happen when those practising a profession are completely isolated from the means of knowledge-creation, as is the case with teachers now. And there are signs that counselling is moving in that direction. For example, how is knowledge created in counselling? Who gets to say what counts and what doesn’t?

Well, to briefly divert into a little Foucault, there are many different discourses through which knowledge is used and defined in counselling. I want to focus on one particular discourse which is steadily gaining power and which I believe, if left un-engaged with, will widen the gap between the creators of knowledge and those who apply it. The discourse is that of evidence-based practice.

This is a discourse which holds that the only real knowledge is knowledge gained through randomised-controlled-trials and objective studies by neutral outsiders. It is a discourse which holds that knowledge is objective and measurable, and all that is not objective or measurable is not knowledge. This discourse has gained its power both through practical means such as the provision of employment to those who agree to it, and by broader cultural means.

On a practical level, for example, if you hope to work for the NHS – the largest employer in the UK – there’s a very good chance that you will have to accept the medical model and drop those elements of your personal beliefs which conflict with this. You will have to accept that you cannot learn from the patient, for example, and that your practice is defined by the research of others – others who measure a relationship as a series of inputs and outputs. You will have to accept that your clients are essentially lacking, and that you will fill in their gaps by operating a manual. If you don’t (or at least if you don’t pretend to), you won’t get work. Them’s the rules.

This practical power is hugely powerful, but there’s a larger societal story to tell too, about the systematic stripping-away of ideology and morality from public discourse. This de-politicising and de-moralising of public debate has left a vacuum into which the evidence-based-practitioners and their friends, the economists, have stepped. Economic impact is now the sole bottom line of almost all public debate, and so, increasingly, the knowledge that counts is knowledge which is measurable and has economic impacts. Just think of Lanyard. Knowledge of a more personal, local kind, does not count, because it cannot be measured.

This means that if you want to be engaged in creating knowledge; knowledge that matters, knowledge that has an impact, then it must be of this sort. Any other just holds no sway. Them’s the rules.

This is particularly pernicious a state of affairs in counselling, where so much of what we do – as is the case in teaching and in creative research – is about remaining open to and meeting the Other. The best of teaching and counselling and research is about a disciplined openness, in which we learn in relationship and from the relationship not about the relationship. But if you’re practising EBP you cannot be open to the client (or the child, or your subject-matter), because they are not in the evidence. And that means that you cannot learn from the client. And that means you let the client down.

As counsellors we can often end up feeling powerless in the face of the ‘evidence-based practice’ discourse: we often feel that the ‘knowledge’ created within this discourse is wrong but feel we cannot say so – we just don’t have the words.

Giving us the Words – Elliot Eisner and the Connoisseur

I want to end today by suggesting a framework within which we can start to stand up for ourselves more vocally and explicitly – a framework which will give us the words. And to do so I’m going to use a concept from the work of an educationalist called Elliot Eisner.

elliot_promotional_photo
Eisner (and a cat)

Instead of the technical or industrial approach to knowledge which we see in evidence-based practice, Eisner suggested that teachers may benefit from adopting a more artistic model of knowledge. Looking to the world of art, Eisner found that although there was no overall regulator dictating standards or evaluative criteria, there were, nevertheless, clear criteria and standards which were constantly being negotiated, developed and refined between artists and critics and audiences. And further, he found that these criteria provided enough structure for people to practice well and to improve their practice.

Within the world of art Eisner found explicit, measurable and objective criteria such as technical skill and draughtsmanship (much as we’d find in EBP), alongside criteria relating to established canons of practice and theory (and so an understanding of what knowledge has been passed down to us – much as we’d find in the ‘schools’ or ‘tribes’ approach to counselling), alongside amorphous but no less important criteria such as, for example, emotional impact and moral worth. Eisner called the person who engages with these different criteria and weighs them up against each other a connoisseur. These connoisseurs have a felt sense honed over years of direct, lived experience and dialogue, and use this engage in a community of rigorous discussion about truth, value and meaning in art. They have a shared sense of purpose, direction and practice, but within that disagree reasonably and rigorously about how to achieve those ends.

