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European Journal of
Psychotherapy & Counselling
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The unfortunate need for
critical psychotherapy and
counselling
Del Loewenthal
a
a
Department of Psychology , Whitelands College,
Roehampton University , Holybourne Avenue, London ,
UK
Published online: 15 Feb 2013.
To cite this article: Del Loewenthal (2013) The unfortunate need for critical
psychotherapy and counselling, European Journal of Psychotherapy & Counselling, 15:1,
1-4, DOI: 10.1080/13642537.2013.763469
To link to this article: http://dx.doi.org/10.1080/13642537.2013.763469
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European Journal of Psychotherapy and Counselling, 2013
Vol. 15, No. 1, 1–4, http://dx.doi.org/10.1080/13642537.2013.763469
EDITORIAL
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The unfortunate need for critical psychotherapy and counselling
This editorial reluctantly puts the case for the urgent need for ‘critical psychotherapy and counselling’ to have a permanent place in their syllabi. This would be
similar to psychology and psychiatry where niches are given to ‘critical psychology’ and ‘critical psychiatry’, tacitly implying that by and large psychology and
psychiatry are examined uncritically.
Perhaps the main reason why this process has already taken place in psychology and psychiatry is that the prime role of these disciplines can be seen as
agents of the state. At least in the UK, recent changes in government policy have
greatly reduced any ability for those involved in counselling and psychotherapy
to fundamentally question what they are doing. Although there has also been the
long-standing argument that counselling and psychotherapy students receive trainings (mainly through private or charitable institutions), rather than an education,
again uncritically putting forth their particular rivalrous gurus. Often this is done
in such a way to make thoughtfulness a remote possibility – see for example,
Kernberg’s (1996) ‘Thirty ways to destroy the creativity of psychoanalytic candidates’. However, for some, there was the hope, if indeed not the raison d’être,
that universities might provide a space where society could allow the questioning
of the assumptions underlying practices, free of vested interests. However, there
have always been concerns from both within and without the academy as to the
appropriateness of counselling and psychotherapy training taking place there (see
e.g. the Special Issue of the European Journal of Psychotherapy & Counselling
on psychotherapy and counselling in the universities: Loewenthal, 2002). The
advent of the commodification of education coupled with increasingly internationally pervasive audit culture (see e.g. Loewenthal, 2010a) together with – in, for
example, the UK – the further effect of government policy on psychotherapy and
counselling of the Layard report (2005) and the National Institute for Clinical
Excellence [NICE] (2009) have increasingly meant that the objectives of the university are becoming synonymous with the state.
The Layard report (2005) can be seen as having for itself two great successes:
the first is to convincingly put the case for the talking therapies when previously
medication would have been prescribed and the second is to have also persuaded
the government that mental health needs to be treated on a population basis. The
first is a great achievement but with regard to the second, such population-based
medicine is still very much lacking in the provision of treatment of physical
health. Yet by bringing it in for mental health not only gives the government a
central role but it also still focuses on the training of individual psychological
therapists in providing what is seen as the best (though for some very narrow and
Ó 2013 Taylor & Francis
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Editorial
ill-informed) evidence-based practice. This is rather than looking at the causes of
mental illness which, ordinarily, a population-based focus would provide also in
terms of primary, secondary and tertiary preventative health and social
interventions.
We, thus, have counselling and psychotherapy increasingly dominated by
government which in the UK is through the Department of Health. Perhaps in a
similar way to psychology emerging out of philosophy with the claim that rather
than having the different viewpoints of philosophers, psychology through science
would provide the answer; a similar process is underway with randomised control
trials (RCTs) being used in an attempt to finally demonstrate what is the best
approach to counselling and psychotherapy. Yet, an examination of the appropriateness of RCTs for determining effective psychological therapeutic approaches
with their multi-variable nature shows that scientifically they are non-starters.
