Feeds:
Posts
Comments

Posts Tagged ‘politics’

Following last weekend’s joint conference of Psychotherapists and Counsellors for Social Responsibility, and the Alliance for Counselling and Psychotherapy, the Psychotherapy and Counselling Union is being formed.

In their own words, the PCU aims to:

  • bring together counsellors, psychotherapists and other practitioners from every corner of the field, including trainees on an equal basis
  • campaign for true diversity and equal opportunities in the therapy world, and support individuals who are discriminated against
  • campaign to reform IAPT and other ‘therapy-lite’ substitutes, while at the same time supporting IAPT practitioners with their grievances
  • campaign against the use of therapy to get people off benefits and/or back to work
  • change the system whereby starting practitioners have to work unpaid, often with very complex issues and without adequate support
  • campaign to defend and extend the provision of open-ended therapy which is free at the point of contact, and where the client can choose their practitioner and modality
  • support and defend practitioners in disciplinary hearings, and also against bullying and harassment
  • support and defend therapy against attacks from government and media, and against creeping medicalisation
  • establish a policy and research unit to develop solid positions on a wide range of issues

unions image
I’m particularly pleased to see issues like diversity in the profession, and campaigning against “benefits therapy” included in the list. This is an exciting development, emerging out of the pull many psychotherapists and counsellors feel towards some kind of activism. I look forward to getting involved and seeing where it takes us.

For further information, or to sign up as a supporter, check out the psychotherapy and counselling union flyer (pdf).

Image credit: Daily Kos

Advertisements

Read Full Post »

Recently, the Centre for Social Justice published the report “Commissioning Effective Talking Therapies” (pdf).

I find this interesting politically, as the CSJ was started by Iain Duncan-Smith, and so is broadly aligned with the Department for Work and Pensions. As the commissioning of talking therapies is the business of the Department of Health, this is an interesting intervention, about which I will have more to say in a future post.

The central message is fairly simple: to commission effective talking therapies, the service should be opened up to the private sector. Now, there’s not much in the way of hard stats on why that should be the case, which makes the report’s one key statistic a bit of a silver bullet to the head of the Improving Access to Psychological Therapies (IAPT) service.

Frankly, when what looks like a hatchet job in the name of free market economics rests its case on pretty much one damning statistic taken from one quarter of key performance indicators, I smell an undead gerbil. And so, inspired by the many, many smack downs delivered to the makers of suspect claims by Cathy Newman’s Fact Check blog, I thought I’d have a go at Fact Checking this core statistic for myself.

The claim:

“The Government has committed to spend an additional £400 million over the next four years on a limited range of National Institute for Health and Clinical Excellence (NICE) approved talking therapies, despite a recovery rate of only around 15% of all referrals” (p4)

The authors are unequivocal about this key fact: the IAPT service has a recovery rate of only around 15% of all referrals. Not only that, but the NHS is actually engaging in statistical skullduggery to disguise this alarmingly low figure:

“In the case of IAPT, it cites ‘recovery rates’ as a proportion of patients treated and also above ‘caseness’, rather than as a proportion of the baseline (patients referred), thus improving the outcome percentage. As described in more detail below, IAPT figures claim recovery as over 40 per cent… but from the point of view of commissioners and referring GPs, 86 per cent are not being helped by the IAPT service” (p37)

The background:

With the passing of the Health and Social Care Act 2012, NHS services are rapidly being opened up to tender by any qualified provider (AQP). The Act specifically opens up NHS services to tender from the private sector; de facto privatisation.

One of the areas open to AQP is adult psychological therapies. Currently, the vast majority of this service is delivered through IAPT. In order to prevent commissioning clusters from effectively defining AQP as an IAPT equivalent service, the CSJ’s report aims to demonstrate that IAPT is failing its users.

The analysis:

First, let’s get our terms clear. The IAPT service uses a peculiar language that aims to do what the majority of therapists tend to claim is not doable; quantify human suffering in statistically measurable terms. When someone is referred to IAPT, they are assessed for ‘caseness’. If someone has caseness, it means they meet the clinical definition for anxiety and/or depression as measured by a specific statistical tool. At the end of someone’s period of therapy, there is a final assessment; if the person’s scores have dropped below ‘caseness’ then they are deemed to have achieved recovery.

The report authors cite the IAPT key performance indicators for Quarter 1 2011/12 (April to June 2011). These figures claim a recovery rate (in England) of 42.5%. Step by step, we get there by:

Step 1. Taking the number of people who a) completed treatment in the quarter, and b) are moving to recovery (this is KPI 6a, and the number is 28,470)

Step 2. Taking the number of people who have completed treatment in the quarter (this is KPI 5, and the number is 75,697)

Step 3. Taking the number of people who a) completed recovery in the quarter, and b) were not at caseness at the start of treatment (this is KPI 6b, and the number is 8,725)

Step 4. Remove the people who didn’t have caseness to start with (step 3) from the total completed cases in the quarter (step 2) to get the number of people who a) completed recovery in the quarter, and b) had caseness at the start of treatment (the number is 66,972)

Step 5. Work out Step 1 as a proportion of Step 4 to get the percentage 42.5%

Phew! At least the stats add up in the way they’re supposed to; so far so gravy, though frankly, a 42.5% recovery rate is not exactly inspiring. But where has this 86% failure rate come from?

