Joanna Ryan

I've been longing to speak with Joanna Ryan since I read 'Landscapes of Inequality' and requested an interview with her for the PCCS book I'm editing. But as one of our pioneers who have become elders Ms Ryan has become less available to strangers.

Listen to her talk at the Freud Museum with Barry Watt:

"What does psychoanalysis have to say about the emotional landscapes of class, the hidden injuries and disavowed privileges? How does class figure in clinical work and what part does it play in psychotherapeutic trainings?

 In these times of increasing inequality, Joanna Ryan will discuss aspects of her timely new book Class and Psychoanalysis: Landscapes of Inequality, exploring what can be learned about the psychic formations of class, and the class formations of psychoanalysis. Addressing some of the many challenges facing a psychoanalysis that aims to include class in its remit, she holds the tension between the radical and progressive potential of psychoanalysis, in its unique understandings of the unconscious, with its status as a mainly expensive and exclusive practice."

Class and Psychoanalysis: Landscapes of Inequality, Routledge, 2017

(2009) Elision and Disavowal: The Extrusion of Class from Psychoanalytic Theory and Practice. Sitegeist ,no 3,p27-40

‘“Class is in you”: An exploration of some social class issues in psychotherapeutic work’, British Journal of Psychotherapy, 2006, 23, 49-63. Reprinted, (2013) with postscript in F. Lowe (ed.), Thinking Space: Promoting Thinking about Race, Culture and Diversity in psychotherapy and Beyond,  London: Karnac

Keeping Politics Out Of Therapy

When I transferred files from an old computer some ancient Letters To The Editor of Therapy Today came up and I was reminded that BACP backed Nadine Dorries' abortion counselling bill.

"The Dorries amendment would have stripped non-statutory abortion providers such as Marie Stopes and the British Pregnancy Advisory Service (bpas) from offering counselling to women. This was designed to provide greater opportunities for independent counsellors, some of whom are influenced by pro-life groups, to provide counselling."

By this time Nadine Dorries had already described abortion as 'murder', her position on the issue was and remains abundantly clear. 

Here's the 2016 letter I wrote to Therapy Today about its - lets say unsophisticated - approach. 6 years on BACP might be slightly less simpleminded but any worldliness they may have gained seems to have been focussed on defending inner sanctums rather than offering thoughtful guidance on values beyond sloganeering. 

People who say they want to keep politics out of anything are generally either very well aware that the politics of a situation are noxious, or are unable to manage any debate on the subject, or are far too innocent to train as a therapist.

Nearly 8 years on things have by no means improved.

Therapists may wish to bear ethics in mind.

 In 2015 Therapy Today published a piece wondering if it was ethical for counsellors and psychotherapy to participate in Workfare:

“In their 2015 election manifesto the Conservative Party said that claimants who ‘refuse a recommended treatment’ may risk having their benefits reduced. The pre-election budget allocated funds to place IAPT therapists in 350 Jobcentres throughout England; the possibility that claimants may be required to attend a course of CBT treatment to improve their ‘employability’ or risk losing benefits has become very real.”

https://www.bacp.co.uk/bacp-journals/therapy-today/2015/july-2015/should-counsellors-work-with-workfare/ 

BACP, BPS and UKCP offered ethical guidance:

 “Individual psychologists will have to make their own decisions about working in this way, bearing in mind that so many professional bodies, including the BPS, have made it clear that it is ethical to offer people therapy only in the context of a free and informed choice.”

 “The principle of autonomy opposes the manipulation of clients against their will, even for beneficial social ends,” and BACP members should “seek freely given and adequately informed consent” from clients.

“Therapists involved in such work may wish to bear the ethical dimensions in mind.”

As long as counsellors and psychotherapists might wish to bear some ethical dimensions in mind they had the blessing of their professional membership bodies to work with people who had been given the choice to meet a therapist or lose their benefits. 

It had taken nearly a decade for our professional bodies to consider the most basic psychotherapeutic principles. In 2008 BACP grasped at the concept that 'Work Is Good For You' because it offered what they identified as 'huge opportunities' for counsellors and psychotherapists. 

In April 2016 Therapy Today became concerned about the links between IAPT and the DWP:

“BACP and its fellow professional associations have stated clearly and publicly that they oppose any use of therapy purely to get people back into work; that the therapy should always be completely voluntary and unrelated to any mandatory work-related package; that the focus should always be on the issues that the client brings to therapy, and that it should be provided in a therapeutically appropriate environment.”

The DWP subsequently invited BACP to visit a clinic above a Job Centre performing this work. The clinical psychologist who owned the private business and the DWP District Operations Manager both thought it was going very well but BACP didn’t get to talk to any claimants. Neither did they seem to be aware that one does not just walk into a Job Centre. Job Centres were never open to the public. Security guards always stood at the door, not where they had an overview of the office.