Eisner hoped to import that culture of critique and connoisseurship into education. He loathed the curricula which sought to control every aspect of a child’s experience in school. But he also distrusted the wooliness of unreflective teachers who were often just going along with tradition because it’s what we do. Education, as he saw it, was a messy human process, with aspects of culture and morality and subjective taste, as well as aspects of efficacy and science and objective research. He wanted teachers to be open to the cultural and individual, as well as the universal and rational. He wanted them to develop their own language to weigh up these different ways of judging and make informed, situated choices between them. Eisner knew that the only way that the art/science of teaching could be protected from industrialised knowledge-creation was to encourage teachers to take an active role in their own community of connoisseurs; for each and every one of them to become a researcher who could stand up for their own lived knowledge, and engage with each others’.

How does this help us in counselling? Well the best counselling is messy and human. It is a moral and ethical as well as a technical process. As counsellors we are artists but we are not just artists. We are concerned with our impact in the world and with doing counselling well. How these different aspects – these different criteria – are to be balanced is an unsolvable conundrum. But what Eisner’s notion of the connoisseur highlights is that this unsolvable balancing act is one which we must continue to debate instead of ceding, frightened, to one particular discourse. It gives us confidence, I hope, to engage in this debate – to say, unashamedly: “My standard of judging is potentially more important than yours”. To say “I understand things from the inside which you, on the outside, cannot grasp, and vice versa”. To face up to the EBP and engage with it rather than rejecting it out-of-hand, or slavishly submitting to it. To place the lived relationship and therefore the client at the centre of our work and to learn from these, arguing once again in our clients’ best interests.

The notion of the community of connoisseurs gives us a language through which to place practical knowledge on a par with technical knowledge, and to take back some control of our work. It gives us confidence, I hope, to acknowledge the compromised, messy nature of relationship, and to reject the totalising, manualising impulses of industrial knowledge where they are inappropriate.

My Journey to Keele

Which brings me to the closing remarks of my paper, and the question: how do we get to a position in which our voices as connoisseurs can be heard?

The battle has been lost – for the moment – in teaching. I left the profession because I felt I was not enough, and that there were too few people to fight with, and too few words with which to argue. But we are fortunate that we already, in counselling, share aspects of connoisseurship in, for example, the supervisory relationship, and in conferences like this, today. This conference is an opportunity for connoisseurship; for us to find our voices. We won’t find our voices by looking above for someone to give them us: we need to look towards each other, and stand up for – and to – each other. But the point I want to leave you with is that we have to look outwards as well as inwards – to those who disagree as well as to those who agree. If our situated, creative local knowledge matters we need to be saying that to others as well as to each other. We need to stand up together and say: “This matters. It is important. You need to listen”.

Part of my journey has been to expose myself here today and to say: my research was worthwhile because, in that instance, the moral and political were worth more than the analytic and judgemental. The lived-experience was more important than the mark scheme. Part of my own journey has also been to switch from the academic route into blogging as an avenue for reaching more people outside of the bubble of those who agree with me: turning out as well as in. Which seems like a very good place to stop and turn outwards to you for questions…


* After I presented this paper, I attended a keynote presentation by Andrew Reeves (of BACP chair fame), and my views have somewhat changed. An article based on this paper will briefly explore this in an upcoming issue of Therapy Today.

Ethics, consequences, victims

Gideon’s little brother is a psychiatrist! Who would’ve thought it? Fair play to the plucky youngster, going against the family grain, dedicating himself to people instead of mone… Oh, hang on. No, Gideon’s little brother is the kind of psychiatrist you read about in Against Therapy – the kind you thought was a thing of the past. Gideon’s little brother has twice been reprimanded by the medical profession, once for falsifying prescriptions for and ‘escort girl’ (prostitute, no?) (6 month suspension(?)), and more recently for engaging in the archetypal therapist  whatever-you-do-don’t-do-this behaviour: having an affair with a patient whom he later dumped, then threatened in order to keep her quiet. She attempted to take her own life on three occasions following the end of the ‘relationship’. To me this is akin to a secondary school teacher taking advantage of a sixth-form student – it has the same power imbalance and, depending on the patient, a similar degree of vulnerability. I’d expect a custodial sentence. He didn’t get one. He got barred from working as a psychiatrist again (good) at a hearing he didn’t even have to turn up to (bad). He has ruined someone’s life through the wilful disregard of pretty much every rule in the book, and doesn’t have to face any serious consequences.

