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'.....
.
Infrequent musings and general comments on life, from the perspective of a UK psychotherapist.
Thursday, 24 October 2013
Wednesday, 4 September 2013
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
.
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
.
Thursday, 15 August 2013
A-Level ... Results day
Today in the UK, students will be collecting their A-level results. Every year this prompts a slew of media coverage as excited 18-year-olds opening their envelopes to great delight.
Of course, we never see or hear coverage of those young people who are less excited, or even disappointed. This is held from us - rightly, perhaps, to save them from embarrassing exposure, but also perhaps to shield us from the uncomfortable truth that normal people also don't get 'A-star' grades.
There is also media focus on the transition between A-levels and the University system. The effect is to create and perpetuate a myth that A-levels naturally lead to University. I have been wondering about this today. How have we created a rite of passage that narrows so much at the completion of formal schooling?
It occurs to me that the link has been artificially fortified, perhaps for political reasons, since people in higher education do not place a burden on employment statistics - and of course, higher education itself has become a growth industry with fee-paying customers.
The flip side? It creates a cultural script, and sometimes a family script, which then falls upon the young person to fulfill. What happens, then, if a young person isn't ready, academically or personally, for University?
An impasse can be created - one part of the personality says "I want (need) to go to University, as that's what is supposed to happen to me". Another part - the inner, maybe quieter voice - says "I can't," , or "I don't want to".
Experience and T.A theory tells us that when people find themselves in conflict with their cultural or familial script, they can experience a deep sense of shame, as if something is wrong with them. The inner critic - sometimes called the "Pig" Parent - is the engine of this feeling of shame.
I remember coming face-to-face with this cultural and institutional script, when I went back to my school to collect my results. I knew I hadn't done as well as I had hoped; my two years had been dogged by glandular fever and depression. I knew my results had suffered. So it wasn't a surprise when the face of my biology teacher dropped, as I walked up to collect my envelope. He conveyed a kind of collective disappointment with his expression and his words. But I was determined that he wouldn't make me feel ashamed, as I had done already many times in that two-year period.
I made a quip about John Major (the Prime Minister at the time) who had 'only' 5 O-levels, and I observed that it seemed to be enough to get him along in life. I willed a smile to my face, turned, and left... and haven't been back since.
My thoughts today are with the happy ones, yes. The ones who have their future mapped out nicely. Great!
But my thoughts are also with those whose maps aren't so clear - just as mine wasn't. They will tread a different path, but it may be better - more autonomous - for them. The road less travelled, perhaps.
.
Of course, we never see or hear coverage of those young people who are less excited, or even disappointed. This is held from us - rightly, perhaps, to save them from embarrassing exposure, but also perhaps to shield us from the uncomfortable truth that normal people also don't get 'A-star' grades.
There is also media focus on the transition between A-levels and the University system. The effect is to create and perpetuate a myth that A-levels naturally lead to University. I have been wondering about this today. How have we created a rite of passage that narrows so much at the completion of formal schooling?
It occurs to me that the link has been artificially fortified, perhaps for political reasons, since people in higher education do not place a burden on employment statistics - and of course, higher education itself has become a growth industry with fee-paying customers.
The flip side? It creates a cultural script, and sometimes a family script, which then falls upon the young person to fulfill. What happens, then, if a young person isn't ready, academically or personally, for University?
An impasse can be created - one part of the personality says "I want (need) to go to University, as that's what is supposed to happen to me". Another part - the inner, maybe quieter voice - says "I can't," , or "I don't want to".
Experience and T.A theory tells us that when people find themselves in conflict with their cultural or familial script, they can experience a deep sense of shame, as if something is wrong with them. The inner critic - sometimes called the "Pig" Parent - is the engine of this feeling of shame.
I remember coming face-to-face with this cultural and institutional script, when I went back to my school to collect my results. I knew I hadn't done as well as I had hoped; my two years had been dogged by glandular fever and depression. I knew my results had suffered. So it wasn't a surprise when the face of my biology teacher dropped, as I walked up to collect my envelope. He conveyed a kind of collective disappointment with his expression and his words. But I was determined that he wouldn't make me feel ashamed, as I had done already many times in that two-year period.
I made a quip about John Major (the Prime Minister at the time) who had 'only' 5 O-levels, and I observed that it seemed to be enough to get him along in life. I willed a smile to my face, turned, and left... and haven't been back since.
My thoughts today are with the happy ones, yes. The ones who have their future mapped out nicely. Great!
But my thoughts are also with those whose maps aren't so clear - just as mine wasn't. They will tread a different path, but it may be better - more autonomous - for them. The road less travelled, perhaps.
.
Friday, 7 June 2013
The Other Side of the Wafer-Thin Barrier
This week, SOAP (Speak Out Against Psychiatry) held a demonstration at the Institute of Psychiatry in London. It follows a long period of widespread criticism of the DSM and its political influence.
I'm with the SOAP people in spirit, because I think someone needs to hold up a mirror to psychiatry, and I hope that psychiatry will be smart enough to look earnestly at itself.
I've written a little about this (see here and here) but I am by no means the most vocal critic or the most prolific writer on the DSM5 and all its problems. A good distillation of the issues, which is kept up-to-date with current material, can be found on the Beyond Meds blog - the DSM update page is here.
