The Politics of Therapy

Currently I am reading Bruce Wampold’s analysis of psychotherapy, “The Great Psychotherapy Debate.” Like other comparative books and meta-analyses, it categorizes therapies into two types: In this case, those following the medical model and those following the contextual model. There are many ways of categorizing therapies, and they are mostly useful in helping people understand what is meant by psychotherapy and how to figure out which type of psychotherapy to pursue. For example, therapies can also be categorized as depth and nondepth. Depth psychotherapies accept and incorporate the idea of an unconscious, and nondepth therapies operate on the level of introspectable (conscious or potentially conscious) thought and feelings.

There is a significant difference in therapies that are organized around concrete, measurable factors (factors meaning problems, outcomes, methods) and those that are based in an assumption of complexity and context. While the former lend themselves to measurements and numbers, the latter types of psychotherapy are more difficult to explain and measure. This ends up making contextual psychotherapies sound like magical thinking, fuzzy rationale, or new age hokum.

These differences are not only relevant to the personal level of psychotherapy but extend to the political. If we cannot explain what we do and show its efficacy, we cannot advocate for clients to receive subsidies for the help they need. In the end, we are able to provide contextual, depth, long-term therapy to those who can afford it, and we can only provide it to other clients if we subsidize it ourselves. We can do this to some extent, but we are limited in our resources. Yet the people who can least afford long-term psychotherapy also recognize its value and effectiveness and are motivated to find ways to pursue it.

The problem of funding for health care extends beyond psychotherapy, of course, but remains a central issue for us as psychotherapists. Not only are we affected by the generalized state of health care distribution, we are also affected by the fundamental differences between mental health and physical health. In some respects, beyond ensuring ordinary functioning, such as holding a job and living within broad social norms, public systems of funding for  mental health care should not be expected to cover an individual’s choice of greater subjective well-being. On the other hand, wouldn’t a greater subjective well-being enhance individual functioning and in this way benefit the larger society?

About norasblog

I am a psychotherapist with a private practice in downtown Chicago.
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