My response to “Overrated: Our capacity to impact policy”

https://thepsychologist.bps.org.uk/volume-31/june-2018/overrated-our-capacity-impact-policy
The ongoing debate over the value of psychological evidence with regard to policy-making makes for great reading. From my point of view, it highlights that wonderful observation that academic research trails behind the reality by about 10 years. The idea that we should be using the current accepted evidence base to inform policy seems well beyond its sell by date.
Currently, the psychological evidence that is informing current government policy is that coming from Improving Access to Psychological Therapies. The evidence that is supporting IAPT interventions now seems to be about 10-15 years out of date. This is so simply because the population has moved on from the kind of individualistic and paternalistic treatment intervention that epitomises current psychological offerings.
Psychological “truths” are not dictated by psychological researchers but by the social milieu. One only needs to read a history book mapping the development psychology and in particular that of psychological therapies to realise that there is a journey in which the nature of interventions changes over time to coincide with the changes in society and the understanding and education of the population as a whole.
I note that the authors of the paper “overrated: our capacity to impact policy” make the following claim,
“Could a focus on practices – rather than on experts, immutable clinical categories, technologies and fixed knowledges – allow us to appreciate the ways that knowledge, status, relief, atmosphere and solidarity come together effectively in informal practices? If we want to recognise the fluid and innovative nature of the many informal care practices then a future course for a psychology of distress could be to develop and celebrate methods that are sensitive to this.”
I think it is important to contrast that with the early history of caring interventions which were strictly the realm of the expert in the form of the psychoanalyst and his esoteric knowledge and just how much the laws of psychology have changed in the last hundred years.
Psychological care, psychological language is no longer the exclusive realm of the expert but is in common parlance and as the authors of the above quoted paper clearly indicate there is much opportunity for the public to become engaged in the process of psychological care whether it is at the level of the individual, the group, the community or a population.
Virchow was a pathologist in the 1800s and once said, “Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution. The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.” Rudolf Virchow http://www.azquotes.com/author/29202-Rudolf_Virchow
Psychology as a discipline has yet to come of age as a science. This can be clearly illustrated by question I found in an online survey being carried out by a PhD student. The question was, “what is your theoretical approach?” This is a question that if you asked an engineer, physicist or a chemist would be met with a blank look, as apart from minor variations, their theoretical orientation is based upon a single set of principles. This is far from true for psychology. In the case of therapy alone there are over 360 different forms of “therapeutic intervention”. Each with their own theoretical underpinning and often at odds with each other.
A good science can also make predictions based upon hypotheses and yet while there are some areas in which there is little disagreement in psychology, there are vast areas where hypotheses have been made, interventions been carried out that have worked initially but then not been replicable by other researchers. Richard Feynman said, “It doesn’t matter how beautiful your theory is, it doesn’t matter how smart you are. If it doesn’t agree with experiment, it’s wrong.” https://www.brainyquote.com/authors/richard_p_feynman Unfortunately far too many academics have far too much invested to be able to let go of their pet hypotheses and as Max Planck once said, “science progresses one funeral at a time”.
Part of this problem it seems to me is somewhat analogous to a discovery made during the Second World War ”Wald (found in Syed) carried out many investigations during the Second World War in an attempt to make Allied planes safer and the most fundamental thing his investigations revealed was “that in order to learn from failure, you have to take into account not merely the data you can see, but also the data you can’t” (Syed 2015). This statement came from observing and analysing bullet holes in the planes that returned from bombing raids over Germany. Initially there was a good deal of effort put into armouring the places where the bullet holes were. Then it dawned on Wald that these were the planes that came back; he realised that they should be looking to armour the places where the planes that didn’t come back got hit!
Yesterday a significant paper was published that says,
“We were surprised that genetic factors of some neurological diseases, normally associated with the elderly, were negatively linked to genetic factors affecting early cognitive measures. It was also surprising that the genetic factors related to many psychiatric disorders were positively correlated with educational attainment,” says Anttila (2018). “We’ll need more work and even larger sample sizes to understand these connections.” https://www.sciencedaily.com/releases/2018/06/180621141059.htm
This is the kind of data that illustrates the point I was trying to make above that currently psychology in the field of therapy is very focused, particularly clinical psychology, on trying to identify and resolve problems rather than looking at potential wider solutions. Antillia’s study gives a clear steer to looking at environmental and social factors as well as genetic factors (genetic factors are only weakly correlated with psychological/psychiatric disorder according to the study).

