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 emotions, personal history 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 bad events is beneficial.

The onus is on the individual to adapt 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 benefits 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 ? Starvation and destitution?

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 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 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 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. It’s well-established that poverty is strongly linked with a higher likelihood of being diagnosed with a mental disorder. 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, whilst the government continue to present mental disorder 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 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 disproportionately for cuts to income and essential services, was one ideologically-driven political decision taken amongst 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 dogmatic, coercive and punitive psychopolicy interventions.

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. Not only is this government trespassing on an intimate, existential level; it is tampering with our perceptions and experiences, damaging and isolating the poorest, burdening them with the blame for the consequences of their own policies whilst 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: 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 Conservatism: propping up an anti-progressive austerity agenda, regressive ideology, endorsing an ever-shrinking state, whilst reflecting Tory misanthropy.

The social problems arising because of a lack of provision will remain unaddressed and unchallenged because of the Conservative paradigm shift in 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 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 leaves 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 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 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.

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 amongst 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 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: unlimted scope and reach, sustainable, self-perpetuating, long-lasting provision with an inbuilt preventative agenda.

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 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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33 thoughts on “The power of positive thinking is really political gaslighting

  1. Kitty, thanks for yet another brilliant critique of the government policy, and the serious implications for government control techniques on vulnerable people. I an concerned about the ethics of having a psychological intervention forced on individuals without medical diagnosis & prescription, or the view of the professional bodies representing the Psychological Therapy profession(s). I’m sure we’ll hear more soon. There is a perception that they may simply put everyone coming through the doors through CBT (the Day1 concept, along with Day 1 workfare too) but it’s not clear who will be chosen & how. JCP no longer provide any real support, just stick & no carrot. From their past behaviours of denigration & demonization of the sick, WCA and sanctions for ESA claimants, limited workfare for JSA, unlimited for ESA, and now Work Focussed interview ‘invitations’ for Support Group, it’s all going to get much, much worse. It’s preposterous to place CBT therapists in Job Centres, places of intense anxiety and stress. If they think that early CBT intervention so so good, why didn’t they direct this budget to Mental Health inside the NHS? Why are the CBT Therapists not placed in medical faculties? What happens if they start to make (more) people ill, as a result of bungled inappropriate CBT, or start sanctioning people because they don’t “get better”?

    I just hope that the Tories are ousted, and this will not be kept by Labour. I dearly want Labour to win, but I still want them to have policies I can support, too.

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    1. Thanks Florence. With regard to Labour, well they will scrap the bedroom tax, sanction targets, workfare, and the current WCA, which will be redesigned using input from consultation with disabled people informing the changes, and Labour will bring in a law to make disablism hate speech illegal, whilst pledging to de-stigmatise welfare.

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  2. I did reply to this post but it doesn’t seem to be on here? I wonder if it was because I mentioned the original idea for CBT in job centres (joke shops, as they were once called) may have been a Labour idea? I suspect what the Tory scum have in mind is more the conditioning techniques of the old behaviourists….

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    1. I am having problems with my site – ever since WordPress changed their format. There’s a big delay in notifications and some comments don’t arrive – you’re not the first to tell me that a reply hasn’t been posted.

      I agree that this is more orientated towards operant conditioning. Labour did put a lot of support mechanisms in place in job centres and I do know that CBT as a therapeutic model became popular whilst Labour were in office. I was working within a social services directorate at the time, and was expected to use CBT. I co-ran group therapy sessions instead with 2 clinical psychologists from CAMHS, and the one-to-one that I undertook, like the groupwork, drew on several therapeutic traditions, which was adaptive in a way CBT can never be.

      As a short term method of boosting confidence, for people without major issues, CBT may be okay. That’s about it! But community provision works much better.

      This govt use phrases such as “behavioural changes” freely, indicating their aim quite clearly. They speak in the language of despots.

      Liked by 1 person

      1. I am Absolutely against group work, for me anyway. What has my life got to do with other “patients”? They couldn’t help me no one can! I do not mean to come off as arrogant or something, but no one could understand all the traumas I have been through, a friend once said to me, she has never known anyone fall through so many safety nets as I have, I didn’t know there were any!

