therapy - ReviseSociology

Does Therapy Work?

Increasing numbers of people in the United Kingdom are turning to therapy to help improve their mental health, but does therapy actually work?

This topic was explored in a recent podcast with Journalist Horatio Clare and Psychiatrist Femi Oyebode.

The focus was mainly on the use of psychotherapy to combat more serious mental health issues such as schizophrenia, bipolar disorder and post traumatic stress disorders, and the overwhelming consensus was that therapy can help and the podcast explores why, as well as what makes for effective therapy.

What is psychotherapy?

Psychotherapy is the use of words as a means of treating another human being

Both psychiatrists and psychotherapists use talking therapy as part of their work, but a psychiatrist is someone who has had medical training, so is qualified to prescribe drug treatments to patients, whereas a psychotherapist doesn’t have prior medical training and so is limited to only do talking therapy with clients.

On misconception about the difference between the two is that psychotherapy focus on dealing with the causes of mental illness whereas psychoanalysis only deals with the symptoms, there is in fact more blurring between the two disciplines.

Types of psychotherapy

The British Council of Counselling and Psychotherapy lists over 30 types of therapy. Three of the main types of psychotherapy are:

Psychoanalysis, developed by Freud, is built on the theory that experiences in early childhood have a deep impact on the formation of adult personalities. Dynamic psychotherapy is a modern version of this.
Behavioural Therapy believes that patterns of behaviour such as OCD or anxiety arise because of conditioned behaviour, abnormalities of learning which developed either in childhood or adulthood.

Cognitive Behavioural Therapy, invented by Aaron Beck was a further development of behavioural therapy theorises that our emotions are dependent on our thinking, so the intent is to alter our thinking so our emotional state changes.

Psychotherapy to treat Schizophrenia

The podcast introduces as a case study one individual who used a combination of medication and talking therapy to ease his symptoms of schizophrenia.

His symptoms were serious, including hearing voices, delusions (having the wrong perception of reality), depression and paranoia which in turn created a number of severe negative emotions such as frustration, hopelessness, disappointment and an overwhelming lack of self-worth, or very low self-esteem.

Talking therapy helped him because his schizophrenia meant he only listened to himself, only heard from himself, having other people’s opinions helped him see from another perspective.

An example of how this can help is if you imagine walking into a room of people who are talking but stop when you enter, you might think ‘they must have been talking about me’ but a different perspective is that maybe they were just talking about something private and confidential.

Cognitive Behavioural Therapy can help calm the symptoms of schizophrenia in two ways.

Firstly it can help reduce hallucinations and delusions that may not have responded to drug treatment
Secondly it can help a patient deal with the low self-esteem and worthlessness that it causes.

It was suggested to him that family therapy may help, since in psychoanalytic theory childhood experiences may have contributed to his schizophrenia, but his parents refused to take part.

The concept of over-resilience was used to to describe his family’s reluctance to take up family therapy: his parents thought the family was fine as an emotional unit and had no need of therapeutic input.

Over-resilience is very common in ethnic minority families and it builds up over generations. Fathers especially want to be the family rock and so don’t want their partners or children to see them crying or stressed, and so children grow up thinking they also need to hide and not talk about negative emotional states, vulnerabilities and weaknesses.

However for some people this builds up and leads to a mental health crisis, or a breakdown as it did with the case study here.

Psychotherapy and bipolar

One guest, Katie Mason, argued that therapy can also help treat bipolar disorder.

In such cases it can help prevent relapse, addresses symptoms that occur in depression and reduce guilt and shame after someone has had a manic episode. It can also help people accept their condition, which can prevent relapse as they recognise when they are getting unwell again and get early intervention.

Eye Movement Desensitisation and Reprocessing

Another guest, Dr Logi, outlined how a relatively new type of therapy called eye movement desensitisation reprocessing can help patients process previous traumatic events and thus help with Post Traumatic Stress Disorder.

The process is roughly as follows:

The patient thinks about a key even that is causing them to have negative feeling and events, for example a road traffic accident.
They identify what emotions these memories trigger and where in the body they are located.

Then they do something which encourages rapid eye movement while the patient thinks about those memories and feelings.