My particular observation in this situation would be that we should be looking for environmental and social conditions in which psychological and psychiatric disorders occur less often and be exploring why that is rather than simply trying to solve the problems and reduce the distress that occur in other less benign environments. In other words, creating the conditions for good mental health rather than trying to reduce the bad conditions that produce bad mental health.
Despite a hundred years of research the holy Grail of psychology, a single unified theory, remains as elusive as ever. Perhaps this is because the human brain is evolving and changing in response to the changes in environmental conditions (and who can doubt that societal and environmental conditions have not changed in the hundred years so since Sigmund Freud) at a phenomenal rate. This ever-changing environment laying waste, in a decade or two, to each last “great theory” produced to explain human behaviour.
Perhaps it is time that psychologists started to work with what is already in place and what is wanted, rather than working with what was and what they would like it to be! There are good steps in this direction (The PTM framework for instance), but they are being met with fierce resistance from entrenched opinions. Letting go of treasured beliefs and ideologies is not easy but at least heretics don’t suffer capital punishment any longer!
References:
Anttila V. et al. Analysis of shared heritability in common disorders of the brain. Science, 2018; 360 (6395): eaap8757 DOI: 10.1126/science.aap8757
Syed, M. (2015), Black Box Thinking, The Surprising Truth about Success, John Murray publishers, Great Britain

Advertisements

A manifesto for Social Change

The SF and Social Change stream at the recent UK Association of Solution Focused Practice (UKASFP) conference marked a significant development in SF in the UK, bringing together people, ideas and hopes for the future relating to solution-focused practice and collective action, social change, community-based work and, dare we say it, politics. It included a rich variety of contributions from SF practitioners already working in ways that promote social justice as well as non-SF practitioners and activists from the community and critical psychology worlds, and from radical social work. A panel discussion at the end of the stream focused on the broad questions of what SF can bring to social change, and what might be required of SF and SF practitioners for SF to be utilised (more) for social change.
The UKASFP conference also marked the launch of a Draft Manifesto for a Critically Engaged Solution-Focused Practice, produced by The Solution-Focused Collective. The latest draft of the manifesto is reproduced below, and it can also be found in the Solution-Focused Collective Facebook group and on Twitter (@solfocollective), which you are invited to join and follow if this project is of interest to you. A number of people have signed up since the conference, so the collective is already beginning to grow.
We are keen now to make this nascent collective bigger, and more collective, to publicise the manifesto further, and generally to take forward the project which the conference stream was very much a part of and has given a big boost to. Our next step has been to set up a meeting, on Monday 6th August in London, to which all SF practitioners who support the aims and vision of the manifesto are invited.
We are hoping that what will emerge from this meeting will be a truly collective voice of SF practitioners committed to using SF for promoting social change, together with a collectively-developed preferred future which constitutes an elaboration of the best hopes set out in the manifesto. We would also like the manifesto – or should we say, a manifesto, as what emerges from our collective conversations may not be anything like the first draft we started with – to become a truly shared, collective statement of intent or orientation. We are therefore also inviting you to come along with your ideas and suggestions relating to the function, content, presentation, style and further dissemination of a manifesto for a critically engaged solution-focused practice.
The meeting will take place between 10:30am and and 4:30pm BST, at St. Margaret’s House, 21 Old Ford Rd, Bethnal Green, London E2 9PL (5 minutes walk from Bethnal Green tube station) on Monday 6th August. Since numbers will be limited, could you let us know by emailing us at solfocollective@gmail.com if you are intending to come. Since we have no budget for this event and will need to pay for the room hire, we’d also appreciate it if you could come along prepared to pay a small contribution to cover this. Once we have an idea of numbers, we will be able to let you know how much we are likely to need each person to contribute.
We hope to see as many of you as possible there and are looking forward to taking forward this exciting and – we believe – much needed and very timely development of SF practice!
Guy Shennan and Suzi Curtis (The Solution Focused Collective)

 

 

DRAFT MANIFESTO
for a Critically Engaged Solution-Focused Practice
We hold this truth to be self-evident, that solution-focused practice can assist people in moving towards the lives they wish to live.
Solution-focused practice helps people to cope with the world in various ways. The point, however, is to change it.
We are angered by the oppression we see around us, believe that public issues should not be translated into private troubles, and thus are committed to social change.
So we have a dream, that solution-focused practitioners can come together, and use the power of our approach collectively towards the social change that is needed.
Our best hopes are for a world where there is social justice and freedom for all.
Our preferred future is a world of equality, reciprocity and interdependence, and of communities that enable people to lead lives of fulfilment.
We believe that there are instances of this everywhere, and that there has always been progress towards this future, wherever people have come together for the greater good.
The history of our preferred future includes the campaign and reform sides of social work present at its beginnings, alongside help provided to individuals and families.
The history of our preferred future includes the critical and radical psychologists who opposed austerity and now call for social change.
The history of our preferred future includes community work and community development, where workers get alongside people in their communities and agitate for change.
The history of our preferred future includes solution-focused practitioners and others who have worked with people in groups and not only on their own.
To realise our hopes, we aim to develop our solution-focused practice so that
• it acknowledges the social and environmental causes of people’s distress and difficulties
• it extends beyond the realm of the individual to embrace collective and social action
• we evaluate the impact of our solution-focused work on promoting social justice and equality, going beyond evaluation focusing only on individual improvement measures
• we build links with movements for social justice and equality, and with practitioners of other approaches committed to these aims
• we critically reflect on our methods and on whether they maintain oppressive relations
We call on solution-focused practitioners everywhere! To join us in our collective aims, for a campaigning solution-focused practice, for a critical solution-focused practice, for a solution-focused practice that we take into our communities and offer to those in greatest need. We call on solution-focused practitioners to rise up, to break free at last, for we have nothing to lose but our individualised chains!

