Social justice and psychotherapy

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aufbau83
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Social justice and psychotherapy

Post by aufbau83 » Sat Jul 11, 2020 1:02 pm

Apologies in advance – this is a long one.

So the university I want to apply to for the doctorate is Lancaster. This is mainly for personal reasons – I currently live in Germany, but my British family lives in the north west, and I already studied in Lancaster. It’s my favorite city in the UK and somewhere I’d be happy to raise my children. I also see that Lancaster does not place quite as heavy an emphasis as other courses on proceeding through the laborious and narrowly defined grinder of "clinical experience" – which from my point of view, is an advantage, because my experience lies in other areas (I work as a history lecturer). However, Lancaster does stress the degree to which a trainee’s approach to the role can be aligned with a broader agenda of “social justice”. This is where I’m a little uncertain.

I will put my cards on the table now: I basically want to be a clinical psychologist because I’m very interested in therapy, and to me, the overall goal of therapy is to help the patient to learn how to think. I get that there are many complex reasons why people come for therapy. But I would nonetheless suggest that, invariably, patients are struggling with life situations and psychological difficulties that they need to learn to think through, and to think rationally about, in order to make progress.

I believe that, whatever psychotherapeutic paradigm you subscribe to, this vision of enhancing the rational, reality-testing, thinking functions of the patient is paramount. You might conceptualize this as strengthening the Freudian ego, or the executive functions, or the “rational mind”, or the “watchful observer”. But ultimately, for me, it’s about learning how to step back, reflect and think about life, yourself and your difficulties. This is by no means a panacea – I realize that. But it’s what attracts me, at least, to the role, and it’s a guiding principle that helped me in my own therapy.

Now the problem. My sense is that this vision of cultivating individual rationality – you might call it cognitive robustness – is rooted in a paradigm of enlightenment liberalism. I don’t mean “liberal” in the way it’s increasingly used in the US, to denote anything left of center. I mean classical liberalism, something distinct from both conservatism and socialism, which emphasizes the rights of the individual as a thinking being. I basically believe that the project of liberal, democratic capitalism is something that should be treasured and preserved, that it has delivered over half a century of peace and prosperity, and that the tradition of psychotherapy – of whatever paradigm – is rooted in that project.

Of course, I’m not suggesting that it’s been great for everyone, and I recognize that there are dramatic (and, as we are presently seeing, racial) inequalities that the project of democratic liberalism has not effectively addressed. But I still believe that the solution to these problems lies within the liberal democratic system, rather than necessitating a radical reform or even overthrow of that system.

But how does this square with a “social justice” agenda? When I hear this term used, I immediately think of a group-based conception of the world – which is something that conservatism and socialism, whatever their dramatic differences, basically share in opposition to liberalism. Yet I find such an approach hard to square with the practice of psychotherapy.

Let’s imagine that the daughter of Bangladeshi immigrants comes to therapy, suffering from depression, and it soon becomes apparent that her depression is heavily linked to the fact that the socioeconomic deck is overwhelmingly stacked against her and people like her. A social justice approach to this situation might argue that collective, political organization is the only thing likely to redress the systemic inequalities which, in the end, lie behind this (apparently individual) case of depression.

But can such an approach be married with the practice of psychotherapy? An enlightenment liberal would focus on this individual, on improving their skills and helping them learn how to think, plan, and make their own individual world a better place. Perhaps, ultimately, with a view to enacting the kind of political organization entailed in a social justice approach. But first, change has to happen at the level of the individual.

So, what am I saying here, in this PhD-length contribution that most of you have probably stopped reading? I’m asking if there’s a certain inherent contradiction between psychotherapy as a project rooted in enlightenment liberalism on the one hand, and the group-based conception of the world that lies behind a social justice approach to clinical psychology on the other.

Thanks for reading...

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miriam
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Re: Social justice and psychotherapy

Post by miriam » Sat Jul 11, 2020 4:29 pm

I think you have expressed some fairly rigid ideas that don't align with my views of therapy, politics or the profession.