Surely, it will be with incredulity that future generations will look back at such
august bodies as NICE prophesying on their basis (see e.g. Guy, Loewenthal,
Thomas, & Stephenson, 2012).
Psychotherapy and counselling can be seen to necessarily be fundamentally
subversive and it seems unlikely that the Department of Health will produce quality assurance criteria to ensure that it is safeguarded, as I have written similarly
previously (Loewenthal, 2008):
Jean Laplanche speaks of starting a session with a young person with the
words: ‘… your parents want this, but we don’t care, we will talk of other things,
of whatever you want’ (Laplanche, 1992, p. 6). I am taking this to represent a
place where psychotherapists and counsellors work – in areas that our society
does not want to think about. So, the work of therapy and therapeutic organisations involves holding a paradox. But then what happens to this space if the state
wants to regulate it?
There have already been moves to introduce critical counselling and psychotherapy, for example, Feltham (2010), has put the case for the importance of critical thinking in psychotherapy and counselling. There is much to learn also from
critical psychiatry and a useful history of it can be found in Thomas and Bracken
(2004). Furthermore, there is an important work currently being written, though
less directly in the academy still involved with psychotherapy and counselling,
for example, on how the construction of the Diagnostic and Statistical Manual of
Mental Disorders is not based on what most scientists would call science (Davies,
2013). Critical Psychology and in particular, the work of Ian Parker and colleagues (see e.g. Parker, 1999) has much for us to learn from.
With the aforementioned commodification of education and the increasingly
dominant role of the state in determining what counselling and psychotherapy is
provided for publicly, there are two further important effects. Firstly, the trainings
are now, at least in the UK, increasingly coming with university degrees in counselling and psychotherapy, and particularly in counselling psychology, the students
are hoping to get publically funded careers. Secondly, the public is being influenced to increasingly seek out, at least in the first instance, such evidence-based
approaches in private practices. There has consequently been a mad scramble for
most approaches and professional bodies to show that they too meet these evidence-based criteria, the consequence of which is that there is even less space for
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Editorial
3
questioning and thoughtfulness. Thus, whilst it may have been the hope that universities would provide such a place of enquiry, what has happened is beyond that
has always been the danger when one approach dominates an institution. Instead,
a cycle has emerged whereby young people interested in psychotherapy and counselling are advised to have an A level Biology so that they will eventually have a
degree that will give them a job. This is coupled with what would appear to be a
shift (see Loewenthal, 2010b) in counselling and psychotherapy from University
Departments of Education (which had previously been very much influenced
regarding learning by those such as Carl Rogers) to Psychology departments
increasingly dominating the psychological therapies (including their very name!).
Psychotherapy may, for the time being, still have some play in English and Sociology departments but, generally, we can no longer rely on universities serving us
as a place which would encourage thoughts to come to us other than from vested
interests. It is thus, with regret, that it would appear that there is an urgent, unfortunate need, for critical counselling and psychotherapy.
Our first paper for this general issue, ‘The place of truth in psychoanalysis: A
Heideggerian contribution’ by Ryan Kemp and Dimitra Lorentzatou, is a stimulating paper which brings together psychoanalytic thought about truth with Heidegger’s use and exploration of the notion of ‘aletheia’ as ‘un-concealment’.
The second paper ‘The pregnant therapist and the psychotic client: A phenomenological understanding of the impact of the therapist’s pregnancy on the
therapeutic process’ by Alison McGourty is an important contribution to the growing body of accounts by pregnant therapists. Little has been written on the work
with psychotic patients during pregnancy and this paper clearly illustrates how
widely different clients with psychosis react to the pregnancy of the therapist.
The next paper by Charlotte Capri from the University of Cape Town, ‘Madness and defence: Interventions with sexually abused children in a low-income
South African community’, highlights the complex emotional and social difficulties faced by young girls who have been sexually abused in South Africa. The
paper utilises psychoanalytic theories of intersubjectivity to explore some of the
paradoxes of this situation and to make comments on the utility of intersubjectivity for the therapeutic encounter.