Solution Focused Practice: Three day intensive course

Time: 9:30am – 4:30pm (tea & coffee provided: on-site café for buying lunch – or bring your own!)

Location: PTU Offices, 54, St James Street, Liverpool L1 0AB

Cost per person
Day 1 only – £140 per person
Days 2&3 only (for those who have already attended a ‘taster’ day) – £250 per person
Days 1-3 – £400 per person

Size of group: between 4 and 8 people: may vary across the three days due to some attending only Day 1, some only days 2 and 3, but there will be a core of people attending all three days.

Eligibility and course description
The course is open to anyone who has an interest in learning about the solution-focused approach, whether this be in a therapy, coaching, education, health, social care, organisational or other setting.
It will be very participative and interactive throughout, but especially so on days 2 and 3 when participants will also be asked to reflect upon the uses that they have made of their day 1 learning, in the context of their work so far. For this reason it is important that those attending all three days – or just days 2 and 3, having already undertaken an introductory course – be in a position to put some of their learning into practice immediately. If this is not possible, please let me know and we can discuss ways in which we may be able to help with this.

Learning Outcomes and opportunities for continued learning
1. Day 1 as a standalone course will give participants a good overview of the approach and will equip them with a number of immediately useable ‘tools’ to fit into their current working practices.
2. The three-day course will give participants a more thorough understanding of how solution focused practice can be used as a universal/generic approach to having ‘helping conversations’, whether this be
a. by using the approach in its entirety, as a stand-alone therapeutic or coaching model, or
b. by incorporating certain elements of the approach alongside other aspects of a ‘helping role’, where it can help to ensure that the worker’s expertise is used in a way that is most aligned with the client’s agenda and also help to clarify the desired objective or outcome of the worker’s involvement with the client.

3. The three-day course should give participants the skills and knowledge to begin working immediately in a solution-focused way in one-to-one helping conversations, if they are in a position to do so. It is recommended that this practice is supported by regular appropriate supervision from an experienced solution-focused practitioner, as it can be difficult to continue working in a solution-focused way in isolation without this support.

4. The PTU can offer follow-up one-to-one or group supervision sessions for those participants who are not able to get this supervision from elsewhere. It is recommended that, in the first instance, practitioners have at least 1.5 hours of supervision per month (though this may vary dependent upon the volume and frequency of clients they are seeing). This can be provided by the PTU at a rate of £70 for a 1.5 hour one-to-one session, or a lower rate (determined by how many people attend) for a 2.5 hour group session.

5. The way in which the material is taught on the course is completely consistent with the criteria for accreditation used by the UKASFP.
Outline Programme

Day 1

1. A brief history of Solution Focused Practice: origins, assumptions and evolution;
2. Introduction to main ‘ingredients’ of an initial solution-focused conversation (with video clips)
3. Further exploration and illustration (with video clips and exercises) of:
– Contracting/best hopes
– Preferred future
– Scaling
– Eliciting descriptions of progress and instance
4. Overview of follow-up sessions
5. Brief discussion on using solution-focused questions outside the ‘pure’ therapy/coaching model (i.e. in the context of other roles) and reflections on applications to your work

Day 2

1. Recap on Day 1 in the light of your experiences and reflections since Day 1 – dealing with questions and revisiting Day 1 material as necessary
2. Skills practice – with detailed feedback from the trainer – on
– Contracting/best hopes
– Preferred future
3. Detailed exploration and illustration (with video clips and exercises) of:
– Scaling and progress descriptions including exceptions and instances
– ‘Coping’ questions
4. Further detail and skills practice on follow-up sessions

Day 3

1. Recap on Day 1/2 in the light of your experiences and reflections since Day 2 – dealing with questions and revisiting Day 1/2 material as necessary
2. Further skills practice tailored to your needs and wishes on the day but focusing on combining the different solution focused ingredients throughout a whole conversation with a single client OR a team/group; may also cover delivering a solution-focused service, if of relevance to the
3. Reflections on learning and where to go next with your SF practice.
Preparing for the training

Recommended reading for the course is Guy Shennan’s book “Solution Focused Practice: Effective Communication to Facilitate Change”. A copy of this will be provided in advance of the course and it would be helpful if you could have dipped into it before your day 1, but don’t worry if you’re not able to! Please bring the book with you as it is sometimes referred to on the course, especially the transcripts of conversations.