Let me start with your whole motivation to be a CP - to deliver therapy that teaches patients to think more objectively. Starting right there, I'd say that isn't a great match with clinical psychology. Firstly, clinical psychologists are not just therapists, we have a massive list of roles and competencies beyond that, and if what you want to be is a therapist, then this is a complicated and long-winded way to go about it. Second, if you just want to look at thinking (and not feeling, or relationships, or the bio-psycho-social context, or the person's story) then I don't think that fits with my view of CP either - the training gives us multiple models and the ability to formulate at multiple levels within the individual and when considering the systems they exist in and the people they have relationships with. Third, the term "patients" refers to accepting a medical model, which isn't something that the majority of CPs would subscribe to. The people I work with are just that, people. Children, families, parents, professionals and importantly the systems around those people, and the colleagues within services supporting them. And finally, the whole assumption of fixing people's broken thinking is an incredibly patronising and narrow way of looking at distress. How would a survivor of trauma or abuse benefit from "learning how to think" the way you want them to? How about a person experiencing dissociation, or intrusive sensory experiences like hallucinations or flashbacks? Or a person with autism, adhd, dementia or brain injury? Or a bereavement, or chronic or terminal physical illness? How would thinking more objectively help the children I work with, who have been removed from harmful care and placed with alternative caregivers? Or a person who has been bullied? Or someone who is overwhelmed with stress whilst struggling to make ends meet financially whilst caring for dependents?

As to your politics and philosophy, I'll leave others to respond. But suffice to say, it doesn't sound like you are a good match for Lancaster!
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Re: Social justice and psychotherapy

Post by Spatch » Sat Jul 11, 2020 5:44 pm

I love, love, love these kind of theoretical posts, and wish there were more of them.
My sense is that this vision of cultivating individual rationality – you might call it cognitive robustness – is rooted in a paradigm of enlightenment liberalism.
Firstly, I would argue that post enlightenment liberalism actually encompasses several different philosophical positions (albeit overlapping ones) and the vast majority of these are consistent with the practice of clinical psychology. You aren't going to find many psychologists that buy heavily into mysticism or the supernatural as the main agent of change in any intervention, or base their assessment through a lens of Feudalism. We are scientist practitioners (of various shades) and you can trace that line straight through post enlightement values. Read John Hall's book Clinical Psychology in Britain: Historical Perspectives to really get into this and see how we are probably more classical liberal than many of our international cousins.
I mean classical liberalism, something distinct from both conservatism and socialism, which emphasizes the rights of the individual as a thinking being.
This is pretty much the main mode of therapeutic working (even systemic or community psychology approaches which are more group focussed). Even family, systems or organisational interventions respect the individuals autonomy, rationality and self determination. I would go further and argue this is why it is often harder to practice psychotherapy in cultures that are collectivistic and why such cultures are often stigmatise therapy.

But how does this square with a “social justice” agenda? When I hear this term used, I immediately think of a group-based conception of the world

The other part is the interpretation of 'social justice', which is equally as varied as 'liberalism', and I am not going to answer on the behalf of Lancaster how they define it. I would even hazard that within the course team there is a myriad of conceptualisations of this, and probably the best thing you can do is ask someone on that team about this.

For me, social justice springs from post enlightenment values. It is John Rawls, Bertrand Russell and pretty much what any good clinical psychology supervisor will call 'reflective practice'. It is taking account of our biases, subtexts, being able to tolerate differences and ambiguity and build up empathy. Outside the most very simplistic, behaviourist therapeutic approaches it's hard to move away from that. Even the most right wing, neo-conservative psychologists will have been exposed to some of this and it will impact on their thinking.
Let’s imagine that the daughter of Bangladeshi immigrants comes to therapy, suffering from depression, and it soon becomes apparent that her depression is heavily linked to the fact that the socioeconomic deck is overwhelmingly stacked against her and people like her. A social justice approach to this situation might argue that collective, political organization is the only thing likely to redress the systemic inequalities which, in the end, lie behind this (apparently individual) case of depression.

But can such an approach be married with the practice of psychotherapy?
Lets use your example. There are several psychological stances one could take, but arguably even the most basic formulation would take into consideration the individual's intrapersonal factors, external context and interpersonal relationships.

