Thanks for your reflections, that was helpful, particular this part:
I did understand from the article that you were making that point. I also feel a little clearer too about why it created such a response in me. I don't really have well articulated theory, ACP references or the collective will of manifestos or press statements to draw on. My point of view comes from having a long history of interest in domestic violence and experience working in the area for five years and wondering how this would sit in the organisation or groups I have worked in. My initial gut reaction was that the flippancy of how the comparison was used somehow felt it was trivialising violence against women, or even exploiting some of the horror of this violence to advance your own point. I have spent plenty of time advocating for woman. In my current work in primary care mental health I spend plenty of time arguing against the use of CBT to address unemployment (not to mention many other things too!).
So to try to work out my discomfort I swapped things around. If I was raising awareness about violence against woman and wanted to use the delivery of CBT onto unemployed people as a comparison to help people think that through, how would that work. Would I be able to say: in a lifetime one in four unemployed people will be abused by their CBT therapist, 2 unemployed people in the next week alone in the UK will be murdered by their CBT therapist, every eight days in the UK a child will die in a home which is likely to contain a CBT therapist, CBT therapists cause more death or ill health than cancer in Europe than cancer for unemployed people between 14 - 44 years old, and violence against unemployed people from CBT therapists accounts for 60 million missing and murdered women in the world today.
Once I put it like that, I can see how for me comparing CBT therapy for the unemployed to domestic violence, has so much more to offer one cause than the other. I am in complete agreement with you that for both issues addressing causes and not symptoms is essential, but the disproportionate nature of the comparison feels trivialising to me. Maybe even exploitative. Maybe even collusive? I'm not sure... still thinking through my discomfort! But did want to reply to your helpful critical reflections.
Kind regards,
Rebekah
I think Sam in a recent post got the main point right in relation to both unemployment and domestic violence: "it is futile treating an individual for something then returning them to the same failing system that caused the damage in the first place . . . it is the root cause that requires treatment" Thanks for your email Sam. It is great that you have joined the list. The archives are well worth exploring.
I hope this clarifies matters, Rebekah. If not if you are able to put your finger on what left you feeling sickened I could try to clarify further
The full press release follows
David
For immediate release 16 October 2007
Changing politicians' minds about changing our
minds?
"Cognitive Behaviour Therapy and associated approaches
are comprehensively problematic. Primary prevention is
the only way to substantially reduce socially, economically
and materially caused distress. To be effective primary
prevention must involve social rather than cognitive
change. Reducing income inequality in our society would
be one of the most effective ways to reduce psychological
distress and ill health”, says the UK Community
Psychology Network.
Contact:
David Fryer01786467650 [log in to unmask]
or
Mark Rapley, 0208 223 6392 / 0208 223 4567 [log in to unmask]
Notes for Editors:
1. The government has recently announced £170m is to be made
available by 2010 to increase the availability of low intensity, high
volume, interventions, of which Cognitive Behaviour Therapy (CBT) is
currently the most favoured, to be delivered at primary care level to
adults of working age by people who have some basic training.
2. We welcome the recognition of widespread emotional distress and the
will to spend public money on it. But the scale of socially caused
distress is so vast, and growing so rapidly, that it is impossible to 'treat
it better' by training enough people to treat all those in distress one at a
time with any therapeutic technique.
3. Even if we could train enough practitioners, there is little reason to think
that the one to one talking treatments by professionals are more than
marginally effective in the hands of some practitioners for some people,
especially those in the most difficult living circumstances. This is so
even when delivery is organised through the stepped care model that
runs from use of self help guides to full therapeutic interventions.
Changing politicians' minds
2
4. Whilst community psychology research suggests that lay people are as
effective as professionals in delivering help through talking and
listening, the effectiveness of CBT and kindred interventions in any
hands is widely exaggerated and they are impossible to apply in many
situations and with many people.
5. Moreover these treatments individualise social problems, draw attention
away from the more important social economic and material causes of
distress and position individual cognitive dysfunction as both the cause
of the person's problem and the locus for intervention.
6. It is bad enough to be depressed because of difficult living
circumstances or to be anxious because you are subjected to regular
domestic violence, without being told your depression or anxiety are
caused by your own dysfunctional cognitions. Blaming the victim like
this imposes irrelevant therapeutic rituals on top of societal oppression
7. Besides, when those treated go back into the psychologically toxic
contexts that made them distressed in the first place, to which many or
most will have no alternative, they are subjected to the same social
causes of distress all over again. If those treated do not go back into
those psychological toxic contexts, there will still be an epidemic of
newly damaged people coming on stream due others being subjected
to the ignored social causes of distress.
8. Cognitive Behaviour Therapy and associated approaches are
comprehensively problematic and primary prevention is the only way to
substantially reduce socially, economically and materially caused
distress. To be effective primary prevention must involve social rather
than cognitive change. Contemporary research shows that reducing
income inequality in our society would be one of the most effective
ways to reduce psychological distress and ill health not just for the
disadvantaged but across society in general.
9. For the sake of conciseness we have not included scholarly references
to substantiate assertions made here, but further background
information can be obtained from the network via the two contact
people identified above.
10.
The UK Community Psychology Network exists to promote communitypsychology as one alternative to the individual focused approaches so
dominant in the psychology of the English speaking world. Its members
include clinical, educational, social, organisational psychologists, both
in the field and in research and teaching posts, as well as people
without formal psychological qualifications.
Changing politicians' minds
3
Signatories
Julie Bird
Jan Bostock
Mark Burton
Julie Chase
Deborah Chinn
Paul Cotterill
John Cromby
Dawn Darlaston-Jones
Bob Diamond
Paul Duckett
David Fryer
Michael Göpfert
Carolyn Kagan
Annie Mitchell
Paul Moloney
Moira O'Connor
Penny Priest
Mark Rapley
David Smail
Janine Soffe-Caswell
Carl Walker
on behalf of the UK Community Psychology Network
"All you are doing," says Dr Fryer, "is making them think differently about being punched."
There is something about this series of statements that left me feeling sickened, but I just cant quite put my finger on why at the moment. David, I would be interested in what you think of how this was presented and what you were hoping to convey by making this particular comparison?
Rebekah