Please come along to the training prepared to use some of your own personal experiences (i.e. being yourself, not role-playing a client) as a means of being able to experience and fully appreciate the benefits of the approach. Please can I stress that I ask you to share only those things they are comfortable with and stress that, because this is solution-focused, conversations will be about where you are trying to get to rather than an exploration of any problems you may have. If you have any doubts or concerns about this, please let me know in advance and we can sort it out together.

Trainer info: Suzi Curtis

I have been a clinical psychologist and solution focused practitioner since 2010 following a 20-year career as a government statistician. I work in a Clinical Health Psychology department in the NHS in Southport with people who have long term health conditions as well as in Liverpool as part of the Psychological Therapies Unit, a Community Interest Company providing one-to-one therapy services and training. I have a particular interest in making talking therapy available to people who find it difficult to access mainstream services and I have recently been providing a free therapy service to the homeless population in Liverpool.

I run regular training courses in solution-focused practice, within both my NHS and Psychological Therapies Unit roles and also as an associate trainer for Solution Focused Trainers Ltd and BRIEF. I regularly teach on the Liverpool and Lancaster University Clinical Psychology Doctorate courses and supervise trainees from those courses. I am also supervisor for groups of coaches working for The Young Women’s Trust and regularly supervise clinical psychology doctoral trainees as well as volunteer therapists working as part of our free service in Liverpool.

I love the solution-focused approach and enjoy teaching it and ‘spreading the word’ about what it can do for people, as it can help not only those working in therapist/counsellor roles (and their clients!) but also organisations, teams, managers, mentors, mediators or anyone at all whose role involves having conversations with people who are stuck or want to move forward.

I have been a Board member for the United Kingdom Association for Solution Focused Practice (UKASFP) for the past five years. Over this time, I have convened and led a group of expert and world-renowned solution-focused practitioners in developing a system of accrediting solution-focused work such that it can be recognised by employers as a credible, rigorous standalone qualification to practice in this way, without the need for additional qualifications. The accreditation system is now up and running and the UKASFP continues to work towards the recognition of this.

 

Please contact me if you have any questions, on 07889 718828
or email suzi@psychological-therapies-unit.co.uk
steve@psychological-therapies-unit.co.uk (tel: 07970610377)
Looking forward to seeing you on the course!

Suzi
&Steve

paradigm shifts – or not.

I’m always fascinated by the debates about mental health on Twitter. The latest most interesting dispute seems to be about whether there has been a Kuhnian paradigm shift or not. In the blue corner we have psychiatry ably defended by Samei Huda and in the red corner we have Lucy Johnstone promoting the power threat meaning framework.
Ironically, the referee seems to be the service users/patients/experts by experience who are constantly making the observation that actually they feel incredibly marginalised by the whole debate. Though some of them clearly fall down on one side or the other.
Likewise, professionals seem to be lining themselves up on one side of the debate or another. Though again I observe that there seem to be more than two protagonists in the ring fighting over the territory that is the minds of the population.
In the minds of the professionals, whichever faction is considered, it seems to me that they are seeing themselves as experts, understanding the human mind better than anybody else whatever perspective they take. This is kind of understandable, most professionals are spent a lot of time and money developing skills that they see as being useful when it comes to helping others who are in distress.
But in my view there is no paradigm shift, it is the same old same old; experts trying to prove how expert they are, people are still suffering in larger numbers than ever despite the best efforts of all the different schools of psychology and psychiatry.
For the first time in the history of our planet a species is knowingly creating a hostile and toxic environment. Some members of our species are then taking advantage of a hostile environment in order to gain advantage for themselves. On this occasion I am not talking about psychiatry and psychology, though no doubt a few of those reading this bristled at that comment – those that did I suggest you reflect upon your own behaviour.
No, the ones I’m talking about are those who have the power to reduce the distress of populations across the world by redefining the priorities of the species. There are few selfish men and fewer still selfish women who choose to inflict misery upon millions for their own self-aggrandisement and their own need to ameliorate their own insecurity. These people are the dangerous ones.
The paradigm shift will come when we realise en masse that it is the way we think that needs to change. We need to begin to consider what the future will look like, what we will be doing when there is less distress and misery in the world, what the form of negotiation will be when we negotiate for success instead of competition. How we will be planning and thinking about the future in order to have a safer and more effective environment in which more people can live safely and securely without fear of starvation or war.
The turf wars in psychology and psychiatry are merely skirmishes over the dribblings of power that leak from the hands of those who are truly sick with the love of money and power. That paradigm shift will come when we stop looking back and begin to seriously look at our future and how we can begin to plan it as a more cooperative and less adversarial species. That change can only come with a paradigm shift in the way we think. That paradigm shift is yet to come.

