Choice and Justice

The recent Government's plan to locate psychological therapists inside Job Centres has stirred up controversy, particularly amongst mental health workers.

​My own professional body, the BACP, has made a strongly worded statement against this move. The BACP's stance is about choice, which is fundamental to counselling. 

The BACP draws on justice as its theme, which is one of the 6 key ethical principles in their ethical framework. Likewise, for Felicty Callard, Director of Hubbub, and Robert Stearn, their article in The Conversation is also strongly driven by the principle of justice,
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"Psychological explanations for unemployment – the failings of the maladjusted jobseeker – isolate, blame, and stigmatise unemployed people.They reinforce myths about “cultures of worklessness”; they obscure the realities of the UK labour market and the political choices that underpin it."

They argue that unemployment is being re-labelled as a mental health condition, whose cause is not lack of jobs, but a lack of a positive enough outlook, which is to be corrected by psychological treatment, under the threat of sanction.

Counselling on the other hand strives to understand the person from their own 'internal frame of reference'.  The counsellor's question, "How do you feel?" is an enguiry about this internal world. Counsellors do not meet 'depressed' people, rather they meet people whose lived experience is one of depression. 

On the other side of the coin, being unemployed, particularly for a long time, causes distress and psychological harm. So there is an argument that it is right and proper that people have access to help, and the best place to locate that help is where unemployed people are, i.e. Job Centres.

However, this argument ignores the reality of the regimes in many Job Centres up and down the country. People often experience them as punitive and coercive, and one of the possible concerns is that this feeling of coercion and punishment would rub off onto any counselling service associated with it.

It is likely a counselling service would find itself in the same position as the mental health workers in the Guardian article above, in trying to resist those coercive and punitive aspects. The BACP's insistance that therapy "must remain a choice which is freely entered into" can also be seen as an act of resistance - by asserting counselling values around choice as a 'must'.

In my own practice, choice is often a central theme. When I was working in a school, the young person who nervously knocked on my door would sometimes start with "I'm here, because my teacher thinks I should talk to you," to which my first question would be something like, "And what about you, do want to talk to me?"

There is a practical point, in that for counselling to work the person has to want to be there; they have to want things to be different; and they have to want to change. And in my experience, coercion leads to poor outcomes.

However, the issue of choice is more fundamental than does it work or not; choosing is at the very heart of therapy.  The moment a person says to themselves "I need to talk to someone;" starts searching through the internet; finds someone they think they can talk to; and picks up the phone and says, "I've been looking at your website;" therapy has already started. 

Choosing not to come is as much part of therapy as the moment of choosing to come. When someone sits in front of me and says, "You know, I think I would like to try leaving it a week, and see how I get on." is not a rejection of therapy, it's a key and essential part. Konwing you don't need therapy is as vital as knowing that you do.

Main picture by succo