The case reminded me of the kerfuffle over Hogan-Howe and the over-zealous investigation of child-sex allegations. I don’t want to get into the rights and wrongs of the way that “believe” is interpreted by idiots, or the, in my mind pointless publishing of suspects’ names. What I’ve found anger-making is the way the story so easily focusses on high-profile establishment victims (retired heads of army, etc), and finds it so hard to focus on the many thousands of voiceless victims, who continue to be abused and unheard. Yes, it’s bad that your man who was a rank in a thing wasn’t told that the investigation had been dropped. It sounds horrible; I can’t imagine the disruption to his and his family’s life. Honestly, awful. I’d not wish it on anyone, and it was handled badly. But it just does not compare in any way at all to the experiences of those children who have been abused by high- or low-profile adults. The time given to each is hugely disproportionate, and, frankly, cowardly in the extreme. The space given to the victim of Gideon’s little brother’s callous misconduct is tiny – the extent to which justice could be said to be done by his disciplinary hearing is non-existent.

Anyway, in amongst all of this slightly coherent anger at the way that the disempowered are ignored as soon as they can be, I felt a warm fuzzy feeling that I am now working in a profession (counselling; very different to psychiatry) that takes its ethics seriously. Engaging with the ethical framework and reasoning our way through dilemmas related to this was a large part of my training as a counsellor. Unlike the psychiatrists who are only out to protect their own, our conduct always comes back to the client at its centre: we are governed by the interests of the person who has the least power and the quietest voice. Warm and fuzzy I felt to belong to a profession which takes its ethics seriously. So seriously that, as trainees and recently qualified counsellors we’re terrified of trying anything new or different or client-led, because the sanctions for behaving unethically are, we imagine, so stringent.

Warm and fuzzy, then, until I saw this – the proceedings of the disciplinary panel of the BACP (for anyone who doesn’t know, the BACP is the de facto regulator of the counselling profession. Joining it is not mandatory, but it’s exceedingly difficult to get a job if you’re not a member). I expected to see lists of people being struck off, referred on to criminal hearings, or, if culpable of lesser misdemeanours, having their work monitored and their fitness to practice rigorously assessed. I expected to be able to read these in an easy to find part of the BACP’s website – they don’t appear in the magazine because presumably they’re too numerous. But no, what I saw instead (and you can see too, if you can battle your way through the deliberately hard-to-read pages of tiny, awfully-written text, found in a shed round the back of the website) is a list of people who behaved pretty awfully being given essays to write.

Essays.

“What you did was wrong, and I hope you’re very ashamed of yourself. Now I want you to write me 1000 words on the subject: “Why what I did was wrong, and why I promise I won’t ever do it again'”.

It sounds like I’m joking, but I’m not, Yvonne. Yvonne took in a client who had recently had a stillbirth. The client was told she was an expert, and presumably hoped to work through some of her traumatic experience with Yvonne’s help. When Yvonne arrived, though, Yvonne spent the first 15 minutes telling her client about her broken leg, and how she got it on holiday. When the client tried to turn the conversation back to her stillbirth, Yvonne went on to describe the unsatisfactory experience she had at hospital with her broken leg. Other things happened which I can’t even grasp as the report is written so thickly.

Not abusive behaviour, Yvonne, but I certainly wouldn’t want to go to see you if I were in a vulnerable state. Nor do I want to belong to the same club as you. Fortunately the client complained and her complaint was upheld. I’d presume that she’d be removed from the BACP until such time as she could demonstrate her fitness to practice. Or that she would be required to work with someone monitoring her practice to ensure she was not continuing to practice in this harmful way. But instead she’s told that unless she writes an essay in the next six months and say you’re very very sorry, she’ll have her membership to the BACP revoked.

I don’t want to come across too facetious here: regulation is a difficult and complex question. I like that counselling is not regulated by government. Having experienced ofsted in education I know that the evils of over-regulation far outweigh the evils of self-regulation. And, to be fair to the BACP, they do revoke your membership if you fail to write the essay, have an affair with a student (I’m looking at you Mr Pickles) or are convicted of child sex offenses (Mr Fothergill). That’s something, but it’s not nearly enough. The hidden, apologetic, essay-requiring approach by the BACP feels so very self-serving.  An organisation which was set up to serve clients rather than counsellors would shout from the rooftops about its investigations and be ruthless in removing or retraining counsellors who are incompetent and dangerous. It does neither, and thereby lets us all down.