IAPT and Deprivation

As is my wont I was browsing Twitter yesterday and I came across a picture from a conference that Prof David Clark was attending. The picture was called “finessing the adverse effects of social deprivation”. On the picture he made the claim that “Slough is one of the most deprived areas” he then provided some figures about the success of IAPT in Slough and compared them to Maidenhead and Windsor which he claimed is one of the least deprived areas in the country. My 1st observation about this slide is that he does not make the claim that Slough is one of the most deprived areas in the country so as not to fall into the trap that I am now going to offer him.

Slough is not one of the most deprived areas in the country – it is one of the most deprived areas in the Home Counties which is not the same thing. Slough is, in fact, 78th out of a total of 152 separate areas in England. This puts it right in the middle of the deprivation table.

However, there are also significant number of other factors that will affect the efficacy of any kind of talking intervention with regard to deprivation. To this end I would like to offer some of the things that have happened to Slough in the last 2 years: how about the £450m Heart of Slough scheme, or £20m being spent on roads infrastructure, around £1bn being spent on other regeneration projects across the borough including 3,000 homes and nearly a million sq ft of new office space and the major improvements to leisure centres. Education results for example, GCSE results were the best; productivity, the third highest; the fourth best connected place in Europe; the sixth highest start up rate; the eighth most business friendly place in Europe and the thirteenth lowest business churn rate in the country.

If Prof Clark wanted to make real comparisons with deprivation and the efficacy of IAPT then perhaps he should be looking at those areas in the North West of England that are the most deprived in the country. Let’s take a look at Blackpool, one of the most deprived towns in the country. The NHS spends more money on anti-depressants in Blackpool than anywhere else in the country.
The tourist destination also has the lowest life expectancy for men, with boys living to an average age of 74.7 years.
Seaside towns, including Blackpool, were once described by the Centre of Social Justice as ‘dumping grounds’ for people battling issues such as substance abuse and unemployment.
Other northern towns also top the bleak list of anti-depressant consumption, with four out of the top five areas spending the most on anti-depressants all in the north-west.(Independent 31/1/16).

What are the IAPT statistics for Blackpool compared to all England?
January 18
All England,                             Blackpool
referred: 133051                     485
self referred 91000 68.3%     485 100%
FCT 47905 36%                        135 27%
Recovery 22800 17.1%           65 13%
Improved 31849 23.9%          95 19.6%
Off sick pay 2438 1.9%           25 5 1%
Deteriorated 2879 2.1%         25 5 1%

FCT = Finished course of treatment.

The figures as percentages are starkly different. I find Prof Clarke’s use of statistics disingenuous and to suggest that a talking therapy can ameliorate the effects of deprivation in this way is just down right dishonest.

 

 

How the light gets in – or does it?