Well, the report authors’ claim is based on different stats. They work things out by:

Step 1. Taking the number of people who a) completed treatment in the quarter, and b) are moving to recovery (this is KPI 6a, and the number is 28,470)

Step 2. Taking the number of people who have been referred for psychological therapies in the quarter (this is KPI 3a, and the number is 206,918)

Step 3. Work out Step 1 as a proportion of Step 2 to get the percentage 13.8%

Now, pop-quiz, have you spotted the two sleights of hand that qualify the report authors’ calculations as bad science? Watch carefully:

Sleight of hand 1. The report authors use a suspicious tone of voice whilst pointing out that the NHS are using a smaller subset of the total available stats. This allows them to remove KPI 4 from view, an indicator that gives the number of people who have actually entered psychological therapies during the quarter. This is 123,792, meaning only 59.8% of referrals actually enter therapy. How can someone reach recovery when they’ve never even entered therapy? As a bonus, by the way, these figures contain a clear footnote stating that the number of people referred in a quarter don’t necessarily complete therapy in that same quarter; this is a totally unreliable figure to use as a baseline.

Sleight of hand 2. This one is the smarter move, and takes advantage of the ridiculous language IAPT is using. The very word ‘caseness’ presses the jargon button of all who hear it, making it a great primer for anti-IAPT sentiment from the outset. And so, because we all think we know what recovery means, but have only a vague idea of what caseness means, we are invited to stick with what we know and ignore a vital piece of causation: without caseness, there is no such thing as recovery. By definition, recovery means going from caseness to non-caseness; how can someone reach recovery when they didn’t have caseness in the first place?

The verdict:

It is incorrect to assert that IAPT has a recovery rate of only around 15%. Out of the total number of people referred into the IAPT service in the quarter examined, only 59.8% received therapy. Furthermore, people entering therapy in the quarter didn’t necessarily finish therapy in that quarter, making the figure unreliable for calculating recovery. Besides which, recovery in IAPT terminology means going from caseness to non-caseness using a specific measure. The inclusion of people who started therapy below the threshold for caseness invalidates the recovery rate because these people have nothing to recover from!

Let’s be frank, even if we’re convinced that recovery can be statistically measured (and whilst that’s an a priori assumption of the NHS, it is by no means a consensus in the wider professional field), a recovery rate of 42.5% is not inspiring. It’s enough to criticise IAPT using its own stats; the use of smoke and mirrors to make it look like a failing service is disingenuous at best, dishonest at worst.

Read Full Post »

I have just finished my first week of paternity leave from therapy practice. Baby is due today and, so far, is declining to make an appearance. What does this have to do with May 3rd’s city wide referendum on whether or not Bristol should have a directly elected mayor? Pretty much everything.

As I started exploring in psychotherapy in a time of political crisis, I am already alive to the overlap between therapy and politics, and to therapy as a distinctly political activity in its own right. Now, it is a gestalt axiom that need organises the organism/environment field, the dynamic interplay between self and situation.

Accordingly, as I start to feel the physical reality of becoming a parent, I become increasingly aware of the social world into which my child will be emerging. The challenge this throws me is simple, difficult, and powerful. I look around me at my situation, and I tune in very quickly to the political domain. I feel urges towards action rise within me and… I explain them away. I’m a therapist, not a politician. There’s no point, I should focus my action in a better direction. Many of the self-same justifications for inaction that I support people in working through in therapy so that they can more fully be who they really are, not who they have been moulded to be.

My experience of starting to become a parent is of suddenly experiencing a need to take action that is stronger than my need to refrain from taking action. It’s not quite that I feel responsible for the world into which my child is being born in a way that I didn’t before, though that is a factor. It’s more that the projection of how my child might see me has revealed to me more starkly how, out of awareness, I am viewing myself. That is, I am fully in contact with the consequences for me of not acting on my political needs. Realising that I owe it to my child to be as fully myself as I can is a bridge to realising that I owe the same to myself. As a therapist, I am constantly re-learning this.

On 3rd May 2012, there will be a city wide referendum on whether Bristol should have a directly elected mayor. There is a yes lobby. There is a no lobby.

The key arguments in favour involve the direct accountability of the mayor vs a current leader who is elected by Council; the transfer of more powers and money (of an as yet undescribed nature) from Westminster to Bristol if we vote yes; and to shake up a tired political system.

The key arguments against involve the belief that the cost of implementing the mayor model will be too high; that the election will descend into a Ken vs Boris style personality contest; that the mayor will not be accountable to Council in the way the current Leader is; and that the candidates will be uninspiring.

In the midst of making up my own mind, I saw Salma Yaqoob‘s article ‘Yes’ to a Mayor who says ‘No’ to Austerity and realised what I want. I want to switch to the directly elected mayor system, and actively seek out the kind of candidate I want to vote for, instead of passively waiting for existing interests to make their offers. In parallel, I’m also seeking to form a political party with a mission to forge a politics of compassion grounded in core therapeutic principles.

