Enforced therapy - part of the problem NOT part of the solution

I did something today that I have never done before – I went on a demonstration.  Since becoming a psychotherapist I seem to have found more of a political ideology, so when I heard about a protest against the DWP rolling out its scheme to integrate mental health therapy services within Job Centres, including that psychological support might be enforced for those unemployed people deemed to have mental health problems, and that they were piloting it on my doorstep, I felt compelled to attend.  

You might ask is why I feel so strongly about this issue, especially since many people might find that a dollop of psychological support would help them manage the emotional impact of struggling to find work in this current economic climate.  So let me get one thing straight – it’s not that I am against psychological support for people in need, far from it. But what really gets my goat is the possibility that it will be an enforced part of a person’s benefit assessment process, and that those who deign to say no to this ‘treatment’ might run the risk of having their benefits cut. The Guardian today (26/6/15) reported that the DWP do not want to do this, but there is still a high level of concern that this is exactly what will happen.  Most, if not all of the psychology, counselling and psychotherapy bodies have published statements expressing concern about this (see UKCP, BACP, BPS, BABCP and BPC), as have service user groups, but I want to share some of my personal thoughts on this important issue.

When I was at the demonstration, people had strong feelings towards those who work offering psychological treatment within this Job Centre.  I can empathise with the viewpoint of my fellow demonstrators, but I can't help but wonder whether these Job Centre staff members really understand what they have signed up to do.  If I hadn't learnt about the impact of trauma as part of my own psychotherapy training, I doubt I would have as clear a sense of how misinformed the idea is either.

Many of my clients have experienced severe trauma in their past – domestic violence, rape or sexual abuse, severe physical punishment in their childhoods, being sent to boarding school at a very young age, war, terrorism, racism, homophobia, bullying, witnessed horrific scenes of violence or trauma, perhaps having to leave their native country because of it, to name but a few examples.  Many of my clients also fit the criteria of the people the Job Centre scheme is designed to work with – people who have not worked for a considerable amount of time, often due in part to their mental health problems. I would wonder if there is no coincidence here, since I believe that people struggling to get to a physical or psychological place where they can look for work often live under the shadow of past or present trauma.

In her seminal book ‘Trauma and Recovery’ Judith Herman states that “no intervention that takes power away from the survivor can possibly foster her recovery” (p. 133).  And this is exactly what the DWP will be doing if they decide to force people to have CBT (or indeed any psychological treatment) in order to be eligible for the benefits they absolutely rely on to survive. They will be taking power away from them on every level.

And I have a further concern – that forcing a person into therapy, even a short number of sessions of CBT, will do harm in the future too.  If, at some point, that person decides to seek counselling or psychotherapy, but their experience of enforced therapy was unhelpful, they will be likely to have a lot of misgivings about re-entering therapy of any form, fearing perhaps that all counselling/therapy works like that.  That person will possibly feel that it was their fault this initial therapeutic help didn’t work, rather than it being a fault of the system.  And that's perhaps because feeling responsible is something people who have lived through trauma tend to do, as it is a way to feel some level of control about something that has felt utterly out of control.

Forcing people into therapy, no matter how well-meaninged this might be, doesn’t work. And it might just cause real harm. 

Reference: Herman, J.L. (1992). Trauma and Recovery: From Domestic Abuse to Political Terror. USA: Pandora books