Sometimes I can’t help wondering if economics and wealth are the only things that have divided British society in the last 10 years. I went to the famous philosophy festival “how the light gets in” at Hay on Wye and while the talks were interesting they seem totally disconnected from the reality of the vast majority of people that I work with.
Who I work with? Trauma victims and people suffering some form of psychological distress; people have often been disenfranchised by the system because they are unable to work and as such have become far less valued by society. For example, I work with soldiers who come back from war, who are so traumatised they want to kill themselves; they can’t bear to be in emotional contact with others and as a result sometimes leave the family, live on the streets or carry out other self-destructive behaviours.
I heard some very scholarly and clearly very knowledgeable people talking about theories of many different kinds whether it was the “theory of everything”, the theories behind “post truth” or theories of mental illness. They were quoting Kant, Derrida and Hume with great gusto; I wondered what those philosophers would have thought of the way that their words and thoughts were being used today. I wondered what would happen if we were able to transport those great thinkers to today’s world? It is likely that after their initial confusion they would delight in exploring a world that was entirely alien to them and their thinking. I also felt that those philosophers would be incredibly dismayed at the way their thinking and writing had been used.
The protagonists in that particular conversation were discussing whether there was a new enlightenment. It was clear that many people in the room really didn’t understand what was being pontificated about – I didn’t! Right at the end one woman summed it up beautifully in a five minute monologue that clearly illustrated that far from answering the question or even raising further questions the conversationalists on the platform merely muddied the waters through their intellectual meandereings. The lady summing up illustrated it by asking one question, “What is the take-home message?”
I attended another session about “a theory of everything” and whether or not it was possible to encompass the universe in a single theory. Again, there were some very thoughtful thinkers on the platform yet the profound disagreements between them seem to me to illustrate in very clear terms the impossibility of a theory of everything. It struck me that the one thing that they made clear was that each person’s perspective is different in some minor or major way depending on how they viewed the universe and, right at the end, a final piece of wisdom: In order to have a theory of everything we would have to stand outside of the universe itself to be able to observe it, making it impossible to have a theory of everything!
The third discussion I attended on the Monday was all about the mind, madness and medication. Where do I begin? I went along with high expectations but these were quickly dashed by entrenched professional positions; David Nutt attempted to defend the position of a psychiatrist and medication and promoted his explorations into Psilocybin. As one of the other panellists, David Healy, pointed out “drugs are poisons” they all have side-effects some of which are toxic. But my point is quite simply this; there are over a 120 different neurotransmitters in the human brain, there isn’t a machine let alone a human being, in the world that that could begin to unravel the specific impacts of any chemical on the organic soup that is human brain chemistry. To change one is to alter the balance of all! David Healy was obsessed with the need for diagnosis, the obsession of human beings to categorise everything in order to make it more “understandable”. Healey’s one headline statistic was that age of death across the population has started going down in the last two years. There was substantial disagreement as to why this was and his attempts to link it to the rise of medication as a solution to the country’s ailments. Lucy Johnstone was perhaps the most entertaining and thoughtful of the three. She was very skilful at promoting her new idea called “power threat meaning framework”. An alternative to diagnosis using individual formulation as a way of working out how to help someone who is struggling with psychological distress. But as I’ve observed in the past while there is much to like about what she says, it is incredibly complex, categorising in its own right, creating fewer boxes to put people in but still leaving the expert very much in charge.
Each of these discussions seemed almost entirely disconnected from the lives of most people who are struggling to survive, struggling to feed their families, working 12 hours and then going to the food bank to find groceries to feed their children. People are working but no longer feel part of the work that they do, carrying out largely meaningless tasks and working so many hours that they have no energy left for leisure and quality time with their families and children. The stress on so many is so enormous that we are seeing huge increases in mental health problems with little time for leisure and pleasure.
This disconnect between these intellectuals talking with considerable passion and knowledge about their particular subjects, but in such an esoteric way as to make it largely irrelevant to the person in the street, was huge. And then I began to think about austerity, not only financial austerity but intellectual austerity. There are those who spend a lifetime studying a particular topic, secure in their tenure, creating their families, enjoying their holidays, building their homes largely based upon their intellectual capacity to explore and communicate their message successfully.
While on the other hand there are a vast group of people, the majority of the population, who struggle in one way or another to keep their job, to keep their family secure, to provide food heat and light and safety for their children and sometimes failing. These people are not only suffering an economic austerity, they are suffering psychological and intellectual austerity as well. The very nature of their existence prevents them from having the opportunity to explore the world around them. Their need to survive reduces their capacity for community and connection with others. This reduced capacity for community is then preyed upon by a neoliberal agenda to sell potions and therapies and services that do more to richify the already wealthy than it does to improve the lot of those to whom they are delivered. Individual medications, therapies and services isolate, divide and reduce our communities to individuals who are competing with each other for diminishing resources. Fortunately, I think the fightback is beginning.
While the elite enjoy the riches of an economic system that is so grossly biased towards them they also reap the benefit of the time that that wealth offers them to explore in an academic and curious way the world of ideas, philosophy, medicine and psychology.
This thought brought me back to those philosophers that I mentioned earlier whose own worlds were largely privileged and this privilege enabled them to have the big thoughts, the big ideas and to have the time to explore them, develop them and expound them.
Perhaps philosophers like Kant, Derrida and Hume wouldn’t find the world so different or be so surprised by it, as theirs was also a world of privilege well paid for by the austerity imposed upon the masses for the profits and pleasure of the elite.

It seems to me that aspects of festivals like, “how the light gets in” are becoming more of an orgy of intellectual masturbation rather than a place where ideas are disseminated. The Leonard Cohen song from which the title of the festival is taken has another line that is much less frequently quoted, “There is a crack in everything,” this line seems to sum up my final observation that our in current world the cracks are indeed beginning to show.

 

Response to the Power, Threat Meaning paper recently published by the division of clinical psychology at the British Psychological Society.

