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134 The Journal of Critical Psychology, Counselling and Psychotherapy

Psychotherapy is Not a ‘Cure’:


the consolations of personal construct
psychology and logotherapy
Kev Harding

SUMMARY: The potential consolations of personal construct psychology and


logotherapy are considered as a contrast to the idea that ‘psychotherapy’ is a
pseudo-medical ‘cure’.

KEY WORDS: Logotherapy, personal construct therapy, cure.

In current times, it is possible in the worlds of psychiatry and clinical psychology to


find ‘evidence’ to support just about any hypothesis that is stated. Pharmaceutical
companies’ literature is awash with pseudo-scientific narratives of how ‘mental
illnesses’ are caused by ‘faulty genes’, ‘imbalanced brain chemicals’ etc. which their
pills will ‘fix’ (Whitaker, 2010). This narrative also includes various explanations
about why taking a particular pill represents the ‘ill’ person’s best chance of
‘managing their condition’ (Lynch, 2015). This is by no means limited to psychiatric
drugs (see Goldacre, 2012) but it is a narrative that isn’t supported by facts despite
years of investigation (see Joseph, 2016, for a comprehensive critique about the
concept of ‘faulty genes’; see Moncrieff, 2008, and Lynch, 2015, for comprehensive
critiques of how pharmaceutical companies claim their drugs ‘work’). Of course
the psychiatric profession has a vested interested in endorsing such literature
(Whitaker, 2010). After all if it was accepted that a person’s distress was not caused
by an ‘illness’ to be remedied with psychiatric medication, then there would be
no particular reason for psychiatry as a ‘profession’ to exist (though it could sit
alongside other pseudo-sciences like astrology).
The conclusions drawn from research conducted by clinical psychologists,
on cognitive behavioural therapy (CBT) in particular, can also be viewed as
pseudoscientific narratives that are short on credible facts (Moloney, 2013; Newnes,

Dr Kev Harding works as a clinical psychologist across the North West of England
© Harding 1471-7646/16/02134-11
June 2016 Kev Harding 135

2014). Such research has underpinned the rise of ‘Improving Access to Psychological
Therapies’ (IAPT), which gives the impression that if people just change how they
view themselves (to be done in a matter of weeks, evenly numbered in multiples of
four i.e., 4, 8, 12, or 16 prescribed sessions of CBT) then their ‘condition’ or ‘illness’
can at least be ‘managed’, and maybe they will even ‘recover’ (whatever that means)
if they follow the script and do their homework diligently. They can then return to
work and stop costing the tax payer money (Layard, 2006). This fits seamlessly with
the UK Government’s rules for anyone unemployed who is claiming benefits, where
they must show evidence that they are looking for work or face the possibility of
sanctions (i.e., losing means to live and survive).
The ‘sanctions’ of psychiatric medication or prescribed CBT (when it doesn’t
‘work’) are likely to be labels of ‘treatment resistant’ or ‘personality disorder’. Both
modern psychiatry and clinical psychology are permeable with the ideas described
above and dominant in Western culture: that each individual has the power to
shape his or her own destiny regardless of circumstances (Moloney, 2013). One
manifestation of such ideas reside in the plethora of books describing how various
‘celebrities’ have ‘overcome the odds’ and made a ‘success’ of their lives (usually in-
between stints in private therapy etc.). The message that if ‘they’ can do it… so can
you!’ implies that a person’s problems are within and can be ‘cured’ by taking the
‘right’ pill, ‘working harder’ in therapy, or a combination of the two. The current
popularity of Westernised Buddhism aka ‘mindfulness’ can also advertently or
inadvertently support such views with its message of focusing on ‘the present’ and
‘letting go’ of such pesky emotions as anger. That’s not to suggest that ‘mindfulness’
(or even tranquillising pills) cannot be helpful for some people at times (especially
in a position of little power to change things), but there are some philosopher’s like
Slavoj ŽiŽek who write persuasively of how such an attitude might facilitate people
becoming more accepting of a neo-liberal status-quo which isn’t in their best
interests, but rather that of multi-national companies instead i.e., are you stressed
through overwork in your job? If so then practice mindfulness, which might
help reduce your anxiety (for a few minutes) by helping you retreat to your inner
world from the harsh real world of job insecurity and overwork. However, this
may deepen a person’s resigned acceptance of the idea that there is no possibility
of meaningful change to the current ‘status quo’ (especially now Trade Unions
seemingly have little or no power to improve ‘work-life balance’ for people). As
ŽiŽek (2009) suggests:

