Tag: Cognitive behavioural therapy

The power of positive thinking is really political gaslighting

The power of positive thinking.

The government invests a lot of time and money in “nudging” people to accept the unacceptable.

George Osborne announced in the budget that the government will be funding a “package of measures” to improve employment outcomes which will entail putting Cognitive Behaviour Therapists in more than 350 job centres to provide “support” to those with “common mental health conditions,” and making online access to Cognitive Behaviour Therapy available for people who are claiming employment support allowance (ESA) and job seekers allowance (JSA).

From the HM Treasury document – Budget 2015, page 64: 1.236:

“Budget 2015 also announces a package of measures to improve employment outcomes for people with mental health conditions. Starting from early 2016, the government will provide online Cognitive Behavioural Therapy (CBT) to 40,000 Employment and Support Allowance and Jobseeker’s Allowance claimants and individuals being supported by Fit for Work. From summer 2015, the government will also begin to co-locate Improving Access to Psychological Therapies (IAPT) therapists in over 350 Jobcentres, to provide integrated employment and mental health support to claimants with common mental health conditions.”

The government put up an online contract notice which specifically states:

“This provision is designed to support people with common mental health conditions to prepare for and move into work, with intervention at the earliest possible point in a claim to benefit or access to the Fit for Work service.”

Under the government’s plans, therapists from the NHS’s Improving Access to Psychological Therapies (IAPT) programme would support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses.

We really must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – this is nothing more than a blunt behaviour modification programme. The fact that the Conservatives plan to make receipt of benefits contingent on participation in “treatment” worryingly takes away the fundamental right of consent.

Cognitive Behaviour Therapy (CBT) is used to change how you think (“Cognitive”) and what you do (“Behaviour”). It bypasses context, emotions, personal history, experiences and narrative, to a large extent, and tends to focus on the “here and now.”

CBT is an approach that facilitates the identification of “negative thinking patterns” and associated “problematic behaviours” and challenges them. This approach is, at first glance, a problem-solving approach. However, it is of course premised on the assumption that interpreting situations “negatively” is a bad thing, and that thinking positively about difficult or distressing events is somehow beneficial.

The onus is on the individual to adapt to their distress and difficult circumstances by perceiving their circumstances in a stoical and purely rational way.

So we need to ask what are the circumstances that the government are expecting people claiming welfare support to accept stoically. Sanctions? Work fare? Being forced to accept very poorly paid work, abysmal working conditions and no security? The loss of social support, public services and essential safety nets?  Stigma? Starvation and destitution? State punishment and exclusion?

It’s all very well challenging people’s thoughts but for whom is CBT being used, and for what purpose? Seems to me that this is about helping those people on the wrong side of punitive government policy to accept and accommodate that, and to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on any sort of democratic dialogue. It’s all about modifying and controlling behaviour, particularly when it’s aimed at such a narrow, politically defined and highly specific outcome.

CBT is too often founded on blunt oversimplifications of what causes human distress – for example, in this case it is assumed that the causes of unemployment are psychological rather than sociopolitical, and that assumption authorises intrusive state interventions that encode a distinctly Conservative moral framework which places responsibility on the individual, who is characterised as “faulty” in some way.

There is also an underpinning assumption that working is good for mental health, and that being in employment indicates mental wellbeing. However, isn’t it more likely the case that healthier people are in work, those who aren’t well enough to work don’t?

It’s well-established that poverty is strongly linked with a higher likelihood of being diagnosed with a mental illness. But that does not mean working is therefore somehow “good” in some way, for mental wellbeing. Therapy does not address social conditions and context, and so it permits society to look the other way, while the government continue to present mental illness as an individual weakness or vulnerability, and a consequence of “worklessness” rather than a fairly predictable result of living a stigmatised, marginalised existence of material deprivation.

Inequality and poverty are political constructions and arise because of ideology, intention and policy-formulated socioeconomic circumstances, but the Conservatives have transformed established explanations into a project of constructing behavioural and emotional problems as “medical diagnoses” for politically-created (and wholly ideologically endorsed) socioeconomic problems.

