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Psychotherapy at a time of social and political change and crisis: Where do we stand? What do we have to offer?

Presentation delivered at conference/fundraiser: Psychotherapy & Counselling’s Contribution to Global Peace, Justice, and Wellbeing: What Difference Can We Make? An Emergency Summit, 26th March 2022.

by John McLeod

The global community is already struggling to engage with challenges arising from climate change, pollution and loss of biodiversity. The Russian invasion of Ukraine, and its possible implications, add a further layer of uncertainty, dread and despair about what the future will bring. As in Palestine, Syria, Kurdistan, Afghanistan, Somalia, Libya and many other places, cruel and destructive military violence is being used to prevent individuals, families and communities from being able to control and live their own lives with dignity and respect. For many people across Europe, what is happening in Ukraine is so geographically close, and has so many implications for our everyday lives, that it carries enormous emotional resonance. This has resulted in the emergence of a critical moment and turning point, that makes visible many of the most destructive and dehumanising aspects of contemporary society.

For those of us in Britain, this moment of collective awakening also invites recognition of our own history of colonialism, slavery, brutality, murder, biosphere destruction and cultural obliteration in America, Africa, India, Australia and China, and closer to home in Ireland and Scotland. Such awareness also draws attention to the complacency and privilege through which the reality of these events has been airbrushed from history. The foundations of the wealth and prosperity of the UK are built on the kind of military action and racist rationales currently employed by Russian armies in Ukraine.

As citizens of an interconnected world, all of us have responsibility, and opportunity, to do what we can to support victims of war, and create more just and ecologically sustainable ways of living together. Working alongside like-minded disciplines, occupational groups and social movements, the counselling and psychotherapy profession has its own distinctive contribution to make. A crucial aspect of a psychological and psychotherapeutic response to war is to provide therapy for refugees who have lost their homes and identities, and for all those affected by trauma. Other speakers at this conference will talk about these vital and urgent forms of human service.

In addition to the vital task of providing emotional and psychological support to those affected by war and dislocation, we also need to look honestly at ourselves. Although psychotherapy has developed many valuable strategies for helping people to handle everyday concerns and the consequences of adverse life events, it has largely ignored the ways that clients and patients may also be troubled by social and political structures and crises. Psychotherapy theory, research and practice has not sufficiently considered active citizenship, solidarity, generativity, mutual aid, truth-telling and wisdom as intended outcomes of therapy. It has focused too much on self-contained individualism and entitlement, and not enough on building communities and tending the more than human world. Psychotherapy has functioned – not entirely, but for the most part – as a form of practice whose purpose has been to help individuals in prosperous societies to make the most of the life opportunities afforded by membership of dominant social groups at a time of historically high levels of material plenty. Issues associated with such matters as violence, slavery, militarism, consumerism, corrosion of social capital and political discourse, and destruction of the living earth, have been addressed only at the margins of therapy. The timescales of events discussed in therapy sessions is typically short-term: typically there are few opportunities to consider the relevance of historical and intergenerational processes, or the future world that will be inherited by our children, grandchildren and later generations.

I believe that an appropriate response to the invasion of Ukraine, and all that it represents, would be to acknowledge the part that over-individualised and narrowly-focused forms of psychotherapy have played in allowing such a thing to happen. Such a response would entail committing ourselves to developing a therapy that can be used by individuals, families and communities not only to handle depression, anxiety, loss, trauma and relationship difficulties, but also as a space for working on dilemmas, choices and capabilities around what kind of society we want, and what we can do to achieve it.

The main public-facing external stone wall of the Scottish Parliament Building in Edinburgh, opened in 2004, carries engravings of sayings chosen to reflect its spirit and values. For many people, the most meaningful of these has been the statement “work as if you live in the early days of a better nation” taken from a poem by Canadian poet Dennis Lee, and later popularised by the Scottish artist and novelist Alasdair Gray. After the many terrible injustices and tragedies inflicted on them during the 20th century, the people of Ukraine were very much living in the early days of a better nation.

At least 5% of the population of Britain and similarly affluent countries make use of some form of psychotherapy or counselling in any single year. At least one-third of the adult population have had therapy at least once in their life. The overwhelming majority of those who have received therapy, experience it as valuable. In addition, psychotherapeutic ideas and narratives permeate many aspects of media and culture, and shape the ways that people make sense of who they are and what matters in life. Is it possible to redirect the immensely powerful resource represented in contemporary psychotherapy, so that it supports not only personal well-being, functioning and recovery, but can also offer a space within which clients learn to work as if living in the early days of a better nation?

