Monday, 20 September 2010

No Man Is An Island

Psychotherapy tends to consider itself discrete from the non-psychotherapy world. When we’re being psychotherapists and discussing psychotherapy we don’t also think about the gross domestic product of the country in which we’re working, or labour relations or what’s on television. There’re good reasons for this, not least being absorbed in the relationship between ourselves and our clients and yet we bring all those things – concern about paying bills, images from the news of war and mayhem, conversations about reform of the benefits system – with us into the room and so do our clients. Like our clients,  psychotherapists are individual people living individual lives that overlap into many different areas.

The life experiences of the psychotherapist – who has to fit too much in to the day in order to pick up her children from school (just) in time; who has to walk home at night through a potentially hazardous area; who worries about how to afford the car tax and mortgage repayments – will all inform the ways in which she is with people from different income groups as will the culture of the country in which she is born, raised and works, and lives.

I trained as a psychotherapist in a university where class and income were not covered at all and the make up of the group was such that only two of us from a group of 27 had any experience at all of living on state benefits or in social housing. This is inevitable in a system where training as a counsellor has moved almost entirely into higher education; where higher education is only available as a commodity that must be paid for; where universities are subject to market forces which are determined by the political processes in which we live and which we as individuals vote for.

Orientation

Counsellors are expected to be reflective and reflexive about our work, we’re expected to reconsider our thoughts and feelings about ourselves, our clients and the relationship that develops between us. We’re given a vocabulary and specialized terms in which to frame reflexivity, which is undoubtedly helpful and can also serve, as all specialized language can, to obfuscate true meanings even from ourselves. This is especially likely when thinking about and working with people who are on state benefits.  A search of the literature shows that there is a paucity of research or even commentary on what has become known as The Underclass, itself a derogatory term, rather like calling gay men ‘Confirmed Bachelors,'

The socio-economic boundaries around counselling mean that counsellors are only ever likely to encounter people on benefits as clients rather than as peers which means that teaching about class, where it is rarely attempted, is purely theoretical. Although there are proportionately few non-white counsellors, non-white counsellors exist and can speak directly to the experience. The same can be said for gay, lesbian and transgender counsellors, counsellors who have experienced child abuse, domestic violence or drug and alcohol abuse. Those people who have the experience of long term poverty remain unrepresented and thus unheard.

This blog aims to offer an experience of living in poverty to counselors who have not had that experience. I hope that, if it doesn’t directly alter some of the commonly held opinions about the poor, it will add to the complexity of the so far very limited debate on how best to understand and work with an enduring experience of poverty. I don’t aim to be an apologist for every person who is living in poverty since every individual will have an intricate and complex multifaceted existence. There are, however, important parts of the life of being a person who lives with poverty that have a direct effect on our wellbeing, our view of ourselves, our view of others. Having an insight into some of these aspects will, I hope, offer food for thought.

A Short History of British Poverty

Historically, social responses to poverty tend to fall into two groups:
  • ‘relief’ of beggars and paupers
  • a profound mistrust and fear of the poor.
Queen Elizabeth the First was the first lawmaker to recognise the need for poverty to be addressed by society rather than by individuals. Prior to this, individuals who felt moved to help their neighbors did so but there was no obligation to. The Church, mainly through convents, abbeys and other religious houses, had offered shelter, food and at times work for the destitute but the Reformation broke this chain of support.

In 1563 the first Poor Laws were introduced which recognized for the first time that poor people were part of a community and that the community, in the form of the parish, must help support them. The system was funded by taxation and each parish was required to provide employment.

The poor were categorized into the deserving poor – infants, the very elderly, the very infirm and families who had temporarily fallen on difficult times; the undeserving poor who were considered a threat to society – beggars, travelers, migrant workers; the deserving unemployed – people who were able to work but unable to find employment.

It’s worth noting the political and social circumstances that preceded these laws. More people were simply remaining alive and there was less food. The Enclosures Act devastated the peasant farming tradition as private landowners found it more profitable to have sheep on their land rather than people, or to increase their personal area of farmland and decrease the number of individuals working it. Prior to the Enclosures Act individual family groups grew their own food in what we might call a smallholding, now they were simply turned out of their homes and made vagrant. Those that didn’t die of starvation or illness came to the city. The numbers of the very poor, the very weak, potential carriers of disease and the very angry increased and it was the fear of civil unrest that caused the Poor Laws to come into being rather than any inherent concern for individual welfare.

Laws altered over time, becoming more or less penalizing. Beggars could be whipped and have their earlobes burned through, be imprisoned and executed. They were returned to their own parishes, limiting where they could live. Houses of Correction, established prior to Elizabeth I and continued well after, were variously places where the poor were punished or rehabilitated: whatever the case, poverty is perceived as a fault that requires correction.

