After reading Terry Birchmore’s letter (July 2018) in reply to the question presented by Hugo Maximillian Metcalfe (April 2018) ‘Why do we think that the standard arrangement of the individual therapy room is recommended?’, I began questioning the standardisation of other areas in therapy.
Birchmore offered an important and valid counter-argument that standard practices maintain a controlled environment to portray the boundaries necessary for an effective professional relationship between client and therapist. However, I feel Hugo is right in questioning this conforming practice and argue therapy is fast becoming prescriptive.
A while back, I was involved in an inter-professional event with individuals from a variety of different health-related disciplines. The medical students of the group discussed their understanding of psychological interventions as ‘talking therapy’ and applied very little detail to the possible outcomes of therapy to mental health. I found the phrase ‘talking therapy’ was used to describe all psychological interventions. I couldn’t help but feel a more dominant and powerful perspective of mental health was pushing psychological therapy into a small box with rules and structures it must follow.
Whilst it is agreed structure provides a coherent systematic approach to treating mental health, there are two problems that are overlooked. First, we need to understand there are various forms of therapy. The aim of therapy is to provide clients with the necessary skills to explore and tackle their difficulties in a safe environment. Not everyone experiencing difficulty discuss their problems and may in fact turn to other therapeutic activities as coping mechanisms, such as gardening, introspection, shopping, and so on. Therapeutic activities such as these have been shown to have less stigma attached to them (Baptista & Zanon, 2017). Yet, the system that psychological therapy has fallen into would classify these activities as ‘bottling up’. We live in a culture that forces people to express their difficulties but then stigmatises them when they do. I feel it is vital therapy does not encourage this culture.
Second, these other activities are often not recognised as effective in their own right. Matt Haig discussed in his new book Notes on a Nervous Planet [see August issue] the importance of staying connected to life. Activities that connect an individual to their environment are lost in the need to only employ evidence-based therapy. This also hinders a person-centred approach and instead adopts ‘fit-for-all’, a criticism usually applied to medical perspectives. For instance, cognitive-behavioural therapy (CBT) is a dominant approach, a go-to for many therapists in IAPT and as advised by NICE guidelines. Whilst there is a degree of flexibility in CBT, therapists are still maintaining a doctrine of a dominant approach.
We may not diagnose in therapy but standardising practice to a specific approach maintains a similar effect of medicalisation, which loses the person-centred focus in interventions. I argue other therapeutic activities should be given recognition inter-professionally as this ensures a person-centred approach to therapy is not lost in the need to provide a ‘talking cure’.
Jasmin Kaur Gill
De Montfort University
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