Teachers Case Discussion Group

Supervision is a bit of a buzz-word in the public sector at the moment. I’ve heard about it being rolled out for mental health professionals, nurses, social workers, special needs practitioners and those with responsibility for child protection. I’ve heard about excellent practice that is human and responsive and helps people understand their work better, and I’ve heard about awful practice which is little more than a box-ticking exercise, and which does more harm than good. I have written here and here about the need that I believe exists for supervision for teachers, but what form should it take?

Compulsory Individual Supervision

Personally, I have found that one of the reasons counselling supervision works is because it is compulsory. For every 8 hours I work with clients, I need to see my supervisor for an hour. This means that even in those weeks when everything appears to be going along just fine, I still have to discuss my practice. Invariably it is these sessions that yield the most in terms of professional and personal growth, as they allow me space to think about myself and my work in broader terms rather than focussing on problem-solving. In these sessions I have found my consciousness raised, as more aspects of my personality and beliefs are challenged and integrated into my identity as a counsellor. I have found myself questioning fundamental assumptions and developing a more nuanced, open, human understanding of my work.

Of course, teachers are not required to seek regular supervision, especially not of the consciousness-raising kind. The state has returned us over the last 5 years to a model of teaching which Elliott Eisener called the industrial metaphor. Within this teachers are cogs on an assembly line, applying best-practice efficiently in order to churn out the kind of economy-fodder that will get us ahead in the global race. Cogs do not need to know why they are doing what they are doing. Cogs do not ask questions about the value and meaning of the work they are doing to children, so supervision (unless it can be shown to be best-practice) is not likely to become an integral part of teaching. Anyway, soap-box aside, the only way to create compulsory supervision would be to work within a school which made it an integral part of their system. This is appealing, but would take the kind of strong leadership which, in the current climate, is not always evident. In addition, supervision provided under the auspices of a school – even if the supervisor was independent – runs the risk of being seen by supervisees as another tool of management, or part of the performance-management regime. As a counsellor, my supervisor is not connected to my workplace in any way, so I can discuss institutional issues without any fear of reprisals or conflicted interests.

Elective Individual Supervision

So, compulsory supervision is out, for the moment, but what about elective supervision? I recently moved to Birmingham and have started working with a new counselling supervisor. Trawling through the counselling directory, I was surprised by how many supervisors offered their services for professionals other than counsellors and psychotherapists, including teachers. So the option is out there, but I wonder how many teachers know about it, and if they did how many would feel confident talking to someone from the murky world of counselling about their work. As I struggled with the decision to leave teaching two years ago, paying to talk to someone outside of education about my fears and worries would have felt too much like an admission of failure, and far too risky.

Balint Groups

If individual supervision is unlikely, what about group work? Although groups can be more daunting than one-to-one supervision, there is also safety in numbers, and the potential for solidarity. Indeed, there is a strong tradition of group supervision in counselling and healthcare, and it is from this tradition that the Teachers Case Discussion Group has emerged.

Michael Balint was a psychoanalyst who, with his wife Enid, developed the Balint group – a method by which GPs (but increasingly groups of other professionals) could discuss and engage with their experience of their work. Without going into the theory too deeply, the aim was to help GPs understand themselves, their patients, and the relationship between them, better. The group leaders would thus focus the discussion, but would not offer advice or solutions.

The Teachers Discussion Group

teachers case discussion group 1.4-page-001Joan Fogel and I have set up a group based in part on Balint’s work, at the Tavistock in North London. In practical terms, in the teacher group the sessions proceed as follows: after the group members introduce themselves, one person offers to discuss a case that is troubling or interesting them. The case might be a particular pupil experienced as challenging, or relationships with staff or parents, or broader concerns with the education system. The speaker is encouraged to explore in as much detail as they can the lived experience of their case. The group may ask factual questions to flesh out the specifics of the situation, but aside from this there is at this stage no interaction.

Their story told, and factual questions answered, the speaker is invited to move their chair back slightly, symbolically leaving the circle of the group. From this slight remove the speaker follows the discussion that the group begin about what they have heard. The facilitators do not lead the discussion, but ensure that it focusses less on recommendation or critique, and more on group members explaining how they were making sense of what they had heard: what resonated, which words made an impression, what memories were triggered? Although there will be a lot of teaching expertise in the room, the facilitators aim to create the kind of space where participants can sidestep the performance management emphasis on accountability, achievement and efficiency, and open up a more human dialogue about teaching – one which they own and define for themselves. The emphasis is more on empathising and making sense than trying to solve problems.