The SOAP web page for this event is well worth a read. There, they explain their position that human suffering is more than a medical issue, and so we should not rely upon a medical treatment for wider problems. Normal human experiences, they say, are being medicalized which results in people being labelled.
I agree, and have agreed for some time. The DSM5 threatens to turn grief into a disorder, and child tantrums into a disorder. This is a dangerous form of 'mission creep'.
My instinctive opposition to diagnostic labelling comes, I think, from what I have learned in my training and experience as a psychotherapist. I have also had some experience of the mechanisms of psychiatry and psychopharmacology, which lead me to believe that both practices have departed significantly from what I hold to be the work of healing mental illnesses.
An article shared on Twitter recently notes that "Psychiatry was not - on Freud's watch - to be swallowed by medicine". Perhaps Freud intended that psychoanalysis be practiced by people who did not go through the sheep-dipping of medical training, and who could connect in a different way to their 'patients' as a result. Clearly, Freud knew that looking at people through a medical lens could be an inherently limited approach.
It's interesting to note the boundaries getting fuzzy here, between psychiatry (which is a branch of medicine) and psychotherapy. It's true that some psychiatrists are also trained psychotherapists who have undertaken extensive personal therapy themselves. But it's true too that many psychiatrists are just doctors. Some of these doctors are working on the assumption that their medical degree and psychiatric training entitles them to carry out psychotherapeutic enterprises under the banner of psychiatry. They also work on the assumption that their medical training (and with this I include the social, cultural, and heirarchical effects of medical and psychiatric training) will not somehow infiltrate the relationship, and the treatment that they offer. As if the person that we are, and the experiences we have, can somehow be irrelevant once we are in the room with a patient.
No.
The article also quotes Robert Spitzer, who headed the development of DSM-III. In a hugely telling remark, he is reported to have said: "..looks very scientific..... It looks like they must know something". For me, this is symbolic of the eternal struggle of medicine as a science - to name, to understand, and thus to defend against the impossible anxiety of NOT knowing.
"The medical model is a wafer-thin barrier against uncertainty" - Irvin Yalom
So, I question psychiatry as it's practiced today because of its over-emphasis on naming, and understanding stuff - much of which (like grief, tantrums, and the stress of someone's death) is actually the stuff of LIFE and not really there to be understood through a medical model.
I want to be prepared to sit on the other side of that barrier, where there is chaos, confusion, or hurt, and allow that to be the stuff. Because that's what I believe people want and need from soul-healing.
Here's the article, by the way
.
I'm with the SOAP people in spirit, because I think someone needs to hold up a mirror to psychiatry, and I hope that psychiatry will be smart enough to look earnestly at itself.
I've written a little about this (see here and here) but I am by no means the most vocal critic or the most prolific writer on the DSM5 and all its problems. A good distillation of the issues, which is kept up-to-date with current material, can be found on the Beyond Meds blog - the DSM update page is here.
The SOAP web page for this event is well worth a read. There, they explain their position that human suffering is more than a medical issue, and so we should not rely upon a medical treatment for wider problems. Normal human experiences, they say, are being medicalized which results in people being labelled.
I agree, and have agreed for some time. The DSM5 threatens to turn grief into a disorder, and child tantrums into a disorder. This is a dangerous form of 'mission creep'.
My instinctive opposition to diagnostic labelling comes, I think, from what I have learned in my training and experience as a psychotherapist. I have also had some experience of the mechanisms of psychiatry and psychopharmacology, which lead me to believe that both practices have departed significantly from what I hold to be the work of healing mental illnesses.
An article shared on Twitter recently notes that "Psychiatry was not - on Freud's watch - to be swallowed by medicine". Perhaps Freud intended that psychoanalysis be practiced by people who did not go through the sheep-dipping of medical training, and who could connect in a different way to their 'patients' as a result. Clearly, Freud knew that looking at people through a medical lens could be an inherently limited approach.
It's interesting to note the boundaries getting fuzzy here, between psychiatry (which is a branch of medicine) and psychotherapy. It's true that some psychiatrists are also trained psychotherapists who have undertaken extensive personal therapy themselves. But it's true too that many psychiatrists are just doctors. Some of these doctors are working on the assumption that their medical degree and psychiatric training entitles them to carry out psychotherapeutic enterprises under the banner of psychiatry. They also work on the assumption that their medical training (and with this I include the social, cultural, and heirarchical effects of medical and psychiatric training) will not somehow infiltrate the relationship, and the treatment that they offer. As if the person that we are, and the experiences we have, can somehow be irrelevant once we are in the room with a patient.
No.
The article also quotes Robert Spitzer, who headed the development of DSM-III. In a hugely telling remark, he is reported to have said: "..looks very scientific..... It looks like they must know something". For me, this is symbolic of the eternal struggle of medicine as a science - to name, to understand, and thus to defend against the impossible anxiety of NOT knowing.
"The medical model is a wafer-thin barrier against uncertainty" - Irvin Yalom
So, I question psychiatry as it's practiced today because of its over-emphasis on naming, and understanding stuff - much of which (like grief, tantrums, and the stress of someone's death) is actually the stuff of LIFE and not really there to be understood through a medical model.
I want to be prepared to sit on the other side of that barrier, where there is chaos, confusion, or hurt, and allow that to be the stuff. Because that's what I believe people want and need from soul-healing.
Here's the article, by the way
.
Subscribe to:
Posts (Atom)