A social justice approach may work:

a) at the level of the therapist (being aware of the differences between themselves and the client, reflecting on John Burnhams's GRACES, their own assumptions and the dangers of imposing the psychologists own frame of reference). So far, so individual and social justicey.

b) at the level of the client. Providing a safe exploratory space to make sense of their individual experience and to validate this as their valid subjective experience. To educate and foster insight into the client's own beliefs, patterns and behaviours in the context of the prevailing hegemony and giving them autonomy and support to make potential changes.

c) at the level of the local system. Providing a framework where people can be more interpersonally effective and assertive, spot inequalities and be supportive in the client's attempt in addressing injustices and inequities.

d) at the macro system, which is the type of approach you outline above. These factors would always have to be considered, but would rarely be the first line of approach with this kind of presentation.

However, lets go with it and say we work at level (d). We put your lady in touch with various culturally approrpiate support and activism groups, focus our work in therapy on raising their political awareness, educating them about their rights and autonomy and you start challenging the more damaging elements of their prevailing cultural context. A lot of that has to be individualistic, as you are working with a single person, not all of that group, and even if you are able to make a cultural level change, a lot of that quickly becomes personal.

To use example from Apartheid era South Africa, you can read about the work of Chabani Manganyi, who really did work at the systemic level. Yet, there is so much individual level work that went into this. You can read some of his writings and see how they fit with your philosophical view. They are as social justicey as you can get, but are still rooted in post enlightenment traditions of scientific, systemic enquiry.
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Re: Social justice and psychotherapy

Post by PinkFreud19 » Sun Jul 12, 2020 9:36 pm

I agree with Spatch. I simply do not see social justice and classical liberalism as particularly mutually exclusive or incompatible values, in the context of psychotherapy.

Can you not both campaign against systemic injustice while also supporting that person individually to identify beliefs, behaviours, or thoughts that are contributing to elevated distress?

aufbau83
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Re: Social justice and psychotherapy

Post by aufbau83 » Mon Jul 13, 2020 10:19 am

Thanks for your very thought-provoking responses.

@miriam: It’s very possible that my (relative) lack of real-life experience with people suffering from mental health problems means that I’m given to this kind of high-flung philosophizing without considering how individual, highly complex cases fit into the paradigms that I’m rolling out, admittedly in a rather cavalier way.

I would nonetheless maintain that the development of the capacity for rational thought remains a mainstay of most (western) therapeutic traditions. You could even argue that therapy itself is inherently western, rooted in western traditions of individualism and confessionalism, a discursive cage that we (as westerners) are never fully able to liberate ourselves from.

Finally, the fact that you use the terms “liberalism” and “libertarianism” interchangeably in your last sentence suggests to me that your understanding of liberalism is – at best – incomplete.

@spatch: Thanks for the John Hall recommendation. I just ordered that book on inter-library loans. Interesting point about British clinical psychology possibly being more rooted in classical liberalism than its European equivalents.

To me, this raises a question about the historical link between liberalism and empiricism, which was always more powerful in the English speaking world (maybe no surprise that empiricist CBT grew up in an English speaking context, whereas rationalist psychoanalysis is more continental?) Having said that, even Freud took as his goal the “strengthening of the ego” – i.e. the liberal ideal of the cultivation of the individual as a rational, thinking being (notwithstanding how some Freudian ideas have been marshalled in service to a post-modern critique of rationality).

This is all getting a bit Newsnight Review…

@spatch and Pinkfreud: maybe you are right that the distinction I’ve drawn between social justice and an (individualistic) enlightenment liberalism is a bit dubious.

Spatch, I very much appreciate your (in my view, convincing) attempt to convert this into an almost programmatic approach to therapy, with Ecological Systems Theory-esque layers extending from the personal to the political. I like this idea of somehow integrating growing intra- and interpersonal acuity with a burgeoning awareness of how broader social/cultural/economic/political factors have contributed to an individual’s distress, and how these could be meaningfully (therapeutically?) challenged, or how the individual could be equipped to challenge them.

