Parker, I. 5 Towards Critical Psychotherapy and Counselling: What Can We Learn from

Critical Psychology a d Political Eco o y ? i D. Loewe thal ed. Critical Psychotherapy,

Psychoanalysis and Counselling: Implications for Practice (pp. 41-52). London: Palgrave

[ISBN: 9781137460561] Link: http://www.palgrave.com/page/detail/critical-psychotherapy-

psychoanalysis-and-counselling-del-loewenthal/?K=9781137460561

3

Towards Critical Psychotherapy and Counselling: What

Can We Learn from Critical Psychology (and Political

Economy)?

Ian Parker

Critical psychology is now a massive expanding field of work that encompasses many

different traditions of research around the world, and it is all the more diverse because it is

tackling a host discipline – psychology – that is a sprawling contradictory mass of approaches

to understanding individuals. We have learnt a lot from critical psychiatry, and many of us

have allied ourselves with the anti-psychiatry and democratic psychiatry movements. We are,

of course, against the medicalisation of distress, and there have been particular lessons from

psychiatry about how not to do clinical psychology – lessons which then impact on how we

think about the place of psychotherapy and counselling (Parker 2011a).

Sometimes we have thought of psychotherapy and counselling as such as part of the

alternative – as an alternative to mainstream psychology because psychotherapy and

counselling value subjectivity and are not intent on the prediction and control of behaviour.

The earlier forms of ‘radical psychology’ that were a precursor to contemporary critical

psychology looked, in particular, to humanistic perspectives on understanding and caring for

others. We are a little more suspicious of those perspectives now, and the scope of critical

psychology today is much broader and perhaps a bit less tolerant of attempts to patch things

up, to make people feel better.

One of the dimensions of debate that structures critical psychology today is precisely

about the possible ‘positive’ role of some form of alternative psychology. So, on the one hand

there are those who would see psychology as such – as so complicit in exploitation and

oppression that our task must always and only be relentless critique. On the other hand there

are those who argue that participatory research, for example, opens up a space for

reconfiguring psychology, and that way of attending to subjectivity and action is crucial if we

really want to bring about social change. I am stretching apart the two poles of the debate to

make clear what the stakes of the argument are. There are many positions somewhere

between the two. One way of opening up the specific question of how the debates in critical

psychology might be useful now for some kind of ‘critical psychotherapy and counselling’ is

to look at four aspects of critical psychology. Let us take them in turn, and think about what

they might mean for therapeutic work.

Four aspects of critical psychology

First, we question the way in which psychologists spend their time studying other people

outside the discipline whom they assume to be ‘non-psychologists’, and we turn the gaze of

the discipline back on psychology itself. We study how psychology has developed and what

psychologists do. This means, of course, that we do not buy in to the assumption that

psychology is neutral about what it studies, and we argue that the observation and

measurement of thinking and behaviour have profound consequences for those who do the

observing and measuring as well as those whom they turn into objects of their research.

There is, at least, a question here for psychotherapists and counsellors about how their

own field of work emerged, and why it is that they feel so strongly about their own specific

identity as a professional. We have seen how important this question is recently with the

development of ‘counselling psychology’ and the way in which claims are staked for

distinctive expertise tied to professional identity. And we know that when moral weight is

given to the position of the therapist it is all too easy for therapy itself to turn into a process of

induction into the notion that the ideal endpoint would be that the client themselves should

become a counsellor or therapist (Rowan and Dryden 1988). That is, there is a reproduction

of a hierarchy of knowledge and insight in which psychotherapy and counselling are higher

up the pyramid, and psychotherapy often likes to think that it is higher up than counselling.

So historical analysis is necessary to dismantle this pyramid of enlightened souls.

Second, we question the attempt to stitch the variety of theories and methodologies in

psychology together in order to arrive at one complete watertight covering explanation for

why people do what they do. We work at the contradictions in psychology to give more space

for resistance to the power of the discipline. This means that we do not buy in to the

assumption that there must be a correct or universal account of psychology, either in any of

the particular approaches or as a combination of them, for elements of psychology to be

useful. Any positive engagement with any aspect of psychology is relativist, opportunistic

and pragmatic.