The theory is that rapid eye movements distract the clients, keeping them in the here and now while they are revisiting the past, thus enabling them to process negative emotional states caused by past events more easily.

EMDR also works with people with depression, phobias and OCD.

Effective Psychotherapy

The most effective thing about therapy is the relationship with the therapist, they work as well as each other!

A good psychotherapist needs to have cultural competence: they need to recognise that their own cultural context and narrative is not superior to that of the patient.

There are some people who believe that a psychotherapist needs to come from the same cultural background to be effective, arguing that positive results are more likely if a therapist is from the same ethnic group as the patient, but Oyebode doesn’t subscribe to this theory.

The most important qualities of a good series of psychotherapy sessions are that they are well structured and allow time for the patient to focus on themselves.

The system also needs broader structures in place to ensure that patients who need medication can find that kind of support which psychiatry doesn’t offer.

Psychiatrists need more time to spend with their patients so they can can tailor therapy more effectively. They are pushed to medicated while therapy is more of a longer game – there are times when it’s more appropriate than others.

There is very little availability of therapy in in-patient services. The average in patient stay in the U.K. is 21 to 28 days and it is not possible to do effective psychotherapy with the patient in an extremely disturbed state and in such a short period of time.

Signposting and Sources

While this material isn’t directly relevant to any of the standard A-level sociology modules I thought it was of sufficient interest given the amount of young people with poor mental health and the fact that therapy is becoming increasingly normal!

Radio 4 (February 2023) Is Psychiatry Working?: Episode 5: Therapy.

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Giddens – The Trajectory of the Self

A Summary of chapter three of Anthony Giddens’ Modernity and Self-Identity

Self-identity, history, modernity

Drawing on a therapeutic text – ‘Self-Therapy’ by Janette Rainwater – Giddens selects ten features which are distinctive about the search for self-identity in the late modern age:

The self is seen as a reflexive project for which the indivdual is responsible. Self-understanding is relegated to the more inclusive and fundamental aim of rebuilding a more rewarding sense of identity
The self forms a trajectory of development from the the past to the anticipated future. The lifespan rather than external events is in the foreground, the later are cast as either fortuitous or throwing up barriers which need to be overcome.
Reflexivity becomes continuous – the individual continuously asks the question ‘what am I doing in this moment, and what can I do to change?’ In this, reflexivity belongs to the reflexive historicity of modernity.

The narrative of the self is made explicit – in the keeping of an autobiography – which requires continual creative input.
Self-actualisation implies the control of time – essentially, the establishing of zones of time which have only remote connections with external temporal orders. Holding a dialogue with time is the very basis of self-realisation, and using the ever-present moment to direct one’s future life course is essential.
The reflexivity of the self extends to the body. Awareness of the body is central to the grasping of the moment. The point here is to establish a differentiated self, not to disolve the ego.

Self-actualisation is understood as a balance between opportunity and risk. The individual has to be prepared to take on greater levels of risk than is normal – to change is to risk things getting worse
The moral thread of self-atualisation is one of authenticity… Personal growth depends on conquering emotional blocks and tensions that prevent us from understanding ourself – recover or repeat old habits is the mantra
The life course is seen as a series of ‘passages’. All such transitions involve losss.

The line of development of the self is internally referential – it is the creation of a personal belief system by which someone changes – one’s first loyalty is to oneself.

The next question Giddens asks is how can we connect up these ten features of self-identity to the institutional transformations characteristic of the late-modern world? (Well, he is a sociologist, after all!)

Lifestyle and Life Plans

Therapy is a response to the backdrop to the existential terrain of late modern life which consists of the following features:

it is reflexively organised
it is permeated by abstract systems

the reordering of time and space has realigned the global and the local.

All of this has resulted in the primacy of lifestyle – A lifestyle may be defined as a more or less integrated set of practices which an individual embraces because they give material form to a particular narrative of self-identity. A lifestyle implies a plurality of choices – it is something which is adopted rather than handed down (and should not merely be conflated with consumerism in this instance).