But actually turning this into a systematic approach to therapy, and using it as a basis for collaborating with an acutely distressed individual, could be tough. It would probably need a very judicious therapist to pull it off. I guess the aim is to avoid the Scylla of apolitically adjusting the individual to a fundamentally unjust social order on the one hand, and the Charybdis of turning therapy into some kind of Maoist reeducation exercise on the other.

Ultimately, all of this shows how therapy - like everything else - cannot be understand beyond the historical context in which it's practised. Forgive me a cruel chuckle, but those are points on the board for the subject I originally studied...

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Re: Social justice and psychotherapy

Post by miriam » Mon Jul 13, 2020 10:43 pm

aufbau83 wrote:
Mon Jul 13, 2020 10:19 am
Thanks for your very thought-provoking responses.

@miriam: It’s very possible that my (relative) lack of real-life experience with people suffering from mental health problems means that I’m given to this kind of high-flung philosophizing without considering how individual, highly complex cases fit into the paradigms that I’m rolling out, admittedly in a rather cavalier way.
Yes, this. To a degree that would be offensive to most people seeking or delivering therapy. Even this sentence. I don't mean to go on, but "suffering" is your externally imposed perspective of what people are experiencing, and "highly complex cases" is a patronising way of talking about people's lived experiences on the basis they don't fit your simplistic model. Even "mental health problems" isn't a term without judgement about the people who are or have "problems". As to "the development of the capacity for rational thought", as if everyone who is distressed is irrational. Yuck.

This might be your little theoretical intellectualisations, but you are talking about the lives of one in four people, with no insight that this will include many of the people who are reading your post - myself included.

So tell me this, I'm a middle class white woman with a supportive family who had a mild depressive episode whilst I was at university - that's as CBT and textbook as you could wish for, right? So was the year I felt depressed really a "lack of rational thought", or was it that any individual would have struggled to cope with their Dad being tested for cancer and collapsing after the biopsy and needing a hospital admission, their landlord deciding to sell their property out from under them, a friend of a friend cornering them in their bedroom and declaring their intention to have (unwanted) sex with them, and being told their university had added a criterion that would prevent them following the career path they had moved to that city and taken that course for, all within a 6 week period? How would "the development of the capacity for rational thought" have helped me?

Or when I had my twin daughters prematurely, my grandfather and a friend at work both died (the latter unexpectedly, in his 50s), my employing NHS trust treated me incredibly poorly during my maternity leave, and my husband was made redundant. I referred myself for therapy via occupational health, before I made the decision to accept a voluntary redundancy. Could "the development of the capacity for rational thought" have helped me then?

(and for the record I said you sounded more libertarian than liberal, but deleted that a long time before you replied, on the basis that I don't feel any kind of expert on politics).
Miriam

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Re: Social justice and psychotherapy

Post by Samays » Tue Jul 14, 2020 10:39 am

aufbau83 wrote:
Sat Jul 11, 2020 1:02 pm
I will put my cards on the table now: I basically want to be a clinical psychologist because I’m very interested in therapy, and to me, the overall goal of therapy is to help the patient to learn how to think. I get that there are many complex reasons why people come for therapy. But I would nonetheless suggest that, invariably, patients are struggling with life situations and psychological difficulties that they need to learn to think through, and to think rationally about, in order to make progress.
Hi,

I'm curious. Why do you want to be a Clinical Psychologist and not a psychotherapist?

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Re: Social justice and psychotherapy

Post by aufbau83 » Tue Jul 14, 2020 11:46 am

@miriam. It sounds a bit to me like what you’re partly objecting to is my invocation of the coldly alienating, somewhat dehumanizing, “medicalizing” language that is (or at least was) sometimes associated with clinical psychology as a profession. Which, I guess, could be positioned squarely against what therapy at its best could be about – a collaborative and explorative enterprise undertaken by people operating on a level playing field.

I have to hold my hands up here – I am indeed prone to using this kind of language. In my defense, I’m coming from a very different background; I’m not so familiar with the evolving language of clinical psychology; and maybe I’m insufficiently sensitive to this kind of thing. I can only learn.