The question for psychotherapists and counsellors, then, is how their techniques might

be useful in enabling people to have some better understanding of themselves, but in such a

way as to avoid endorsing the complete package of any theory that houses the technique or

the complete package of therapy as a cure-all. There is a general problem in that

psychotherapy and counselling coexist with psychology and psychiatry in a constellation of

theories and practices – which we term the ‘psy complex’ – which prescribe good behaviour,

and even correct thinking and feeling (Ingleby 1985; Rose 1985). A specific problem with

psychotherapeutic practice is that local domains of the psy complex are sometimes governed

by charismatic individuals who then provide moral examples for those whom they treat. So

attention to contradictions is necessary to unravel those particular regimes of truth and power.

Third, we question the expansion and ambitions of psychology as a framework, or set

of frameworks, with a reach and appeal way beyond the colleges and the clinics. We attend to

the increasing psychologisation of contemporary society, and the way in which psychological

models of the person facilitate the globalisation of ways of being and reflecting on ourselves.

This means that we are just as critical of pop-psychology and self-help approaches that

operate as informal and ostensibly homegrown alternatives as we are of the theories and

methods that are peddled by those who are paid to develop and test them out. Any form of

psychology that claims to describe how we develop and learn, for example, tends to end up

proscribing and then pathologising other ways that people do actually think and learn.

Psychotherapists and counsellors will respond to this problem, perhaps, by claiming

that the more intensively reflexive nature of their practice means that they would always

already encourage critique and self-critique. Their understanding of other rival theories and

of their own chosen modality is more sophisticated than that of psychologists and, of course,

psychiatrists. And the therapeutic process, it is true, encourages such reflexive work as

crucial to the cure. The problem, however, is that the appeal to reflexive mindful activity, to

the disentangling of feelings and thoughts from each other and the attempt to find a better

way to live, is exactly how psychologisation works today (De Vos 2012). So a focus on the

way in which useful frameworks congeal into psychologised systems of thought is necessary

to good critical reflexive practice.

Fourth, critical psychologists question the way in which our colleagues construct their

favourite theories, and most of the time they do that by correcting, refining and systematising

what the less canny non-psychologists already think about themselves. Psychology is

grounded in actually existing practices of prediction and control, and it has been so successful

because it formalises everyday ideological explanation and sells it back to our managers and

to us. This means that the issue here is that we are concerned not only with where incorrect

ideas come from but also with where some of the good ideas might be. When we look

critically at mainstream academic and professional psychology we ask ourselves why some of

it seems to make sense, and when we look critically at pop-psychology and alternative

psychology we explore what the appeal of those approaches are, not only how they mislead.

Psychotherapists and counsellors do, of course, build their own sense of what it means

to help someone and what their own ethical investment is in the theoretical frameworks that

they use in their clinical practice. And as they do that they piece together facets of theory and

of everyday understanding. Much more than psychology, and with important lessons for

mainstream psychological research practice here, therapeutic work involves careful listening,

witnessing and honouring of the strategies and hypotheses that people bring to the task of

making sense of their lives. Now the question is how the institutional frame of ‘therapy’

channels that understanding into what the therapist or counsellor will be able to recognise as

useful, and how we might break that frame so that we can appreciate the many different

forms of practice that are just as effectively ‘therapeutic’. So exploring non-therapy could be

a way of deconstructing the frameworks that privilege an apparently real therapy (Parker

1999).

The fantasy that there might be a domain of ‘real therapy’ against which the various

components of the psy complex conspire to inhibit brings us to the even more powerful

fantasy that the state presses down on the potentially free activities of the individual

presupposed in most psychological theory. The aspects of critical psychology that I have

described so far are informed by an analysis of structures of power given by Michel Foucault

and his followers, whence comes the use of the conceptual device the psy complex (Rose

1985). However, there is another conceptual framework that is useful in describing the place

of psychotherapy and counselling in contemporary society and in addressing the vexed

question of their relation to the state. This is the critique of political economy (Marx 1867).

Psychotherapy and the state

There have been interminable analyses of state regulation of psychotherapy in the UK in

recent years. Humanist-inflected objections to regulation have railed against the reduction of

personal and relational phenomena to procedures and outcomes that can be evaluated and

monitored according to positivist criteria (e.g. Mowbray 1995). Psychoanalytic studies have

emphasised the way in which one generalised standard, bureaucratised ethics and a discourse

of the university blot out the particularity of the subject and facilitate adjustment of the

individual to the social (Parker and Revelli 2008). Across the spectrum of debate – humanist

to psychoanalytic – some other arguments have been mobilised to draw attention to

disciplinary mechanisms, surveillance of the apparatus of therapeutic confession and the

malign effects of the psy complex in governing who should speak to whom, where and about

what (House 2002).