Reflections on Economic Theory

Economic theory is intimately bound up in how the poor are perceived and treated. Thomas Malthus published his hugely influential Essay on the Principal of Population in 1798. It went through a number of reprints and revisions but basically suggested that an increase in population must result in an increase in suffering of the poor via a depression in wages and decrease in food production. The book had a direct influence on how government treated the poor: famously, Pitt the Younger withdrew his bill for the extension of Poor Relief, something that Malthus advocated. Malthus was criticized for only applying his principals of reducing birth rates to the poor and, by extension, being uncaring of the poor. He replied:
I have written a chapter expressly on the practical direction of our charity; and in detached passages elsewhere have paid a just tribute to the exalted virtue of benevolence. To those who have read these parts of my work, and have attended to the general tone and spirit of the whole, I willingly appeal, if they are but tolerably candid, against these charges … which intimate that I would root out the virtues of charity and benevolence without regard to the exaltation which they bestow on the moral dignity of our nature…. (p. 607)
Malthus is clear that individual charity is necessary but doesn’t retract his stance that the population of the poor must be checked if the entire population is not to suffer starvation.

Victorian responses to poverty are well recorded by authors like Dickens. Scrooge in A Christmas Carol speaks for the general consensus:
Are there no prisons? And the Union workhouses? Are they still in operation? The Treadmill and the Poor Law are in full vigour, then? I was afraid, that something had occurred to stop them in their useful course. If [their occupants] would rather die they had better do it, and decrease the surplus population.
The pre-Christmas Scrooge pays his taxes which in turn pay for the prisons and workhouses and so he feels that he has done all he should for the poor.

The Industrial Revolution occurred around the same time as a further increase in farm size and a resulting decrease in numbers of farm workers. There were fewer jobs in rural areas but a massive increase in industrial jobs. Housing was at a premium and the simple economics of this situation resulted in huge areas of slums. Factories swallowed men, women and children at subsistence wages and with no employment rights. Abject destitution, starvation and disease flourished.

Adam Smith is best known for his Wealth of Nations, an economic model that has been interpreted in various ways. Before Wealth came a paper on the Theory of Moral Sentiments which seems to go against the popular concept of of Utility (The greatest pleasure for the greatest number) to suggest that
The ability to appreciate other people’s agony is achieved by the same parts of the brain that we use to experience pain for ourselves.
(Chapter 1)
Smith describes empathy in a curious, if unknowing, precognition of modern neuroscience.
He also famously advocates the free market. It’s well worth reading his work and commentaries on it, since his work has been ill-interpreted to suit political agendas. He absolutely does not promote a ravenous form of free market in which the sole aim is for the individual to become as rich as possible as quickly as possible without any concern for the consequences. Smith was deeply concerned with poverty.
. . . poverty, though it does not prevent the generation, is extremely unfavourable to the rearing of children… It is not uncommon… in the Highlands of Scotland for a mother who has borne twenty children not to have two alive… In some places one half the children born die before they are four years of age; in many places before they are seven; and in almost all places before they are nine or ten. This great mortality, however, will every where be found chiefly among the children of the common people, who cannot afford to tend them with the same care as those of better station.
1:8 para 37.
Charity, that is, the sympathetic involvement of the individual who is better off in the lives of the less well off, is a central aspect of his economic theory. Whilst individual charity was a central part of his own life and one that he advocated he also understood that
Man has almost constant occasion for the help of his brethren, and it is in vain for him to expect it from their benevolence only.
part 6, section 2, chap. 3, para. 18
He suggested, therefore, that the nation should also use its wealth to provide public works and in support of vulnerable groups.

It’s natural that when the economy is strong legislation around poverty is less punitive. Ruling groups, whether monarchy or government, have to be seen to be addressing a particular political issue. We see it in our own time, with debates about asylum seekers and an ‘indigenous population’, the rapid increase in numbers of unemployed people and an increasingly fractious debate about people on benefits. In the 1970’s when jobs in industry and manufacturing were decimated it was important for the unemployment figures to be reduced by almost any means necessary and a number of the long-term unemployed were put onto sickness benefit.

Psychotherapy and Money

Psychotherapy began as a private practice and thrives in a free market economy. A good number of psychotherapists treat their practice as a way of making a great deal of money from the unhappy wealthy. Every psychotherapist with a private practice will have come up against the ethical dilemma of wanting to be with the client in a particular way but hesitating because the client is a source of much needed income.

It is a fact that the profession is absolutely dependent on the poor as clients and that the poor are denied the opportunity to join the ranks of the profession. As the professionalisation of counselling becomes the dominant model so courses move from local colleges and into universities. University courses are obliged to become accredited by the British Association of Counselling and Psychotherapy (BACP) so tutor workload increases which in turn means that they can justify higher wages and so the cost of the course increases.