There is so much I can agree with in this paper – it is an insightful piece of work but whether it warrants either the accolades that seem to be expected by some of its authors or the brickbats that have been thrown at it already is, in my opinion, doubtful.
I think the paper will be helpful in a public health kind of way, guiding policy makers in putting together a more coherent approach to some aspects of the development of more effective mental health services but whether it will help therapists and clients in the room to work better together for the benefit of the distressed individual is another matter.
First of all, it is yet another static model firing at a moving target. It is an improvement on the fixed single barrel sniper rifle of psychiatry whose diagnoses are inevitably going to label the individual, though those labels can be helpful in this current climate of categorisation, litigation and limitation, but the PTMF is little better than the “duck foot” gun favoured by security guards in the C18th that sprayed a limited but wider area with several bullets in the hope of hitting a number of targets.
I want to make a few observations about the development of the concept of trauma and why I think that this new framework is little more than a yet another particular feature in the view seen from the railway carriage of human development racing through the countryside of social evolution.
Human beings as a species have been experiencing trauma throughout their existence. That human beings could experience psychological damage related to traumatic experiences was not recognised in any meaningful way until the beginning of the 20th century. Since then trauma, in the form of the diagnoses of post-traumatic stress disorder, adjustment disorder, et cetera has been increasingly recognised as phenomena experienced by individuals in response to events that are frightening and out of the ordinary. It is necessary to ask the question as to how these behaviours became abnormal and the medicalisation of behaviours in response to trauma occurred.
During the 20th century vast social changes took place and particularly after the Second World War the world became a much safer place (Pinker 2011, Harari 2015). For the first time in our lives the majority of human beings could expect to live out their lifespan in relative comfort and safety. As a consequence of this improvement in security and safety, particularly in the West, unpleasant experiences such as war, violence and natural disaster became much less common and when they did occur far fewer people were injured or killed. Furthermore, many forms of trauma and abuse were being exposed, and still are, and thus the commonality of violence and abuse against the vulnerable became less common. It is also increasingly becoming a subject awareness for the population and increasingly disapproved of. Many forms of abuse that have been previously acceptable are now treated as crimes, for example the abuse of women in one form or another for sexual pleasure by men.
That more people are now traumatised by abnormal and horrific experiences is not so much a tribute to professionals recognising these events but that they are brought into profile by a much more benign environment that causes them to stand out. There are also the traumas of everyday life such as road traffic collisions, injury at work and other personal injuries that in themselves have become much more apparent due to the increase in regulation of activities that might be considered dangerous but were part of everyday life previously. One only needs to look at the nature of health and safety on building sites, in industrial settings and even in office settings to see how much more physically benign these environments now are. Road traffic collisions are a particular example as the number of deaths has declined consistently over the last 30 years, though there may be a number of reasons for this, for example, the improved safety features of cars and restrictive driving regulations play a large part.
That these events now stand out in our lives as worthy of attention by medical and psychological professionals is a tribute to how society and its lawmakers have contributed to making this aspect of the environment much safer. However, it does not mean that these behavioural responses by people who have experienced unusual and traumatic events are now the remit of the medical profession in the form of a disorder. These responses remain a normal and when thought about carefully, a logical response to an unpleasant experience. Allen Frances makes the observation:
“Our brains and our social structures are adapted to deal with the toughest of circumstances-we are fully capable of finding solutions to most of life’s troubles without medical meddling, which often muddles the situation and makes it worse. As we drift evermore toward the wholesale medicalisation of normality, we lose touch with our strong self healing capacities-forgetting that most problems are not sickness…” (Frances 2013)
Unfortunately, like most theories of human psychology this power threat meaning framework remains threatminded and backward looking. Assessment and formulation are subjective, capricious and based upon the ability of the practitioner to ask the right (and sufficient) questions about a person’s history and the trauma.
Assessment and formulation is also based upon the accurate memory and honesty of the client. I for one would never disclose my darkest secrets and thoughts to a relative stranger, nor is my memory sufficiently good to remember the details of what happened to me. Furthermore, my memories are coloured by my own emotions and experiences since that time. So, any description of those events is clearly questionable, which is why uncorroborated evidence is not admissible in legal situations. For example, notes of medical and psychological interventions have to be written as soon as reasonably possible after the event (within 24 hours) Loftus’ work for example gives us plenty of examples. A short trawl of Twitter researching the experiences of people who have suffered trauma and are in the mental health system very quickly throws up plenty of examples of thoughtless, unhelpful assessments and history takes.
The framework itself is complex and open to misinterpretation, as has already happened in the discussions I have seen on social media. How a therapist is supposed to hold all that framework and theory in their head while working in the room is beyond me. Furthermore, if it were to become a taught model it is going to be open to the interpretation of the tutors with their own innate bias and preferences. Again, something we have seen time and again expressed in the classroom and upon social media.