I am unlikely to pull off such a feat on my own, so this is my call for support. Here is the kind of Mayoral candidate I am looking for:

A Mayor who opposes austerity: the austerity drive has failed and continues to fail. Britain is not only in a double-dip recession, but in a depression that is now more prolonged than the Great Depression of the 1930s. I want a Bristol Mayor who will actively oppose austerity.

A Mayor who will devolve power: one of the dangers of an elected mayor is that power becomes more centralised. I would like to see Bristol become a functioning e-democracy in which any Bristol citizen with an interest can be part of the decision making process. I want a Bristol Mayor who would seek to make that a reality.

A Mayor who is a woman: the mayor debating panels have been dominated by the usual white, middle-aged men, and the candidates so far proposed belong to this demographic. According to the 2001 Census Bristol’s population was 51.2% female. Austerity measures disproportionately affect women, who, absurdly, form the majority of the population but hold a minority of political posts. I want a woman for Bristol Mayor.

A Mayor who places humanity above economy: we are living through a time of atrocity in the name of balancing a national budget sinking under the weight, not of excessive public spending, but of bailing out the banks. Welfare is under attack, and the NHS is being thrown to the wolves. This is not unique to the Coalition; all three main parties are part of a neoliberal consensus that equates human activity with economic activity. This then justifies the most ruthless of decisions, as economy and humanity are one. I want a Bristol Mayor who will place humanity above the economy.

You might not want what I want, and that’s fine (and if I’ve inspired you to do the same thing as me but for a different kind of candidate, then even better!). Possibly I will get no further with this than the warm glow I get after publishing a new blog post. And if Bristol votes no on 3rd May, it’ll all be fairly academic anyway.

But suppose you want the same thing as me. And suppose Bristol votes yes on 3rd May. Then maybe you can take your own step towards action, and instead of waiting for the usual suspects to offer us up a selection of the same old faces, lend me your support.

Let’s get together, and find a candidate worth voting for.

Read Full Post »

It was with much conflict that I attended an information evening for therapists by a social enterprise called Get Stable on Tuesday.

On the one hand, here is a company whose aim is to widen people’s access to psychological therapies beyond the CBT hegemony currently held in place by NICE guidelines. Adult Psychological Therapies is an area of the NHS being opened up to delivery by ‘any qualified provider’ (AQP). Get Stables’s main objective is to make it possible for people seeking therapy to be referred to private practitioners by their GP. As a therapist in private practice, my attraction to this idea is clear.

On the other hand, the legislation that has made this possible is the much-maligned Health and Social Care Act 2010-12; a bill so steeped in Fecklessness and Lose that Health Secretary Andrew Lansley defied FOI legislation to prevent publication of its risk register during its passage through Parliament. An early draft of the Health Bill risk register has now been leaked, confirming pretty much every argument against a Bill opposed by the majority of the medical profession. It’s probably clear where I stand on this issue.

So you can imagine the conflict; here is a company, aiming to deliver the kind of access to therapy I think people need to have, made possible by legislation I have actively campaigned against. Never had it been any clearer: I am a private psychotherapist; I am a private sector interest!

I remain opposed to the opening up of the NHS to ‘external markets’, and consider the term ‘any qualified provider’ to be an act of misdirection. It is clearly intended to play on most people’s assumption that ‘qualified’ means ‘good’, while in fact, ‘qualified’ simply means ‘meets the criteria’. As the manager of a small charity pointed out to me a few weeks ago, one of the qualifying criteria in tendering for service delivery is often that the organisation demonstrates a minimum annual turnover, or minimum level of reserve capital. So there are ways of ensuring that the ‘any’ qualified provider criteria are skewed towards, say, organisations that have paid your political party lots of money, or on whose Boards you can expect to sit.

That said, the starting point in gestalt therapy is to make contact with the actual situation and respond accordingly. The Health Bill has passed, ‘the markets’ are mobilising, and I find myself living in interesting times. So…

Who is Get Stable?

Although I asked at the end, I’m still unclear on the governance arrangements of Get Stable. Which doesn’t sound like an interesting thing to be concerned with but is, I think, very important.

The language of Get Stable is one of therapists as partners. The problem with that language is that, to me, partnership implies a more or less equal power relationship. However, Get Stable is a limited company, not a co-operative or collective, so while therapists may be referred to as partners, that doesn’t empower anyone to make organisational decisions; the Board will retain that authority.

That said, Get Stable isn’t (or at least doesn’t seem to be) a shadowy corporation moving in to snaffle up NHS goodies. Benjamin Fry, Get Stable’s founder, gave a very warm and personal account of his motivation for setting the company up, grounded in his own experience of trying to get therapeutic support through the NHS. If Get Stable is successful in its bid, I would like to see it move to a co-operative set up with charitable status.

Scene setting

The following is my understanding of what’s happening, so I’d appreciate it if any factual errors or mis-interpretations could be pointed out in comments.

Delivery of adult psychological therapies will be opened up to tender on 4th April. Any organisation that meets the AQP requirements will be able to put in a bid, with the bidding process closing 24th April. This is Get Stable’s initial window of opportunity.

PCTs are being dissolved, and their place taken by larger clusters, aligned to Local Authority boundaries. Get Stable is bidding in relation to the Bristol, North Somerset, and South Gloucestershire (BNSSG) cluster. This made some of the presentation confusing for me, as Ben mostly referred to how ‘Bristol’ would be doing things; I’m assuming that he was using Bristol as shorthand for the BNSSG cluster.

