I was reading an interesting article in the Medical Humanities journal, about use of psychological therapies to “help” unemployed people find work. The article, rightly in my view, points out that such therapies are on very dubious ethical ground.
There’s a view out there, which I think is utterly erroneous, that therapy and psychiatry can act as a remedy for all sorts of social ills. Give everyone enough CBT and fluoxetine, so the idea goes, and poverty, social inequality, abuse, bad housing etc will simply cease to be a problem. Does it work? Of course it doesn’t.
The article describes some “motivational” statements that were sent out to people on the Work Programme.
Go hard, or go home
My only limitations are the ones I set for myself
Failure is the path of least persistence
Success is getting up one more time than you fall down
It’s always too soon to quit
Unsurprisingly, those who received this responded with “anger, humiliation and depression” rather than being encouraged to get up and seek work. One can only imagine how such banal rubbish sounded to people who sent out multiple job applications at the height of the Credit Crunch, only to discover that nobody was hiring.
There’s other examples of such “therapy” being offered as a solution to problems in society. News reports have suggested that jihadists may be forced to undergo “deradicalisation” therapies. Although I agree that radical Islamism is a danger, the idea that people will give up their beliefs because a therapist told them to strikes me as naive in the extreme.
We’ve been here before. In the seven years I’ve worked in Child and Adolescent Mental Health Services [insert usual disclaimer here about how views expressed are in a personal capacity and not necessarily those of my employer] I’ve seen the vogue come and go for anger management. Schools, voluntary services, youth offending services and CAMHS were all sending vulnerable, often traumatised kids to anger management, so they can learn how to control their “anger problem”.
I’ve been struck by how many young people benefited from this. Virtually none of them. If they did, it usually wasn’t for a reason to do with the actual model of therapy. Perhaps they developed a good relationship with the worker, and the anger management exercises were simply something to do while they got to know each other.
Part of the problem is how it’s framed as an “anger problem”. Of course, the problem isn’t really anger. Children aren’t sent to anger management because they kept writing indignant letters to their MP. The problem that everyone is concerned about is their behaviour – smashing up bus stops, getting into fights and so on. It’s what they do that gets them sent to anger management, not how they feel.
As for those feelings of anger, those are often rooted in a much wider systemic problem – they live in a bad part of town, they aren’t getting appropriate parental boundaries, in some cases they’re being abused or neglected. To simply say they have an “anger problem” is a reductionist, narrow explanation that ignores wider issues outside of their control. What they often need is nurture, care, compassion and stability, not a finger pointed at them saying that they’re the problem and they need to sort it out.
Mostly importantly, what all these therapies ignore, whether it’s mandatory CBT on the Work Programme, forced deradicalisation or anger management, are the issues of consent and a client-based approach. It ignores a basic and fundamental tenet of therapy – that it’s there to help the client do what they want to do, not what everyone else wants them to do. That’s what makes such therapies not only unethical, but ultimately ineffective.