BACP became so alarmed “that employment may be regarded as a clinical outcome of psychological therapy" that they wrote an entire letter to the government.

This rather missed the point that 'psychological therapy' had been explicitly used as a means to move people into employment for several years; that BACP and other professional membership bodies entirely embraced the government concept of Work Is A Health Outcome; that their own enthusiasm for this project when it was first announced and in subsequent years had given, not just permission but encouragement to their members to do precisely what they were now alarmed about.

The letter was no doubt posted and that was the end of the matter, for BACP, the government and the profession. 

Therapists Working With The DWP

A number of therapists have contacted me over the years to tell me, in strict and frightened confidence, how traumatic it was for them to work with the DWP. They chose this employment because it paid a salary and because they thought they could be useful to claimants but very quickly came to realise that they were working in an intentionally abusive, coercive culture. When they couldn't endure being abusive or coercive any more they left.

They had not been aware of the reality of the culture they were entering, and it was striking that independently all of them used the same language that so many claimants use about their experience. They were frightened, a kind of pervasive and difficult to define anxiety around being found out, punished, removed from some kind of support if an undefined authority discovered they were talking about their experience.

Who was this authority? Not any professional body. Employment and unemployment, health and its opposites hold and infuse profound meanings throughout our society; in counselling and psychotherapy we have been explicitly told that getting people 'to increase their employability so they can get work, and help keep them at work' is an ethical opportunity. What might be called the Superego or the External Locus of Evaluation (forgive the very inaccurate shorthand) – the part of us that learns moral standards and values from superiors – would have been all for it.

Was the DWP the source of  this anxiety? It is (or it should be) common knowledge that the DWP has particular powers of surveillance and control over vulnerable people’s lives. A dedicated free hotline has been available to anyone to anonymously report a claimant to the DWP for fraud, for decades. No research has been done on numbers of malicious calls, but once a call is made benefits are stopped.  Claimants have had long-lens photographs taken of them in their own homes, been secretly filmed to see if they're having a relationship, had photos of their drying underwear taken to gain evidence of them not living alone. The Human Rights Act does not apply to people on benefits.

In 2021 claimants were made to photograph themselves with their right hand on their street sign, sometimes holding that days newspaper, and threatened with loss of their benefits if they couldn't.

This wasn’t a central government policy, it wasn’t a DWP policy. It emerged from individual, multiple Job Centres. Universal Credit Director, Neil Couling, said it looked like fake news and it took him three days to admit that it was ‘legitimate.’ So yes, anxiety about what individual people in individual centres who work for the DWP can do with impunity should be very real.  If you’ve worked as part of it you will know this very well.

Shame might have been part of the anxiety, I never asked. Without entering in to a boundaried therapeutic relationship how would I? “The things you’re saying sound terrible. You were working as part of a team that you saw doing these things day in day out, and I’m wondering how that might have been for you?” Exploring this kind of experience even at this beginning stage has the potential to be very unpleasant for the person thinking about it, and none of the therapists who approached me were asking me to be their therapist. 

It might be that, knowing I have a particular stance on this subject, they came to me because I would believe and understand them? Less consciously, that speaking with me might be an act of some kind of confession? Therapists and priests know the power of speaking a secret to a trusted person who is taught both to listen without judgement and how to keep those secrets. Priests can offer absolution and although judgement or forgiveness are not any part of a therapists role, many therapists seem keen to offer forgiveness in the guise of helping a person understand why they made various choices, or suggest forgiveness as a way to bypass difficult feelings, often their own. I'm not one of those therapists, it's not my role or need to 'make' people feel good, bad or indifferent about what they've done or not done, and forgiveness is not part of my vocabulary in any setting. Forgiveness and punishment is way outside of my understanding of the function of therapy, and it may be that some therapists who came to me wanted me to punish them? 

Whatever the case, our conversations lasted no more than a couple of hours.

Those who found this employment satisfying, satisfactory or even just worth the money have not been in touch. The lack of information on experience of this psychotherapeutic ‘opportunity’ is information in itself.

Another reason for the dearth of material is that for many years the DWP refuses to allow any independent research into any part of their role, function, activity or outcomes and routinely conceals its own research. This should be profoundly interesting to a profession that encourages its members to work with any group. But it's not. 

In a culture that repeats the mantra of 'evidence based practice' there was something weird about the complete lack of references in Therapy Today articles announcing the opportunities available for counsellors to work with the DWP. Academic publishing is a factory that churns out contradictory evidence all day long, it's always possible to find evidence to back up any assertion, but these articles contained none. They didn't need to. It is so blindingly obvious throughout to our professions that Work Is Good For You and Unemployment Is Bad For You that to question this would be like questioning if women could be doctors. 

