The therapy industry : the irresistible rise of the talking cure, and why it doesn't work

265 Pages·2013·2.648 MB·English

by  Moloney, Paul

The Therapy Industry
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The Therapy IndusTry
The Irresistible rise of the Talking Cure,
and Why It doesn’t Work
Paul Moloney
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First published 2013 by pluto press
345 archway road, London n6 5aa
www.plutobooks.com
distributed in the united states of america exclusively by
palgrave Macmillan, a division of st. Martin’s press LLC,
175 Fifth avenue, new york, ny 10010
Copyright © paul Moloney 2013
The right of paul Moloney to be identified as the author of this work has been
asserted by him in accordance with the Copyright, designs and patents act 1988.
British Library Cataloguing in publication data
a catalogue record for this book is available from the British Library
IsBn 978 0 7453 2987 1 hardback
IsBn 978 0 7453 2986 4 paperback
IsBn 978 1 8496 4876 9 pdF eBook
IsBn 978 1 8496 4878 3 Kindle eBook
IsBn 978 1 8496 4877 6 epuB eBook
Library of Congress Cataloging in publication data applied for
This book is printed on paper suitable for recycling and made from fully managed
and sustained forest sources. Logging, pulping and manufacturing processes are
expected to conform to the environmental standards of the country of origin.
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Typeset from disk by stanford dTp services, northampton, england
simultaneously printed digitally by CpI antony rowe, Chippenham, uK and
edwards Bros in the united states of america
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Contents
Acknowledgements vi
Introduction: The Light at the End of the Tunnel? 1
ParT I EvaLuaTIng PsychoLogIcaL TEchnIquEs
1 Misery, Mind cures and Fashion 9
2 The Psychopathology of Everyday Life 30
3 The ‘cEo of self’ … ? 51
4 Does Therapy Work? 67
5 ‘I’m not ill, I’m hurt …’ – The hidden Injuries of social
Inequality 94
ParT II ThEraPy In socIETy
6 sweet Medicine – Talking Therapy as control 117
7 Theory Into Practice – The Programme for Improving
access to Psychological Therapies (IaPT) 139
8 The Therapy Market – From the Third Wave to
‘happiness’ 156
9 Towards a Psychology that reflects what the Therapy
Industry Will not Tell us 181
Notes 209
Index 249
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acknowledgements
For their continual encouragement and editorial advice I would
like to give special thanks to carol Morris, Dave crook and
David castle.
I would also like to express my gratitude for the assistance of
Jan Bostock, John cartmell, John cromby, clive chimonides, Bob
Diamond, William Epstein, val gillies, Dave harper, carl harris,
guy holmes, Paul Kelly, sue Mahoney, Barry McInnnes, Penny
Priest, Kieran Lord, Zounish rafique, David smail, David smith,
Jan soffe-casswell, Biza stenfert Kroese, Fran Taylor, Mike Tupling
and Fran Walsh.
Finally, I must gratefully acknowledge the help of a grant from
the British society of authors.
Dedicated to the memories of Mark Rapley,
and of my grandmother, Gladys, and of my father, Roy
vi
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Introduction:
The Light at the End of the Tunnel?
The sense of control, hopefulness, and comfort [is] common to many forms of
psychotherapy … Through the adoption of a set of organizing principles or a coherent
world-view, the patient comes to see a ‘light at the end of the tunnel’.
R.J. De Rubeis and colleagues1
Therapeutic assumptions and jargon have spread into our lives
– from school to university to workplace, from the health advice
clinic to the prison, and to popular entertainment programmes
where experts advise lonely people how to attract a partner, or
parents how to be better ones. These specialists seek to persuade
us that our troubles stem, not from the world in which we live, but
from our lack of insight into ourselves and from our failure to take
responsibility for what we think, feel and do. All might be well if
their ideas were better grounded in science than their forerunners
from even 50 years ago. The main task of this book is to show that
this is not the case.
In the western world, treatments for the mad, the disturbed and
the undesirable have been in continual flux down the centuries,
and perhaps most rapidly in the last two. At the beginning of the
second millennium, the majority of mental health professionals
are acquainted only with the more recent treatments, or with as
much of them as are deemed relevant to their occupational niche.
They have little time or incentive to question the scientific – much
less philosophical – basis of what they are doing. A historical view,
however, soon shows that it has always been a mixture of fashion,
political upheaval, institutional demands, and competition between
rival professions and interest groups that have shaped how misery
and madness have been treated, and regarded. Science, understood
as the attempt to learn from systematic observation, has come
a very long way behind. Insights such as these are perhaps the
hardest to grasp. After all, psychologists and therapists are trained
and accredited by prestigious universities and colleges, they are
relatively well paid and they write books and speak confidently of
their theories and techniques. As often as not, they try to pass this
1
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2 ThE ThErapy IndusTry
