Training | 2009.03.15
Zoe Williams: Can't fix it till you feel it
The offer of therapy for the unemployed ignores the inconvenient fact that life isn\'t always fair
It is the easiest thing in the world to laugh at new ideas, especially in the middle of a crisis, when political discourse is teeming with them. Before I even start on the proposal to offer free counselling to people made redundant then, I\'ll just say that there are many other ideas emanating from the Brown/Darling machine that I do support (though it\'s possible that that\'s because I don\'t understand them).
Some "talking therapy" services (these are like counselling clinics within PCTs), offering cognitive behavioural therapy, were planned for this year anyway, but there\'s been a 25% increase in these to 81, and nurses on NHS Direct, as well as jobcentre employees, are to be trained to recognise depression in the unemployed. All of this is based on the assumption that CBT works - that it is the superhero-talking cure to psychoanalysis\'s tinkering janitor. I was always sold on this line, having seen up close the prison courses based on CBT (because I was researching an article - not because I was in prison). Enhanced Thinking Skills and Controlling Anger and Learning to Manage It courses dismantle cognitive illusions, of which prisoners have many (among them high self-esteem, which causes them to esteem their own needs over other people\'s). Once those illusions are pointed out, there are behavioural changes, and prisoners report feeling liberated from the cognitive cycles of criminality - or maybe that\'s just in front of their parole officer.
In the wider world, evidence mounts that the treatment is bogus. The psychologist Oliver James is the pre-eminent anti-CBT fury and his core objections are as follows: first, that it doesn\'t work. The Drew Westen study of 2004 showed that, within 18 months, there had been no material impact on the wellbeing of those treated with CBT, compared with those untreated. "It gives sufferers the illusion that they\'re feeling better," James summarises, "but that illusion passes quite quickly, usually within a few months ... it\'s hypnosis, basically. It\'s Paul McKenna." This is no exaggeration - patients describe negative thought processes, and have them challenged by the therapist until they start to think differently. It\'s like weight-lifting for your inane-enthusiasm muscle.
But let\'s leave aside the claims of the Department of Health. Imagine that CBT practitioners were only claiming short-term benefits, were only claiming to help some people out of some of their destructive cognitive loops. It is still an amusing tool to wield in the face of an economic meltdown, though not for those who will find themselves uncured at the end of it. The first principle of CBT is that you cannot control the world, you can only control your response to it: that your negative emotions do not simply arrive in your head, unbidden, they are the result of your thoughts, and only you can control those thoughts. But for the outside world, this talking cure relies on a patient\'s problems being all in the mind. It relies on concepts such as rejection and failure and poverty being matters of perception. It relies, in other words, on a perfect world.
Even a moderately perfect world can sustain people who believe in CBT, but the world as it is at the moment is a hostile environment for this fake-it-till-you-feel-it fix. It cannot talk you out of being unemployed; it cannot repackage redundancy as something other than rejection. Perhaps it would be useful to be able not to take rejection personally, but even if you don\'t, you are left with these pesky circumstances - such as, you still don\'t have any money, your relationship is still under pressure, your family is still suffering the brunt of this poverty from which you have been unable to protect them. And yet CBT might turn out to be an ancillary victim of the credit crunch: the talking cure that hit the brick wall of a reality that is very unfair and does treat some people worse than others.
For more information, please visit
http://www.guardian.co.uk/commentisfree/2009/mar/11/redundancy-therapy-cbt