(Westernised Buddhism allows us to) fully participate in the frantic pace of the
capitalist game, while sustaining the perception that you are not really in it,
that you are well aware how worthless the spectacle is – what really matters to
you is the peace of the inner self to which you know you can always withdraw.
136 The Journal of Critical Psychology, Counselling and Psychotherapy

Again, if practicing mindfulness is beneficial to a person in such circumstances


and not promoted as something that promises to ‘transform your life’ and/or ‘cure’
you then that is fine, but if not then as ŽiŽek suggests it can be viewed as like
taking a painkiller but dissociating from what is causing the pain. Maybe a person
wouldn’t have to practice mindfulness specifically for the type of anxieties largely
caused by their job (insecurity) if he or she worked less hours on better pay, which
would of course require a political solution, an in-depth discussion of which is
beyond the scope of this paper.
The late David Smail persuasively wrote about the limitations of any form of
psychotherapy in the context of the realities of political power (Smail, 2005), but
nevertheless he did see a role for psychotherapy in current neo-liberal society. He
pointed out that very few people have an opportunity to spend an hour with someone
who is (hopefully) giving them their full attention and taking their problems
seriously. Smail (2005) spoke about psychotherapy (at its best) being able to provide
‘clarification, comfort, and encouragement’ in a setting that is non-threatening,
which might be the best that can be hoped for if a political solution seems unlikely.
A look back over history suggests this to be a similar theme throughout history. For
example, the ancient philosopher Seneca, wrote of how humans might be compared
to being ‘dogs on leads’ (De Botton, 2001); the idea that each of us has a limited
amount of freedom on a ‘leash’ but will be choked if we go against the grain too
much i.e., like being sacked from a job, or in more extreme cases placed in prison or
sectioned under the Mental Health Act etc. Of course, mortality also gets in the way
of what we might like or at least have the means to do in one lifetime.

Old snake oil in ‘new’ bottles


Given our mortality and extremely limited influence upon the world in
general (voter apathy anyone?) then it seems ludicrous that some (perhaps the
majority of) psychiatrists and psychologists essentially claim that their pills or
psychotherapeutic techniques constitute some kind of ‘cure’ for ‘mental illnesses’
(Whitaker, 2010; Moloney, 2013), as if these ‘illnesses’ or ‘disorders’ are separate
entities from each person’s social world and ‘status’ (or lack of). As Butt (2008)
eloquently states:

The self is an invention, a construction put together by the person in connection


with his social world. We are inseparable from our social world, grounded in it
just as we are in our physical bodies. Our freedom is ‘situated’, limited by our
bodily and social existence, and we have no access to horizons beyond it.

So the idea that psychotherapy ever ‘cures’ people in some sort of pseudo-medical
way (i.e., eight sessions of CBT will ‘cure’ your ‘anxiety disorder’ like antibiotics
June 2016 Kev Harding 137

cure a sore throat) can be dismissed in the same way that Layard (2006) seems
to dismiss the significant methodological flaws of the ‘evidence base’ he lauds
(Moloney, 2013), because such an idea is not something that can ever be objectively
‘proven’, though the psychotherapy professions do try (and fail). For example,
Epstein (2006) thoroughly reviewed what was considered to be ‘credible’ evidence
from ‘credible’ journals and concluded that:

… there has never been a scientifically credible study that attests to the
effectiveness of any form of psychotherapy for any mental or emotional
problem under any condition of treatment.

Furthermore, even when accounting for the flawed methodology of psychotherapy


research, some literature reviews (again from ‘credible’ journals) suggest that ‘non-
specific’ factors such as the personal qualities (or charisma) of the therapist can
account for around 85 per cent of the claimed beneficial effects (see Moloney,
2013), and as Masson (1988) asked: is it plausible that such personal qualities or
charisma can be ‘taught’ in the form of ‘skills and techniques’? There is nothing
scientifically credible in the literature to support such a notion, but there is
support for the idea that just as psychiatric diagnoses are ‘subjective opinions
masquerading as fact’ (Timimi, 2005), the same can be said for the ‘techniques’
of the various psychotherapies. For example, some cognitive-behavioural therapy
(CBT) studies, which in recent times have been promoted as the cure all to ‘get
people back to work’ (Layard, 2006), suggested that when some of the ‘distinctive’
elements of CBT are eschewed, it makes no difference in terms of reported
‘successful outcomes’ (Longmore & Worrell, 2006), thus supporting the view that
if a therapist blames their ‘clients’ e.g., non-completion of ‘thought diaries’ etc. as a
reason why their ‘techniques’ have failed then that can only be their opinion rather
than fact. However, to reiterate, that is not to say that what is called ‘psychotherapy’
cannot be beneficial and even helpful at times (Smail, 2005), in the same way that
a chat with a friend or (in the opinion of the author) reading one of Dr Dorothy
Rowe’s books can be beneficial and helpful.
Throughout history, whether through ancient philosophy or religion to name
just two avenues, some anecdotal and even scientific evidence lends support to the
idea that humans continually strive to make sense of themselves and their world
(see Frith, 2007), and ‘psychotherapy’ might be one way a person obtains the help
to do this if they feel in need of ‘clarity, comfort, and encouragement’ from a neutral
in the guise of a ‘psychotherapist’. As a currently practicing clinical psychologist
in England’s National Health Service (NHS), it seems to me that providing a
place for people to reflect on their lives and circumstances in what is essentially a
philosophical manner can at times be beneficial and provide consolations, if only
138 The Journal of Critical Psychology, Counselling and Psychotherapy

