Recognising ‘therapy culture’

An Oxford bookshop window currently displays two new books: Cognitive Behavioural Therapy for Dummies (a rather unfortunate title if you are suffering from severe depression, I would have thought) and Positive Psychology for Dummies. Perhaps my next education book should be ‘Get the Buggers to have Emotional Well-Being’. As part of a miserable series of popular books for teachers suggesting that it’s hard to get ‘the buggers’ to do anything at all, at least emotional well-being is a softer option than Maths.

Books like this are the tip of a cultural iceberg that American sociology professor James Nolan called a ‘therapeutic ethos’ or ‘sensibility’ in his seminal 1998 book, The Therapeutic State. In 2003, Frank Furedi applied this idea to the British context in Therapy Culture: cultivating vulnerability in an uncertain age. And since my book with Dennis Hayes in 2008 charting the rise of therapeutic activities throughout the British education system from early years to universities, parents, teachers and students of all ages have offered us numerous other examples.

Signs of a therapy culture are all around. One of my favourites is Tigger on the Couch, a book for parents and children showing how favourite childhood characters suffer from syndromes and disorders. The moral of the story is that, behind our outward facades, many of us have emotional or mental health ‘issues’ that need help and understanding. I can vouch for this - I’ve needed counselling since discovering that my own favourite, Tigger, far from being a joyful and life-enhancing (if irritating) character, is really concealing Attention Deficit and Hyperactivity Disorder, ‘risk-taking’ behaviour and possible signs of bi-polar disorder. My other favourite example is a scene in Ken Loach’s film, Living with Eric where a group of postmen sit in a circle and, in appropriate ‘counselling voices’ use a self-help book to address their emotional problems.

Yet signs that therapeutic ideas and practices permeate everyday life have eluded authors of the latest British Social Attitudes survey who, after questioning a large sample aged 16-90, conclude that Frank Furedi’s ‘bleak’ fears that Britain has become a ‘therapy culture’, are completely unfounded. Although more adults and young people like to talk about their emotions compared to the past, and think this is a good thing, there is no evidence that more are seeking or using more therapeutic support (Anderson et al 2009).

This fundamental misunderstanding of therapy culture makes it crucial to show the influence of therapeutic ideas and practice on how we think and behave. More importantly, in the 11 years since Nolan first noted contemporary manifestations of therapy culture, there has been a significant shift from addressing the emotional vulnerability of a growing minority to a positive belief, backed up by claims from behavioural psychology, in the efficacy of preventative interventions.

Institutionalising therapy in social policy

The most tangible sign of a therapy culture is a big expansion of counselling, therapeutic support, psychoanalysis and psychology through private practice, the health service, schools, colleges, universities and the workplace, and for the unemployed. Some schools combine a universal approach with targeted interventions, involving charities and other organisations such as ‘Place2Be’:

We take an holistic approach, offering school-based counselling services to children and their parents or carers, accredited training to school staff members, and professional qualifications for those who wish to become child counsellors. Our services address the problems of individual children and adults and help to build ‘mentally healthy’ schools where all children can thrive. Children who can resolve their emotional and behavioural difficulties are less likely to go off the rails, whilst parents who are equipped to tackle their own issues are able to form more positive relationships with their children. The result is happier children with better prospects and that benefits everyone (see Sodha and Guglielmi 2009).

In education, specialist support is increasingly supplemented by mainstream activities derived from counselling and therapy. Children might bring home worksheets advising the family to do a version of ‘circle time’ after supper. Some schools run peer mentoring schemes that train 14 year olds in rudimentary counselling to become ‘Angels’ (‘A Nice Guy Every time Life Sucks’) to mentor 11 year olds going to secondary school. And those 11 year olds may have acted out fears about the transition and role played solutions in drama workshops.

Advocates of therapeutic activities think there are high stakes in all this. At a seminar on ‘childhood, well-being and a therapeutic ethos’, hosted by the Research Centre for Therapeutic Education at Roehampton University in December 2006, 70 representatives from mental health organisations, children’s charities, education psychologists, psychiatrists and therapists and teachers could not agree how many children need therapeutic interventions but they all agreed that the scale of emotional problems was ‘huge’. According to the head of the centre:

if we are to stand a chance of our children and ourselves leading good lives, it may be vital for psychotherapists….to examine how we can influence education in general…. Perhaps [we] need to look at psychotherapy as an educational practice, not only in the consulting room but to see the wisdom for both children and adults to learn from each other and for our society to continue to attempt to ensure that scientific and technical learning, whilst important, is secondary to the resources of the human soul… thus, education and therapy might be seen not so much about knowledge but rather about awakening….by imparting and acquiring through the relational (quoted in Ecclestone and Hayes 2008: 48).