There are many steps that the counselling and psychotherapy profession can make in order make a meaningful shift in such a direction:

• emphasising, promoting, re-defining and re-visioning therapy as a place where clients can engage in open dialogue about social as well as personal concerns, and their political self as well as their private and personal self. How many therapist and therapy service websites indicate that this is even a possibility?;

• training and preparing practitioners to actively engage with difference, diversity, moral injury and injustice;

• constructing and disseminating healing narratives (i.e., therapy theories) that help people to make sense of how their quality of life, and experience of suffering, are shaped by historical, social, political and ecological factors;

• publicly supporting and standing alongside those who are in the front line of social change;

• actively building and populating a cultural space for therapy practice that sits alongside, but separate from, discourses of health; 

• conducting research that evaluates the effectiveness of therapy in terms of the enhancement of social action, citizenship, courage and wisdom, rather than anxiety and depression; and, documenting cases and telling the stories of people who have used psychotherapy in these ways; 

• making therapy skills and knowledge available in other settings, for instance, helping politicians to learn how to listen, how to speak authentically from the heart, and how to find meaningful points of connection across different backgrounds, histories and agendas.

These themes, values and possibilities have always existed within the psychotherapy profession. For me, crucial sources of inspiration have included narrative therapy and community work (Denborough, 2019; Waldegrave, 2009), the open dialogue approach (Seikkula and Olson, 2003), the writings of Erich Fromm (Rasmussen and Salhani, 2008; Thomson, 2009) and Frantz Fanon (Turner and Neville, 2020), network-based therapy (Goodman et al., 2016), the recovery perspective (Klevan et al., 2021), the concept of critical consciousness (Choi et al., 2015; Diemer et al., 2017), the writings of Miraj Desi (2018), and the final two chapters of Cushman (1995). There is much, much more (see, for example, LiVecchi and Obasaju, 2018, and the collections of papers in Proctor et al. (2006) and Totton (2006)).

However, I believe that it would be fair to say that these concepts and forms of practice have not been widely influential. For the most part, the training of therapists, and theoretical and research literature, do not address social and political issues in any kind of systematic manner. Recent studies that have surveyed or interviewed therapists on their experience and attitudes to exploring social and political issues with clients have found that the majority of practitioners are uncertain and hesitant about engaging in such dialogues, and generally avoid talking about such topics (Garrity, 2011; Gölz, 2019; Jordan and Seponski, 2018; Winter, 2021).

I would like to be clear that politically-informed therapy is not about using the therapy relationship to manipulate emotionally vulnerable clients to sign up for Greenpeace or join a left-wing political party. What it means, instead, is being responsive to concerns and dilemmas that clients are already feeling and are unable to explore in a satisfactory manner within their everyday relationships. Scenarios in which psychotherapy might contribute to building a more just and sustainable world include:

• a client enters therapy because she has been married for 12 months and troubled by some of her relationships with members of her new extended family with whom she is in frequent contact. She is vegan and strongly committed to women’s rights. They are not, and make jokes at her expense. In therapy, alongside exploring deep-rooted personal issues around self-worth, she develops strategies for explaining her values to other members of the family, and recruiting her husband in these initiatives. Over time, she develops a portfolio of information that she then becomes able to use in other situations such as her work, and a blog, and makes speeches in campaigns;

• a climate crisis action group holds regular meetings and events in their region, particularly focused on lobbying for change around specific, highly-visible issues such as air pollution is areas around schools, greater use of public transport, and water quality. Few of these activities produce tangible results, and the organisation has had a history of low morale and loss of members. Some local therapists get together to make free individual counselling, and group sessions, available to the action group, to help build emotional support and resilience;

• a client enters therapy because he realises that there is a fundamental contradiction between his political beliefs and values, and his lifestyle. He believes that it is essential to live with less, and make sacrifices around consumption of goods and services. However, his sense of his own worth, long-ingrained habits, use of leisure time, and relationships, are all associated, in various ways, with creating pollution and exploitation of people and the environment in far-away less prosperous countries;

• inspired by the example of Frederick Douglass, a group of political activists decide to hold a series of events where refugees who have escaped from political oppression and genocide can tell their stories in face-to-face situations where their audience can directly experience what they have to say. From the start, and during and after each event, psychotherapists are involved in order to help make sure that what is happening takes place in a context of respect and mutual support, for example by facilitating break-out groups and being available for individual consultation;