The paper is repetitive, and this seems to me to be largely to ensure that as many of the great and good get a referenced mention in the document, after all we have to keep as many powerful and influential academics onside as possible, don’t we?
The paper criticises psychiatry for its logical positivism and then goes on to use the same approach to showcase its own ideas.
The paper remains problem focused in much the same way that psychiatry is; it just does away with the labels. There have been many people have criticised the increasing medicalisation of human emotion and experience in an attempt to check the onward march of psychiatry into normality as Frances’ quote above illustrates. Focusing upon problems merely emphasises problems.
My immediate response to power threat meaning is that clinical psychologists have not attempted to check that march on normality but simply to attempt to impose a new paradigm upon that onward march.
Professionals having a narrow view is a criticism aimed at medical diagnosis, yet surely the same criticism can be made of this theoretical framework as well? Certainly, the social media discussions illustrate a very clear, “you are either for us or against us!”
There is a further fundamental problematic assumption in this document. There seems to be a sense of what is normal and what is not normal. An arbitrary line drawn between acceptable behaviours and responses and those that are traumatic. As I have pointed out in the past and this has been illustrated shockingly in the last few weeks in relation to what is acceptable in the way that women are treated. Acceptable behaviour by human beings one to another is constantly evolving and what was acceptable 300, 200, 100 even 10 years ago is not acceptable today. Therefore, what may have been considered acceptable 50 years ago for example is no longer acceptable today and thus now becomes traumatic. This is a complex area. I have already seen examples in the press of people questioning this evolution or even perception of abuse to be shot down immediately by proponents of power threat meaning without discussion or apparently much thought.
While there is a nod in the document to individual strengths, most of the attention is focused on problems and trauma. There seems to be very little attention to the things that people are coping with that are helping them survive. Where the paper does allude to this I get the sense that it is unnecessarily complicated and the need for professional “expert interpretation” seems to override client experience. My own experience is that these interpretations often get in the way; these tend to be assumptions that are accepted by the client on the basis that the expert knows best. This attribute to the professionals is carried throughout the document with the idea that the professional can empower the client. This is at best a dubious idea and at its worst illustrates the need for the professional’s sense of control and power which is one of the things the framework is trying to deal with and dissing the psychiatric profession for.
The writings within the document seem to suggest that there are patterns but is constantly recognising that these are not consistent patterns and “The implication is that ‘comorbidity’ is not a nosological problem to be solved, but a reflection of the fact that people can use multiple ways to respond to adversity and threat.” I don’t understand; if people respond in multiple ways to what may appear to be the similar stimuli then how can a pattern be imposed upon it?
One of the most interesting statements in the whole document is:
“The evidence cited in the main publication supports the contention that humans are social beings whose core needs include: To experience a sense of justice and fairness within their wider community.
The Power Threat Meaning Framework states explicitly the following core needs:
To have a sense of security and belonging in a family and social group.
To be safe, valued, accepted and loved in their earliest relationships with caregivers.
To meet basic physical and material needs for themselves and their dependants.
To form intimate relationships and partnerships.
To feel valued and effective within family and social roles.
To experience and manage a range of emotions.
To be able to contribute, achieve and meet goals.
To be able to exercise agency and control in their lives.
To have a sense of hope, belief, meaning and purpose in their lives.
…all of which will provide the conditions for them to be able to offer their children…
Secure and loving early relationships as a basis for optimum physical, emotional and social development and the capacity to meet their own core needs.”
While they are all very laudable and clearly we would all want them in our own ways, these are political aspirations for a society and not usually the remit of theoreticians and therapists. They are a very middle-class, professionally based set of aspirations and criteria. These are WEIRD criteria! They are also based upon current Western thinking. Another aspect that the paper claims to be aware of yet seemed rather confused in its thinking about it.
While I may be at appear to be at odds with the paper, I do agree with much of what it says particularly with respect to the statements above. It is high time that psychologists stepped away from the almost entirely individualistic approach to matters psychological and began to look at the wider aspects of the impact that communities, security and a sense of future will have upon any population anywhere in the world. It is time for psychologists to become overtly political, begin to study and research in detail what it is that actually impact upon our well-being and how that might be better derived. Following a neoliberal and individualistic pathway is not going to change levels of well-being in this country or globally. It is time to stop thinking about threat and to begin to build opportunity, security and a sustainable future.
So, in conclusion while I can agree with many of the aspirations of the paper, I find it confusing, repetitive and unclear about what it wants to be and even how it intends to achieve it. It is far too academic and technical, it is based upon an understanding from the viewpoint of the ivory tower and seems to take little into consideration of the common person stood at the base of the tower who may be either “waving or drowning”.
I’m quite sure that most people will never read it properly, many will never understand it and I doubt very much whether it will ever be taken up seriously as a challenge to psychiatry.
References:
Frances, A. (2013) Saving Normal, Harper Collins, London.
Harari, Y. (2105) Homo Deus, A Brief History of Tomorrow, Penguin, London.
Pinker, S. (2011) The Better Angels of Our Nature: Why Violence Has Declined, Penguin Books, London.