The Personal Is Political

Stories of Difference and Psychotherapy

Martin Milton

• Publisher: Bloomsbury Academic
• Year: 2017
• Print ISBN: 9781352001709
• eBook ISBN: 9781350305823
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Written by an eminent psychologist and psychotherapist, this book explores how therapists and counsellors can address the key issues of 'difference' in working with their clients. No matter how much the therapist knows, how knowledgeable they are or how expert they are, they all face the same dilemma – their clients are always unique, ever-changing, subjective beings. By taking a pluralistic approach and interweaving theory with a range of clinical stories offering insights into specific issues, client populations and therapeutic contexts, this text will enable readers to develop context-sensitive practice. It will equally appeal to students, newly qualified counsellors and more experienced professionals looking to develop their practice, becoming theperfect companion for students and trainees in applied psychology, psychotherapy and counselling.

1

INTRODUCTION

Politics and the consulting room

I

It’s London, late afternoon, Friday, 24 June 2016. I close my consulting room door, lean against the wall, close my eyes and breathe. Fridays often weigh heavy but today I ache, feel beaten, depleted and ready to drop. I have felt a gamut of emotions today – anger, fear, hopelessness, disgust, and anxiety.

As I lean, I realise that every single client has commented on Brexit,¹ some fleetingly, others as an issue that needed our full attention. With some it proved to be a way to understand their psychological splits and divisions, for others it was an urgent need to explore the world we live in. I heard, ‘Could I have really gotten it this wrong?’, ‘I didn’t know how many people I am different to’, and most desperately, ‘How can I survive with all this hate out there?’

But let’s go back to the morning …

It is 7.45 am and I am driving to work. I am reeling from the shock of the result of the referendum. Like so many people, I have been disturbed by the enormity of the question and the tenor of the ‘debates’. It has been nasty and full of lies; obfuscation and deceit have been utilised and accepted as seldom before.

I have to manage myself as best I can; I need to be able to listen, to tune into client concerns rather than be too affected by this and what it will, might, could or won’t mean.

At 8.30 am I let Will into the clinic. He is a young American client, over here on a year’s exchange programme. His opening line today … Brexit.

‘Bet you weren’t expecting that, were you?’ he laughs. ‘What did you vote? If I’d had to vote I am not sure what I would have done; my head would have said one thing, my heart another.’

I don’t respond, or at least I say nothing, but that is a response all in itself. Will often tries to get me to talk about events of the day. I have been invited to comment on the weather, on the train service and on The Revenant – we have recognised that this is a way of him distancing himself from his worries. His question – and my silence – helps me realise that I don’t yet know what I am comfortable saying, to him or to anyone else. On one level it is a matter of what is professional of course. He isn’t here to examine my political opinions. On another, more visceral level though, it is that I don’t know whom I can trust anymore.

Will moves us on: ‘Well, my week hasn’t been too bad and I haven’t felt too anxious … which is a good thing.’

From that point we are back on familiar ground but I haven’t forgotten his telling comment about how his head and heart are sometimes quite divided. That’s useful for understanding the root of his anxiety across a range of issues.

My second client is Jacinta. I am still closing the door as she tells me, ‘I am gutted’.

I don’t want to assume too much, so I ask ‘about?’

With raised eyebrows she says, ‘the vote of course, the fucking Brexit vote’.

I am not surprised that she has raised this so strongly and so quickly. Jacinta is from Spain; she lives here and works in Europe part of the time. Her life is wrapped up in Europe in a very real way.

During the session her anxiety is almost uncontainable. There are tears, she hyperventilates and there is a stark terror in the face of the enormity of the unknown. ‘What is going to happen?’, she asks.

There is no point in me trying to answer that question with any political facts (even if I did think I knew) as she immediately asks, ‘How am I going to survive?’ And then most painfully she questions, ‘Why have we done this? What have we … me and people like me, ever done …?’ The rest of that sentence, ‘to people like you’, hangs unspoken in the air.

During the session I feel so limited. Sure I can listen to the questions and to the underlying themes that she brings. I try hard to think about what this tells me about her now but also what this adds to what I already know about Jacinta and her distress. But I feel slow, stagnant, impotent even. I manage to nod, to agree a few times and make a couple of comments to acknowledge that I am here and that I understand the fear, and that there are grounds for such fears – ‘normalisation’ as therapists sometimes call it. But that’s about all I can manage. I find myself momentarily regretting that I am a mere muggle; I want the talents of Madam Pomfrey, reaching into a magical bag of psychological spells to make her feel calm again. I know better. I know so much better, but it’s hard to be with someone so distressed and not be able to offer some relief. As Jacinta leaves we acknowledge how much we do not know, and the importance of thinking of how to support herself, to accept that she is scared and that maybe that’s OK for now.