The BNSSG cluster appears to be the first in the country to be interested in commissioning an adult psychological therapies service that isn’t simply IAPT v2. Rather, the cluster is apparently open to the possibility of tapping into modalities beyond the prescription of NICE guidelines.

The referral process

In Benjamin Fry’s ideal world, Get Stable has successfully been awarded the tender for delivering adult psychological therapies in the BNSSG cluster. The journey from suffering to recovery goes something like this:

You go to your GP. You might have already self-assessed using Get Stable’s website, or you might not know what’s wrong. Your GP agrees or assesses that you need therapy. You then use Get Stable’s website to choose a therapist, using therapist profiles to decide who is right for you. Your GP refers you to that therapist, you make contact to arrange an initial meeting, and off you go.

Essentially, the process is pretty much the same as finding a private therapist, but with your GP as gatekeeper (s/he will hold the money), and Get Stable providing the background administration and quality assurance (only qualified and accredited practitioners can sign up).

This maximises choice on the part of the person seeking therapy in a way that is designed to reassure commissioners that what Get Stable will make available meets the same standards as what is already available in the NHS. It means that therapists who have chosen not to accredit, or who have sought alternative accreditation paths (such as the peer-review system of the Independent Practitioners Network) are unlikely to benefit from this system.

If this model is successful, then I would expect to see organisations like BACP and UKCP grow in strength, especially if this model spread to other clusters. Further, I would expect some degree of ‘therapist immigration’ as therapists outside the cluster area travel into the area, specifically to tap into this referral process. Especially if neighbouring clusters are commissioning services that essentially replicate the current IAPT provision.

I experience a lot of excitement as I make initial contact with these possibilities because it certainly looks like the kind of access to therapy I would like everyone to have. As a private practitioner, I hold a conflict between wanting to support people on the one hand, and needing to make a living on the other. Consequently, I have to acknowledge that my fees are beyond the reach of a large number of people.

Clearly, the Get Stable vision is one in which people can get, through their GP, the same access to therapy that only people with the means to pay can currently enjoy.

Money money money

At one point, I wondered to myself whether we were all going to be asked to pay some money into some kind of pyramid scheme-esque therapy racket. Amusingly, that thought was followed by Ben drawing a pyramid on the flipchart as a visual aid. He was explaining the logic behind Get Stable’s funding model, so far as it exists (the pyramid didn’t detail the funding by the way, it detailed the hierarchy from IAPT (top) down to self-certified therapists (bottom) from the commissioning perspective).

The understanding I’ve come away with is this:

Each person referred by a GP would have an amount of money associated with them. That money is only released to Get Stable when a successful outcome is achieved. A successful outcome in Get Stable’s model is achieving ‘recovery’ as defined by CORE (regular readers will be remembering my post on the Gestalt CORE project at this point). CORE is a way of measuring the impact of therapy in order to allow quantitative assessment of service provision.

This is a murky area of the model for many reasons, and is the main dampening factor on my excitement.

Ben’s argument is that, in order to meet the needs of the commissioners that will be deciding which bids are successful, Get Stable need to minimise the financial risk to the cluster. The NHS already uses CORE to measure the strength of a wide range of services (hence the logic behind the Gestalt CORE Project). Nothing reduces financial risk more than ‘no win, no fee’, so if ‘win’ is defined in terms the NHS already considers definitive, a major hurdle is, theoretically, overcome.

Further, by applying existing NHS standards as sign up requirements for therapists, Get Stable can argue that they are safe in the same way that NHS services were safe. Qualified and accredited therapists provide therapy in the NHS already, so Get Stable isn’t exposing people to anything they wouldn’t already be able to find in the NHS nationally.

The rub for me as a therapist comes in a number of places.

First, CORE methodology consists of a long list of measures at the start and end of therapy, and a shorter list of measures in every other session. So some therapy time must be given over to filling in CORE forms.

Second, it remains unclear to me what happens in terms of payment in the instances where: the person referred doesn’t show up; the person referred comes for assessment and we end up not working together; the person referred disengages from therapy before the agreed end date. My current reasoning is that, in these cases, no money will come from the cluster to Get Stable because there is no ‘win’ (recovery, in CORE language).

Third, suppose I’m seeing two people and see both through to an agreed ending; the CORE scores for one indicates recovery, the scores for the other indicate non-recovery (either no movement in scores or not enough). My current reasoning is that Get Stable receives money for the person with recovery scores but no money for the person with non-recovery scores.

Get Stable has asserted that it will take money centrally from commissioners and re-distribute to partner therapists so that everyone gets paid for their time. If I’ve understood correctly, and money only comes to Get Stable when a recovery score is achieved, then a bizarre economy is created in which the money gained through people with recovery scores subsidises the people without recovery scores. I find it hard to see how that could average out at a decent level of fee for each individual therapist (though a caveat here would be that the money available per person isn’t known yet so no one can crunch any numbers!).

Fourth, I’m unclear on this but assume that the money allocated per referral is a fixed amount, creating an environment that is better suited to brief therapy. If the money per person is fixed, then the money:session ration clearly reduces with every session, creating an incentive to take as few sessions as possible.