Following this reflective discussion, the original speaker is invited to return to the circle and pick up on anything s/he has noticed, felt, or wishes to share. At this stage the discussion is less formally delineated and may take many different forms, though the facilitators will ensure that the discussion remains non-judgemental.

This process is repeated with another case from a different group member. Over time everyone has the opportunity to present their own cases and so benefit from the reflections of others. However, many participants find that hearing and empathising with others’ stories is of equal value. As the group grows and develops, participants will often offer brief updates from previous sessions, sharing what has changed (or not) for them.

It is the group that does the work in the Teacher’s Case Discussion Group, but the facilitators have an important role to play too. They create the space in which people can begin to feel confident to let their guard down, and they monitor the discussion to ensure that it continues to remain safe and non-judgemental. Beyond this, they also have an eye to the dynamics that exist within the group, and to what these might tell us about the case in discussion, and about the members of the group more broadly. This attitude is based in Group Analysis, which pays close attention to the way in which unconscious processes may play out in personal processes or organisational issues. For example, the facilitator may note the way in which a presenter who feels unsupported by their colleagues may feel similarly towards group members. Or, if the presenter feels frustrated by a pupil, the group might consider the possibility that that’s how the pupil might be feeling.

Challenges and the Future

The main difficulty of getting a group like this up and running is that those who would get the most out of such an opportunity are those who are least likely to have the energy and resilience to take the risk of joining. I know that I would not have exposed myself in this kind of setting when I was at rock-bottom, or even half-way up: I was too concerned with getting through and surviving. I was too afraid of opening up and being swamped by what lay beneath. Although the feedback when we first advertised and discussed this group was overwhelmingly positive and enthusiastic, take-up has been less so. This is not necessarily surprising; we understand and are resigned to the fact that it takes groups like this time to become established, but it is frustrating to think of those who would benefit greatly from having such an opportunity feeling too isolated to take it.

There is also the question of stigma. Within teaching it is expected that you will find the job draining and difficult, but it is also expected that you will suck it up and soldier on through. You have the holidays to recover, after all. Even if I had felt able to seek this kind of support, I wouldn’t have felt able to admit it to my colleagues.

That said, the response has been optimistic, and there are a number of people across the country who are passionate about starting up groups like the Teachers Case Discussion Group. Hopefully these will contribute to a change in the culture of teaching which re-empowers those who engage daily with our nation’s future, rather than waiting for change to appear from above.

Supervision for teachers

One of the reasons I left teaching a year ago was the emotional burden of the job. I’ve already written more than enough words about that decision, so won’t bang on about it now. But something has occurred to me about teaching as I’ve been studying counselling: teachers need, no, deserve supervision.

At the time I left, I felt that although I could talk about the worries, stresses and anxieties (as well as the joys) of teaching, it was safer to keep these bottled up, reined in. Let a little out, I feared, and you risk being overwhelmed. Much better to keep it all under wraps until the next holiday, and then do your best to forget about it.

I’ve just about finished my counselling training, and feel like I’ve learnt either a lot or near enough nothing, depending on what day of the week it is. But one thing I have definitely learnt is that, more often than not, the fear of being overwhelmed by the emotional burden of work does not play out. I’ve learnt this not through theories about personality (lies), but through the process of supervision.

For those who are not familiar with the term, within counselling/psychotherapy supervision refers not to line-manager type stuff, but to the process of unpacking the emotional burden (this seems an unnecessarily negative word; sorry) of working with clients, generally with someone who does not work with you or know your clients. In my case, this means going to someone’s house (not just anyone – a counsellor who has a lot of experience) once a fortnight and talking through any worries and anxieties I may have about my counselling work.

It works, and it works because of trust.

Although it’s called supervision, and is compulsory for counsellors, it embodies a trust in the individual which ofsted would decry as unaccountable: there is no reporting procedure, no set of standardised descriptions which counsellors must meet, and no mechanism for public humiliation. My supervisor does have a role in ensuring the safety of my clients, and would challenge me if she thought they were at risk (or take her concerns further, if she thought I was reckless in response to her challenges), but the emphasis is on dialogue, not judgement. The expectation is that I, as a counsellor, will be able to work out problems and anxieties in that dialogue, and will be proactive and responsible in self-examination. And I am, because I am trusted, and because I can talk within a safe, confidential space about things I would otherwise bottle up.