I want to take a different tack – one which accompanies these existing critiques but

focuses on the political economy of state regulation. This is designed to take a critical

distance from the historical moment we are living through so that we can perhaps find some

new coordinates to get through this. It draws on some of the analysis developed in ‘critical

psychology’, but by applying it to the particular question of psychotherapy, counselling and

state regulation we can see implications for the way we better grasp the nature of the psy

complex in contemporary political economy. This analysis involves some necessary level of

abstraction to grasp what is happening, so that we are not trapped in the immediately intuitive

nature of the problem, and it combines this abstraction with an account of us inside it as

something contradictory, as something we can change. Even the shift to an analysis of

political economy already pits us against a context in which certain assumptions about the

individual and the social are naturalised, taken for granted, and it pits us against the specific

ideological mutations which reflect, warrant and support life under contemporary neoliberal

capitalism. Those assumptions and mutations provide the conceptual ground for much

psychotherapy and counselling, so it is worth starting by briefly reviewing them now.

The work of individual reflection, clarification and empowerment that most

psychotherapy concerns itself with, as well as being part of the wider project of the Western

Enlightenment, rests upon conceptions of the productive citizen in a free-market economy

that followers of Adam Smith still look to today. For Smith (2008), self-interest gives rise to

the collective good, and both blossom in civil society when left unhindered by the state. The

separation of civil society from the state is therefore a precondition for the self-regulation of

individuals acting in commerce with each other. One can already hear echoes of the

reassurances given by some existing registration bodies to government that statutory self-

regulation is quite sufficient, and that it promises the best measure of good behaviour. This is

not to say that judicial review of the threat of regulation by the Health Professions Council

(HPC) was not tactically the right course of action, but it does mean that this tactic chimes

with calls for the free-market ‘big society’ to be free of ‘red tape’. And the defeat of the HPC

was quickly followed by what is now an attempt to get the registration bodies to regulate

themselves, overseen by the Professional Standards Authority for Health and Social

Care (previously known as the Council for Healthcare Regulatory Excellence). The

issue here is not so much the shuffling around of signifiers of ‘health’ as an ideal against

which psychotherapy should measure itself as the attempt to enrol each collective body as an

obedient and adapted ‘self-regulatory’ mechanism (Reeves and Mollon 2009).

One way beyond this idealisation of civil society and the contradiction between it and

the political state was to try to resolve the contradiction by appealing to broader historically

transcendent agencies. This was the way of Hegel (1991), for whom such agencies eventually

resolved once again into some kind of state apparatus. Another way out of the contradiction

was to understand the ostensibly autonomous operation of civil society as a fictional

arrangement which obscured the conflict between labour and capital, and to work towards the

dialectical resolution of the contradiction and the withering away of the state. Far from being

a realm of harmonious exchange, ‘civil society’ in emerging critique referred to the place in

which ‘the individual’s relation with others are governed by selfish needs and individual

interests’ (Marx 1843: 59). This approach, which is that of Marx, brings us to critique of

political economy of the relationship between the state and civil society under capitalism

(Mandel 1971).

This approach entails not merely the analysis of economic forms – production,

consumption, commodities, exchange value and so forth – but also the political processes in

which they are embedded. Class, which is central to Marx’s analysis, of course, is but one

instance of a social relation that is reified under capitalism such that it becomes a social

position tied to a form of identity, but it is itself a process (Bensaïd 2002). It is a function of

the labour process, a relation to the state which guarantees capital accumulation, and

conditions of life in civil society which include political representation and self-exploration

that occurs in, among other places, the consulting room (Samuels 1993). Civil society,

separated from the state, still shapes the state as a political apparatus, and it calls upon the

state to regulate it, whether that is to ensure the smooth running of the supposedly ‘free’

market or to provide welfare support so that producers and consumers will themselves be free

to participate in it. The state thereby also ‘protects the imaginary universality of particular

interests’ (Marx 1843: 107) as if it were the universal interest.