ebullience on to their clients. When it comes to trying to glimpse
the emptiness at the heart of the therapy industry, however, the
importance of a questioning, historical outlook cannot be overstated.
The first chapter of this book – ‘Misery, Mind Cures and Fashion’ –
accordingly tries to give a brief, critical overview of some of the main
currents in psychiatry and psychotherapy since the late nineteenth
century, leading on to an evaluation of the status of these fields in
the twenty-first.
Despite the popularity of therapy, it is psychiatry that remains
the most powerful mental health profession, the older and wealthier
sibling against which all of the others must measure themselves –
whether in envy, admiration, or contention. But as Chapter 2 shows,
the psychiatric map of the disturbed mind – as little more than the
by-product of faulty genes and of wayward biochemistry – is itself
a distortion, brought about by the overweening confidence of its
creators, and by the power that they enjoy in prescribing drugs for
the treatment (more often the management) of distress. There is
nothing like tablets and injections for conferring a spurious reality
to the ‘mental illnesses’ that they are ostensibly designed to tackle. If
the science of psychiatry is shaky, then this has not stopped hordes
of its practitioners, with a few psychologists for company, from
stepping forward to create new forms of deviance. For the shy and
the socially awkward, for the restless and the disruptive, or for those
who are merely ‘odd’ – a host of stigmatising diagnostic labels await.
The consequences are far reaching. Outside of the Shangri-La world
of media celebrity, social tolerance for eccentricity is narrowing.
If psychiatrists have fostered an impoverished and one-dimen-
sional view of the patient, then have the talking therapists done any
better? Some of these practitioners at least have seen the richness
and uniqueness of the sufferer’s subjective experience, and how
it echoes what their world has done to them. Too many of them,
however, have assumed that, given the right therapeutic advice
and techniques, their clients will be able to muster wide powers of
determination, unlocking what amounts to their own ‘inner CEO’,
who will take charge of their troubles. When contrasted with what
50 years of laboratory and social research have been suggesting
about the limits to human self-awareness and freedom, however,
this picture starts to look as myopic as its psychiatric counterpart.
In 1959, the sociologist C. Wright Mills described the gap between
what people say and what they actually do as the central problem
of the social sciences.2 These words remain true today. For the
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InTroducTIon 3
therapists, there is room for a lot more humility in their claims to
understand, cure and console.
Indeed, this boils down to a fundamental issue of the value of
what therapists do, a subject about which they have long been
defensive, and cannot answer a deceptively simple question: does
therapy work? Despite many years of research into the effects of
psychological treatment, the standards of investigation are still
so poor that it is hard to say with confidence just how helpful
or unhelpful therapy might be. This conclusion applies even to
the evidence quoted in such authoritative tones in the UK central
government’s National Institute of Clinical Excellence (NICE)
database and to the clinical guidelines issued by the American
National Institute of Mental Health. Careful scrutiny of even the
best of the research literature suggests that, because of the powerful
placebo effects involved in this kind of treatment, and the historical
failure of most researchers to adequately control for them, then all
of the main psychological therapies are of marginal helpfulness at
best, and are probably ineffective.
The practices and prescriptions of modern-day psychologists
may be much closer than believed to the nostrums of the medical
profession before the modern era: a time when a soothing touch
counted most, when patients often had strong views about the
correct dose of laudanum for their illnesses, and when he or she
who paid the piper called the tune. The main difference between
current psychological practice and nineteenth-century medicine is
that Victorian doctors would frankly acknowledge the uselessness
of most of their remedies, at least in private. Their patients knew
that health was precarious and life often short, and they seldom
expected great results.3
If the psychological therapies do not do what they are supposed to
do, then it is worth asking why. After all, most of them amount to
distillations of our common-sense notions of how people change any
aspect of their conduct, by making a decision to act differently, and
then sticking with it. One reason might be that many of us are locked
in tough or demoralising circumstances that do not admit of change,
despite what our therapist tells us. Another reason, complementary
to the first, might be that some of us have been seriously mistreated
by other people earlier on in our lives, and, at the level of unvoiced
feelings, can no more forget this than we can forget to speak our
native tongue. The distressed person therefore is not so much ill as
hurt by what others have done to or withheld from them. Some of
the ways in which this might happen are explored in Chapter 5,
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