In 2005 I became involved in organising workshops at person-centred conferences on the person-centred approach and social change. I was always struck by how many people attended these workshops and how passionate they were about this issue. It seemed that many people, like me,1 had come into the person-centred approach from left wing backgrounds and were looking to see how stronger links could be forged between the person-centred approach and a progressive political agenda.
An interest in these links is not just limited to the person-centred field, nor to the present times. From the earliest days of psychoanalysis writers such as Reich, Adler and Fromm have tried to bring a social change dimension to psychotherapy and counselling. Today organisations such as Psychotherapists and Counsellors for Social Responsibility (pcsr-uk.ning.com) continue this tradition, and counsellors and psychotherapists work with some of the most displaced and marginalised people across the globe (see, for example, the September 2014 international issue of Therapy Today). At the University of Roehampton we have recently set up a Centre for Research in Social and psychological Transformation (CREST) to try to develop these links between social and psychological change.
Yet the psychological models that dominate counselling training and practice continue to construct psychological distress and change in primarily intrapsychic terms, with little role for wider political, economic or social forces in the aetiology or maintenance of psychological distress. In cognitive therapy, for instance, emotional disturbance is seen as the result of biased information processing, while person-centred therapy construes it in terms of alienation from authentic experiencing. But what about such socio-economic factors as poverty, inequality or racism, all of which are known to adversely affect wellbeing?2 None of our psychological models would deny the impact that such factors can have, but they place them outside of the core theories and formulations. This means that we can become myopic about the causes of our clients’ difficulties. Worse, it may mean that we end up interpreting our clients’ social and economic difficulties in personal and psychological terms.
The aim of this article is to outline a framework for understanding psychological distress and change that tries to draw together psychological and social processes. The framework has evolved slowly over the past decade,1,3 and it is still very much in development. It draws from the psychological and psychotherapeutic evidence and is based on humanistic, existential and pluralistic understandings of human being, although it is intended to be inclusive of the full array of therapeutic orientations.
Wants, desires and strivings
The starting point for this framework is that our thoughts, feelings and behaviours are primarily determined by our ‘wants’. These are our goals, purposes and motivations – our ‘desires for some state of affairs’.3 For instance, right now I want to go home and watch Game of Thrones series three and, because this is what I most strongly want, it is what I am most likely to do.
Wants can be seen as existing in a hierarchy, with lower order wants (such as ‘I want to watch Game of Thrones’) acting as a means to achieve higher order wants (‘I want to experience excitement in my life’). In this respect our wants are not just our immediate desires but also our deepest, most fundamental strivings (for instance, for connection to others, or for autonomy). Wants can also be conscious or non-conscious, and may be synergetic with other wants (ie pulling in the same direction) or dysergetic (ie in conflict). Hence, although I might consciously desire to go home and watch Game of Thrones, at a deeper, less conscious level I may also be yearning for connection with my partner and family.
In this framework, psychological wellbeing can be seen in terms of our capacity to actualise our wants. We tend to feel good when we attain them (satisfaction), progress towards them (positive expectation), perceive them as attainable (hope), or know that they are there (purposefulness). I feel really excited knowing that I will be watching Game of Thrones later tonight, for instance, and it gives me a sense of orientation and structure to my evening.
Conversely, we tend to experience distress when we do not attain our wants (dissatisfaction), do not feel like we are progressing towards them (frustration), do not feel like we will ever attain them (hopelessness), or do not have any wants (purposelessness). So, having seen five more favourite Game of Thrones characters killed off, I feel bereft: I wanted to see how their stories evolved. And I also go to bed with a feeling of dissatisfaction: everyone else left the TV room at Game of Thrones time and I didn’t quite get the interpersonal connection for which, at a deeper level, I was yearning.
Wants and distress
Based on this model, and from a wellbeing perspective, the key question is: why do people not actualise their wants? There are several ways to answer this. First, it may be that people do not know what they want – particularly the higher order desires. This may lead to feelings of apathy, purposelessness or disorientation, or people may end up striving for things that may not be genuinely satisfying, like money, power and success. Helping people to discover their genuine wants and purposes is the focus of the meaning-oriented therapies. Indeed, all insight-based approaches encourage clients to focus on their experiences and feelings so that they can become more aware of their genuine wants and desires.