Austerity, which targets the poorest citizens disproportionately for cuts to their lifeline income and essential services, was one ideologically-driven political decision taken among alternative, effective and more humane choices.

The government are not strangers to behaviour modification techniques and have been applying crude behaviourism to public policy, drawing on the “expertise” of the Behavioural Insights Team (BIT)  – the “Nudge Unit” – that they established and installed in the Cabinet Office in 2010. (See Mind the Mindspace, which outlines some of the implications of a government extending operant conditioning via policies to an unconsenting public.)

It is disadvantaged people and excluded groups who are the primary targets of enormously pseudoscientific, coercive and punitive psychopolicy interventions. It’s a kind of technocratic ‘fix’, designed solely to align the perceptions and behaviours of those citizens failed and harmed by our current socioeconomic organisation to nonetheless accommodate and accept neoliberal outcomes.

The casual manner in which advocates of behaviourism dismiss the right of people to behave in accordance with their own feelings, intuition and instincts exposes their authoritarian (not “libertarian paternalistic”) ambitions.

It’s frankly terrifying that our so-called democratic government is waging an ideological crusade directed at altering citizens’ thoughts and behaviour, and avoiding any accountability, sidestepping any engagement in potentially difficult political debate about their policies and the impacts that they have.

The objectives adopted by the Nudge Unit choice architects, politico-therapists and psychocrats are entirely about the state micromanagement of public perceptions and behaviours.

These objectives resemble ambitions usually associated with totalitarian regimes. This is a gross state intrusion into a previously private domain – our thoughts, perceptions and behaviours. Not only is this government trespassing on an intimate, existential level; it is tampering with – editing – our perceptions and experiences, damaging and isolating the poorest citizens, burdening them with the blame for the consequences of state policies while also editing out state responsibilities towards citizens.

Both CBT and Nudge are aimed at pushing people in ways that bypass reasoning. The assumption is that because our decision-making ability is limited we need to use non-rational means to persuade people to do what is “good” for them. But who has the moral authority to decide that? This is not about helping people make better choices – it’s about coercing people to make the choices that policymakers want them to make. And again, those “choices” are based on enforcing conformity to the ideological commitments of policymakers.

This psychocratic turn is in diametric opposition to Enlightenment narratives – it fosters a profound anti-rationality and anti-autonomy approach, it’s not remotely democratic: it’s based on a ridiculous premise that people use their freedom and liberty poorly, but somehow, those passing that judgement on everyone else are exempted from such judgements themselves. It is also extends profoundly anti-humanistic consequences.

Apparently, some people think that everyone else is susceptible to flawed thinking and behaviours, but that theory magically excludes the theorist from such human failings, since they are claiming some objective, mind-independent vantage point – a position far away from the rest of us. It’s like saying: this is your “human nature” but not ours.

Whether or not we agree on the efficacy of CBT as a therapeutic model in principle is a small consideration which is overshadowed by the fact that the government are using such “therapeutic” techniques as a highly partisan tool – to enforce traditional Tory biases and prejudices and to achieve their ideologically-driven policy agenda.

CBT will be deployed in job centres to simply favour the political objectives of neoliberal Conservatism: propping up an anti-progressive austerity agenda, regressive ideology, endorsing an ever-shrinking state, while reflecting a profound  Tory misanthropy.

The social problems arising because of a lack of provision will remain unaddressed and unchallenged because of the Conservative paradigm shift in positivist – causal explanations of political and social problems: it’s not down to policy, it’s all the fault of individuals (who are of course those individuals affected adversely by state policy.)

CBT is a short-term treatment, which is cheap and simple to deliver. I suspect this is one other reason for it becoming more popular with the Coalition than is warranted.

CBT has limitations for treating certain groups, including people with severe and treatment-resistant depression and those with personality disorders.

Studies concerning the efficacy of CBT have consistently found high drop-out rates compared to other treatments, with the numbers abandoning therapy often being more than five times higher than other treatments groups. (P. Cuijpers,  A. van Straten, G.  Andersson & P. Van Oppen. (2008)).

