Critical Psychotherapy, Psychoanalysis and Counselling

Implications for Practice

D. Loewenthal

• Publisher: Palgrave Macmillan
• Year: 2015
• Print ISBN: 9781137460561
• eBook ISBN: 9781137460585
• Topic: Psychology
• Subtopic: Critical Theory
• Index: Psychology

This book explores what 'critical' means for the talking therapies in a climate of increasing state influence and intervention. It looks at theoretical and practical notions of 'critical' from perspectives including queer theory, feminism, Marxism, the psychiatric survivor movement, as well as from within counsellor training and education.

Part I

Introduction

1

Talking Therapies, Culture, the State and Neoliberalism: Is There a Need for Critical Psychotherapy, Psychoanalysis and Counselling?

Del Loewenthal

Introduction

We already have critical psychiatry and critical psychology. In this book we explore whether there is now an unfortunate need for critical psychotherapy, psychoanalysis and counselling. The proposition will be considered that the main reason we have critical psychiatry and psychology is that they are primarily agents of the state, and that this is becoming increasingly true for psychotherapy, psychoanalysis and counselling.

In this chapter, I attempt to provide an overview of notions of ‘critical’, revisit psychotherapy, psychoanalysis and counselling as cultural practices in the light of both critical psychiatry and psychology and consider the apparent paradox of increasing state intervention in a neoliberal world. In the subsequent chapters, space is given to a range of narratives about ‘critical’ approaches where authors have been commissioned to help with such questions as:

• Can there be a ‘critical’ approach to practice from inside the psychotherapeutic modalities?

• Can psychotherapeutic practice be theorised or researched as it is fundamentally different when one is in it?

• Do critical theory, critical psychiatry and critical psychology limit or further the potential development of ‘critical’ psychotherapy, psychoanalysis and counselling?

• Should we as talking therapists be able to explore how our practices may legitimise various power structures?

• Should we be more aware of how we are engaging politically with issues around mental health?

• Do we need to revisit how madness and distress are experienced and to what extent our debates are constrained by state and other interests, including professional?

• How much are we still caught up with modernism attempting to separate an individual’s wellbeing from social contexts which may be the prime cause of ‘psychosis’ and other forms of distress?

• To what extent are our modalities, whether they be psychoanalysis or cognitive behavioural therapy (CBT), primarily exercises in power?

• Will the rise of the service-user movement make a beneficial difference to service users?

• Is it time for psychotherapists, psychoanalysts and counsellors to start thinking more critically about how much we’re caught up with individualism, pseudoscience, and the language of medicine and clinical psychology, all of which can be seen as instruments of the status quo?

• Is it possible for us to be able to be thoughtful about where our knowledge comes from and yet not be banished or incorporated by dominant choices in our culture?

• What sort of political agency do we as practitioners (and our clients/patients) have?

• How possible is it for us to consider the abuses stemming from our own personal and professional position, as well as of related managers and their audit cultures, and even of users, as well as how their voices are managed?

Such questions are interrogated here with reference to the talking therapies in a climate of increasing state-regulated practice (Mace et al. 2009; Parker and Revelli 2008) with its growth of manualisation, the training of technicians and approaches that favour taking clients’ minds off their concerns. The contributors to this book are practitioners from North America and the UK who are known for their engagement, from a range of perspectives, with the various notions of ‘critical’ in the context of therapeutic practice. Their abstracts, critiques of their own work and brief biographical details are given separately before Part I. In editing this book the question has emerged as to whether the potential need for being ‘critical’ applies at least as much to what appears to be the state-sanctioned talking therapies’ greater propensity to help us to deny our own violence and sexuality as it does to our unwillingness to think politically. This potential need to be critical of the personal as well as the political is also returned to in my concluding contribution (Chapter 17, ‘Psychotherapy, psychoanalysis and counselling for oppressors and oppressed: Sex, violence and ideology in practice?’).

It is hoped that one outcome will be to encourage readers to consider their modality, whatever it is, as also an exercise of power, and wonder about the use of, often so-called, ‘science’ in the pursuit of vested interests’ notions of progress and authority. Throughout this book the terms ‘psychotherapy’, ‘psychoanalysis’ and ‘counselling’ are collectively referred to as ‘the talking therapies’. It is intended that with both sets of terms this includes ‘counselling psychology’. At other times the term ‘psychological therapist’ is used, and this is intended to include those that I have just mentioned, together with arts and play therapists. There are, however, some occasions when the term ‘psychotherapist’ is used to include all of the above.