Andrew and Sandy are next, and slightly late for their appointment. They often are. But this time Andrew comments on it. ‘This morning we lost track of time, listening to the radio and trying to make sense of what is happening. I can’t believe that wanker has got away with it.’

‘Andrew’, Sandy says sharply, she never likes his swearing, at least not in my consulting room.

Andrew doesn’t seem to hear her and he carries on, and as he does Sandy seems uncomfortable and purses her lips a great deal. ‘Sorry about his swearing, Martin.’

Before I have time to raise an eyebrow or ask why she feels that she has to apologise for him, Andrew says coldly, ‘Don’t start’ and there is an uncomfortable silence.

It’s clear that this is a couple who have opposing views on this issue as they do on so much in life: sex, raising their son, finances and even what therapy is for. I often suspect that they are just trying to keep the peace rather than trying to understand how the other one sees the world, and this may not be any different. Getting to understand what Brexit means to Sandy and what staying meant to Andrew may be helpful for them politically but also in terms of their relationship.

I am pleased when lunchtime arrives. I need the break, a walk and to just watch our kittens at play before returning to work.

Mark is my first client this afternoon and he seems perky. His only mention of the vote is that ‘people shouldn’t be upset. “The people have spoken”’, he says with dramatic, grandiose air quotes. ‘Let’s just get on and do it. It will all be OK.’ I am a little surprised by this but a part of me also likes it. It’s seductive and I experience relief. Business as usual is good.

Mark talks about how annoyed he is with his boss. ‘I had my appraisal last week … my development review’, his tone drips sarcasm. ‘Like that means anything. I talk, my boss talks and then there’s a form and that’s what takes precedence. We both think I am doing well, the form says differently. But fuck it … Tick the box and move on.’

My heart sinks, even if I want not to connect this with the referendum, I know it is connected. This is not to suggest that one necessarily ‘causes’ the other, but Brexit and the appraisal relate to similar experiences. Once a box is ticked your fate is sealed. There is no going back even if you have no faith in the process.

Mark and I have been here before. It’s what he does with so many dilemmas; its typical of his approach to life’s problems and while it gets him through the tough spot, in a few days he will experience the kick, the unfairness of it, the powerlessness that he struggles so intensely with. And we know that he will then experience trouble, start taking risks and his passive aggressive retaliations will be evident.

Casey is my last client that day and seems … ‘fine’, very involved in therapy, preoccupied almost with the complexity of navigating the rigid expectations of the world. Brexit is mentioned but it seems simply to be another example of the costs of thinking in what they consider a simplistic ‘either-or’ manner – ‘in vs. out’, ‘British or immigrant’, ‘Good or bad’ … The same old problem.

It’s after Casey leaves that I get to lean against my wall, switch the light off and acknowledge just how much the day has taken out of me.

II

This book focuses on the ways in which people are affected by and navigate difference and the political aspects of life. It explores how we, in the psyprofessions, might be of assistance. Psychologists and psychotherapists have a history of struggling with this domain, both politics with a ‘big P’ (the impact of issues such as elections and referenda, economic policy and the governance of the country) and politics with a ‘small p’ (everyday issues such as difference and diversity and the way we act towards one another). Among other things, this book explores the experience of disability, race and gender as they are policed and managed in our everyday lives, in that space where the big and small Ps intersect, where the personal is political and the political personal.

In the area of psychotherapeutic theory and practice, some of our models have rejected any focus on real-life politics and diversity, seeing them as a deviation from the practice of psychological analysis. The focus in this vision is the ‘internal’ world, the brain, unconscious drives, cognitive schema and the like. For these world views, thinking about politics can be seen as a collapse into the sociological – it is assumed that it may be a valid focus but one more for social workers and policy makers than for psychotherapists.

Other schools have simply not seen the necessity of attending to the political, assuming that a robust adherence to a manual or application of technique will suffice. This approach, of a universal methodology, is not just thought to be politically neutral, some have argued that it protects against discrimination and oppressive practice (see Milton et al., 2010). This is discussed further in Chapter 2.

However, psychologists, psychotherapists, clients, philosophers, economists, historians and policy makers alike, have all noted how important it is to understand the contexts within which we exist because, without that, it is simply not possible to understand experience, formulate client difficulties, or tailor practice appropriately. Without understanding our embedded-ness in the world, we are working with mere ghosts and projections of experience. As scientist-practitioners, we also have an enormous amount of research and theory that helps us understand our relational and intentional existence; this body of knowledge and experience reminds us that the notion of the ‘self-contained’ individual is as problematic as it is inaccurate (see Strawbridge, 1996). Like our mammal relatives, our elephant, dolphin, monkey and ape cousins, we are social animals. We exist in relationships, in personal, community and socio-political interdependencies. When these relationships offer support and validation we do well. When the world is against us, when it excludes or oppresses us, we suffer and that suffering takes the form of community, family and individual distress. While it may be individuals who experience the various manifestations of distress, anxiety, depression, eating disorders and experiences of madness, the roots of this distress can be traced to toxic and oppressive relational and social experiences. Jaspers (1963), Szasz (1960) and Laing (1961) all helped outline this in the 1960s and more recent contributions have been made by Dallos and Draper (2015), Douglas (2010), Johnstone (2014), Langdridge (2014) and Wilkinson and Pickett (2010) among others. This book illustrates some of the areas where the policing of policy and interpersonal freedoms impinges on our psychological well-being.