Researchers analysed several clinical trials that measured the efficacy of CBT administered to young people who self-injure. The researchers concluded that none of them were found to be efficacious. (See: Task force on the promotion and dissemination of psychological procedures: A reported adopted by the Division 12 Board – D. Chambless, K. Babich, P. Crits-Christoph,  E. Frank, M. Gilson & R. Montgomery. (1993)).

CBT fails fundamentally on a theoretical level: it lacks basic clarity, depth and coherence. It doesn’t provide a definition of “clear and correct” thinking – curiously, CBT theorists develop a framework for determining distorted thinking without developing a framework for “cognitive clarity” or what would be deemed “healthy, normal thinking.” This has left a large space for partisan definitions and political agendas.

And why is irrational thinking considered to be a source of mental and emotional distress when there is no evidence of rational thinking causing psychological wellbeing? Furthermore, social psychology has never demonstrated that the normal cognitive processes (whatever they are) of the average person are irrational.

CBT is deterministic: it denies agency and any degree of free-will. Human behaviour, in this view, is determined by the cognitive processes invoked by external stimuli. It focuses on the former, ignoring the latter. CBT theory basically contends that what you feel is somehow not very important to why you do what you do and think what you think.

But human beings are not automata: we are complex and multi-faceted. Our emotionality is a fundamental part of being human, too – our emotional bonds and attachments, and our interactions with significant others over time contribute hugely to shaping who we are: we are socially situated and contextualised. We are intersubjective, reciprocal and intentional beings. A therapy that sidelines how we feel must surely, at best, be regarded as superficial in its efficacy, scope and reach.

Moreover, in emphasising thought processes to the exclusion of complex and legitimate emotions, therapists may contribute to the harmful repression and denial of feelings.

CBT encourages an unhealthy avoidance of psychological discomfort and distress by diverting thoughts from the source of discomfort. CBT may rouse immature, neurotic and pathological defence mechanisms. It devalues resilience based on mature coping strategies such as openness, courage, mindfulness, acceptance and emotional self-sufficiency.

Not only is that psychologically unhealthy for a person, it’s bad for society as it desensitises and de-empathises people, stultifies learning from experience by disconnecting people’s thoughts from their circumstances and from others. It discourages personal development and stifles ‘resilience’.

Perhaps the most damning criticism of CBT is that it encourages self-deception and self-blame within clients and patients, because it maintains the status quo. The basic premise of cognitive therapy is: except for how the patient thinks, everything is okay. You can see why this would appeal to the Conservatives.

Poor mental health is often linked with poverty (Melzer et al. 2004) poor community integration, and competitiveness among social groups (Arrindell et al., 2003). Key questions arise as to the efficacy, therefore, of working with individuals, when much research suggests community work would be much more effective (Orford, 2008).

The Beacon Project (Stuteley, 2002) was pioneered by health workers who supported those with depression and other health problems by working with their whole community – addressing their basic social needs and developing mutual social support systems. There were significant changes in physical and mental health for the whole community, showing the benefits of fostering a psychology of mutual support, altruism, cooperation and collaboration: building social capital.

Human needs, public services and provisions, developmental processes, social relationships and contexts are important to any comprehensive model of mental health. Community work offers something that CBT can’t: unlimited scope and reach, sustainable, self-perpetuating, long-lasting provision with an inbuilt preventative agenda. It’s also a prefigurative model. As such, it is founded on democratic principles and the values of  genuine dialogue.

But the government has no interest in addressing mental health and wellbeing or building social support provisions. The government insists that people’s problems are self-generated and endogenous. But the socioeconomic context, policy decisions and consequences are the fundamental cause of unemployment, poverty and much mental distress.

When people are affected by social problems with structural causes, such as poverty and inequality, this in turn leads to a lack of opportunity, economic disadvantage and deprivation, unemployment, ill-health, absolute poverty (increasingly), poor housing, political scapegoating and punishment via policy, it’s ludicrously and grossly unfair to further stigmatise them and claim that their problems arise because of how they think and behave.