This book arises therefore following increasing concern about the growing state influences on talking therapies’ practices. As one commentator has put it, there has been a transformation in practice in recent years, moving from a ‘cottage industry to a factory-based production line’ (Parry et al. 2010) with equally disruptive effects for practitioners. There would appear to have been a significant shift from accepting talking therapies as essentially both confidential and subversive, and inevitably being located on the edges of our society, to such confidentiality (Loewenthal 2014a) being constantly risk assessed together with practices and trainings being increasingly registered, regulated and incorporated into mainstream society. Much of this change has been legitimised through an increasingly pervasive audit culture, coupled with a narrow notion of evidence-based practice involving some very dubious claims to being ‘scientific’. Yet isn’t this more to do with those in power at a particular time attempting to determine what is and is not science? As Foucault states, ‘if we ask what is, in its very general form, the kind of division governing our will to knowledge – then we may well discern something like a system of exclusion (historical, modifiable, institutionally constraining)’ (Foucault 1971). Andrew Samuels, in Chapter Ten, is one who argues that we are fooling ourselves if we think that the talking therapies were ever free and independent. Certainly it appears that most trainings do train people with regard to their particular guru, leading perhaps to less rather than more thoughtful practice. Yet previously, didn’t seeing a talking therapist lead to far fewer possibilities that what one said would be reported to the ‘authorities’? This increasing role of the state in the training provision and so-called ‘quality assurance’ of the talking therapies, in parallel with what is being described as an era of neoliberalism, where market-based economies, we are told, promote efficiency and value for money, is regarded here as the essential new development. As a consequence I wrote an editorial for European Journal of Psychotherapy & Counselling entitled ‘Is there an unfortunate need for critical psychotherapy and counselling?’ (Loewenthal 2013). My concern there was, and still is, that once the field of critical psychotherapy, psychoanalysis and counselling is established it will become a minority module on mainstream programmes with the implication that (as with psychiatry and psychology) mainstream psychotherapy, psychoanalysis and counselling become by definition primarily ‘uncritical’. The ‘critical’ add-on is then there to allow for a notion of democracy and what is increasingly becoming perhaps the illusion of academic freedom. The above mentioned editorial led to three further activities: a London conference (Critical psychotherapy and counselling – if not now, when?, Universities Psychotherapy & Counselling Association/Research Centre for Therapeutic Education Conference 2014), a special issue of European Journal of Psychotherapy & Counselling (Loewenthal 2014b) with the same title as the conference and a request to edit this book.

Some preliminary considerations

There is the question of what we might mean by ‘critical’? In this chapter I will look, albeit briefly, at the history of this question in psychiatry, psychotherapy and counselling. There are several traditions in the notion ‘critical’. There is ‘critical theory’ coming from the Frankfurt School of Adorno, Horkheimer et al. with one of their assumptions being that we will need to make some fundamental changes to the language we use in order to think outside the ideology that has imprisoned us. Another notion is a more libertarian view of those such as Thomas Szasz, where freedom of expression and confidentiality would be given primacy. Another notion of ‘critical’ is the sceptical tradition from the Greeks through to continental philosophy, with more recently such figures as Heidegger (who in contrast with the Frankfurt School stresses the importance of ordinary, non-technical language), Levinas, Derrida, Wittgenstein and so forth. Another possibility of being ‘critical’ is from other ways of thinking that are currently outside the dominant discourses in the talking therapies – for example, queer theory, literary criticism, and cultural and emotional critiques. John Heaton (2006), who was involved with Ronnie Laing and David Cooper in developing the Philadelphia Association in London (where I am also a member), argues against the notion of ‘radical’ and in favour of ‘critical’, pointing to the sceptical tradition. While I am very much influenced by this sceptical tradition, in writing this book I have become increasingly concerned that this can too easily become a process of watering down political/ideological implications.

Hence, one important question appears to be whether practitioners can be critical through just reconsidering the literature in their field or whether different external theoretical ideas need to be introduced in order for ‘critical’ perspectives to be adopted. In Chapter 13, ‘Psychoanalysis and the event of resistance’, Steven Groarke, drawing particularly on Derrida, is one of our contributors who does both in exploring whether the concept of resistance can both help us to be and prevent us from being critical.

Questions about the role of the talking therapies in capitalism have been raised at the start of this chapter, and this is developed further later, particularly through Ian Parker’s Chapter 3, ‘Toward critical psychotherapy and counselling: What can we learn from critical psychology (and political economy)?’, Lois Holzman’s Chapter 8, ‘Relating to people as revolutionaries’, Michael Rustin’s Chapter 9, ‘Work in contemporary capitalism’ and Chris Oakley’s Chapter 12, ‘The Deleuzian project’.

