The Future of Therapy Part 2

Anne Kearney’s book Counselling, Class & Politics is both timeless and exactly of its time. In many ways, not much has changed in therapy during the lifetime of this book published in 1996: the distortion of public service by neoliberal economics and the resistance within our society to frame mental health as a political arena and a reluctance within the profession to see the concerns of therapists as genuinely political ones.


But as the conditions of work for therapists decline, there is a renewed possibility for therapists to think and act collectively. Four things are happening right now in our mental health services that make this book important and urgent. Whether in IAPT or third sector, performance management is being used to drive the wholesale implementation of short-term and diluted forms of therapeutic work, downgrading both the services and the jobs within them. As the jobs are downgraded, a growing number of therapists are unable to afford training or find work that financially supports them. The growing majority of therapists work in multiple jobs and settings, far from our professional fantasies of career progression or the comfort of a sustainable private practice. As a result of the fragmentation and flexibilisation of work, we are tempted to retreat into professional silos that stop us developing collective thinking and challenging the breaking up of services. An emerging workforce crisis is reaching its peak as people without independent incomes increasingly cannot afford to enter a profession that requires long trainings and working unwaged in order to qualify. To read more about this, go to


Subsequently, there is a growing concentration of wealth in therapy, involving both the patient and the therapist, as increasingly only some can afford to buy or provide therapy. When neither therapist or patient can afford therapy, and wages and working conditions decline, the assumption of the privilege of the therapist is eroded. For the next generation of therapists, the prospect of earning a sustainable income becomes remote, and the need to speak openly of what it means to work as a therapist in the context of economic crisis has become explicit.


The most profound political attack on therapeutic work involves the current government strategy to introduce ‘psycho-compulsion’ as therapeutic services are co-opted into implementing welfare reform. Even two decades ago, there were attempts to enlist mental health services to implement cuts in welfare; the only change now is that the front line of reform is the introduction of mental health ‘services’ into job centres and employment support services into primary care.


This is not just a therapeutic problem of working with class in the consulting room; it is a political one about how the therapy industry and the people working in it are able to address issues of power. So far, issues around money and inequality have been easily evaded in our trainings and supervisions. With the notable exception of the critical networks and self-organised groups of therapists, the debates so far about the future of therapy have been institutionally defended and professionally territorial. This has a cultural aspect within the mental health professions of what the psychoanalyst Sally Weintrobe (2002) calls Noah’s Ark mentality – the belief, at an individual and collective level, that enough people have a place on the boat for us to keep things as they are.


What Anne’s book gently does is to argue that the practices of therapy and the relationships that they rest on demand that a political perspective be allowed and encouraged within those professional networks that can bear to look at the emerging reality. If nothing else, this is because patient safety requires us to build our own and each other’s political awareness and with it a practice of solidarity.


Anne’s book is a clever piece disguised as simplicity. The methods used in this book are important, based on a longstanding tradition of adult and dialogic education. Each chapter includes tasks and discussion points with a simple writing style and absence of intellectualisations and political posturing. As often happens when people use this approach, the result looks simple, even mundane, but this undervalues the space that such a book offers to us to ask the right questions and to negotiate the different interests of the people we work with.


Although this model of education is not a therapeutic practice per se, it shares important developmental concepts with psychoanalysis, including its emancipatory aims, the emphasis on understanding internal and external realities and building ego strength, using dynamic and dialogic processes and providing a containing framework for building relationality between people. For all its current weaknesses, therapeutic training offers us the potential of safe spaces to build emotional ties sufficient to build a sense of identification and collectivism in the sector.


This is an opportunity to build not just social capital but political capital as well – the resources to make political gains and address power dynamics at work. It is through the development of collective interests that the politics and principles of collective action are determined.


It is rare in the current climate to find a book that generously offers a way to think about what is happening to mental health services without flinching and without feeling the shame and splitting that often accompanies our conversations. Although the political economy debates have been revived so that people talk about neoliberalism in an ordinary way, the politics of therapy require more than superficial posturing it will require genuine attempts to re-invent solidarity.


This book is helpful. Helpful in encouraging the future therapeutic workforce not to back away from the political nature of their work but to understand it and work through to a position of survival and solidarity.


Dr Elizabeth Cotton will be speaking at Edinburgh Napier University’s Working in Healthcare tomorrow about Join us here.

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