For the Tories, the only aim of CBT is a strongly emphasised participation in the labour-market, with minimal expectations of the state and minimal reliance on public services.

“Social problems are often the consequence of the choices that people make.” David Cameron.

No. Social problems are most often the consequence of a government that uses policy to create social inequality, poverty, social exclusion and extremely challenging economic circumstances for those people who have the least to start with. The government uses denial and a process of individualising blame for the problems caused by this government’s ideological austerity programme, which is used to legitimise further cruel constraint by those socio-economic factors caused by the government.

The Tories would have us believe that poor people suddenly become inadequate whenever we have a Tory government. They don’t, but they do become poorer. They are then held responsible and punished for the consequences of Conservatism.

If anyone needs to change the way they think, it’s certainly the Conservatives.

Update June 26, 2015: Mental health workers protest at move to integrate clinic with jobcentre

“This month Prof Jamie Hacker Hughes, president of the British Psychological Society (BPS), pointed out recent research which presented evidence that claimants had been forced to accept psychological treatment. Researchers from Hubbub and Birkbeck, University of London, found unemployment was being rebranded as a psychological disorder in many advanced economies, with interventions being introduced to promote a positive outlook or leave claimants of welfare to face sanctions.

Dave Harper, a reader in clinical psychology at the University of East London, told the Guardian he believed there was an ideological agenda driving the government’s proposals.

“We are in a recession,” Harper said. “There are not many jobs out there and this is implying that unemployed people are to blame for their situation. It’s shifting the focus away from economic policy and on to the individual.”

As a BPS member, I was happy to see a clear, ethical statement from the President.

Related

The just world fallacy

Cameron’s Nudge that knocked democracy down – a summary of the implications of Nudge theory

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Pictures courtesy of Robert Livingstone

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The just world fallacy

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The Tories now deem anything that criticises them as “abusive”. Ordinary campaigners are labelled “extremists” and pointing out flaws, errors and consequences of Tory policy is called “scaremongering”.

Language and psychology are a powerful tool, because this kind of use “pre-programs” and sets the terms of any discussion or debate. It also informs you what you may think, or at least what you need to circumnavigate first in order to state your own account or present your case. This isn’t simply name-calling or propaganda: it’s a deplorable and tyrannical silencing technique.

The government have gathered together a Behavioural Insights Team (BIT) – it is a part of the Cabinet Office – which is comprised of both behavioural psychologists and economists, who apply positivist (pseudo) psychological techniques to social policy. The approach is not much different to the techniques of persuasion used in the shady end of the advertising industry.  They produce positive psychology courses which the Department for Work and Pensions (DWP) are using to ensure participants find satisfaction with their lot; the DWP are also using psychological referral with claims being reconsidered on a mandatory basis by civil servant “decision makers”, as punishment for non-compliance with the new regimes of welfare conditionality for which people claiming out of work benefits are subject.

Positive psychology courses, and the use of psychological referral as punishment for non-compliance with the new regimes of welfare conditionality applied to people claiming out of work benefits are example of the (mis)application of Cognitive Behavioural Therapy (CBT).

CBT is all about making a person responsible for their own thoughts and how they perceive events and experiences and can sometimes be used to empower people. But used in this context, it’s a political means to push an ideological agenda, entailing the “responsibilisation” of poverty, with claimants being blamed for not having a job or for being ill and/or disabled.

However, responding with anger, sadness and despair is normal to many events and circumstances, and to deny that in any way is actually grotesque, cruel and horrendously abusive – it’s a technique called gaslighting – a method of psychological abuse that is usually associated with psychopathic perpetrators.

Gaslighting techniques may range from a simple denial by abusers that abusive incidents have occurred, to events and accounts staged by the abusers with the intention of disorienting the targets (or “victims”.)

The government is preempting any reflection on widening social inequality and injustice by using these types of behavioural modification techniques on the poor, holding them entirely responsible for the government’s economic failures and the consequences of  class contingent policies.

Sanctions are applied to “remedy” various “defects” of individual behaviour, character and attitude. Poor people are being coerced into workfare and complicity using bogus psychology and bluntly applied behavioural modification techniques.