        I just do not like to be forced to speak to people who have no professional role in my recovery, if there is such a thing, in the name of therapy. That approach would not work for me because I would resent it so much.

        I see life as a prison sentence, yet I have never done much, that could be classed as immoral or any where near evil, certainly not as a child, which is when all the trauma happened.

        CBT should never be used as a plaster! Did you know there is also DBT (Dialectical behavior therapy)? A friend of mine was used as a guinea pig for that, she ended up being sectioned 3 times as a result?

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  3. The thing that frustrates me about CBT is that the rational bit of my brain knows that my response isn’t rational, but it’s not necessarily the rational bit of my brain that’s driving. And even if it is, it’s a lot more difficult to get where it’s trying to go when the instinctive bit of my brain is sat in the passenger seat howling, trying to grab the wheel, slam the handbrake on, and so forth. Being forced to use a therapeutic technique on pain of loss of benefits is just going to be counterproductive, especially when that technique is mainly favoured because it’s cheap to implement.

    Liked by 2 people

  4. Some time ago I read an article on the atrocities inflicted on Public School pupils in the name of ‘character building’. Plus some appalling experiences of ex-public schoolboys which had resulted in them becoming more ’rounded’, as far as they were concerned. (An example was when one prominent ex-public schoolboy boasted of being regularly ‘rogered’!) There appears to be a culture of a certain type of bullying endorsed by the ‘upper-classes’ and elites which separates ‘them’ from ‘us’. This forced, and reinforced, sense of privileged separateness allows them to believe the narrative that we who have not experienced their life-scripts have little or no understanding of how to manage our own lives. ‘Failure’ to overcome such a traumatic schooling is perceived as ‘weakness’. Ergo, we in the lower echelons are ‘weak’! And obviously in need of some psychological tinkering! Notice that the worst offenders in the “blame-the-poor” narrative are public school graduates – and all bullies.

    Liked by 1 person

  5. Reblogged this on stewilko's Blog and commented:
    “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.” so true.

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  6. I agree in part and disagree in part. I have some anxiety issues and have found CBT to be one of the more effective approaches I have tried to deal with them. It is early to see what the government are intending with this initiative but CBT should be directed by the inner wishes of the people and should not be some kind of brainwashing technique. Ideally those who are given CBT should be empowered in such a way that they can change the system as well as themselves. I do not know whether it is actually possible to accomplish anything online, that doesn’t seem to make much sense to me. It gives me the impression that they are just making a show of doing something while actually doing nothing. I wouldn’t have continued with my programme had it been online only. The Beacon project you mentioned or something similar would also be an essential adjunct to any CBT. Any help in that manner combined with CBT has been shown to be more effective than either approach on its own.

    Liked by 1 person

    1. I think there are two problems. And I agree that CBT may be effective for addressing anxiety, too. But many mental illnesses are more complex and require other types of intervention and support.

      The intention behind its use in this context isn’t empowerment: it’s about coercing people into work, regardless of whether they are ready for that. The telling part is that there is no mention of consent. In order for any therapeutic method to be effective, and actually, to qualify it as “therapy”it has to be on a consensual basis, otherwise it is something else, not therapy. The aim is a very narrow one. And also, we must be very cautious about a government using psychological methods as a tool to fulfil policy outcomes and uphold prejudices, which is the case here, since it is assumed that being unemployed is simply because of a faulty “mindset.” In some cases, in this context, CBT may well make some people’s anxieties much worse, especially if people are threatened with sanctions for not participating or for opting out.

      It’s worrying that the current government see unemployment as a psychological disorder, and also, that they feel free to use psychological techniques to fulfil policy outcomes based on such thinking. And on such a level – it’s a way of micromanaging citizens, in this context.

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  7. CBT can has actually been shown by world trauma experts to be harmful to certain people with trauma related mental disorders. Most people who have a mental disorder have a history of abuse (mental, physical or sexual) and to coerce or force them into trusting a stranger in a job centre to whom they must divulge their most private beliefs and thoughts is utterly criminal. Is there no privacy? Are nervous patients going to be given Valium as they go through the doors of job centres? Treatment is treatment after all and who would, with integrity, discriminate against the mentally ill? Cameron has a disabled child (supposedly), should this child be given therapy and told to work? Lead by example Mr Cameron.

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