Political economy of psychotherapy

The political economy of psychotherapy is a necessary starting point for thinking more

generally about the domain of psychological health under capitalism (Singer 2007), and a

critique of that political economy therefore attends to at least the following two aspects of the

practice. First, it attends to the production and circulation of value, and how the

sedimentation of this value in things bought and sold divides exchange value realised in

commodities from another apparently more fundamental use value that seems to be hidden

within those commodities. The labour of the psychotherapist is at issue here, as is the labour

of the patient, as something of value might be produced and circulated as if it were a

commodity and perhaps accumulated as a form of capital. (I will return to this form of capital

later.) The conditions in which the psychotherapist works will determine the production of

‘surplus value’ and the estrangement of the worker from their creative labour. I leave open

the question as to whether the patient is also alienated as a worker producing value for the

moment, partly because the psychotherapist does also assume the function of patient at points

in the history of the practice. It is not immediately clear whether the psychotherapist is

always only a worker or consumer or petit bourgeois with their own particular exploitative

function. This is a question that requires further work.

If the first aspect concerns the specific political economic arrangements of the

individual psychotherapist’s practice, the second aspect of the political economy of

psychotherapy we need to attend to is its societal function. Here we turn to the production

and circulation of abstract value in a society where psychotherapy in its various guises

becomes important, where its place in the process of capital accumulation must come under

the purview of the state. There are a variety of accidental and idiosyncratic reasons why some

legislators are interested in the regulation of psychotherapy, and it is not unimportant to keep

track of them for lobbying purposes, but the question that underpins this second aspect of the

political economy is independent of the intentions of any particular state agent; rather, we

need to ask what is produced and consumed by psychotherapy such that its form of value

becomes included in calculations that pertain to investment and growth.

Historical trajectories: Class and gender

To the first and second questions raised by these two aspects of the political economy of

psychotherapy – the class position of the psychotherapist and what of value is produced by

psychotherapy in society – I will add a third question, which arises from our analysis as a

critique of political economy rather than as a disinterested description; only as something

‘partly as it exists in reality and partly as it exists in its own view of itself’ (Marx 1843: 106).

If the analysis is Marxist, then the question that drives the analysis is what the point of view

of the working class is as an historical agent in relation to these issues. This is, needless to

say, an extremely difficult question, and its complexity flows from the history of modes of

production that coexist under capitalism today and from the transformations that the working

class has undergone with the emergence of contemporary globalised neoliberalism (Went

2000). Let us briefly take each of these historical processes in turn. (The first bears primarily

on the class character of the psychotherapist, and the second more on the societal function of

psychotherapy as such.)

With respect to modes of production and psychotherapy, it is still possible to find

residues of pre-capitalist forms in the networks of privilege and patronage which made it

possible for some members of the aristocracy, the haute bourgeoisie and associated artistic

circles to develop an interest in psychotherapy (Hinshelwood 1995). In some cases, medicine

– specifically psychiatry – was the arena in which a dilettante involvement in psychotherapy

developed. These individuals have always been quite marginal to their class, but those class

networks have facilitated personal contacts between the House of Lords and the Royal

College of Psychiatrists. They become more significant in relation to the mercantile

bourgeoisie, which is more interested in what use psychotherapy might serve, and there is

usually little direct evidence that it is useful at all. Together, they (aristocratic and bourgeois

elements) tended to exclude and disdain working-class involvement in training until the

advent of the NHS, when the provision of psychotherapy opened up access not only to

patients but also to a new layer of professionals (Miller and Rose 1988).

Then we can see the class differentiation of psychotherapy reconfigured to some

extent around professional titles, with British-tradition psychoanalysis tied more closely to

the older patrician psychiatric practice (e.g. around 1,450 registrants with the British

Psychoanalytic Council), psychotherapy opening up a space to the middle class (with about

7,000 registered through the UK Council for Psychotherapy) and counselling drawing in

more lower-middle-class and working-class practitioners (with over 37,000 members of the

British Association for Counselling and Psychotherapy). These are broad-brush

characterisations that do not do justice to the internal contradictions of each distinctive class

involvement in psychotherapy. The impact of immigration from continental Europe with the

rise of fascism is an important factor that complicates the picture, as is the involvement of

women in psychotherapy, and that issue leads us to transformations of the labour force under

capitalism in recent years (Mandel 1974).