• a local community counselling agency, that works with a large number of clients each year, develops a simple report form through which counsellors document social and political dimensions of issues presented by clients. This information is reviewed on a six-monthly basis by a group in the organisation, leading to a range of possible further actions – reaching out to look at possibilities for collaboration with other organisations, such as foodbanks and housing agencies; training events for counsellors around how to work with clients around issues such as overcoming social anxiety barriers to participating in political action, or on personal awareness of white fragility; calling out, and acting as a witness to oppression, by drawing attention to topics (e.g., impact of fuel poverty) through events and publications;

• a client who comes into therapy uncertain of who he is, and what he wants from life, gradually realises the extent to which his world-view has been shaped by the experiences of his grandparents in China during the time of Mao’s cultural revolution, their single-minded pursuit of professional success and status since immigrating to the UK, and the effects of these events on his mum and dad and himself. An important strand of therapy, for both client and therapist, consisted of learning about what took place in China, gently asking his grandparents to talk about what they had seen, and making contact with others in a similar life position.

A useful example of interwoven political and personal concerns is a study by Budziszewska and Jonsson (2021, 2022) that interviewed clients who chose to use therapy to talk through their deep fears around the climate crisis.

My own sense is that movement in a more socially and politically-oriented therapy practice will not primarily be driven from within the current counselling and psychotherapy mainstream establishment - but instead will come from colleagues in immigrant, refugee, indigenous, and other oppressed communities. A major challenge, and urgent need, is to create structures, spaces, opportunities, funding and an overarching manifesto that will enable these new ideas, practices and voices to flourish.

Earlier in this paper, I suggested that the awful events in Ukraine had created a moment at which many people were able to grasp, for the first time, the corruption, destructiveness, short-sightedness and inhumanity of the system of government and international relations that exists in the world today. It may be valuable to consider this from a wider perspective. There seems to be good evidence that, throughout human history, there have been two contrasting structures or patterns of human society (Graeber and Wengrow, 2021; Scott, 2008). One pattern has comprised groups of people, sometimes quite large groups, who have managed their affairs in a largely egalitarian and peaceful manner. The other pattern has consisted of hierarchical societies, dominated by a ruler, dynasty or ideology, that uses violence and slavery to impose its will on the lives of ordinary people. What is happening in Ukraine can be understood in these terms – a clash between incompatible and competing visions of society.

Psychotherapy as we know it has evolved and thrived in the relatively benign and stable social democratic and economic conditions and (relatively) egalitarian way of life that has existed since the 1950s (Mason, 2015; Piketty, 2014). We are possibly moving into a quite different sociopolitical environment, whose characteristics are dramatically and forcefully demonstrated by what is happening in Ukraine and elsewhere. We need to decide where we stand, and what we have to offer. Therapy cannot function, at least in the way we understand it, in totalitarian societies (see, for example, Cocks, 2018).

There is great urgency. To implement these shifts soon enough to make a difference, we need to work together, alongside those from different professions and occupations, and across different approaches to therapy. This is not a situation in which rivalries between different models of therapy is appropriate or helpful. What needs to be done stretches far beyond the scope of any single approach to therapy – and beyond the remit of therapy as a discipline and body of knowledge. The journal Psychotherapy and Politics International and the Pluralistic Practice Network (pluralisticpractice.com) are two – of many –arenas that already exist to enable counsellors and psychotherapists of different approaches to exchange ideas that are relevant to the overarching project of transition to a more just society. We live in an era of crowdfunding, wikis and social media in which it has become much easier for those working in the frontline and at the grass roots to find each other and find strength through collective action. There are many therapists and therapy organisations that are already implementing politically informed therapy – in big ways and little ways, and in accordance with local needs, opportunities and circumstances. There is much that can be achieved in being open to learning from each other.

John McLeod is Emeritus Professor of Counselling at the University of Abertay Dundee and Professor of Counselling and Psychotherapy, IICP College, Dublin, and has previously held Visiting Professor positions at the University of Oslo, University of Padua, and Massey University. John can be contacted at johnmcleod2016@gmail.com

References

Budziszewska, M., & Jonsson, S. E. (2021). From climate anxiety to climate action: An existential perspective on climate change concerns within psychotherapy. Journal of Humanistic Psychology, 0022167821993243.

