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Breaking down the walls of the therapy room

Psychotherapy and psychological treatment are typically private processes, bound by the unique relationship between client and therapist, and by strict rules of confidentiality. But there’s a growing realisation…

Sometimes, the walls of the therapy room may simply be getting in the way of recovery. János Balázs

Psychotherapy and psychological treatment are typically private processes, bound by the unique relationship between client and therapist, and by strict rules of confidentiality. But there’s a growing realisation in therapy circles that the community may have a critical role to play in making people better.

In many ways, traditional one-on-one treatments are seen to work because of the client and therapist relationship, where historical interpersonal dramas might be played out and resolved, where the individual learns to face fears, deal with the past and take more responsibility for her inner life.

But there are an increasing number of people in the field, who are questioning the value of this conception of therapy, from philosopher-psychologist Kenneth Gergen to local academic Mark Furlong.

In particular, psychology is being implicated as promoting our increasingly individualistic society. Let’s take Facebook or Twitter as examples of this culture. Under the auspices of social networking, aren’t we all simply becoming more self-focused, more narcissistic, more driven to establish ourselves as mini-celebrities?

These theorists suggest that therapy can sometimes do the same, especially when the aim is to focus exclusively on intra-psychic processes (inside us) at the expense of interpersonal (between people) or community-based initiatives.

A case study

Here’s an example to illustrate my point (I’ve changed lots of the details).

I once worked with a 19-year-old girl with mild developmental delay, suffering from neurofibromatosis, a condition that can leave you with visible tumours on the body. She was depressed, unsure about her future and was clearly poorly connected with other people.

Would a diagnosis of depression really help? And medication? Would they change her perceptions and help her see life more positively?

Possibly, but what then about her social exclusion and loneliness? Shouldn’t these also have a primary role in her therapy?

The answer came in employing a practice developed by narrative therapists, such as Michael White and Steve Madigan. These therapists position themselves as the mediator between the individual and the community, rather than as a professional replacement for missing supportive relationships.

We worked together to uncover times in her life where she had stood up to “the depression” or “hopelessness” she felt, occasions where she was demonstrating resilience, creativity and optimism.

I then asked her to tell me who she thought would be the least surprised to see her resisting “the depression” at the moment. She nominated a few people, from her family, volunteer work, and prior school years.

We worked on developing a team of people who would drop in occasionally and attend therapy, witnessing her growing strength and helping her remember empowered moments from her past.

The walls of the therapy room where broken down and therapy became about social inclusion and community-based healing.

Embedding the subject

For Kenneth Gergen, the idea that we even have our own individual identity and emotions is problematic. Is there really a blob of jelly inside us we can call the self? Are our emotions really hanging around somewhere underneath our liver?

Gergen suggests that these things only make sense within relationships. Is it possible, for example, to be sad or angry without it being about or at someone? Have we simply used language to make all our insides up when they don’t really exist?

These ideas are gaining momentum in cutting-edge clinical psychology for young people. There are a number of emerging therapies, including multi-systemic and multidimensional therapy and the Open Dialogue approach.

All these approaches are geared towards our most intractable and complex problems – substance abuse, delinquency, psychosis. The results of randomised controlled trials are showing that family and community engagement is what works for a lot of people.

The recovery movement is also gaining ground. This a consumer-driven approach to mental health that emphasises self-determination but also solidarity and storytelling.

While it has its origins in Alcoholics Anonymous and the civil rights movement in the United States, it’s been adopted as the guiding philosophical principle for mental health care in Scotland and by many public health services in the United Kingdom and United States.

I am not saying, of course, that traditional therapy isn’t needed. We may all need a private and safe place to work through hurt and pain.

Sometimes, however, we also need to learn to reach out to others, to both give and receive support. In these cases, the walls of the therapy room may simply be getting in the way.