(NB Giddens also says that we do not all have complete freedom of choice over our lifestyles – we are restricted by work, and by class etc… and moreover, the lifestyle pattern we choose limits what we can do if we wish to maintain an authentic narrative of the self.) (NBB – If you’re an A level sociology student, a recent podcast by the AQA criticises Giddens for not saying what I’ve he’s just said in this book that he wrote, thus that particular podcast is wrong.)

The plurality of choices which confronts the individual in this derives from several influences:

We live in a post-traditional order, the signposts offered by tradition are now blank.
We have a pluralisation of lifeworlds – the millieu to which we are exposed are much more diverse.

Experts do not agree, so there is no longer a certain source of knowledge.
The prevalance of mediated experiences – the collage effect of the media – we have new communities and shed loads of new possibilities

Life planning becomes essential in the above social context – life planning is an attempt to ‘colonise the future’ under conditions of social uncertainty – teenagers who ‘drift around’ today are increasingly going against the norm!

Two things in particular change in this context – (1) The Pure Relationship comes to be crucial to the reflexive project of the self and (2) the body becomes subject of ever greater levels of personal control – both become attempts by the individual to sustain a ‘narrative of the self‘.

Giddens’ Modernity and Self Identity – in 14 bullet points

A brief post covering the relationship between self and society in late-modernity according to Anthony Giddens, covering concepts such as Globalisation, abstract systems, ontological security, manufactured risks, narcissism and fundamentalism.

This is very much my own reading of Giddens’ text – Modernity and Self-Identity: Self and Society in the Late Modern Age.

Gidden’s Key Ideas about Self and Society in the Late Modern Age (Taken from Modernity and Self Identity – And Against Post Modernism)

There is a global structure – e.g. it’s Capitalist and Nation States remain powerful, but it’s dynamic, constantly changing, and not predictable.

Institutions (political and economic) are ‘reflexive’ – they try to ‘steer’ events in the future in the light of existing and continually updating (imperfect) knowledge.
There are significant global problems (manufactured risks) which we all face and none of us can escape – e.g. Global Warming. These are real, objectively existing problems, not hyperreal, and they bind us together, even if many of us fail to accept this.
The increased pace of change and Uncertainty are a fundamental part of late-modernity.

Globalisation penetrates our lifeworlds through abstract Systems (money, clock time, expert systems, especially science).
The media is more important and influential in late-modern society, but Giddens rejects the concept of hyperreality – the main significance of the media is that it makes us more aware of diversity and of the fact that there are many different ways of living.
In Late Modern (not Post-modern) Society, there is what Giddens calls a ‘duality of structure’ – social structures both empower us and constrain us (differentially, and broadly along the lines of class, gender and ethnicity, although not perfectly) – people are not just ‘free’ to do whatever they want – their freedom comes from existing structures – think of your typicaly fashion blogger on YouTube for example – you may think of them as ‘free’, but they are fundamentally dependent on global capitalism, a monetary system, and the infrastructure of media technology.

In terms of the self – Identity is no longer a given – we no longer have a pre-existing identity based on our gender, class, family or locality, everything is open to questionand we are forced to contunally look at ourselves and continuously ask the question ‘who am I’ – identity becomes a task, something we must do for ourselves, and nearly every aspect of our lives becomes something we need to reflect on as a result.
It is for this reason that we become concerned with constructing a ‘Narrative of Self’ – A coherent life story, so that we can convince ourselves that we have a stable identity through time. Constructing a self-identity takes a lot of time and effort.
Therapy emerges as a new expert system to help people in the process of continual identity reconstruction – especially useful at epochal moments like divorce.

The construction and expression of the self becomes the new norm – there are many ways we can do this – mainly through consumption (buying and doing stuff), through relationships, and through developing bodily regimes (health regimes).
An unfortunate consequence of this focus on the self is the rise of Narcissism, with very few people asking moral and existential questions about existence.
However, this process is dialectical and New Social Movements (e.g. the Green Movement) which do consider moral and existential issues – in which people attempt to incorporate moral and existential questions into the construction of their ‘political’ identities.

Late Modernity produces various ‘Generic’ Types of Identity – The Narcissist, the Fundamentalist, both are extreme expressions of the same social system.