Politics with a ‘big P’

Politics with a big P, has recently been brought into the consulting room like seldom before. We have heard about the impact of austerity, despair in the face of the Syrian genocide, shock and confusion about the referendum result and the election of Donald Trump. Radlett also notes ‘soaring unemployment; zero hour contracts/low pay/job insecurity; savage cuts to housing, sickness and disability benefits; profit-gauging landlords demanding extortionate rents; evictions; homelessness; foodbanks’ (2017, p. 34).

These issues directly affected therapy, becoming topics in client sessions, supervision groups, in conference discussions, on social media, in the press and on TV. Optimistic visions and their more negative alternatives vied for airtime, and the expression of xenophobia, homophobia and misogyny flourished, as did anxiety and fear about such expression. People suffered from actual, and threatened, xenophobic and racist violence, the overall rate of which was significantly higher than in corresponding periods in previous years (see Stone, 2016). A report by Galop, the Lesbian, Gay and Bisexual Anti-Violence and Policing Group, indicated that a similar process was directed towards gender and sexually diverse communities with a 147 per cent increase in anti-LGBT crime in the three months after the referendum (Antjoule, 2016).

The responses to big and small P politics were raw and full frontal. No one seemed unaffected: individuals were shaken up, families were brought into conflict, Facebook friends were deleted and communities subject to hostility. Clients brought painful material related to Brexit immediately, and of course, that’s not the only way it affected therapy. Whatever our own concerns and decisions about Europe, we psychologists, psychotherapists and counsellors, those whose work it is to assist with the psychological well-being of our clients, were already reeling. These events reminded us that it is impossible not to be affected by politics and we can’t expect it to mean nothing to our clients either.

Politics with a ‘small p’

Psychotherapy is a profoundly personal process, where clients embark on a process of discovery, finding out about themselves, who they are, what lurks in the shadows and who they might become. While it can be an extremely rewarding process, one cannot deny that it can also be an excruciatingly personal process. Yet while it is so personal, it is undertaken in relationship with another, the therapist. This process is one where dilemma is ever present – trust and mistrust, dependence and the urge to be independent, the personal insight and its political ramifications; these are at the very heart of the process because, best will in the world, and one of the reasons psychotherapy works, is that difference is there. It stares you in the face. The client is not the same as the therapist and the therapist can never be the same as the client. Where difference is relevant, the client and therapist embody it in each other’s presence – whether that be through actual or perceived markers of wealth, gender, race, nationality or any other difference that may carry meaning.

One response to this has been to try and limit difference. We sometimes try to match clients on relevant demographics, a black client may prefer to see a therapist of colour, women sometimes request to see a female therapist and LGBT clients often fear the possible homophobia or insensitivity of the heterosexual therapist and so seek out an LGBT therapist. But even these attempts at ‘matching’ do not avoid the fact that the two people are different and that this will inevitably become apparent. The fact that two people, with profound differences attempt to relate deeply and to understand the client’s experiences, choices and ways of being, means that what might seem something personal hidden away in the safety of the consulting room, is actually a profoundly political engagement.

Some in the therapeutic professions recognise that the political dimension is relevant to human well-being and to the therapeutic endeavours of many who are struggling. Indeed, Pearce contends ‘that the essence of our work as psychotherapists is political and that it is authentic and therefore ethical […] that we recognize the work as such’ (2017, pp. 29–30).

But, this view cannot be said to be universal. In fact, this view is under attack. Our paymasters, political leaders, health policy makers, interpretations of the medical model of human distress and Pharma companies all come together to encourage, instruct and force therapy to be reductionistic, to see the problem in the individual sufferer and overlook the impact of culture and capitalism, oppression and disavowal.

The contested nature of this field has a number of possible explanations – some are economic, some are related to who is in power (and who wants to keep power), but some are also to do with the fact that while the reductionists have been writing manuals and illustrative cases for years and years, other perspectives have had much less ‘air...

Table of contents

• Cover
• Title
• Copyright
• Contents
• About the author
• Acknowledgements
• Preface
• 1 Introduction
• 2 Difference and diversity in the consulting room: Theoretical and professional perspectives
• 3 Race
• 4 Gender
• 5 Sexuality
• 6 Faith
• 7 Non-binary gender
• 8 Disability
• 9 Othering and the environment
• 10 Big P politics
• 11 Epilogue
• References
• Index