While this appears to be a good thing (and Fritz Perls was very opposed to the idea of spending years in therapy), it fails to take into account that people need to move at their own speed. In the case of depression, for example, a depression that is highly situational is more likely to pass more quickly than a depression that is rooted in long-standing problems.

So a further nuance to the therapeutic economy becomes people with simpler therapeutic situations subsidise people with more complex therapeutic situations.

If the money available per person is flexible subject to assessment of complexity and time needed; and/or if there is a ‘basic + commission’ model where Get Stable get a standard payment at the start, and an additional, recovery-linked payment at the end, then much (though not all) of that bizarre economy will be mitigated.

Overall impact on therapy provision

From the perspective of someone seeking therapy through their GP, this model provides a wider choice than currently exists, and I think that is a good thing. Having received my own therapy purely through the private sector, I would have a very hard time being allocated to someone by my GP

From the perspective of the commissioning group, this model clearly transfers all the financial risk away from the commissioners and onto the practitioner. At the same time, it ensures that only private practitioners who meet the current NHS standards for therapy provision are available for referral. I’m not a commissioner, but the no win no fee & NHS standard equivalency logic seems to me to stand a good chance of being appealing.

From my perspective as a practitioner… I don’t particularly like the risk of not getting paid for my time. Get Stable seem to be wanting to use the bizarre economy I’ve described to ensure that everyone gets paid for their time. In which case, I suspect the bigger risk is that the average therapeutic fee will fall below what practitioners currently get privately. Get Stable quoted an expected average fee of £45; given that no numbers are available, I’m assuming that to be an air-plucked number meant to attract an initial wave of therapists to sign up.

Overall, I see the impact as being largely determined by how much money is available for each person referred, and what proportion of that money is dependent on hitting the win of recovery scores.

In the worst case, therapists adapt to a therapeutic economy that is skewed towards people who are more ‘responsive to treatment’ and have ‘simpler presentations’ because these are the most ideal conditions for a speedy journey towards statistical recovery.

In the best case, therapists have the freedom to give each person the time they need, and the discipline of CORE assessment supports practitioners in developing a more sophisticated ability to assess likely therapeutic timeframes.

I suspect there’s a bell curve in this, with ‘available funding’ along the x axis, and ‘therapeutic efficiency’ along the y axis. Whilst it’s obvious that too little money leads to poor conditions for therapy, I do also think that too much money does the same.

That said, I doubt we have to worry about too much money being made available!

In closing, I’m aware that there are many nuances and aspects to this that I haven’t discussed, not least of which being whether the very idea of quantifying a ‘no win no fee’ approach with CORE is good, bad, or meh.

What I’ve stuck to for this post is an immediate remembrance of and response to Tuesday’s meeting; it’s my hope that some discussion will take place in the comments, especially among people who attended the meeting.

My current position is that I think Get Stable is basically a good idea in need of the numbers necessary for financial modelling. I can’t see any real loss involved for a therapist wanting to give this a try by experimenting with making three or four slots available on a one year trial basis to assess whether it works.

I wish Ben Fry and his team the best of luck with the bidding process!

Read Full Post »

I’m going to be facilitating a planning event for a group of people intending to run discussion events for something called Bristol 2050. This is a development of the Occupy Bristol movement by people who are interested in ‘what happens next’, ie how best can Occupy Bristol evolve. The aim is to use the Open Spaces methodology to explore the kind of society people want to live in by 2050.

The planning event will itself be an Open Spaces event as that is the only meaningful way to learn an approach to group discussion that I will wax lyrical about another time. For now, what is needed are people who are interested in getting involved at this stage. The focus of the planning event is making Bristol 2050 as open to as wide a range of voices as possible, and how to make sure events run smoothly. An interest in evolving participatory democracy in a manner that is accessible for a wide range of people is pretty much the only pre-requisite; Open Spaces is very easy to get to grips with and is designed to be empowering.

If you’re free Saturday 21st January, then the training event will take place in the upstairs hall at The Trinity Centre in Lawrence Hill, 2pm to 4pm. Apparently there will be an indoor picnic in the downstairs hall all day and we’ll be welcome to drop into that.

Email me (simon@silvercatpsychotherapy.co.uk) if you’re interested. If you’re interested in getting involved and can’t make the 21st, then still email me, your support is bound to be helpful at some point!

I’ll elaborate on this in another post, as I see a large overlap between this process and the spirit of gestalt therapy. For the time being though, this is the call to arms, and I’d appreciate it if you could spread word to any Bristol-based people who might be interested.

Read Full Post »

I have an irrational and visceral dislike for list based blog posts. Every time I see a blog post title that goes “ten reasons why…” or “the seven principles of…” etc, a little piece of me dies and reincarnates as a berserker with a nasty case of blood lust.

Gestalt itself seems particularly fond of the number five for this sort of thing; hence Perls’ five layers of neurosis; Parlett’s five principles of field theory; and Clarkson’s five levels of relationship. I mean seriously, at least try some different numbers people!

Anyway, one of the things that makes me a gestalt therapist is my pre-disposition towards noticing what gets my hackles up, having an internalised therapist/supervisor/trainer jump up and declare ‘projection!’, and then crossing over to my dark side for a bit to see what it’s all about.