What is new is the extent to which the state’s involvement in purchasing/providing specific psychological therapies has been introduced, alongside our new era of neoliberalism with its audit culture, and in the UK what is referred to as New Public Management (Barzelay 2001; Gruening 2001). Thus while we might question whether the talking therapies have ever been free and the extent to which many previous trainings have discouraged rather than encouraged thoughtful practice (see for example Kernberg (1996), ‘Thirty methods to destroy the creativity of psychoanalytic candidates’), what we have now is something else besides.

Other preliminary considerations include whether we see the talking therapies and the way in which they are researched/evidenced as primarily cultural practices. We might then critique any theory or regulation in terms of implications for our practice at any moment with any specific client/patient rather than starting with theory (Loewenthal 2011).

There is the perhaps fundamentally important consideration, and ever-relevant notion, of Plato’s defining therapeia by urging us to attempt to regard science and technology as important but always secondary to the resources of the human soul (Cushman 2002). Plato, however, was not very optimistic about our succeeding in this and, disturbingly, we seem increasingly to have not only ‘technology’ pretending to be ‘science’, but also less interest in what we might mean by the ‘human soul’.

Perhaps a related aspect is the question of what we regard as human values. For example: Are we fundamentally good or evil? Are we rational or irrational? Are we free or determined? Such questions are not uncommon (Coleman 1979). However, in response, are the usual ‘bit of both’ answers more part of a deluding smokescreen in order to attempt to not stay with thoughts of our evilness, irrationality and relative lack of agency? In particular, if we are all not only at least potentially evil but also increasingly alienated, what can we best hope for through the psychological therapies? Perhaps to realise just this. But how long can we stay with that?

In Chapter 6, ‘Critical theory and psychotherapy’, Anastasios Gaitanidis reminds us of our ability to do violence to each other. Also, the history of psychotherapy, psychoanalysis and counselling would seem to be a watering-down of the recognition of not only our potential violence but all of us as sexual beings. Furthermore, sociologists such as Etzioni (1961) attempt to offer us an escape route by suggesting that ‘moral involvement’ can be experienced rather than alienation. But wouldn’t the best we might come closest to be ‘calculative alienation’ (Loewenthal 2002a)? Also, those particularly stemming from Levinas (1999) have increased our awareness of our responsibility to be open to the Other’s Otherness. Yet to what extent is our awareness of our and Others’ evilness really avoided through such religiosity?

Again, if we consider being critical of texts outside the talking therapies, Donna Orange (Frie and Orange 2009: 126) suggests a particular distinction between the perspectives of Gadamer and Derrida, which could also be helpful in considering critical psychotherapy, psychoanalysis and counselling. For her, Gadamer (2004) might be seen as arguing that the precondition for dialogue is the trust in the goodwill of the Other. Whereas Derrida suggests ‘not only that this good-will should never be trusted, but even that we will be blinded by our desire to trust the other’. In an interesting footnote, Orange proposes that this attitude possibly represents the hermeneutics of suspicion that Paul Ricoeur attributed to Marx, Nietzsche and Freud. So to what extent do psychotherapy, psychoanalysis and counselling texts provide a surface level meaning as ‘a method to conceal the political interests which are served by the texts?’ (Ricoeur 1970: 27). So as talking therapists are we set up through our training to fail if ‘The purpose of interpretation is to strip off the concealment, unmasking those interests’? (Ricoeur 1970: 27).

Orange further suggests that postmodernism can be seen within those involved in the tradition of scepticism who have over the centuries ‘protested against exaggerated claims to knowledge, unmasked dogmatism and relativist totalizing world views’. ‘The resulting skepticism has ranged from a refusal to make any truth claims to holding theory lightly and suspending judgment, perhaps following more closely, Aristotle’s injunction to seek in every domain, the head of knowledge and degree of certainty appropriate to it.’ However, what these authors have in common is tha...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Tables and Figures
• Acknowledgements
• Authors’ Biographies, Abstracts and Self-Critiques
• Part I: Introduction
• Part II: What Can We Learn from Critical Psychiatry and Critical Psychology?
• Part III: Users’ Perspectives
• Part IV: Critiques Coming More from Outside
• Part V: Critiques Coming More from Inside
• Part VI: Critiques of Training and Learning
• Part VII: Is There an Unfortunate Need for Critical Psychotherapy, Psychoanalysis and Counselling?
• Index