Status, Ethics, Consent

 The abuse of politically vulnerable groups by mental health professionals has a long and shameful history. Whether it’s single mothers being subjected to electro convulsive therapy, ‘protest psychosis’, the incarceration of political dissenters or the Martha Mitchell Effect, each individual professional involved in this scapegoating is ultimately paid by and works for the government of their time. The BACP professes to be concerned with an ethical approach to practice but that doesn’t seem hold true when ‘opportunities for counsellors’ are at stake.

In April 2015 442 counsellors, psychotherapists and academics put their names to a letter published in the Guardian calling for our professional organisations to act against the ‘Fit to Work’ programme which linked receipt of benefit to ‘state therapy’: 

“Get to work therapy’ is manifestly not therapy at all. With the ominous news that Maximus (the US company replacing Atos to do work capability assessments) will also be managing the new national Fit for Work programme, it is time for the field’s key professional organisations to wake up to these malign developments, and unequivocally denounce such so-called ‘therapy’ as damaging and professionally unethical.” https://www.theguardian.com/society/2015/apr/17/austerity-and-a-malign-benefits-regime-are-profoundly-damaging-mental-health 

Some of the signatories, like Susie Orbach, were household names. Some, like Andrew Samuels and Ian Parker were presidents of high-status professional bodies. Some were professors based at the Tavistock and red brick universities, others were very well known and respected professors within our professions, some were admired academic authors. Perhaps it was this status-led criticism rather than years of objections from ordinary therapists that finally got through to BACP and UKCP.  Within three months BACP had curbed its enthusiasm about the ‘huge opportunities’ for counsellors to work with the DWP. 

To return to the subject of consent, 

Therapy Today published a piece wondering if it was ethical for counsellors and psychotherapy to participate in Workfare:

“In their 2015 election manifesto the Conservative Party said that claimants who ‘refuse a recommended treatment’ may risk having their benefits reduced. The pre-election budget allocated funds to place IAPT therapists in 350 Jobcentres throughout England; the possibility that claimants may be required to attend a course of CBT treatment to improve their ‘employability’ or risk losing benefits has become very real.” https://www.bacp.co.uk/bacp-journals/therapy-today/2015/july-2015/should-counsellors-work-with-workfare/ 

BACP, BPS and UKCP offered ethical guidance:

 “Individual psychologists will have to make their own decisions about working in this way, bearing in mind that so many professional bodies, including the BPS, have made it clear that it is ethical to offer people therapy only in the context of a free and informed choice.”

 “The principle of autonomy opposes the manipulation of clients against their will, even for beneficial social ends,” and BACP members should “seek freely given and adequately informed consent” from clients.

“Therapists involved in such work may wish to bear the ethical dimensions in mind.”

It's worth noticing that 'even for beneficial social ends' in this context can only be assumed to mean that employment is a beneficial social end, even after many centuries of evidence of many kinds of employment having very dubious social ends. 

As long as counsellors and psychotherapists might wish to bear some ethical dimensions in mind they had the blessing of their professional membership bodies to work with people who had been given the choice to meet a therapist or be sanctioned and become destitute - not poor, destitute. 

That this was not blindingly obvious to BACP and UKCP 'experts' in ethics is yet more depressing testament to the bias, lack of experience and naivety that are the foundations, the bricks and mortar of our professions.

Attitudes to Work within UK Counselling and Psychotherapy

In 2007 the Medical Research Council, the Royal College of Psychiatrists, the Department of Health (DoH) and the Department of Work and Pensions (DWP) held a joint conference: Employment and Mental Health. Absence from work due to mild and moderate mental ill health. This was intended as a gathering together of the research into mental health, mental ill-health, employment and unemployment. One of the conclusions of this conference was that:

“Work is broader than ‘employment’ and should encompass voluntary work, home making etc. The majority of the research evidence refers to full time work whereas it might be more informative to consider ‘activity’.” 

In 2008 the BACP campaigns manager wrote an article on how changes to employment legislation might be a useful 'opportunity for counsellors.' It included this sentence:

“. . . access to psychological therapy and/or support, with the aim of helping people achieve improved mental health and wellbeing, thus improving their ability to gain and/or maintain employment.” 

The October 2009 issue of Therapy Today published an article called ‘Work is good for you’. It was illustrated by a picture of a godlike figure - the counsellor - holding a key with which he winds up tiny broken people on one side of him to send them on their happy, straight-backed, employed way on the other. The article was based on government policy and mentioned “… growing evidence that work is good for your health” but offered not one reference to research.

This was repeated in February 2012 in another Therapy Today article: ‘Counselling the jobless back to work.’ Again assertions were made about the “research evidence” of the harmful effects of being unemployed with not one reference to that research. This piece was, like the October 2009 article, concerned with “opportunities for counsellors.” 

