A central role of the clinical psychologist is to deliver (or supervise the delivery of) psychological therapy. A societies dominant higher macro-level political and cultural ideas or beliefs about how society should be structured influence and shape societal practices at lower micro levels, such as the development of local services (e.g. policies, structures of schools, health services etc), provisions for communities (e.g. recreational spaces, leisure centers) and the beliefs, behaviours and interactions of individuals & families (see figure 1.1). Thus the operations of a societies higher level macro socio-political systems filter down through social structures (e.g. through schools, local services, environment, health service, economic practices), affecting the individual health and wellbeing of residing citizens.
Figure 1.1. Macro-Micro Ecological Levels
Western societies largely draw from ideas of capitalism and individualism. Therefore it follows that individualistic models of therapy are the current dominant approaches taught in psychological training programmes, with CBT being the main model drawn upon by many psychological therapists in the NHS. Such therapies can be life saving to many recipients; when used ethically and contextually their value should not be understated. A commonality across individualistic therapy models is their focus on understanding and changing the distressed persons inner world (i.e. thoughts, feelings, physiology) through awareness raising, restructuring or changing their relationship to this content. Whilst external relationships are explored, these seldom go beyond the family unit and often neglect the wider macro ecological levels that influence our lives. Through adopting such an approach individualistic therapy models can implicitly locate social causes of distress and ill health in the individual person, absolving wider social influences of responsibility and inadvertently supporting the maintenance of harmful social practices.
Individualistic models of therapy can inadvertently locate the causes of distress in the person, detracting from and maintaining wider harmful social practices
Therefore when employed as a universal panacea to treat distress and ill health, individualistic models of therapy can at best be a temporary solution and at worst a harmful and unethical practice. Through the sole adoption of such models, psychological services, most often unintentionally and unknowingly, can become complicit in maintaining harmful and oppressive social structures, systems and practices through neglecting these wider factors in their individualistic approach to assessment, formulation and intervention. Further, the sole adoption of such models in services is an example of systemic racism, denying the needs of those from non-western, non-individualistic cultures and ethnic groups.
To neglect non-western cultural norms, beliefs and practices regarding distress and health within service provision is an institutionally racist practice
Ethical psychological practice should always seek to contextualize a persons experiences, understanding such experiences within their cultural heritage and social, political, economic and material circumstances. Assessment and formulation of these factors would undoubtedly lead to a radical shift in the intervention approach adopted. For example a reduction in staffing levels within NHS services as a consequence of austerity measures imposed by the government can have a significant impact of staff wellbeing, heightening stress and anxiety responses. Under current service provisions such reactions would be ‘diagnosed’ as an anxiety disorder and medication and / or psychological therapy would offered as treatment. However a more ethical stance would be to address the government enforced austerity measures through challenging dominant political rhetorics, using ones electoral vote and campaigning, advocating and lobbying for fairer working conditions.
Causes of distress identified to be located outside of the person can indicate that intervention should take place beyond the therapy room. Many ways of working as a clinical psychologist are already instrumental in addressing wider societal factors. CBT can be an empowering tool when these wider factors are incorporated into the formulation, aiding the identification of proactive actions a person can take to tackle harmful social practices and signposting to relevant advocacy groups or sources of support. Systemic therapies offer space to think about the dominant stories operating in our lives and to become aware of and question our taken-for-granted realities, creating opportunities to transform such stories to for the better.
Therapy beyond the therapy room
Working as a scholar-activist the psychologist can critically draw upon the available evidence-base to inform the development of social policy. This may involve working closely with political groups, health and wellbeing boards, clinical commissioning groups and service managers for example to promote just, equal and fair psychologically-informed policy that promotes physical and mental health for all. This may also involve lobbying, activism and protesting unjust policies and practices. Further this could involve working with under-represented communities to develop an understanding of their beliefs and practices regarding health and wellbeing and using these understandings to empower such communities to meet such needs where evidence is lacking or reflects western and individualistic biases.
Coproduction with communities can help to develop services that meet the needs of underrepresented groups
Many mental and physical health services are evolving to offer a more holistic approach to treating distress and ill health. It is my hope that services continue to evolve, creating contextualised psychology services where psychological therapists are able to intervene at all ecological levels, from micro to macro. To fully address the distress and ill health present in our society we need to pay attention to the socio-political circumstances surrounding us and those we work with, ensuring that individual therapy is not the only tool in our intervention tool belt, and that it is only offered when it is ethical to do so.
#Thepsychologicalispolitical #communitypsychology #clinicalcommunitypsychology #socialjustice #ecologicalpsychology
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