So here’s a festively themed list-based post about my irrational and visceral dislike for everyone’s favourite mince pie munching bearded reindeer abuser.

Four reasons I set man traps for Santa:

1) he is a patriarchal symbol of parental tyranny

2) he is a capitalist symbol of social control

3) he is an agent provocateur for the Coca Cola corporation

4) … this one’s a secret, shhhhhh!

Stick with me while I elaborate, it might just change your life…

1) he is a patriarchal symbol of parental tyranny

It’s Father Christmas, not Mother Christmas. Ok, so lip-service gets paid to gender equality by a number of films that do cast a Mother Christmas. But that actually serves to highlight the underlying patriarchal assumptions; Mother Christmas is always cut from the long-suffering-wife-whose-husband-is-a-really-important-public-figure cloth. It is Father Christmas who holds the power, and the power he holds is incredibly sinister.

You better watch out
You better not cry
You better not pout
I’m telling you why
Santa Claus is coming to town

Now, try (and unless you don’t recognise the song it’ll be hard) to read this as a threat. Because it is a threat. Try reading it out loud through gritted teeth. A bit extreme maybe, but the point is clear: you, child, had better start behaving in a manner that I consider to be good because an extremely powerful man is about to arrive.

He’s making a list,
Checking it twice;
Gonna find out who’s naughty or nice.
Santa Claus is coming to town

That’s right kid, you’re going on a list. And this is a black and white kind of affair; you’ve either been naughty, or you’ve been nice. There is no in-between. There is no process of appeal. There is only Santa’s judgment. Oh, and just in case you thought you had any way of hiding from the man with the big white beard:

He sees you when you’re sleeping
He knows when you’re awake
He knows if you’ve been bad or good
So be good for goodness sake

That’s right; every second of every day, Santa is watching you. So be good for the sake of being good, because that is behaviour that Santa has been created to reward; actions that appear to be good. Niceness, that bland little alias for obedience to status quo.

And here’s what you get if you’ve been naughty (NB Tony is one of my cats. Yes, it’s a ridiculous name for a cat).

I labour this point because I consider it the principle point. Every time a parent tells their child ‘carry on like that and Father Christmas won’t be visiting this year’ to get them to obey, a vital message about society is being conveyed: obedience is good, disobedience is bad. Yet so often the people who hold social power and demand obedience are not people whose motivations and actions are all that good.

And of course, Father Christmas grants parents the vital tactic of deferred authority. It’s not me, it’s him; I’m just the messenger. Because the kids need to know how to get on the good list right? And they can’t ask Santa directly, so they need parental cues on what counts as good and what counts as bad. So the parents get to enjoy the authority conveyed by service to a higher power, at the same time as the comfort of delegated responsibility; it’s easier to implement a higher authority’s rules than to own and assert one’s own needs.

Remember, young kids think this stuff is real. They literally think that actual Father Christmas will punish them for being on the naughty list by withholding presents and only reward them with presents if they get on the nice list. Doesn’t that directly assert from day one that the child’s own nature is to some degree inherently unacceptable?

So, Father Christmas is a patriarchal symbol because he perpetuates male dominance of power. He is a symbol of parental tyranny because his function is to give parents an unaccountable deferred authority with which to condition children into obedience.

2) he is a capitalist symbol of social control

If you have kids, and do the Father Christmas thing, I’ve possibly just offended you deeply by implying that you are a tyrant. Soz. Most parents aren’t tyrants, and don’t use Father Christmas as an overt tool of tyrannical control. Unfortunately though, the effect remains the same; however benevolently Father Christmas is presented, he is still the arbiter of the getting of presents.

And there is one very good reason why Santa retains this power: commerce. The christmas shopping period is the retail occasion of the year. There are shops whose existence throughout the year depends on Christmas trade. That is, the profit they make in the run up to Christmas offsets the losses they make in the rest of the year. Watch in the New Year for businesses going into administration as a result of holding out for the Christmas revenues that didn’t come.

That’s a pretty powerful social pressure. Christmas is a vital economic stimulus; profits have always been at stake, meaning the interests of powerful people (it’s that 1% again!) are at stake, meaning a powerful controlling symbol is needed. That’s right, Father Christmas is in the pay of the corporate elite. This makes absolute sense; only multinational corporations can rival Santa’s ability to deliver presents worldwide in a single night without falling prey to the contradiction of timezones.

The point here is this: the vested interests that give the symbol of Father Christmas its power are corporate and motivated by profit. Just look at where the activity is focused; people queue to get into shops, empty the shelves of food, and fight each other to make sure their kid gets the must-have present of the year.

Now stop, breathe, and ask yourself: why does this happen? I’m serious, what’s the motivation here? Wasn’t the 25th December Christ’s official birthday last time I checked? For the record, I’m neither Christian nor driven by the need to labour the ‘but the Christians stole it from the pagans’ angle. All of that is somewhat irrelevant when we take gestalt’s here and now perspective and ask:

What is the need that mobilises all this action now?

