Why therapeutic psychology needs less ‘in-sight’ and more ‘out-sight’

As a group of clinical, counselling, and academic psychologists, we have been meeting over many years to critically analyse mainstream psychology.  We have published a number of papers addressing issues such as the work of the National Institute for Health and Care Excellence (NICE), the impact of austerity politics in the UK, the growth of Positive Psychology and of 'the Happiness Industry', and the IAPT initiative, to name but a few (see www.midpsy.org). We have also helped to organise two national conferences, the last one in memory of and tribute to the work of one of our founding members, David Smail.

In our view, when it comes to helping all of us to understand and reduce widespread personal malaise, mainstream psychology has mostly served to reflect and support a damaging societal status quo.  It has achieved this, in both its theories and its methods, through its alignment with positivism and individualism, and with forms of subjectivism which hold our interior psychological world to be the fount of our conduct and of our ability to cope, and to flourish. Mainstream psychologists thereby claim to produce 'scientific' knowledge about individuals, held to exist in splendid isolation from their social, political, and historical context.

In contrast, we argue that individuals can only ever be understood at a particular time and place, inextricably interwoven with a social and material world that sustains their capacity for feeling, thought and action – in a word, their personhood – often in very complex and subtle ways (Cromby, 2015; Fuchs, 2018; Smail, 2006; 1987).

We refer to this perspective as 'Social Materialist Psychology'.  Two core concepts - interest and power - highlight the need for psychologists, and indeed all of us as citizens, to take more account of the current socio-political arrangements of our society (Midlands Psychology Group, 2014; 2012; Smail, 2005). We need to ask whose interests these arrangements serve, and how they might shape subjectivity and personal malaise, above all. Ignorance can be more than just the absence of knowledge - it can be an active presence, with its own contours and structures (Epstein, 2019; Proctor & Scheibinger, 2008). In their determined disregard of these issues, mainstream psychologists resemble client farmers - doing their best to tend their plants, but with little heed for questions of growth, soil, climate, and still less for the issue of who owns the land and of what this might mean for everyone's long term wellbeing.  

Our current socio-political context, often referred to as neo-liberalism, has been the credo of all British governments for more than forty years. The defenders of neo-liberalism claim that markets work efficiently and fairly and that all government efforts to constrain them are futile and self-defeating. The reality has proven otherwise. In the UK and in many other post-industrial countries, neo-liberal policies in the shape of privatisation, swingeing cuts in public services, attacks upon trade unions, and the weakening of public institutions have led to widening inequality, to diminished economic security, and ultimately to a threat to democracy itself. (Brown, 2017; Gerstle, 2022; Harvey, 2005) Scant surprise that the downstream ills of poverty, community breakdown, and personal precarity, have manifested in unprecedented rates of personal malaise (Michael et al., 2020; Whitaker, 2015; Wilkinson & Pickett, 2010).  In 2018, the UN Special Rapporteur on extreme poverty and human rights, commenting on the UK, noted the 'the sense of deep despair that leads even the Government to appoint a minister for suicide prevention and civil society to report in-depth on unheard levels of loneliness and isolation'.

For the most part, therapeutic psychologists have responded with the creation of decontextualized and superficial psychological therapies, which treat the mind as manipulable software: thereby reinforcing the very problems that they are supposed to resolve (Dalal, 2018; Midlands Psychology Group, 2007).  Take, for instance, the mass administration of CBT in England and Wales, via the 'Improving Access to Psychological Therapies program' or 'IAPT'. This is based on practitioners explicitly trying to persuade people that it is not malign social conditions that create or amplify their distress, but rather their own faulty thinking and behaviour (Jackson and Rizq, 2019: Midlands Psychology Group, 2007).  Arguably, assertions like these might have some credibility if CBT and other popular talking therapies worked as claimed. However, the evidence base for these interventions turns out upon close scrutiny to be highly questionable (see, for instance, Epstein, 2019; 1995; Fancher, 1995; Forde, 2018; Hallam, 2018; Kelly & Moloney, 2018; Mair, 1992; Moloney, 2013; Zilbegeld, 1983). Their popularity, especially with the UK government, suggests that these 'technologies of the self' are deeply entwined with and serve the interests of the neo-liberal agenda. Their application amounts to collusion with widespread social harm.   

Are there any alternatives for psychologists and for the people who consult them? If we look carefully, there are some examples of current psychological practice that could be seen as compatible with some of the principles of social-materialist psychology.  These primarily involve initiatives where psychologists have tried to address key aspects of the toxic environments in which some people have to live – including prisons, care homes, and socially deprived and impoverished communities.  The difficulty with most of these interventions is that system-level change is notoriously hard to achieve, let alone sustain.

In contrast to mainstream psychology's habit of 'insight' (looking inwards), we argue that it is only by looking outside ourselves, at our social and material world, that we will ever be able to understand and work toward changing the conditions of our lives for the better. In the long run, how a society takes care of its members is a political rather than a therapeutic matter.     

Outsight: Psychology, Politics, and Social Justice, by The Midlands Psychology Group, was published in May 2022 by PCCS Books, Ltd.