Poor people are punished for being poor, whilst wealthy people are rewarded for being wealthy. Not only on a material level, but on a level of socially and politically attributed esteem, worth and value.

We know from research undertaken by sociologists, psychologists and economists over the past century that being poor is bad for mental wellbeing and health. The government is choosing to ignore this and adding to that problem substantially by stripping people of their basic dignity and autonomy.

The application of behavioural science is even more damaging than the hateful propaganda and media portrayals, although both despicable methods of control work together to inflict psychological damage on more than one level. “Positive psychology” and propaganda serve to invalidate individual experiences, distress and pain and to appropriate blame for circumstances that lie entirely outside of an individual’s control and responsibility.

Social psychologists such as Melvin Lerner followed on from Milgam’s work in exploring social conformity and obedience, seeking to answer the questions of how regimes that cause cruelty and suffering maintain popular support, and how people come to accept social norms and laws that produce misery and suffering.

The just-world” fallacy is the cognitive bias (assumption) that a person’s actions always bring morally fair and fitting consequences to that person, so that all honourable actions are eventually rewarded and all evil actions are eventually punished.

The fallacy is that this implies (often unintentionally) the existence of cosmic justice, stability, or order, and also serves to rationalise people’s misfortune on the grounds that they deserve it. It is an unfounded, persistent and comforting belief that the world is somehow fundamentally fair, without the need for our own moral agency and responsibility.

The fallacy appears in the English language in various figures of speech that imply guaranteed negative reprisal, such as: “You got what was coming to you,” “What goes around comes around,” and “You reap what you sow.” This tacit assumption is rarely scrutinised, and goes some way to explain why innocent victims are blamed for their misfortune.

The Government divides people into deserving and undeserving categories – the “strivers” and “scroungers” rhetoric is an example of how the government are drawing on such fallacious tacit assumptions – that utilises an inbuilt bias of some observers to blame victims for their suffering – to justify social oppression and inequality that they have engineered via policy.

The poorest are expected to be endlessly resilient and resourceful, people claiming social security are having their lifeline benefits stripped away and are being forced into a struggle to meet their basic survival needs. This punitive approach can never work to “incentivise” or motivate in such circumstances, because we know that when people struggle to meet basic survival needs they are too pre-occupied to be motivated to meet other less pressing needs.

Maslow identifies this in his account of the human hierarchy of needs, and many motivational studies bear this out. This makes the phrase trotted out by the Tories: “helping people into work” to justify sanctions and workfare not only utterly terrifying, but also inane.

Unemployment is NOT caused by “psychological barriers” or “character flaws”. It is caused by feckless and reckless governments failing to invest in growth projects. It’s not about personal “employability”, it’s about neoliberal economics, labour market conditions, political policies and subsequent socio-structural problems.

Public policy is not a playground for the amateur and potentially dangerous application of brainwashing techniques via the UK government’s Behavioural Insights Team (BIT) or “nudge unit”. This is NOT being nasty in a nice way: it is being nasty in a nasty way; it’s utterly callous.

The rise of psychological coercion, “positive affect as coercive strategy”, and the recruitment of economic psychologists for designing the purpose of  monitoring, modifying and punishing people who claim social security benefits raises important ethical questions about psychological authority. Psychology is being used as a prop for neoliberal ideology.

We ought to be very concerned about the professional silence so far regarding this adoption of a such a psychocratic, neo-behavourist approach to social control and an imposed conformity by this government.

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Pictures courtesy of Robert Livingstone 

Related reading:

AFTER FORCED-PSYCHOMETRIC-TEST DEBACLE, NOW JOBCENTRES OFFER ONLINE CBT – Skywalker

The Right Wing Moral Hobby Horse:Thrift and Self Help, But Only For The Poor

From Psycho-Linguistics to the Politics of Psychopathy. Part 1: Propaganda.

The Poverty of Responsibility and the Politics of Blame

Whistle While You Work (For Nothing): Positive Affect as Coercive Strategy – The Case of Workfare by Lynne Friedli and Robert Stearn (A must read)

 


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