to challenge the tendency for self-blame about problems caused by governments


and politics. If anyone does find such an arrangement beneficial then that’s fine, but
it doesn’t need to be constructed as a pseudo-medical narrative that it constitutes
a ‘cure’ (and stretch credibility somewhat to suggest that it is given the flawed
evidence base, Moloney, 2013).
Two approaches to the practice called psychotherapy which might facilitate
such a limited but potentially beneficial goal, especially in the context of austere
times, are personal construct psychology (PCP) and logotherapy, which have
their roots in philosophical traditions of pragmatism (see Dewey, 1931) and
existentialism (see Sartre, 1997), both schools of which developed in the midst of
great social upheaval in their respective continents (the American civil war and
World War II in Europe respectively, Butt, 2008).

The potential consolations of


philosophically informed psychotherapy
If we accept a description of ‘psychotherapy’ as being a place where a person can
(depending on the service) gain ‘clarity, comfort, and encouragement’ from a
neutral (aka the ‘psychotherapist’), then if ‘psychotherapy’ is de-medicalised (or
de-IAPT’ed!) there may be times and circumstances when it might be a worthwhile
endeavour and even potentially ‘helpful’, depending on what each person defines
as such. George Kelly’s personal construct psychology (PCP) and Viktor Frankl’s
logotherapy are both construed by the author as offering more ‘philosophical
inquiry’ than ‘psychological intervention’. Both approaches were tested under
extremely adverse conditions.
George Kelly worked as a clinical psychologist and had a ‘travelling clinic’
during the time of the Great Depression in America, where he regularly encountered
poverty and starvation (Fransella, 2003). PCP is based on the idea of ‘constructive
alternativism’, which was the term Kelly used for the notion that humans cannot
see reality directly, but rather place their interpretations upon events (like the
ancient philosopher Epictetus had said). Therefore, the consolations of PCP rest
on the idea that there is always the potential for reconstruction of interpretations
and conclusions drawn. Kelly considered all people to be scientists in this regard
– constructing theories based on conclusions drawn from experiences. However,
these conclusions represent our ‘best guesses’ and never ‘the truth’, because ‘the
truth’ can always be reconstrued in the light of new knowledge. However, unlike
the psychiatric profession (and politicians like Margaret Thatcher) Kelly did
not appear to assume that a person’s problems were largely separate from their
circumstances, as he states:
June 2016 Kev Harding 139

To believe that man is the author of his destiny is not to deny that he may be
tragically limited by his circumstances. I saw too many unfortunate youngsters,
some of them literally starving in that depression-ridden dustbowl, for me not
to be aware of their tragic limitations. Clearly there were things they might like
to do that circumstances would not permit… But, nevertheless, there was still
an infinity of possibilities open to them (Kelly, 1955)

So Kelly wasn’t suggesting that his theory of PCP was a prescribed ‘fix’ or ‘cure’
like some CBT practitioners seem to suggest (see Moloney, 2013). Nor did it place
the ‘responsibility’ for a person’s difficulties squarely with the person like IAPT
inspired manualised CBT (Layard, 2006). But Kelly did offer the possibility that a
person could reconstrue their difficulties in ways which might help them to live
their lives better, and so PCP might in a philosophical sense offer some worthy
consolations. Above all, he offered a theory which suggests:

… there are always some alternative constructions available to choose (from)


in dealing with our world. No-one needs to paint themselves into a corner; no-
one needs to be completely hemmed in by circumstances; no-one needs to be
the victim of their biography (Kelly, 1955).