The experiences you describe sound individually crushing – coming in such a litany, they sound devastating. I am sorry you had to go through them, and I suppose Dr Spock walking into the room to tell you that you “just have to think rationally” about your travails would leave you, possibly, wanting to punch him in the face. I get that and I can see how what I’m saying would appear, as you put it, patronizing. Let me stress, as someone whose own father died of cancer well before his time, I’m not left cold by what you relate.

But I nonetheless stand by my argument about the importance of (what I understand to be) rational thought for (what I understand to be) recovery. To me, a salient point is that your experiences would have broken some people, perhaps even many or most people. Why did they not break you? Maybe good luck. Maybe you had excellent support. I want to suggest that it was, at least partly, your ability to think, to step back and reflect, to organize things and formulate plans for action, that helped you come out the other side and, ultimately, make it as a clinical psychologist with her own business, her own thriving forum and magazine. In fact, without these qualities, I don’t think you could’ve done what you’ve done. I’m not saying it’s a panacea – but even the refugee fleeing war and oppression who can think rationally is much better off than the one who can’t.

And what I’m ultimately saying is, this tendency can be encouraged, stimulated, even taught. I think it’s the key to recovery; I think it’s the most valuable contribution that a therapist can make; and I’d even argue that it’s the key to living in a civilized society.

I also get that life would be pretty boring without emotion and what it inspires; I’m not on a crusade to Dr Spockify the world. There'd be no Cure or Smiths in such a world...

Miriam, can I ask – and I hope I’m not simplifying your position here – given your skepticism about the centrality of rational thought to the “therapeutic endeavor”, are you also skeptical about the whole intellectual and therapeutic project of CBT? And of IAPT more generally? Is this why your left the NHS?

@Samays: a very good question; actually, I’m not sure I do. I still don’t fully understand this idea that the CP is a kind of jack-of-all-trades with functions beyond therapy, a kind of manager and overseer of psychotherapy. I’m probably misrepresenting it just in this paragraph, in fact. All I can say for sure is that my main interest is in this question of what helps people, what helps them change, and indeed, in understanding the epistemic (if you like) foundations of this process. Maybe CP wouldn't actually be the best route for me (notwithstanding the excruciating 15% chance of actually getting onto one of the courses).

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Re: Social justice and psychotherapy

Post by lingua_franca » Tue Jul 14, 2020 1:49 pm

Aufbau83, you have written elsewhere that you work in a very different field and haven't yet gained any practical experience working with people who are experiencing psychological distress. What you're saying here isn't grounded in any evidence; it's a theory that you've made up while completely detached from the field.

I did my PhD research with conflict-affected children who have experienced severe trauma, many of them refugees, and now I teach in a school for young people with trauma-related mental health difficulties. Their difficulties and the often painful strategies they've developed to cope with these are rational. They might not look it to someone without an understanding of how trauma works, but they make perfect sense in the context of what these young people have experienced. The idea that they can recover if we just "teach them how to think" is not only painfully tone deaf, it can also be harmful and even segue into victim-blaming. It is their situations that are abnormal, not their thought processes. I think you have got the wrong end of the stick about CBT if you think that what you've written gels with that model.

The whole concept of recovery itself is a loaded one, and it doesn't even make sense to use it in many psychological contexts, and especially not with people who have very painful and intricate histories. I think the best thing would be for you to gain some experience with some of the different client groups that CPs work with. It doesn't make sense to choose this as a career without doing that.
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"Suppose it didn't," said Pooh, after careful thought.
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Re: Social justice and psychotherapy

Post by lingua_franca » Tue Jul 14, 2020 2:01 pm

aufbau83 wrote:
Tue Jul 14, 2020 11:46 am
Miriam, can I ask – and I hope I’m not simplifying your position here – given your skepticism about the centrality of rational thought to the “therapeutic endeavor”, are you also skeptical about the whole intellectual and therapeutic project of CBT? And of IAPT more generally? Is this why your left the NHS?
I don't want to speak on Miriam's behalf, but given that she described taking voluntary redundancy after being treated poorly by her Trust and experiencing numerous extremely stressful life events, I think she's answered the question of why she left. This is why it's dangerous to have a pet theory and to try and shoehorn everything into it. It stops you from actually listening to what people are saying.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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Re: Social justice and psychotherapy

Post by Geishawife » Tue Jul 14, 2020 3:43 pm

This has developed into a fascinating discussion! aufbau83, can I ask you how you would measure rationality? You have used the term "rational thinking" and posited that people who think "rationally" are better equipped to deal with emotionally challenging experiences. That suggests you have some notion of where rational ends and irrational begins (and vice versa). So, by what metric is that to be judged or measured? I am genuinely curious as to why you think therapy is about encouraging "rational" thinking and what you see that term as even meaning.