I don’t want to get into an argument with myself about the rights and wrongs of ‘accountability’, but it has struck me throughout the year how useful supervision of this kind would be for teachers. Teachers are required, daily, to engage on an intensely human level with incredibly difficult and moving situations. More often than not, even in supportive schools such as those I worked at, the nationally-instilled culture of fear curtails any serious attempts to open up these experiences. There’s always another lesson to plan, and this always takes precedence. If you’re lucky, like I was, you will have colleagues with whom you can open up your fears of inadequacy, but even then I backed away from really opening up, fearing the fallout from that. If you are not you can be left hopelessly isolated.

teachers case discussion group 1-page-001One of my plans, once I am fully qualified, is to establish a mechanism whereby teachers can access supervision outside of the systems of accountability, performance management, and professional development. It will be a space where teachers can share their anxieties, puzzlements and troubles without fear of judgement.

With some of the fear lifted, teaching could once again be the rewarding profession it should be; the same challenges and problems and joys and successes, but without the fear and isolation. And, most importantly, a better, more human education for the children we teach.

In the meantime I am very excited to be co-facilitating a case discussion group for teachers, which will provide many of the benefits of supervision – perhaps more. Please share with anyone you think may be interested, or get in contact if you would like to join.

Forgetting

I’ve been meaning to write something about forgetting for a while, but I keep on forgetting AHAHAHAHAHAHAHAHAHA.

HAHAHA.

Ha.

Ugh.

Of all of the hippy, wishy-washy, jumper-wearing things I’ve done this year while training to be a counsellor, getting in touch with my inner child has to come pretty high up the list. I’d like to say that was my inner child taking over the beginning of this post, but he was never that funny – he preferred working through maths problems and burning things.

In a therapy session recently my counsellor took the wooliness a step further and suggested I might want to make contact with my inner teenager. Masturbation jokes, and a naturally cynical queasiness around notions of inner/outer aside, it was enlightening. I’d written off my inner teenager’s concerns with authenticity as gauche, his creativity as derivative, and his emotional intensity as self-indulgent. Actually, he had quite a lot going for him.

1490603_10100103277772681_1986852830_o
There was a lot to forget or ignore in my teenage years. I never realised I looked like this, for example.

What I like most about him is how automatically he forgot things that were harmful to him. He didn’t dwell on crap, or get taken up in self-destructive cycles of self-undermining thought, because he was never aware of them in the first place. Sometimes his lack of awareness went too far – the protective mechanism censored too much, making him at times callous or ignorant. But his life had an immediacy and a naturalness which I envy.

Little Freddy Nietzsche said it’s our ability to forget that sets us apart from the animals – our ability to be selective in what we learn from and what we ignore. Where animals learn ‘lessons’ from obscure stimuli which will never be repeated, humans, he reckoned, don’t. We’re selective, and instinctively so (unless you’re a little baby with a metal bar being struck behind your head). Nietzsche also said “Beware the golden trellacework”, though, so I guess you have to take it with a pinch of salt. Freud stole the idea (of forgetting, not ornamental gardenware) and invented a complex machinery to explain the processes of forgetting what we actually know, and although he recommended unearthing some of the more pernicious unknown-knowns, he thought we could never properly integrate in an open and fully conscious way that which drives us. CBT and Buddhism do the same thing with varying degrees of explicitness, instructing us to unknow and ignore that which is not useful, and thereby to become more effective or at-peace.

This is all well and good so far, Phil, but when are you going to slag off therapy?

Now.

Because along came your man Charlie Rogers, and pretended to be above all of this human-bashing, holding that the more you come into contact with what you’ve ignored/forgotten/suppressed the better and purer you’ll become. Very much the last gasp of the enlightenment belief in emancipation through truth, Carl wrote his case-history from the viewpoint of the victor, attributing all advances in therapy to a closer contact with emotional truths. And of course, clients will often say that they feel they’ve uncovered something fundamental and true about themselves and that this is why they feel better (especially if we’ve been using language of depth and essence and authenticity in our non-directive reflections). Carl was sure this was the case because humans are just good, innit. God told him so.

A better story, which occurred to me when I was listening to this podcat, is that maybe what happens in all therapy, including person-centred, truth-centred therapy, is that we learn to forget things that are not helpful.

//www.radiolab.org/widgets/ondemand_player/radiolab/#file=%2Faudio%2Fxspf%2F91618%2F (I thought this would embed as a nice little player thing, but it didn’t. Sorry.)