Another approach to psychotherapy which is also firmly rooted in philosophy


is Viktor Frankl’s logotherapy. The ‘logo’ is taken from the Latin word of ‘logos’
which is translated as ‘meaning’, so logotherapy can be construed as a ‘meaning-
centred’ psychotherapy which dovetails nicely with PCP, though it has a particular
focus on the ‘existential’ questions of the ‘whys’ of existence in contrast to PCP
which is essentially an attempt at a grand theory of how humans make sense of
themselves and their world (Fransella, 1995).
Frankl was a Viennese neurologist and psychiatrist who had similarly
concluded that personal meaning and purpose is ‘central to human life’ (Frankl,
1997). He theorised that all humans have what he called a ‘will to meaning’ and
that a frustration of this ‘will to meaning’ can result in feelings of emptiness and
meaninglessness whilst finding expression in ‘overindulgence, boredom, lack
of purpose, and numb despair’ (Lukas, 2000). Logotherapy theory, like PCP,
emphasises the possibility of a more helpful reconstruing of difficulties whilst
acknowledging that:

… human freedom is not freedom from conditions, but rather freedom to take
a stand; to face whatever conditions life presents us with. (Frankl, 1997)

Frankl (1997) acknowledged that meaning in life is variable – from person to


person; and in the individual – from moment to moment, which highlights the
140 The Journal of Critical Psychology, Counselling and Psychotherapy

folly of a ‘one size fits all’ approach to psychotherapy. He proposed ‘three main
ways’ to ‘meaning fulfilment’, firstly by fulfilling creative values i.e., creating a
work or doing a deed; secondly by experiential values i.e., taking in a sunset or
encountering someone; and thirdly by attitudinal values i.e., the attitude a person
takes towards unavoidable suffering. There are obviously numerous examples
that could be conceived for all three values and of course what one person finds
meaningful another person might not. However, Frankl (1997) was keen to point
out that if a person was depressed and felt that life had no meaning for them then
this wasn’t necessarily due to a ‘mental illness’ but rather evidence of the person’s
human dilemma (the idea in this notion that to the best of our knowledge ‘no
animal ever concerns itself with contemplating the meaning of existence in
contrast to mankind’ Frankl, 1986) and need to find a philosophy that is helpful
for them to live by. It is well documented that Viktor Frankl was tragically able
to test out his theories personally, when he was incarcerated in Auschwitz –
Birkenau for close on three years during World War II. His immediate family
were all murdered in the gas chambers. Despite these grimmest of circumstances
Frankl wrote that:

We who lived in concentration camps can remember the men who walked
throughout the huts comforting others, giving away their last piece of bread.
They may have been few in number, but they offer sufficient proof that
everything can be taken away from a man but one thing: the last of the human
freedoms – to choose one’s attitude in any given set of circumstances, to
choose one’s own way (Frankl, 1997).

Like Kelly, Frankl is acknowledging the limitations of changing one’s circumstances


in certain conditions, but retained the hope that approaching such conditions in
certain ways might provide more consolation than some other ways. The question
as to which is the ‘right’ way is never imposed upon an individual, and this is
in contrast to the idea of a psychotherapist judging whether a person’s ideas are
‘rational’ or ‘irrational’. Philosophical approaches like PCP and logotherapy can
instead offer the possibility of reconstruing rather than the demand for reconstruing
based on what the psychotherapist, doctor, or government of the day says a person
‘should’ think. As Frankl said:

Clinical practice is always determined and influenced by the view of the human
being that the clinician brings to the client, even though it may be hardly
conscious and controlled (Frankl, 1986).

For the purposes of this paper, the above quote from Frankl demonstrates the
differences between the idea that ‘mental health problems’ have their roots in ‘faulty
June 2016 Kev Harding 141