Therapeutic processes are also being adapted for legal systems in numerous countries, including Britain. Imported from America, ‘problem-solving courts’ train judges, jury members, lawyers and court officials to ‘facilitate’ ‘clients’ (rather than ‘defendants’) to participate in therapeutic processes and to consider emotionally-rooted explanations and remedies for their crimes, either during a trial or as part of a sentence (Nolan 2008). Similar practices are increasingly prevalent in overseas aid, reconstruction work in war-torn countries and truth and reconciliation processes (Pupavac 2001).

Popularising therapeutic orthodoxies

Expansion of specialist activity goes hand in hand with the growing presence of therapeutic assumptions in public policy, the media, popular literature and self-help books. One outcome is a vocabulary and a set of therapeutic orthodoxies that affect work, personal and family relationships and educational settings. These include:

• we are all, to a greater or lesser extent, emotionally vulnerable
• behind our confident facades, we have ‘esteem issues’
• we all, to a greater or lesser extent, have ‘emotional baggage’ that we suppress or repress at high costs to ourselves and others
• mundane and serious life events alike leave lasting ‘legacies’ for our behaviour and emotions unless we ‘deal with them’
• we need to address negative emotions before ‘learning can take place’
• ‘emotional baggage’ and feelings of not being listened to hinder authentic personal development
• self-awareness is integral to personal development, emotional well-being and learning
• exploring our emotions through an ‘emotions vocabulary’ and listening to those of others makes us more emotionally-literate, more tolerant and empathetic.

If you want to see most of them played out in front of your very eyes, the film Creation depicts Charles Darwin’s discoveries as playing third fiddle to the prolonged acting out of eight of these ten orthodoxies with accompanying clichés and requisite ‘emotional vocabulary’ (1). According to the film, only after ‘closure’ of ‘emotional baggage’ caused by the death of his daughter, realised through therapy with his doctor and a co-counselling session with his wife that would have had Relate counsellors weeping in the aisles, could Darwin write The Origin of the Species. Of course it’s historical fiction but perhaps two hours of this rubbish is supposed to make the fleeting references to his scientific ideas palatable to an audience steeped in therapy culture. A new series on the American HBO channel, to be broadcast here from October 2009, follows clients going through the minute by minute drama of their therapy sessions.

Although every single one of these orthodoxies is highly questionable, they exert a subtle but powerful influence on beliefs about how to express emotion ‘appropriately’, on our explanations of human action and on the ways in which we relate to each other, and encompass expanding categories of emotional need for a larger proportion of the population. In a recent study of how a further education college supports students’ ‘emotional well-being’, the learning support manager argued that everyone should have lessons in well-being because we all have mental health ‘issues’, whether we realise it or not (Ecclestone and Bailey 2009).

Such views are widespread, reflecting the most insidious orthodoxy of all, namely that if we are unaware of our ‘issues’ or unwilling to explore them, we are in denial, repressed, in need of emotional literacy classes, therapy or ‘consciousness-raising’. This belief signals the decline of a key principle in different therapeutic traditions, including Freudian psychoanalysis and Rogerian counselling, that a minority need intervention to be psychologically well (or, as Freud had it, to turn common hysteria into everyday misery).

In contrast, contemporary therapy culture shows a significant increase in formal diagnoses of mental and emotional disorders and syndromes, together with more self-reporting of ‘dysfunction’. Not only does this show how influential the idea that we all have ‘issues’ needing therapeutic attention has become, but it is also an outcome of the loosening of formal assessments for categories like Attention Deficit and Hyperactivity Disorder, bi-polar disorder and Asperger’s Spectrum.

These trends go hand in hand with everyday uses of psychological labels where men and women alike, say (only half-jokingly) ‘He’s a man – he’s on the Spectrum/has ADHD’. Children and young people use these labels too, or talk about their ‘issues’ with ‘esteem’ or ‘anger management’, expressing how they ‘feel got at’ or telling parents not to speak to them in a certain way because it makes them ‘feel uncomfortable’. Some learn this from interventions like circle time, others from specialist psychological assessments, others just absorb the wider manifestations of therapy culture.