All three pieces were alarmingly unbalanced with no reference to serious criticisms that were live in the public sphere over the years they were written in, including allegations of fraud within the privately owned, publicly funded organisations contracted to implement the Government’s Welfare To Work policy. There was no exploration of the complex external influences (such as the demonisation of the unemployed across media and the ubiquitous rhetoric around ‘hard working tax payers’ vs. ‘benefits scroungers’) that gratuitously contribute to the distress of people whose identity is fundamentally altered the day they become unemployed or claim benefits. There was no recognition that unemployment rates were at their highest in 17 years or how failure to find employment after being processed through various ‘back to work’ schemes might affect a person’s wellbeing. 

Neither was there mention of dissent to the Welfare Reform Bill (which became the Welfare Reform Act in 2012) from respected organisations like the Joseph Rowntree Trust, Disability Alliance, MIND, National Housing Federation and the CAB amongst a great many others; no mention of the Royal College of Psychiatrists’ concerns about “the capacity of relevant members of staff in Jobcentre Plus and work programme providers to make appropriate decisions about what type of work-related activity is suitable for claimants with mental health problems” or the fact that the College would not support the Health and Social Care Bill.

There was no discussion of the Welfare Reform Bill being demolished, cross-party, in the House of Lords, or that the Government forced these policies into law despite its Lords defeat. There was no mention of the DWP’s six-point guidance to Job Centre staff around increases in self-harm and suicide.

There was no recognition of, let alone reflection on, the essential shift in the purpose of counselling summed up by Kevin Friery, past chair of BACP Workplace, who became the Clinical Director of an EAP:

“The prime contractor doesn’t want to pay you to have a nice chat and help the person cope with being unemployed; they want you to increase their employability so that they can get work, and help keep them at work.” 

We’ll return to the complete absence of any discussion around consent, informed or otherwise.

In sharp contrast to this, in October 2009 when Therapy Today led with the news that “One in 6 therapists still sees fit to offer gay clients treatments that aim to make them straight"  that article resulted in shock and outrage that so many counsellors should be abusing clients by telling them what they should be and do, purposefully aiming to change them to suit the counsellor’s worldview. Therapy groups large and small had meetings, events and discussions and a Memorandum of Understanding was created, agreed and adapted over many years. CPD courses on sexual identity and preferences exploded, language and understanding evolved quickly and people who did not keep up were censured until even the most resistant or disinterested therapist was either forced or came to realise that it was expedient to do so.

There has not been a similar reaction to the same and recurrent message when it involves people who are unemployed. Instead, there seems to be a consensus that counselling and psychotherapy should be one thing for people who can afford private practice but the polar opposite when the counsellor is working as part of the Work Programme, or indeed when meeting with any person who is unemployed. This attitude was described as a “hanging offence under our Ethical Framework,” by the BACP itself.

But not if you’re unemployed, or poor.

Why Work?

"The enslaved ploughman cries: O! O! magnus labor etiam, magnus labor est, quia non sum liber in Latin, or Hig! Hig! micel gedeorf ys hyt. / Geleof, micel gedeorf hit ys, forþam ic neom freoh.

 Oh! Oh! The labour is great. Yes, the labour is great, because I am not free."

Very few of us work to survive, although in recent years it has increasingly felt as if that is the case. The social safety net has become all but impossible to access and so profoundly shaming and destructive when it is that most of us would rather do anything rather than use it, even if that means becoming physically and mentally unwell.

At the same time, rates of workplace stress and bullying have spiralled out of control. This is nothing new. Legislation has had to be created and enforced to protect people from colleagues and employers for centuries. Since 2009 many pieces of academic research consistently show that most of us dislike our employment and that record numbers of us are being bullied.

The interest that governments take in work moves far beyond economics. Work is an idea, an ideology with multiple, contradictory meanings: a virtue, a curse, a necessity, a right, a duty, a punishment. It is a source of individual and societal, national and international health and illness, unrest and stability, satisfaction and dread. It is an indication of your status, worth, values, goals, ideals, attitudes, beliefs, your place in your family and wider communities, your religion.

Yet we find it difficult to define what work is.

At its most basic, work is the transfer of energy.

Work is employment

Work is activity

Work is task fulfilment

Work is manifestation

Work is an ethic

Work is a spiritual principle

Work is a socioeconomic relationship

Work is an action involving mental or physical effort done in order to achieve a result. Money is not necessarily involved. It can be a hobby, a passion, an obsession, a drudge, a punishment, an act. Machines work. Non-human animals work, and can be worked. Money is not necessarily involved. 

Activity is simply the condition in which things are done. Money is not necessarily involved. 

Employment is an agreement between an employer and an employee that the employee will provide services in return for money and other benefits. More granularly, it is the offer from the employee of their capacity to work. Whether we do that work or not is another matter.