One Hundred Years — And Counting

I’d like to say that it is an essential part of psychotherapy to contribute to making the world a better place.

A few years ago now James Hillman and Michael Ventura published a book called We’ve Had a Hundred Years of Psychotherapy — And the World’s Getting Worse [Amazon-US | Amazon-UK].

It was an attempt to ask whether psychotherapy has achieved what it set out to do: to make the world a better place. I think this is both a fair and important question.

I have a few problems with this question and answering it.

How do we assess the state of the world? The values we use are implicated here. If we value leisure, then many a medieval farmer had more free time than an office worker — how many office workers get to stay home through winter? If we value health, then public health has made huge strides in the last hundred years. If we value happiness, then material abundance (once we are out of poverty) is largely beside the point.

One of the big values: what status does the individual and their happiness have? We can do psychotherapy with individuals living under tyranny. Does it matter what type of government people live under — as far as psychotherapy is concerned?

To put the question of the role of psychotherapy most sharply: does psychotherapy have any business trying to change the world? Perhaps psychotherapy is to help individuals live more enjoyably, whatever shape the world is in.

Hillman and Ventura don’t lay out their case for why psychotherapy should change the world. They largely assume this is the value.

I’d like to say that it is an essential part of psychotherapy to contribute to making the world a better place. In this post I’m going to make an argument for this value — hopefully making a case for what Hillman and Ventura (to me at least) seem to assume.

1. People live in and respond to their situations. Some situations tend to lead to one type of response, other situations lead to a different response. Different situations are conducive to different behaviour.

If I turn up to a building with a high ceiling and poor heating, if I sit on a hard and uncomfortable seat, if I sit through a ceremony largely without meaning to me but which I do because I believe it is right to do so — this will usually lead to particular kinds of experience. Going home from this situation, I find my lover in bed; they invite me to join them. This situation will usually lead to different behaviour.

The way people behave is more or less a response to their environment (I don’t see how it would be possible for their behaviour to have nothing to do with their environment). The distress and pain for which people seek psychotherapy has something to do with their environment and their response to it.

In this way, psychotherapy is concerned with people’s situation (their part of the world) at its very core.

2. Psychotherapy is value laden.

My value is that psychotherapy is to do with awareness — awareness of ourselves, others and the world around us. To my way of thinking, psychotherapy has preferences: psychotherapists want people to have enough to eat and drink, adequate shelter, health care, education, loving touch and so on.

3. Having values can promote freedom.

I don’t think that having values is necessarily impinging on other’s freedom. I think that valuing the nurture of people’s health over random violence promotes freedom.

4. People have important similarities.

People’s physical, psychological (and I would argue spiritual) needs are much the same. Few people live a long and happy life in a war zone. A person (offered a safe alternative) doesn’t choose to stay in a family where physical and sexual abuse is common.

5. That people are similar means that situations often lead to similar responses (point 1 above).

That there are different reactions to some situations doesn’t threaten this proposition. Most people like the smell of fresh bread, but I know one person who hates it. This is a Dutch friend of mine. This is because his mother smuggled fresh bread to people when Holland was occupied. The smell of fresh bread is associated with anxiety for his mother’s life. I don’t think this in any way does away with the similarities that my friend shares with the rest of the human species.

6. Individuals respond to others and their environment. All of us are shaping our world to a greater or lesser extent.

To the extent that psychotherapy changes behaviour (and it would be a pretty useless enterprise if it didn’t), it is involved in, to a greater or lesser extent, changing the world.

7. There is no neat dividing line between helping a person leave an abusive family and establish healthier relationships, helping an individual find a house, and helping an individual found a housing co-op.

A person may find it far more therapeutic to start a housing co-op than many a psychotherapy session.

My argument is that individuals act on and are acted on by their environment. They both receive and shape their context. Psychotherapy does shape the world.

The question then is this: why hasn’t psychotherapy been more effective? My answer:
Psychotherapy has (with some notable exceptions) remained concerned with isolated individuals and not seen it’s task as building coalitions of people to achieve a healthier environment (for themselves and the rest of us).

There are many aspects to this: our individualistic view of the human person, our view of the person as unaffected by their environment, the social organisation of psychotherapy (professionalism), the moral failure of individuals, the need for therapists to make a living, the failure of therapists to use better forms of organisation, the neurotic nature of some therapy…and many other aspects too, no doubt.

I realise that this may be a controversial position. It is very debatable in a number of ways. So let’s have the discussion. Do you think it is the job of psychotherapy to change the world? How would you like the world to change? How do you think psychotherapy should contribute to this change? I’d love to hear your views in the comments.

[Editor’s note: Our review of Colin Feltham’s book What’s the Good of Counselling & Psychotherapy? covers some related work on this topic.]

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