While critics might mock these developments, it’s important to recognise that people are not making up their emotional difficulties or emotional responses: these are experienced and real. While there are elements of suggestibility, where the more we talk about our emotional ‘issues’ and the more we present ourselves publicly and privately through therapeutic orthodoxies, the more we come to believe we have problems, there are undoubtedly more people who feel a lack of emotional well-being or who have debilitating mental health and emotional problems.

In education, one effect is to embed therapeutic orthodoxies into the curriculum. For example, the arts might help people express emotions through movement, sound and picture, or develop empathy by reading and hearing about others with the same experiences and understanding the causes of emotions. English might develop a positive self-concept through talking and writing about the self, create a sense of coherence through family history. Biology might help children understand the physiology of emotion including how the brain works, the centrality of emotion to how we think, learn and experience the world, emotion in animals and our ‘common ancestry’. History might shed light on causes of emotion through biography and the relative impact of individual versus social forces in shaping events, develop personal coherence through family and local history, illuminate emotion in major events such as war, terrorism and atrocities and in humanitarianism such as human rights and the abolition of slavery (Weare 2004: 92).

Supporters of a therapy culture see such developments as progressive. Some believe we have become more aware of our own and others’ emotions, and are more able to manage and express them. Others welcome an antidote to an education system driven by too many targets and a ‘cold’ over-intellectual curriculum, and point to reports by UNICEF and the OECD showing high levels of self-reported unhappiness and social problems caused by poor emotional well-being. While some supporters lament simplistic labels and reduction of specialist interventions into activities like circle time run by amateurs, they support the goal of a more emotionally tolerant, emotionally literate society.

In educational settings, advocates believe this encourages compassion and care so that people can achieve more and learn better. Others hope that combining psycho-social understanding of the self and of how we make sense of the world with insights from child psychology and neuroscience and a humanist view that there is a ‘core’ self might provide a stronger basis for approaches that enable learners to engage reflexively with, and use, their emotions for ‘heartfelt thinking’ about themselves, others and the world (Hunt and West 2009).

Explaining the rise of therapy culture

While it’s relatively easy to identify signs of a therapy culture, it’s more difficult to explain why they arise and why they resonate with contemporary concerns, not least because the concerns are disparate. A number of studies have traced the rise of therapeutic ideas and practices over the past 40 years, first in American society and politics and more recently in Britain (for extensive discussion see Nolan 1998, 2008; Furedi 2003; Lasch 1976; Rieff 1966; Ecclestone and Hayes 2008, chapter 1).

In Britain, the goal of emotional well-being is currently influential, leading former adviser to the British Prime Minister’s strategy unit, Geoff Mulgan, to assert in February 2008 that well-being would become as important in the goals of national governments as military prowess was in the 19th century. Government departments such as International Development, Environment and Rural Affairs, Children, Families and Schools have ‘well-being’ of individuals and communities in their official remits. The DCSF is establishing a research centre for childhood well-being and its Social and Emotional Aspects of Learning strategy has been adopted by many primary and secondary schools. The government is also piloting lessons to develop the psychological constructs claimed to comprise emotional well-being, namely stoicism, optimism, resilience and altruism.

But while emotional well-being might be the latest political expression of therapeutic ideas, policy alone cannot create a therapy culture. Instead policy makers respond to and then appropriate a culture’s concerns about people’s mental and psychological states, about what counts as a good and meaningful life, and about how governments should support us. Therapy culture also reflects political emphasis on individuals’ emotions, either to explain the effects of changing social and economic conditions, or to render those conditions invisible.

So, although economic and social pressures, simultaneously, are reflected in and encourage contemporary features of therapy culture, we cannot ‘read these off‘ from structural conditions. Instead, it is important to understand therapy culture as a cultural, political and philosophical phenomenon, a particular response to changing conditions, expressed in different ways in different periods and contexts whilst also having underlying continuities.

Shifting images of the human subject

Convincing people of the validity and significance of this explanation is no small feat when therapy culture is either misconstrued, denied or seen as a benign and progressive response to changing social, cultural and economic pressures. It is even more challenging to show the influence of a long-running anti-humanist view in culture, politics and philosophy of what Furedi calls a ‘diminished self’, a cultural perspective that ‘regards most forms of human experience as the source of emotional distress….[where people] characteristically suffer from “an emotional deficit and possess a permanent consciousness of vulnerability’ (Furedi 2003: 110/414). A diminished self finds exposure to uncertainty and adversity, including disappointment, despair and conflict, simultaneously threatening to ‘the integrity of the self’ and inhibiting of it.