Students are required to gain at least 100 client hours and those hours are gained via counselling agencies that offer a low-fee or free service to clients – that is, those people who cannot afford private counselling. Which in turn means that people on a low income in need of counselling are also most likely to encounter the least experienced counsellors.

Agencies offer some supervision but a majority don’t offer adequate supervision, in some cases requiring that volunteer counselors first prove that they have a private supervisor before they’re allowed to offer their services. In addition, some agencies also require volunteers to show proof of personal insurance cover which costs at least £100. BACP membership at the time of writing is £60 a year for student counselors in receipt of state benefits. Psychotherapy courses start at around £2,000pa and can be as much as £15,000. A single person on Job Seekers Allowance gets around £60 a week.

Once qualified, many counsellors will continue to volunteer in order to gain experience as well as client hours towards BACP accreditation. Some of us will feel a kind of duty to continue offering a service to clients who cannot afford private counselling, and some of us will not. There are counsellors who on qualifying are given a Harley Street practice as a congratulatory gift from a spouse. In therapy today, the magazine for members of the BACP, there is the occasional classified advert for ‘Prosperous Private Practice.’

The Byzantine BACP accreditation process has created a new way of spending and making money: BACP accreditation workshops, paying supervisors or counsellors who are already accredited to help the applicant complete the process; the cost of the BACP administrative process which is at least £90 and which takes around 3 months for them to process, plus £110 more if one mistake is made. The ads at the back of Therapy Today have 2 pages of jobs, some voluntary, and 27 pages of CPD: counsellors making money from each other.

So money is absolutely central to the profession of counselling and psychotherapy and one that remains taboo. As one of the founders of  the BACP noted, it is the elephant in the room. Intimately entwined with this taboo is the way in which counselling perceives and works with ideas of poverty, class, income and what a ‘good life’ might be. This is so taboo that the BACP campaigns manager can write
. . . access to psychological therapy and/or support, with the aim of helping people achieve improved mental health and wellbeing, thus improving their ability to gain and/or maintain employment.
Robinson 2008:5
The above is from Therapy Today and as such represents the BACP’s opinion on the importance of the links between employment to mental health. Importantly, it also places the BACP in political relation to the importance of employment, suggesting that getting people to work is a positive thing for counsellors to work towards with their clients. Interestingly, this conclusion is not the one that the Royal College of Psychiatrists drew from the joint Department for Work and Pensions (DWP) Medical Research Council and Royal College conference.
Work is broader than ‘employment’ and should encompass voluntary work, home making etc. The majority of the research evidence refers to full time work whereas it might be more informative to consider ‘activity’.
Waddel 2007:5
Of course, what a client chooses to do in terms of employment or unemployment is none of the counsellors business, just as what a client chooses to do with an intimate relationship is none of our business. If the purpose of counselling is to allow a person to explore their lives and relationships in order to gain a better understanding and perhaps better mastery of their life then the counsellor must be very clear in their own mind about what their own expectations might be.

This can be difficult when the counselor lives in a society that equates poverty with victimhood at best and more often as badness, a position that isn’t helped when it’s 'common knowledge' that good mental health is helped by being employed and that the reverse is also true, that being unemployed results in poor mental health. When the BACP reinforces this, clients on a low income are doomed to second class work from counsellors.

Context Is Everything

A man is hanging out of the windows of the block across the road, he’s quietly telling a couple of children which door to go to and what to say. One the children, polite, neat and apparently confused, goes up to a door, looks back over his shoulder towards the man and says: “Is this the one?” I don’t hear any answer but the child raises his voice and says: ‘Excuse me. Excuse me. Do you live here?’ to the person going into the block. She doesn’t answer and the children wander off, back towards the other block where the man says: ‘See that car? Yes, that blue one, that’s it. Spit on it. Spit on it.’ The children, confused enough now to feel fear, walk away.

The man continues in his low, not unfriendly tone. ‘I want to fuck you. I want to fuck you. Oh, is that how it is now? Don’t you love me any more? I want to fuck you.’ My neighbours’ adult daughter comes into our block and we say hello. “Do you know that man?” I ask. She doesn’t, but he somehow knows her name and she’s more bemused than aggrieved. She goes inside, I carry on gardening, the man continues his monotone commentary. The children have long gone.

My daughter and I are walking home and we hear a cacophony of bird noises then see a blackbird fly out of a bush. There’s a nest in there with a second brood of fledglings and I take my daughter over to see it, high up above our heads in the municipal bushes. We listen to the young birds then hear an outraged: “Do you mind?” We can’t work out where it’s coming from, and again “Do you mind? I’m trying to go to the toilet.” And there, 4 feet from us squatting behind the large communal bins is a woman with her skirt pulled up around her hips. I am so shocked that I can’t find the urge or the words to reply and just leave, with no sense of threat but with the feeling that I’ve moved into a Kafkaesque world where squatting, shitting women are outraged that I’ve interrupted their public ablutions.