The overwhelming majority of psychotherapists in the UK are women, a

preponderance that is mirrored across most countries of the world. The analysis that we need

must therefore be as much feminist as it is Marxist, and so must connect the two traditions of

work while acknowledging the contradictions between them (Arruzza 2013). The proportion

of women practitioners varies across different modalities, with large numbers working in

what is usually perceived as lower-status ‘counselling’. One of the peculiarities of British-

tradition psychoanalysis is also that, apart from its organisations being open fairly on to non-

medics, women have been visible as leaders, which may partly be an effect of prominent

figures who were not medically trained arriving in the 1920s and 1930s as immigrants from

central Europe and gathering other women around them (Frosh 2003). Even so, the overall

pattern of the distribution of gender in psychotherapy organisations has been that while most

practitioners are women, the higher levels of management are populated by disproportionate

numbers of men. There is an issue here to do with the image of psychotherapy as a ‘caring

profession’ (which applies more to counselling and less to some forms of psychoanalysis,

which are then as a result sometimes accused of being more stereotypically masculine), as a

profession that has to some extent operated as a ‘feminised’ domain of work and labour

process.

What is important now for our understanding of psychotherapy is that a certain kind

of labour in the home was carried out by women. When many women in the UK re-entered

the workforce with the rapid expansion of the service sector after the Second World War,

labour in that sector was reconfigured such that women’s work, at one time undervalued

(including in Marxist analysis), now assumed a significant role. The segregation of men

labouring outside the home from women labouring inside it meant that it was women who

then brought to the service sector (and to many organs of the welfare state) what has been

termed ‘emotional labour’, no less creative and alienating when it produces surplus value

than men’s manual labour (Hochschild 1983). The ‘feminisation’ of work, then, does not so

much mean that it is women per se who are the workers – and men have been adept at

developing stereotypically ‘feminine’ skills to keep managerial positions in the caring

professions – but that empathic and interpretative qualities that were historically assigned to

women’s roles become valued as commodities.

It is evidently profitable for an organisation to buy this kind labour power, this labour

as a commodity, and then it makes sense for a state that is sensitised to the importance of this

form of labour to guarantee it as a source of surplus value. Abstract value, which it is the

function of the state in capitalist society to ensure the production and circulation of, now

includes as one component the kind of value that is realised in a constellation of practices that

are concerned with personal growth and wellbeing, and so it includes ‘psychotherapeutic

labour’.

Conclusions

In place of a conspiracy theory of attempts to regulate psychotherapy, political economy

provides us with an analysis of how it is that this regulative process should appear to be a

conspiracy in the first place. On the terrain of economic self-interest that capitalism bases

itself on, and that the capitalist state facilitates, cluster a number of forms of capital. These

include ‘cultural capital’ that those already with sufficient resources can accumulate from

their unpaid labour in psychotherapy services – for example, a form of capital that reaps

dividends when an administrative position is obtained that calls for psychotherapeutic

emotional labour (Bourdieu and Passeron 1977). There is also a distinctive

‘psychotherapeutic capital’ accrued through training and supervision, and then in committee

work that may or may not be part of paid employment, in educational settings that value the

circulation of this kind of knowledge (Parker 2011b).

These political-economic questions are preliminary to an analysis of the relationship

between Marxism and psychotherapy as such (Cohen 1986). What underpins this analysis is

an attention to this work as productive labour that gives rise to value that then operates as a

form of capital. It is at that point that it becomes of interest to the state. Political economy of

psychotherapy that is also a critique of this political economy would attend to the separation

between civil society and the state without romanticising civil society, and thereby imagining

that the state is an unnecessary impediment to good practice. The state already enters into

everyday economic transactions, shaping what we understand as a contract and the value

produced from psychotherapeutic labour. A wish to be rid of the state is a fantasy formation

that functions ideologically, in the service of capital and so eventually in the service of the

state as well.

This is important not only for psychotherapists and counsellors but also for

psychologists and ‘critical psychologists’. Psychology is necessarily entangled with

therapeutic work, with many of the more radical psychologists who express the same hope

that is voiced by most undergraduates beginning a psychology course who want to eventually

be ‘clinical psychologists’ because they want to care for others. The hope is that some good

can come out of psychology, and that psychotherapeutic and counselling practice might show

the way forward. If we are to learn lessons from critical psychology for psychotherapy and

counselling, however, we need also to be critical of psychotherapy, and one way of being

critical that then has implications for the contemporary practice of all of those working in the

psy complex is to look carefully at what the psy complex is part of – that is, capitalism and

the operations of the capitalist state.

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