Of course, no policy maker or supporter of therapy culture could express their view of people in this way! (see Ecclestone and Hayes 2008, 2009). Yet, while supporters argue that they seek to empower people, a diminished view is evident in the British government’s emphasis since 1997 on the emotional and psychological effects of poverty, unemployment and low educational achievement. Many policy initiatives arise from that view. But much more widespread is a belief that life generally and childhood in particular is highly problematic. A leading proponent of ‘learning to learn’, Guy Claxton, justifies an affective turn in education:

It is not too fanciful to see, behind the youth culture of raves and drugs, sport and celebrity, the rise of teenage pregnancy and fundamentalism, the shadow of insecurity: the feeling of not being able to get a grip on the miasma of choices and opportunities….No wonder so many young people clutch at the first kind of boy or girl, the first shallow ideology that comes along. It’s not so much that young people live in poverty… as they do not know where to turn for direction and value. In such a state, algebra and parts of speech can seem a little beside the point (Claxton 2002: 48).

Citing a survey of 3,500 11-25 year olds by the Industrial Society which reports young people as fearful of challenge, future opportunities and trends, Claxton argues that they see schools as failing to equip them with the ability to learn for life rather than for exams, and adults for not ‘listening enough’: ‘That’s why they turn off from school… they are not intrinsically lazy or bolshy or lacking ability: they are disappointed in our reactions to their predicament and flailing about’ (2002: 48).

Controlling the emotional subject

Yet, depictions of ‘vulnerability’, ‘low self-esteem’, ‘being at risk’ or ‘not being listened to’ are giving way rapidly to political and academic interest in finding out what makes us emotionally and psychologically well rather than diagnosing and pathologising dysfunctional responses. ‘Positive psychology’ fits well with notions of giving young people the ‘means to be their own happiness creators and maintainers’, encouraging pleasure, joy, flow, optimism, curiosity, self-efficacy, engagement, resilience and stoicism, mindfulness, holistic approaches and developing the means to flourish (see Claxton 2007; Huppert 2007; Seligman 2009). Much more persuasively than expanding interventions for those deemed to be dysfunctional or emotionally vulnerable, these developments offer an upbeat view that the state and its institutions and agencies can foster emotional well-being through preventative activities that encompass all of us.

This shift in therapy culture is highly likely to drive new developments, whichever political party is in power after 2010. Indeed, the Conservative party is particularly interested in using psychology to change behaviour, building on the Labour government’s groundwork (BBC Radio 4, 15 September 2009). The difference is likely to be its harnessing of private organisations and the ‘third sector’ rather than state institutions, especially as these organisations are already very active in therapeutic interventions.

Yet, underneath this positive gloss, the idea that we are emotionally vulnerable to the effects of modern life, whether through its traumas or its everyday events, has not gone away: policy-makers and advocates of therapy culture will continue to see us as emotionally reformable, able to experience well-being and to help others to be emotionally well – in the appropriate way.

These developments are backed up by scientific claims and supported by an influential ‘emotions industry’. Increasingly sponsored by policy makers, this industry comprises academics from the fast rising fields of behavioural and social psychology, psychotherapists and psychoanalysts, and over 70 other interested bodies, including mental health charities and campaigning organisations, are currently promoting the orthodoxies and interventions of therapy culture (DfES 2005). The emotions industry is reinforced by related professionals, including specialists in psychodynamic therapy, psychoanalysis, liberal humanist counselling and cognitive behaviour therapy, together with large numbers of lifecoaches, workplace and educational mentors (including peer mentors in schools).

Whoever wins the tender to run the new government-funded research centre on childhood well-being, and those who will be successful in the forthcoming ESRC call for bids on every type of well-being there is, we can expect the influence of this industry to grow.

Challenging the emotional subject

Conclusions drawn by the British Social Attitudes survey therefore show a very poor understanding of what a therapy culture really is. Not only is it highly questionable that more people are not seeking or being given specialist therapeutic interventions, but it is hard to refute the more subtle manifestations of therapeutic orthodoxies in social policy and everyday life and the influence of the emotions industry.

Perhaps advocates of therapy culture will cast its critics as part of that industry! Yet challenge is essential. We have to debate and question these developments, show how they represent a distinct cultural, philosophical and political trend and raise pressing and difficult questions about their ethics and effects.

• Are people simply becoming more empowered and responsible for their emotional well-being?