Across the road there’s a camper van, one of the cheaper ones and very old. The locks aren’t any good and a group of 10 year olds has broken into it. They throw everything out of it onto the street, bedding, pots and pans, a television, reams of paper, tea towels, everything. Then they cross the street and begin ripping a young pear tree apart, bending it under their combined weight, screaming loudly and intensely until the tree suddenly snaps and they land heavily. One boy is hurt and they begin to kick him. He has to get up or be beaten, staggers to his feet, laughs, throws a punch which misses and the lot of them move off down the street, leaving the road covered in the strangely unsettling contents of someone’s holiday life and the young tree. A number of us called the police who never arrive.

A family just up the road allowed their two elder children to smoke dope when they were 12 and 14 years old. The parents often went away leaving the three children alone, the youngest being 10, and they would have parties in which alcohol and illegal drugs contributed to the house being trashed, time after time. The 15 year old daughter started a relationship with a 30 year old whom her parents welcomed into the home and he tattooed her at 16 with her parents consent. On a school exchange the elder son made constant Nazi references at the two young German people staying with them which the rest of the family found amusing, and at 15 the youngest daughter put up pictures of herself on Facebook snorting coke.

Dee had what used to be called ‘emotional incontinence'. She felt she must share the most intimate aspects of her life with anyone who’d listen. Her partner who was over a decade older than her and demonstrably didn’t love her; her multiple, dramatic affairs; her children both of whom were taken from family home at the age of 8 to spend the rest of their childhood in special schools; the fact that her younger child has a close resemblance to one of her lovers; her eating disorders and self-harm. She had one job working as a nursery assistant and the rest of her life was spent supported by the State. Dee was killed in a high-speed, late-night, alcohol-fueled crash.

Context is everything. Dee is, of course, Princess Diana who is still treated with the veneration afforded to a saint. The family with dope smoking children live in a detatched home in huge grounds which means that neighbours don’t need to call the police to their rowdy parties and the underage sex and drug abuse is ignored. All of these people and families are worthy of our care and concern, but the woman who, with great dignity, squatted down in the hedge, the man in the council flat, the ‘feral children’ are much more likely to be dealt opprobrium, low-quality interventions and incarceration.
Why is that?

Them And Us

Counsellors function as part of society: as individual practitioners we hold differing political, social and personal opinions, if we didn’t there would be one psychological model and no professional debate. As members of society we are not immune from the concerns, interests and zeitgeist of that society and of course we bring all of that into the counselling room with us which is why counselling trainings are expected to address issues such as racism, sexism, homophobia, and disability awareness. Amidst the many anti-discriminatory trainings, class and income come very low down in training establishment priorities.

And yet counselling as a profession depends on people on low or no incomes. All of the agencies that student counsellors attend to gain experience and hours are attended by low or no income people because of the simple fact that they can’t afford to pay very nearly an entire weeks income for 50 minutes. In effect, low and no income clients service an industry that has demonstrated no real interest in them.

One of the reasons for this lack of interest is that low income people don’t train as counsellors.   All training establishments will all have some kind of equal opportunity statement along the lines of
It is our policy to contribute to equality and social justice by ensuring that all members of staff and applicants for employment shall receive equality of opportunity irrespective of sex, gender (including gender reassignment), sexual orientation, sexuality, race, colour, creed, religion, political beliefs, ethnic or national origin, age, marital status, disability.  [This university] is striving to break down barriers, extend opportunities and improve access to the resources of society.  It aims to reach out to all sections of the community as employees, students, clients, partners and suppliers.
People on low or no incomes are excluded from this statement. If an individual has the qualifications, aptitude and life experience perfectly suited for counselling training but cannot pay for the training she will not be accepted onto the course soley and absolutely on the basis of her income. People of colour, disabled, gay and elderly people do train as counsellors, have brought their experience to the training and challenged negative attitudes: there is no such challenge from poor people.

The experience of being in counselling has been researched over many years. We have some concept of client outcome, drop out and compliance based on statistical evidence and there is some – though very little – academic writing on the experience of the client herself. We all know from our own experience that when faced with people who have power over us we have to behave in a particular way. Incredibly, power dynamics in counselling are very seldom discussed in any detail in training or in academic literature though some counsellors will have some idea that this will be at work in all of our relationships. The experience of low income clients in counselling has been totally unresearched. Yet the low income client must contend with grotesquely unbalanced power dynamics in their everyday lives, simply to live indoors or to feed their children or buy sanitary towels. Behaviours and attitudes will form around this dynamic and these, consciously or unconsciously, will be brought to the counselling relationship.

The poor have always been discriminated against, in every period of history and almost every society. We hate Them. They are not Us. They function as something We can form our own identities around, defining what We are not. Despite being most often cited as a reason to be concerned about the poor, behaviour is certainly less important to society than economic status.