Budziszewska, M., & Jonsson, S. E. (2022). Talking about climate change and eco-anxiety in psychotherapy: A qualitative analysis of patients’ experiences. Psychotherapy. Advance on-line publication.

Choi, K. M., VanVoorhis, R. W. and Ellenwood, A. E. (2015). Enhancing critical consciousness through a cross-cultural immersion experience in South Africa. Journal of Multicultural Counseling and Development, 43, 244–261.

Cocks, G. (2018). Psychotherapy in the Third Reich. Routledge.

Cushman, P. (1995). Constructing the Self, Constructing America: A Cultural History of Psychotherapy. Addison Wesley.

Denborough, D. (2019). Political dictionary for the field of narrative practice. Adelaide: Dulwich Centre Publications.

Desai, M. (2018). Travel and movement in clinical psychology. London: Palgrave Macmillan.

Diemer, M. A., Rapa, L. J., Park, C. J., & Perry, J. C. (2017). Development and validation of the critical consciousness scale. Youth & Society, 49(4), 461-483.

Garrity, M. K. (2011) Counselling sexual–violence survivors: The evolution of female counsellors’ critical political consciousness and the effects on their intimate relationships. Canadian Journal of Counselling and Psychotherapy, 45(1).

Gölz, A. (2019). Bystander,‘mitläufer’, collaborator—a personal reflection on crossing borders between politics and psychotherapy. Group Analysis, 52(4), 520-531.

Goodman, L. A., Fauci, J. E., Sullivan, C. M., DiGiovanni, C. D., & Wilson, J. M. (2016). Domestic violence survivors’ empowerment and mental health: Exploring the role of the alliance with advocates. American Journal of Orthopsychiatry, 86(3), 286-296.

Graeber, D., & Wengrow, D. (2021). The dawn of everything: A new history of humanity. Penguin.

Jordan, L. S., & Seponski, D. M. (2018). “Being a therapist doesn’t exclude you from real life”: Family therapists’ beliefs and barriers to political action. Journal of Marital and Family Therapy, 44(1), 19-31.

Klevan, T., Jonassen, R., Topor, A., & Borg, M. (2021). Mutual learning: exploring collaboration, knowledge and roles in the development of recovery-oriented services. A hermeneutic-phenomenological study. International Journal of Qualitative Studies on Health and Well-being, 16(1), 2001898.

LiVecchi, P., & Obasaju, M. (2018). Utilizing an ecological framework to integrate social identities and sociopolitical analysis in psychotherapy. Journal of Clinical Psychology, 74(5), 755-765.

Mason, P. (2015). PostCapitalism: A Guide to Our Future. Allen Lane.

McLeod, J. (2019). Therapy and the social (chapter 24); A social justice orientation: therapy as political action (chapter 26). In An introduction to counselling and psychotherapy: theory, practice and research. 6thedn. Open University Press.

Piketty, T. (2014). Capital in the Twenty-First Century. Harvard University Press.

Proctor, G., Cooper, M., Sanders, P. and Malcolm, B. (eds) (2006) Politicizing the Person-centred Approach: An Agenda for Social Change. Ross-on-Wye: PCCS Books.

Rasmussen, B., & Salhani, D. (2008). Resurrecting Erich Fromm. Smith College Studies in Social Work, 78(2-3), 201-225.

Scott, J. C. (2008). Seeing like a state. Yale University Press.

Seikkula, J., & Olson, M. E. (2003). The open dialogue approach to acute psychosis: Its poetics and micropolitics. Family Process, 42(3), 403-418.

Thomson, A. (2009) Erich Fromm: shaper of the human condition. London: Palgrave Macmillan.

Totton, N. (ed.) (2006). The Politics of Psychotherapy: New Perspectives. Maidenhead; Open University Press.

Turner, L. and Neville, H.A. (eds)(2020). Frantz Fanon’s Psychotherapeutic Approaches to Clinical Work: Practicing Internationally with Marginalized Communities. Routledge.

Waldegrave, C. (2009). Cultural, gender, and socioeconomic contexts in therapeutic and social policy work. Family Process, 48(1), 85-101.

Winter, L. A. (2021). Swimming against the tide: Therapists’ accounts of the relationship between Politics and therapy. Counselling and Psychotherapy Research, 21(2), 303-312.

IAHIP 2022 - INSIDE OUT 98 - Autumn 2022