• What are the positive benefits of interventions for emotional well-being in different areas of policy?

• Is attention to emotional well-being a progressive sign of social justice, or does it undermine our capacity to cope with life without official support and to define our own emotional well-being?

• What power should the state and its agencies have in defining and developing people’s emotional well-being?

 

Dr Kathryn Ecclestone is Professor of Education and Social Inclusion at the University of Birmingham. She has published and spoken widely on the effects of education policy on everyday assessment and teaching activities and attitudes to learning in further, higher and adult education. Her most recent book, with Dennis Hayes, is The Dangerous Rise of the Therapeutic Education, a controversial critique of the ways in which education policy and practice focuses increasingly on the emotional vulnerability of children, young people and adults. She is currently directing an ESRC-funded seminar series on emotional well-being and social justice, sponsored by the RSA

1) See Darwin on the couch, by Kathryn Ecclestone, Culture Wars, 2 October 2009

Anderson, S., Brownlie, J.and Given, L. (2009) Therapy culture?: attitudes to emotional support in Britain, in Park, A., Curtice, J., Thomson, K., Phillips, M and Cleary, M. (eds) (2009) British Social Attitudes 25th Report (London, Sage)

Antidote Manifesto: developing an emotionally literate society (London, Antidote, www.antidote.org)

Claxton, G (2002) Building learning power (Bristol, TLO)

DfES (2005) Social, emotional aspects of learning strategy for schools: guidance (London, Department for Education and Schools)

Ecclestone, K. (2009b) A new epistemology of the emotions?: philosophical and political perspectives on the ‘therapeutic subject’ in education, paper presented to the British Educational Research Association Annual Conference, University of Manchester 2nd-5th September 2009

Ecclestone, K and Hayes, D. (2008) The Dangerous Rise of Therapeutic Education (London, Routledge)

Ecclestone, K and Hayes, D. (2009) Changing the subject: educational implications of emotional well-being, Oxford Review of Education, 35, 3, 371-389

Ecclestone, K and Bailey, J (2009) Emotional well-being and interventions in further education colleges: implications for teachers’ roles, Report for the Centre for Excellence in Teacher Training, Oxford Brookes University

Ecclestone, K., Hayes, D., Pupavac, V. And Clack, B. (2008) ESRC-funded seminar series ‘Changing the subject?: emotional well-being and social justice’, Universities of Birmingham, Derby, Nottingham and Oxford Brookes

Field, J. (2009) Well-being and Happiness: thematic paper 4, Inquiry into the Future for Lifelong Learning (Leicester: National Institute of Adult and Continuing Education)

Furedi, F (2004) Therapy culture: creating vulnerability in an uncertain age (London, Routledge)

Furedi, F. (2009) Wasted: why education is not educating (London, Routledge)

Giddens, A (1998) Third Way politics: the renewal of social democracy, Oxford: Blackwell

Huppert, F. (2007) Presentation to the All-Party Group seminar ‘Well-being in the classroom’, Portcullis House, London, 23 October 2007.

Hunt, C. and West, L. (2009), Salvaging the self, Studies in the Education of Adults,.41, 1, 68-82

Lasch, C. (1979 [1991]) The Culture of Narcissism: American life in an age of diminishing expectations, New York: W.W. Norton.

Layard, R. (2005) Happiness: lessons from a new science (London, Allen Lane)

Layard, R. and Dunn, J. (2009) A Good Childhood: Searching for values in a competitive age (Harmondsworth, Penguin Books)

Nolan, J. (I998) The therapeutic state: justifying governance at century’s end (New York, Teachers’ College Press)
Nolan, J. (2008) Legal Accents, Legal Borrowing: the International Problem-Solving Court Movement, Princeton: University of Princeton Press

NEF (2008) A well-being manifesto for a flourishing society (London, NEF)

Rieff, P. (1966 [1987]) The Triumph of the Therapeutic: uses of faith after Freud, Chicago, IL and London: University of Chicago Press.

Seligman, M, Randal, E, Gilham, J, Reivich, K and Linkins, M (2009) Positive education, positive psychology and classroom interventions, Oxford Review of Education, 35, 3, 293 – 313

Social Exclusion Unit (1999) Bridging the gap: new opportunities for 16-19 year olds not in education or training (London, SEU)

Sodha, S and Guglielmi, S (2009) A stitch in time: tackling educational disengagement (London, DEMOS)

Weare, K. (2004) Developing the emotionally literate school (London, Paul Chapman)