It occurred to me that although the person centred therapist focusses on what new truth (lie) is discovered, maybe what’s doing the real work is the old lies (truths) that are forgotten. To be fair to Carl he did notice that it’s in lifting the burden of previous truths that helped his clients feel free. It’s just a shame that he went the step further in claiming that they were getting closer to the truth.

Nietszche said (every time I write “Nietzsche said” I hear my voice as a snitching inner child – “Miss! Miss! Nietzsche said that women are slow and stupid!”) that the stronger we are the more we are able to realise the truth, which is that it’s all lies, or something. He definitely said something (“Fraulein! Fraulein! Phil is pretending to know more about Nietzsche than he actually does!”). Look, my point is that it doesn’t matter so much that truth-discovery might be a lie – it might be a really good way to free people of other lies.

(Incidentally, every time I write Carl, I picture this guy (not safe for your work):

)

Anyway, I like very much my teenager’s ability to live instinctively, forgetting or ignoring that which it benefited him to ignore or forget. In Nietzsche’s terms, he was a bit of an ubermensch. The problem with the ubermenschen, of course, is that they’re twats, and the model for the Nazi’s blue-eyed beasts. It’s great as a period to go through, and I’ve enjoyed getting back in touch with the lad, but it’s not a way to live. Plus, I got old and insecure (I… grew up?) and don’t have the instinctive faith I used to. Which is a good thing – it would be very easy, from a position of privilege, to go through life ignoring – for example – the way that society is set up to benefit me. This would be an instinctive area to cultivate ignorance, but it would be wrong. Nietzsche never had to put up with the exigencies of reality and friendship and love because he never had any of those things. He had his pure strong truths precisely because he couldn’t handle messy, involved ones.

So, I’ve come to a new accord with counselling/therapy – for me it’s a way to sift through the lies and have new stories imposed or negotiated upon the old ones. There’s no underlying truth to discover, but there are a hell of a lot of things to forget – it’s the selection process that counts. But if it’s all lies, and if your therapist has a great deal of influence over what you will come to see as discountable and forgettable, how do you choose a therapist or a school? How do you pass over that power? The choice of can no longer be based on the ontological security of underlying truth, the epistemological certainty of a correct method of assessing it, or even on the pragmatic raft of data (as it’s super-equivocal). The choice, for me, is an ethical one: which is right? With whom, and how, should I create a new set of lies to impose on the last, less ‘right’ bunch?

PS. I just came across this, another npr podcats which won’t embed nicely: http://www.npr.org/player/embed/375928124/375928444. It gets therapy wrong, of course, but nicely illustrates how futile it is to argue away thoughts/feelings/beliefs/memories, and how letting go is the more dishonest (from an enlightenment, truth=progress=purity=right perspective) but effective approach.

Demystifying Therapy

P1010199You guys, I’m nearly a counsellor, or therapist, or whatever [lesson #1: there’s no difference between therapists and counsellors, but you can tell a lot from which label they choose. I prefer therapist, because it makes me sound clever and deep and possibly magic and a little bit medical and so proper and so better than the jumper-wearing woolly-minded do-gooders who call themselves counsellors].

So anyway I’m nearly a counsellor, in that I’m nearing the end of a year of lectures and training on and in counselling.

But in fact, as far as the law is concerned, we’re all nearly counsellors. We any of us can put a plaque up above our door, knock up a profile on a counselling website (complete with heavily-censored profile pic) and start charging money for our counselling services. Initially this lack of regulation troubled me: if anyone can set up as a counsellor, how do I know the guy I’m spilling my guts to isn’t a charlatan. How do I know he isn’t just some guy who reckons he knows something about the world and the people in it? And if he is just some guy, how can I be sure he won’t get things wrong, misunderstand me, give me the wrong advice, trample all over my fragile self, and all that?

But the more I learn about counselling the more I like the lack of regulation. (To be clear, there is a regulatory body (the BACP) who ensure that certain standards are adhered to. They require a certain level of practice and qualification and all of that, but it’s not statutory. Most organisations require you to be a member if you want to work for them, but you don’t have to if you want to set up in private practice.)

51wPupfNvXL._SY344_BO1,204,203,200_
The name of this post is the name of a very good book about therapy by a very good man called Spinelli. If you’re at all interested by what I write you should read it. It’s long mind.