My conclusion is that profit drives this action. Generally speaking, I do not observe families benefiting from Christmas. I do observe parents feeling an immense pressure to give their kids what they want for Christmas. I observe advertising telling kids what they should want for Christmas. I observe a level of activity that can only be described as manic taking place in retail centres; not a rush to attend church, not a desperate flailing to go home and play board games with family, but a frenetic stampede to buy stuff. And it’s all stuff that is largely not needed other than to live up to a collective idea of what Christmas should look like.

And Father Christmas is the lynch-pin. For one thing, he’s the symbol that many of us grew up with, so he now sits active in the psyche of many adults wanting to give their children the kind of Christmas they wanted and didn’t get (or worse, the sentimentalised Christmas they remember but that never actually happened). More importantly, he ensures that no parent is in any doubt that Christmas is about giving your children presents.

When your kids go back to school, the question will be: ‘what did you get for Christmas?’. Not, ‘don’t you think it’s ironic that our Government is forcing another 100,000 children into poverty at a time of year when we celebrate Christ being born in a stable?’. Not, ‘did you enjoy spending time with your family over the holiday period?’. But, ‘what did you get for Christmas?’. Because kids are authentic (that is, they respond to the actual situation) and they know what Christmas is really about.

So, Father Christmas is a capitalist symbol because he is the jolly bearded face that demands you shop like a maniac for the benefit of the wealthy few. He is a symbol of social control because his image demands action that is hard to disobey without attracting social disapproval.

3) he is an agent provocateur for the Coca Cola corporation

Holidays are coming, holidays are coming, holidays are coming…

There’s a nice overview of the history of Santa Claus on wikipedia. A brief synopsis of this would be:

Father Christmas started out life as a pagan symbol of the coming of spring. In time, this merged with the legend of a Christian Saint famed for making anonymous gifts to the poor. Under the influence of Victorian sentimentalism, the erstwhile variable form of Father Christmas crytsallised into the kindly old sleigh riding, present bearing bearded one we know today. Finally, Coca Cola popularised the red version.

Coca Cola say: “though some people believe the Coca-Cola Santa wears red because that is the Coke® color, the red suit comes from Nast’s interpretation of St. Nick”. A more accurate way of putting that would be: “some people believe the Coca-Cola Santa wears red because that is the Coke® color; this is true”. After all, the decision to use Nast’s interpretation of St. Nick will have included the rationale “it matches our corporate colour”.

And in the spirit of the imperialistic urges of multinationals, this corporately sponsored Father Christmas has so homogenised the celebration of Christmas, that a natural abundance of diversity in portraying the spirit of mid-winter has been largely wiped out. That’s right, Santa Claus is also a genocidal maniac.

He’s probably not really an actual agent provocateur though, I just put that bit in because it sounded good.

And finally…

4) FATHER CHRISTMAS DOESN’T EXIST!!!

Even ignoring the fact that our entire society collectively puts effort into lying to children, forcing inquisitive children to remain in the lie, and using social pressure to force parents into maintaining the lie, we are left with an undeniable truth:

The guy in the red suit sneaking around my home in the middle of the night is a burglar.

Upstanding pillar of the community, Secretary of State for Justice Ken Clarke says I can stab people for being burglars. In the light of the level of menace this man represents to society at large (Santa Claus, not Ken Clarke, though I’ll leave you to make your own judgment in the latter’s case), I am therefore justified in ensnaring him in jaws of merciless steel should he cross the threshold of my humble abode.

And that, ladies and gentlemen, is why I set man traps for Santa.

HAPPY HOLIDAYS EVERYONE!

Read Full Post »

I’ve been wanting to write a lot more about the overlap between politics and psychotherapy these last few weeks. Recent world events have got me thinking more about the impact of transpersonal processes on the emotional wellbeing of the individual. This was brought home to me by a number of traumatic images of police brutality coming out of the Occupy protests. Here I am, able to make contact with a situation unfolding on the other side of the world, immediately in contact also with a sense of powerlessness. I think that the advent of web 2.0 has the power to support individual contact with forces that, even ten years ago, were far more indirect and background than the dominating figures they are capable of becoming today.

This has huge implications for doing therapy. Gestalt in particular, with its here-and-now focus, and a field theoretical outlook that specifically demands we address the context within which the individual exists, has a role to play in supporting individuals in withstanding exposure to otherwise quite overwhelming social forces. I have a post (to write!) on different levels of self that will be a useful map for exploring this.

In the meantime, I’m reminded of what Fritz and Laura Perls had to say about this area:

“As you know, there is a rebellion on in the United States. We discover that producing things, and living for things, and the exchange of things, is not the ultimate meaning of life. We discover that the meaning of life is that it is to be lived, and it is not to be traded and conceptualized and squeezed into a pattern of systems. We realize that manipulation and control are not the ultimate joy of life.”

Fritz Perls, Gestalt Therapy Verbatim, p3.

“You know, I think the work that I am doing is political work. If you work with people to get them to the point where they can think on their own and sort themselves out from the majority confluences, it’s political work and it radiates even if we can work only with a very limited number of people. We choose the kind of people to work with, who again have influence on others. That is political work.”

Laura Perls, Living at the Boundary, p17.

Fritz and Laura Perls both left Germany as Hitler rose to power. After some years in South Africa (where Fritz wrote Ego, Hunger and Aggression, one of the tributaries that later flowed into Gestalt Therapy: Excitement and growth in the human personality), they came to America. I think Laura captures the fundamentally political nature of their work more elegantly than Fritz, though Fritz communicates the vibrancy of that stance with greater energy.

