The Sale of Certainty

This morning I heard health expert Dame Prof Sally Davis, on BBC radio 4, talking about the health of UK children. (It seems that cases of rickets are on the rise. She suggested the introduction of vitamin supplements for all kids).
During the interview (which you can listen to here, at approx 2h 39min), she was also called upon to comment on mental health issues in family life, and their treatment.
How disappointing it was to hear the same old line trotting out once again, like a soundbite, or one of those management-speak buzzwords that seems to be infectious in the meeting-room spreading from one employee to another. It goes something like this:
 (a lot of mental health problems) "will respond to.... Cognitive Behavioural Therapy... talking therapies..... "

The words used here are telling. They show a lack of understanding about the therapy world; its different modalities, and their potential use in the wide range of mental health issues. The words also show a willingness to endorse, publicly, a particular form of treatment.

I have previously drawn attention to this advertising of the CBT 'brand' here.

Dame Sally makes it very clear to us exactly why she wears this logo on her T-shirt. She says "I believe that we should only offer treatments that are evidence-based."
What she's saying, then, is that she only values treatments (and that includes therapies) which offer a statistical probability of "success" based on "outcome measures", and perhaps therapies which lend themselves to a widely-accessible "treatment protocol".
(For a deliciously sarcastic take on this kind of approach, see my friend Jason Mihalko's blog here).

Dame Sally is, of course, coming from her own training and heritage. She is steeped in the politics of medicine; a world of ever-increasing tension between public treatment needs and public costs. She values 'evidence-based' therapies, because, perhaps rightly, it would be hard to advocate the spending of public cash on therapies that aren't shown to be 'cost-effective'. The taxpayer deserves value for money, of course.

Evidence-based treatments are useful because, in the medical world, they offer the best assurance that a certain drug/intervention will work. The science tells us that in (n) cases, (x) show a measurable improvement compared to a control group who haven't been given this intervention. Therefore, the chances of your symptoms improving with this treatment are predictable to a certain level of probability.
Evidence-based treatments are also seductive, because they offer us a sense of safety and hope for a particular outcome that we are invested in.
We invest psychologically as patients, because we all want our symptoms to improve.
We also - as Dame Sally illustrates - invest financially. This, on a political level, has huge consequences, because government will clearly be much happier to offer therapy that offers clear, predictable outcomes.

Easy, then, to be fooled into thinking that therapies offering statistically-supported outcomes are the 'best'.
Sure, if you have the type of problem that fits neatly into the standardized diagnostic boxes that NICE and the APA prefer. But the problems of our life and our world are, to my mind, mostly in a different category than this.

How many times, for instance, have you lost a night's sleep because of a meeting, interview, or other event the next day that you are uncertain about?
We have all become stressed and irritable, maybe felt depressed, because of an ongoing issue in life that we can't control or predict.
Maybe you have thought about making a major decision in your life but have been held back for some time, because of the fear of the unknown. "If I knew I could get more work over there, I'd leave this job for good. But how do I know...?"

If only there were an assured, statistically-supported outcome, that you could be certain of....!

I don't believe I'm in the business of offering people assured or certain outcomes. Because in lots of ways, I don't believe there are many to be found. However, the selling of empirically-supported therapy is popular because it fits with an economic and medicalized model of human suffering. The natural human needs for self-exploration, mutual discovery and understanding, and psycho-spiritual development, are not necessarily part of the 'treatment plan'.....

.

A-one, a-two- a-three .... and ....

It was the end of the session; one of those last-five-minutes that is an open space for anything to come in. The therapeutic work was done (?) , and the conversation drifted onto ... something quite random.... maybe colds or 'flu or something.....

An observation was made that the therapist had a gravelly voice this week.

"Yes...ok for talking, but with this kind of voice, you can only sing one song... and that's 'I Walk The Line'..."

"Hmm?" Puzzled, curiously. "Never heard of that one."

Then came a gravelly but tuneful couple of bars - "Because you're mine..... I walk the line..."


Okay - the song has been changed, and the example is deliberately vague - but this is a description of something that happened to me once, as a client in therapy. It was just a moment in the relationship, but now I'm writing about it, I realize that no therapist had ever sung to me in a session before (and hasn't since). What an interesting experience that was, on many levels!

I realize also that I have found myself singing in a session, more than once. This is usually because the musical world has so much to offer us, in illustrating the breadth of human experience. Songwriters, and composers, are chroniclers of the soul. Heartbreak, ecstasy, loss, disconnection, anger, eroticism, it's all out there - in a nicely distilled form that pools in our unconscious and reinforces our shared humanity.
Singing is also part of my life, part of my history. I guess singing in-session in a kind of self-disclosure, too. I am saying something about myself (or perhaps my inner 11-year-old choirboy is...)
In and out of the therapy room, I naturally reach to song lyrics or music, at different moments..... A friend is telling me about a situation brewing with her husband, and I find myself chiming in - "There may be trou-ble ah-ead....".  Another friend stops for a chat, and for the rest of the morning I am singing or humming a song that uses her name. A fresh brew at the office brings delight and gratitude, and I find myself crooning in praise of caffeinated drinks.


I wonder if any therapist colleagues or clients out there have sung in-session, either 'accidentally' or deliberately, in order to communicate something?

In a spirit of playful curiosity, I invite you to share a story on my blog*, if you wish; let's see who the singers are!   ;o)



References

"Let's Face the Music and Dance" - Irving Berlin (1936)  http://www.youtube.com/watch?v=TnfKmNRfLYU

"Looking for Linda" - Hue and Cry (1989) http://www.youtube.com/watch?v=ONc3OMOb98I


"Java Jive" - The Ink Spots (1940) http://www.youtube.com/watch?v=iP6IUqrFHjw


 *p.s. Professionals are gently reminded to protect the confidentiality of your therapeutic relationships, current and historical

.