Why do I like the lack of regulation? Because ultimately all of us therapists and counsellors are charlatans. We none of us know any more about motivation, emotion, conflict, desire, love or despair than anyone else. We may have spent more time thinking about these (or we may not, despite the training), and may (or may not) be more open to engaging with them without following the urge to flee to safer territory, but our theories and frameworks are no closer to the truth than yours, or hers, or his.

Realising this came as a shock to me. I had entered the profession apprentice-like, expecting to find a theoretical home that would be based on solid foundations. I wanted to find the theory which uniquely amongst all others captured the nature of human suffering, and told me how to help people who were suffering suffer less. And there’s plenty to choose from: a figure often bandied about is that there are over 400 types of therapy available, each with it’s own foundational theory of human nature and wellness.

The problem is, of course, they’re all lies. Not deliberately (well, not all of them), but they’re all lies. And the idea that the therapist practices out of these foundations is a lie too. All the theory does is helps the therapist feel more confident, gives them less to worry about (because it focusses their attention on specific utterances or dynamics), and gives them a tool with which they can dominate the client. I still hate the term ‘client’, despite having used it dozens of times every day for a good 6 months now. But this is what you are, if you see a therapist. A client. In that name are contained all of the assumptions (lies) about professionalism, expert status, and product purchase. And the problem with this is that, well, it’s not a problem. It can be very useful to believe that your therapist is an expert, or a little bit magic. As a client I’ve experienced this a few times, and without that faith (which, in secular times must be based on status, or the authority of regulatory bodies) I would not have got anywhere near so much out of the work we did.

P1010227But it’s still lies. What happens in therapy is that two people talk to each other for a bit. This is all. It’s just like talking to your friend. It’s just you’ve paid them to be your friend. It feels taboo to say this, but therapists are, like your man ‘someone’ says, essentially prostitutes without the sex [I think it might be Masson – he’s fun]. You pay them to sit with you and talk. They might, like some friends might, just listen and give you space to ‘let it all out’. They might, like some friends might, link your current problems to past problems, or to ways of thinking that, to them, seem strange. Or they might, like some friends might, tell you about this great technique they’ve heard about to help you get out of the self-destructive spirals you find yourself in. Or they might, like some friends, do something completely unexpected.

P1010236You can choose to go and see your solid, safe friend, the one you’re fairly sure will sit back and won’t impose or diagnose or interpret you (person-centred). Or you can choose your problem-solving friend who doesn’t seem comfortable dwelling (he’d say wallowing) in the emotional shit, but always motivates you to get things done (CBT, SFT, coaching). Or youmight go to your perceptive friend who always has a different perspective, but who you worry has a bit of an axe to grind about something to do with his mother or death or something (existential analysis, psychodynamics). Knowing what these friends are like provides a little safety, but not that much. Each of them knows that their theories are lies, and that it’s often (always?) more important to follow their gut, or to let the relationship lead them. In fact, this is written in to some of their theories.

P1010205So, how can I know that my therapist won’t get things wrong? How can I trust that I can let down my barriers and open myself up without being fucked up by some two-bit snake-oil merchant posing as a sage? I can’t. And regulation won’t do it either. Your man Attlee said something nice about trust: “It is a fundamental fallacy to believe that it is possible by the elaboration of machinery to escape from the necessity of trusting one’s fellow human beings”. He’s right.

Realising that therapy is just two people in a room, talking (or not talking), has been liberating for me. It’s not ‘just’ paid-for friendship, it is paid-for friendship. Friendship is amazing, and terrible. It is mundane and transcendent. It is harmful and healing. Ultimately, no amount of theories or regulations can protect clients from the fact that walking into a counselling room is as risky as entering into any close relationship. Just as risky, but with just as great rewards. Within the therapeutic relationship you may be completely misunderstood and further isolated, or you may make incremental or paradigm-shifting change which reconnects you to yourself and the world.

The factors which decide between these outcomes, and the many shades of grey in-between, are not known. Each school has it’s own ideas, but they’re all, I’ll say it again, lies. Nice ones, mostly. But lies nonetheless. There is no theoretical machinery, no matter how much we might research the micro-processes of human interaction (and this is where the hot research in counselling is right now), that can get over the need to trust another human being.

At its best, and at its worst, therapy is human. This is all.

P1010241
PS. The photos here are all ones that I took on the way to, or on the way back from, therapy sessions.