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Re: Social justice and psychotherapy

Post by AJ555 » Tue Jul 14, 2020 8:46 pm

I echo Geishawife and I'm also interested in your view of rationality. It has made me reflect a bit on my own experiences...

In March I was feeling very anxious due to covid19 and quite terrified of getting it (and I still am). My colleague kept telling me that I just needed to "think rationally" and "use the knowledge you have to stop this thinking". Attempting to 'reassure me' because the risk wasn't that great according to that person.
I have a health condition (which the colleague knew about) which puts me in an extremely high risk category. So in reality, my thought process was very rational. I had to work out my level of personal risk if I was to catch the virus, and the likelihood of catching it given the area of the NHS I work in.

My version of "rational thinking" and my colleagues version of "rational thinking" were two completely different things because of our own individual experiences.

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Re: Social justice and psychotherapy

Post by xxpoogletxx » Tue Jul 14, 2020 11:01 pm

I concur that this is a really interesting discussion! Just a few ideas I had whilst reading through your comments aufbau83.

In terms of applying to Lancaster I would agree with Miriam in that perhaps it's not the best fit for you. Manchester or Liverpool might be better options, are still close to Lancaster and actually all three universities share placements between them. I am due to start Lancaster this year and I chose this university over other offers I received because of their commitment to social justice. Being a clinical psychologist is far more than just doing therapy, in fact some clinical psychologists do not engage in therapy at all in their role.

Your thoughts on therapy seem quite narrow and are very different to how I would describe the purpose and benefit of therapy. My understanding is not that therapy is there to teach people how to think, to be more rational or to 'fix' people. I would much rather get alongside a person, listen to them, validate their experiences and try to understand how I might be able to support someone. Therapy can help people to gain an understanding of themselves, their thoughts, behaviours and emotions. But I see this more as merely 'holding a mirror up' to someone, and giving them a safe space to work these things out for themselves. Perhaps sometimes we give people words and a framework to describe themselves and their experiences that they could not find before, but we do not teach people 'how to think'. I think it's easy to underestimate the power of just listening to a person and really being in the room with them, as Jung said "Know all the theories, master all the techniques, but as you touch a human soul be just another human soul".

My current experience comes from working in an 'acute inpatient' setting (mental health hospital). Now, I am someone who would not use the word 'patient' and perhaps would go as far as saying that the setting being a 'hospital' and the staff being 'doctors' and 'nurses' does not fit in with what I personally think should be the understanding of human distress and mental health, i.e. it is highly medicalised, often experienced as oppressive by the individuals within the system, and can be (re)traumatising. The area I work in is very diverse in terms of peoples' ethnicity, culture, religious beliefs, socioeconomic status etc. The majority of the people I work with are diagnosed as having schizophrenia/psychosis and I have to tell you that their 'paranoia', 'unusual' beliefs and experience of voice hearing make PERFECT sense given the context of their life experiences. Their 'symptoms' are not a result of them being 'irrational', they are ways in which their mind has tried to create an understanding of a world that often doesn't make sense, isn't fair and has treated them badly.

In terms of social justice, whilst I agree that people have a certain level of autonomy over their lives and view of the world, there are systemic inequalities, barriers and biases that pervade every corner of our society. There are ways that clinical psychologists can champion social justice beyond therapy or individual formulation. For example; being involved in policy making, facilitating staff training and reflective practice, facilitating supervision.

A disclaimer that I personally disagree with your thoughts that democratic capitalism has brought 'half a century of peace and prosperity'. For whom? Certainly not the people who live in countries that we have been 'at war' with, certainly not for the people who were wrongfully deported during the Windrush scandal, certainly not for the people who do not fit in with our societal 'norms', I could go on. I fundamentally disagree that the solution to systemic inequality lies within the liberal democratic system, the system was built to uphold these inequalities and as such is working perfectly for those who created it.