genes’ etc. to be somehow (and implausibly) ‘managed’ or ‘cured’ by psychiatric


medication, CBT, or a bit of both, in contrast to the idea that such problems have
their roots in a person’s life experiences, circumstances, societal expectations,
and do not necessarily mean that there is something inherently ‘wrong’ with the
person in distress (Smail, 2005).
The first idea can lead to long term involvement in mental health services, the
person already with little or no power being told the confusing contradiction that
they must ‘take responsibility’ for their ‘illness’ while being told not to trust their
own mind because they’re ‘ill’. If such an idea is accepted then it seems unlikely
that such a person will be able to pursue their interests in life wholeheartedly.
For example, such a person who may wish to become a schoolteacher might
find this an extremely difficult ambition to pursue due partly to their own lack
of confidence but also the unlikeliness of being able to gain a place on teacher
training if they disclosed that they have or have had ‘a mental health problem’,
no matter what the well-meaning but often misguided ‘anti-stigma’ campaigners
might say. The second idea highlights the limitations of psychotherapy
argued within this paper and is consistent with Smail’s assertion that at best
a psychotherapist might offer a person ‘clarity, comfort, and encouragement’
but realistically no more than that. If a person does gain this from ‘therapy’ it
doesn’t mean that there was ever anything intrinsically ‘wrong’ with them before
such an undertaking, nor does the fact that they might feel ‘better’ afterwards
mean they’ve been ‘cured’ in anything other than a metaphorical sense (that is
if a person uses the word ‘cure’ in a non-medicalised sense). As Frankl (1986)
and Kelly (1955) have stated, the attitude and philosophy of the psychotherapist
can very much influence the ‘outcome’ and this might well largely explain the
findings that ‘non-specific’ factors such as the personal qualities (or charisma) of
the therapist can account for around 85 per cent of the claimed beneficial effects
for psychotherapy whichever ‘specialism’ is claimed (see Moloney, 2013).
Of course PCP and logotherapy are not immune to such ‘therapist effects’,
and there is a danger that a psychotherapist could glibly use the example of
Frankl’s experiences to advertently or inadvertently convey a harsh message i.e., ‘if
Frankl can survive Auschwitz… what have you got to complain about?’ etc. Such
an attitude might inspire some people but be potentially destructive for others,
and would also conveniently sidestep Frankl’s view that construing hopefully is
‘necessary but not sufficient on its own’ (Klingberg, 2002), which by the author’s
construing acknowledges that larger distal forces can often overwhelm and derail
the best efforts of each and every one of us.
142 The Journal of Critical Psychology, Counselling and Psychotherapy

Consolations rather than ‘cures’


The author has lost count of the number of people he has worked with over the
years who upon first meeting have already seemingly accepted a medical account
of their difficulties as if such a narrative is a fact. This often leads to the problem
of such people largely construing their difficulties in terms of something being
‘wrong’ with them. If they’ve already tried numerous concoctions of psychiatric
medications or ‘courses’ of ‘psychotherapy’ and they haven’t been ‘cured’ then
this can compound the despair of the person the therapy was meant to ‘cure’. The
construing of psychotherapy as a pseudo-medical ‘cure’ can also be observed in the
number of colleagues who spend years training in different therapies, seemingly
in the hope that if their ‘toolkit’ is big enough then the ‘cure’ will reside somewhere
in one, or a combination of, some of the different approaches to psychotherapy
(perhaps the oft-observed progression from CBT to Cognitive Analytic Therapy
(CAT) to Mindfulness training could become part of clinical training for
psychologists?) However, if the practice of psychotherapy is construed in terms
of an undertaking which might provide the consolations of ‘clarity, comfort, and
encouragement’ (Smail, 2005) rather than as a pseudo-medical ‘cure’ then it might
sometimes be beneficial for a person if only for the fact that one human can help
another at times.
It seems highly unlikely that psychotherapy will ever be construed in the way
Smail recommended, especially in current times due to the government’s NHS
business model and private sector insurance companys demand for ‘payment by
results’ and ‘cost-effectiveness’. Furthermore, IAPT seems to be funded on the
notion that it will ‘pay for itself ’ when the benefit bill is reduced by people returning
to work (Layard, 2006). From this view it seems that if you’re not ‘resilient’ enough
to ‘get over it’ and ‘learn new skills’ then tough… too bad you have a ‘personality
disorder’. However, a look at Sweden’s similar IAPT-type experiment, which took
place over a decade, ended in dismal failure (Miller, 2012), and there’s no reason
to expect a different outcome in the UK as long as the ‘professions’ of psychiatry,
clinical psychology, and politicians continue to separate the individual from their
social circumstances in terms of ‘mental health’.
To summarise, the consolations of philosophically informed approaches like
PCP and logotherapy might provide a structure for a person to critically question
the idea that ‘mental health problems’ are some sort of personal defect/failure rather
than the manifestation of distress caused and maintained by numerous factors
way beyond our control i.e., the 2008 financial crash… if you lose your business
due to the profound stupidity of bankers is it really a personal failure or just bad
luck that a lack of governmental regulation allowed such folly? (Lewis, 2015).
If a person blaming themselves in such an example decided to reconstrue from
being a ‘failure’ to being ‘unlucky’ then they might still be in financial difficulties,
June 2016 Kev Harding 143

but they may also decide that life is still worth living rather than contemplating
suicide. This might be construed as psychotherapy providing consolations but it
doesn’t constitute a ‘cure’ because the person wasn’t ‘defective’ to begin with. Such
limited consolations seem no different to those offered by ancient philosophers
like Seneca over 2000 years ago (De Botton, 2001). So much for the ‘up to date’
(pseudo) scientific assertions of IAPT inspired CBT…

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