My overall sense is this: gestalt therapy is about becoming your self, an individual in community with other individuals. That doesn’t mean the corporate reflection of individuality espoused by adverts that seek to sell various brands of individuality to mass markets without any sense of irony. It means something more like Jung’s individuation process, in which each of us becomes increasingly unique with each assimilated experience and moment. Interestingly, this growing idiosyncracity leads not to isolation but to contact: there is no contact with others in a group that has merged into a single entity.

I really like Laura’s phrase ‘the majority confluences’. When Laura refers to ‘majority confluences’, she means the social and cultural choices and actions that we go along with through either automatic agreement or non-choice. Following the crowd in a kind of hypnotic unquestioning state is our automatic agreement to the majority will. Allowing a situation to unfold that one in theory opposes yet to which one chooses not to choose to object is non-choice. The existential commitment of gestalt therapy is this: you have no choice but to choose; not-choosing is itself a choice.

Confluence is a modification to contact that involves erasing the contact boundary and merging with the other. There must be a boundary separating you and me in order for us to be in contact. If I can merge with you, we can exist as a single entity, no boundary between us, no contact. Clearly I can’t merge with you in any literal, physical sense. However, we can merge our ego boundaries, our sense of ourselves, and slip into a strange us-world in which we maintain a boundary around us and all contact with others is ‘us’ in contact with ‘them’. Re-read this paragraph with an aliveness to how you feel as you read all those ‘we’, ‘us’, and ‘our’ statements. It gets me feeling kind of trippy.

This is at once the triumph of safety in numbers and the horror of the herd mentality. It is also an instrument of control that ensures the individual is subsumed into the group.

Gestalt therapy was formed by people who had fled Nazism. In the wake of World War II, ‘majority confluences’ held connotations of fascism, communism, nationalism and other isms against which Ferris Bueller would advise. However, these isms did not and do not form in a vacuum; they are latent in all cultures, emerging as they do out of the interplay between individual and group, personal and collective.

Psychotherapy is an innately political force all the time it encourages an active questioning of that which is socially accepted as being the way things are or should be. This questioning isn’t the blind rejection of rebellion for its own sake but the critical questioning that equates to chewing one’s food before swallowing; or indeed, at least looking at what’s on the fork before putting it in one’s mouth.

If there are two modifications to contact that are the traditional villains of gestalt therapy, then they must be confluence and introjection. Fritz in particular had a visceral intolerance for confluence and an almost pathological insistence on contact. That’s understandable considering how mass confluence in Nazi Germany supported the atrocities of the holocaust.

Introjection is different. This is the uncritical swallowing of the attitudes, beliefs, and ideas of others; usually society at large, parents, teachers, and authority figures generally. Confluence makes a nice safety blanket for introjects, and this is visible whenever someone speaks out against a majority confluence. When feminists, for example, point out that there’s no reason why a woman should perform this or that expected social role, they question introjects that hold powerful social confluences in place; confluences that ensure that men retain a position of privilege and power in society, and that the women who support those men gain a complementary social privilege.

The woman who has accepted such a social role, not out of genuine choice but as an adaptation to patriarchy, is suddenly brought into contact with her situation. Now she must fight to silence the feminist so she can return to the comfort of confluence, or question and extract herself from her situation and risk losing the advantages that have come with adaptation.

As for the man; well, as a man I come up against this struggle regularly and can acknowledge that it is one of the most singularly uncomfortable experiences to realise that I enjoy a social position of privilege (however under-privileged I might otherwise feel!) over another simply on the basis of my gender (and that’s before I consider the privileges that come with also being white, able-bodied, and well-educated).

And worse, that I can’t see that privilege, on account of how basic it is to my place in society. So my position becomes similar to the adapted woman’s position: I can fight the feminist and protect the patriarchal confluence that affords me the privileges I either deny or claim as natural right. Or, I can come into contact with my situation, and also risk losing the advantages that come with playing along.

The potential political power of psychotherapy is vast when I consider that political discourse emerges from exactly the subjective interpersonal themes that are the substance of therapy. So your parents force-fed you a work ethic, the yoke of which you now struggle to throw off. Yet that work ethic is reinforced as a transpersonal force by a society and Government that values the individual only as an economic unit of productivity. Question that work ethic, and you question society itself; and society doesn’t much like being questioned.

Field theory allows the gestalt therapist to ask: to what extent is this or that feeling or action or behaviour a way of embodying or tolerating or otherwise creatively adjusting to the individual’s wider context? Is that young person’s eating disorder the family’s way of manifesting a systemic or transgenerational problem? Is that other person’s psychosis society’s way of finding someone to carry the madness the rest of us can’t accept as our own? Is it any wonder that the survivor of sexual assault blames herself by saying she should have done something to stop it when that is exactly the defence her attacker will use if she goes to court?

In this respect, the two most political words in the English language are probably ‘no’ and ‘why’. Against confluence: ‘no, I will not be part of this’. Against introjection: ‘why must this be so?’. If psychotherapy does nothing else, it empowers people to say both; and that is both simply and profoundly political.

Read Full Post »

Older Posts »