All that being said, of course there are all types of different practitioners with wildly varying political and social leanings. My advice would be similar to lingua's in that it's probably a good idea to try and gain more varied experience that is relevant to CP so that you can broaden your knowledge and understanding of the area.

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Re: Social justice and psychotherapy

Post by hawke » Tue Jul 14, 2020 11:14 pm

I am a current trainee, and my experience has been seeing the profession wrestle with these kinds of questions.

How much of a clinical psychology role should be individual therapy, vs other kinds of direct clinical work with families and carers, or groups? With many client groups, individual therapy is simply not an option anyway. How much should be indirect clinical work through teams and supervision? How much should be non-clinical service development? How much should be working with wider systems, from communities to commissioners? How involved should we be in research?

You are certainly not alone, in my experience, in having a particular interest in individual therapy. However, I’m not sure clinical psychology offers the best opportunity to do that. We get excellent training in assessment and formulation (at an individual and wider level), but our training on therapy itself seems comparatively weak. Many visiting lecturers are quick to tell us that therapy requires further training, and psychologists in services are mainly funding this themselves. A senior psychologist in my local trust is known for saying “If I want to employ someone to do CBT, I’ll employ a CBT therapist not a clinical psychologist – they’re cheaper and better at it”.

Ultimately, I agree with you, that therapy has its roots in individualism, and I think there is growing awareness of the philosophical assumptions that our work is built on but much disagreement over what that means for practice. The debates around psychology as an empirical science vs the influence of postmodernism are still live in the profession. I’ve seen a bit of a disconnect between the abstract embrace of social justice issues with the teaching and placement work itself which still tends towards individual and family-based formulations. Psychologists disagree over the level that individual therapy needs to be adapted to accommodate issues of social justice – following the debates about the Power Threat Meaning framework is particularly interesting from this higher-level perspective. Other psychologists are turning away from individual work completely, increasingly frustrated at dealing with the consequences of social injustice on an individual level, rather than preventing it.

In terms of rationality being the central pillar of therapy: I would challenge you to consider how you would evidence that (in the loosest definition of evidence) beyond your own value system and experience. How would you conceptualise and measure rationality? What is the research on non-specific therapeutic factors already telling us? How would you work with someone who didn’t share that outlook on the world? How would you work with some of the client groups Miriam mentioned – how does seeing them as complex affect your work with them? Would the goal of your therapy be to bring them over to your way of looking at the world? How would that affect someone (both positively and harmfully?)

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Re: Social justice and psychotherapy

Post by Samays » Tue Jul 14, 2020 11:27 pm

aufbau83 wrote:
Tue Jul 14, 2020 11:46 am

I’m probably misrepresenting it just in this paragraph, in fact.
Yep. But luckily this site is a wealth of information. This is useful in understanding the breadth of training and the profession - viewtopic.php?f=19&t=5835 - it might be fun to consider how the thoughts you've outlined above apply to each area which might inform your thinking re. a more therapy based role vs. CP?

It seems you have a romanticised view of therapy (though which modality, I don't know), perhaps informed by your singular experience of it. I agree that empowering the individual is part of the role of therapy or the therapeutic relationship. This might work well for a psychotherapist in a service for individuals with less complex presentations. But, enabling an individual to overcome a difficulty by thinking differently might only work for a small percentage of the populations that CPs work within and therapy makes up a small part of many CPs' roles. I work with people who have a diagnosis of intellectual disability. The idea that learning to "think rationally" would solve the suffering that they or other marginalised populations can experience has me at a loss. The "question of what helps people" to me is about much more than what exists within the individual.

Excuse my ignorance, I'm not too well read on political philosophies, but doesn't liberalism also infer a power structure acting for the individuals? In which case, wrestling this power structure into something that more fairly serves the diversity of the individuals is pursuing social justice without challenging the overall ideal of liberalism?? (Be kind...)

It would be interesting to see what empirical research supports your thought that enabling rational thinking is the "the most valuable contribution that a therapist can make".

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