The fourth paper entitled ‘Feeling accepted: A phenomenological exploration
of adolescent patients’ experiences of the relational qualities that enable them to
express themselves freely’ by Solfrid Henden Sagen, Didrik Hummelsund and
Per-Einar Binder explores adolescents’ experiences of therapy and their ways of
attributing meaning to these experiences. This, in turn, provides a greater knowledge of the ways of relating to patients in this age group, considered challenging
by many therapists.
Our last paper before our book reviews is by Henna Penttinen, Jarl Wahlström
and Kirsti-Liisa Kuusinen from Finland on ‘Self-descriptions of socially phobic
persons in short-term group psychotherapy’. This study reveals interesting patterns
of self-image, coping strategies and subgroups of the social phobia category and
should be of value to clinicians working with this client group in individual and
group therapy contexts.
Following this last paper, there remains the general question though of how
European counsellors’ and psychotherapists’ and their clients’/patients’ self-image
4
Editorial
and coping strategies will be affected by universities being increasingly involved
with the state’s agenda for our mental health and the extent of the effect of this
on our thoughtfulness individually and culturally.
Del Loewenthal
Department of Psychology, Roehampton University
Whitelands College, Holybourne Avenue, London, UK
d.loewenthal@roehampton.ac.uk
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References
Davies, J. (2013). Cracked: The unhappy truth about psychiatry. London: Icon Books.
Feltham, C. (2010). Critical thinking in counselling and psychotherapy. London: Sage.
Guy, A., Loewenthal, D., Thomas, R., & Stephenson, S. (2012). Scrutinising NICE: The
impact of the National Institute for Health and Clinical Excellence Guidelines on the
provision of counselling and psychotherapy in primary care in the UK. Psychodynamic
Practice, 18, 25–50.
Kernberg, O. F. (1996). Thirty methods to destroy the creativity of psychoanalytic candidates. International Journal of Psycho-Analysis, 77, 1031–1040.
Laplanche, J. (1992). Notes on afterwardsness. In J. Fletcher & M. Stanton (Eds.), Jean
Laplanche: Seduction, translation and the drives (M. Stanton, Trans.) (pp. 217–223).
London: Institute of Contemporary Arts.
Layard, R. (2005). Mental health: Britain’s biggest social problem? Paper presented at the
No. 10 Strategy Unit Seminar on Mental Health, LSE 20th January 2005. Retrieved
December 31, 2012, from http://www.cep.lse.ac.uk/textonly/research/mentalhealth/
RL414d.pdf
Loewenthal, D. (2002). Special issue on counselling and psychotherapy in the universities.
European Journal of Psychotherapy & Counselling, 5, 329–418.
Loewenthal, D. (2008). Regulation or ethics as the basis of psychoanalytic training. In
I. Parker & S. Revelli (Eds.), Psychoanalytic practice and state regulation (pp. 85–93).
London: Karnac.
Loewenthal, D. (2010a). Audit, audit culture and therapeia: Some implications for wellbeing
with particular reference to children. In C. Moutsou & L. King (Eds.), Audit cultures: A
critical look at ‘evidence-based practice’ in psychotherapy and beyond (pp. 75–96).
London: Karnac Books.
Loewenthal, D. (2010b). The psychological therapies and research assessment exercises:
Have we got the right REF? European Journal of Psychotherapy & Counselling, 12,
287–291.
NICE. (2009). Treatment and management of depression in adults (CG90). National Collaborating Centre for Mental Health, Published by The British Psychological Society
2010 [Online]. Retrieved from http://www.guidance.nice.org.uk/CG90/Guidance/pdf/
English
Parker, I. (1999). Critical psychology: Critical links. Annual Review of Critical Psychology,
1, 3–18.
Thomas, P., & Bracken, P. (2004). Critical psychiatry in practice. Advances in Psychiatric
Treatment, 10, 361–370.