Second, people may not attain or progress towards their wants because they may not be very good at doing so. Someone may be yearning for social connections with others but may behave in ways that put other people off. The cognitive and behavioural therapies may be very good at helping people with this – by, for instance, teaching people social skills so that they are more able to actualise their relational wants.
Third, a person’s wants may be configured in such a way that they are in conflict with each other. That is, they are dysergetic: the more a person strives towards one want, the more they pull themselves away from another. So, as in the example above, my want to watch Game of Thrones conflicts with my want for connectedness: I get one at the expense of another. Such dysergies are probably the foci of much insight-based therapeutic work. A client may want to move on from the death of his mother, but also does not want to let her go; a client may love her partner, but she also feels like she wants space in the relationship. Here the therapist’s role is to help clients understand these conflicting wants, particularly at the highest order level, and to try to find ways of creating more synergetic configurations. For example, the bereaved client may be helped to see that his fear of moving on stems from an anxiety about letting his mother down and that she would have actually wanted him to get on with his life. Hence, a more synergetic configuration is established between his desire to live his life and his desire to express care and respect for his mother.
And fourth, a person may not actualise their wants because of the barriers placed in their way by the world that they inhabit. A young, working-class woman wants to be a lawyer but does not have the financial resources to achieve this; an asylum-seeker wants to experience physical safety but instead faces threats and abuse from his local community. These external constraints may be political or economic, and they may also be social and interpersonal. For instance, a young boy wants to be loved for who he is but finds himself judged for being vulnerable or gentle.4 In this respect we can see Rogers’ conditional positive regard as just one form of external constraint that prevents people from actualising their wants.
In fact, these third and fourth explanations for why people do not get what they want are closely interlinked. In many instances dysergies exist because of the way that a person’s external world is configured – it only allows them to actualise one want at the expense of another. If my wife loved Game of Thrones as much as I do, then there would be no conflict: I could be watching it and snuggled up to her at the same time. Similarly, it might be that the young, working-class woman could train to be a lawyer if she threw all her resources at it – worked 18 hours a day and sacrificed her relationship, say – but in doing so she would lose out on so many of her other wants. In other words, the more that a person’s social and economic circumstances are restricted, the more likely it is that their wants are going to come into conflict. Give people unlimited resources (if that were ever possible) and their tendency to fight against themselves might be substantially attenuated.
Fostering individual wellbeing
This framework points towards three inter-related ways in which people can be helped towards greater psychological wellbeing. The first is through work in the ‘internal’ realm: helping people to have a clearer sense of what they want from life, how they can attain it most effectively and how they can reconfigure their wants in more synergetic ways. The second is through helping people change their external worlds: by supporting them to become more assertive or more politically active, for example. And the third way is through direct action on the external world itself: helping to change social, political and cultural configurations so that more people are more able to get more of what they want more of the time.
In this framework, none of these approaches are more important than the others. Rather, different people at different points in time may be helped by different pathways to a greater or lesser extent. What this framework highlights, however, is that people’s psychological difficulties may be as much a result of their social and economic circumstances as their mental or emotional ones. Hence, we should always be mindful of the socio-political dimensions of our clients’ lives. Moreover, if we genuinely want to help our clients feel better, then directly engaging in social and political change processes may sometimes be as important as one-to-one therapeutic work. Even if we choose not to engage in such activity, it may be important to remember that such political processes are fundamentally aligned with what we are trying to do with our clients and not of an entirely different order.
Parallel dimensions
There is a second way in which this framework can help to develop a more integrated psychosocial understanding. This is by creating a structure in which the parallels between social and psychological change processes can more clearly come to light. Indeed, although this article starts with a focus on wants at the individual level, it could have started at the social or community level; there are similar processes at each one. For a start, just as individual wellbeing can be understood as the maximal opportunity to actualise one’s wants, so social wellbeing can be understood as the maximal opportunity for the maximum number of people in a society to actualise their wants. In other words, a good society is one in which as many people as possible have as many opportunities as possible to get the things that they really want in life, whether that is relatedness, autonomy or security. And a poor society is one in which only minimal numbers of people are able to progress to their goals – often at the expense of others.
Through this framework we can also see parallels in the ways in which wellbeing can be attained. On the individual plane, for instance, social wellbeing can be enhanced if societies find more effective ways of attaining their wants or by making more resources available to more of the people. Importantly, too, social wellbeing can be enhanced through the development of more synergetic forms of social organisation. Indeed, we might say that social structures and operations are ‘good’ to the extent that they support synergetic processes. An example might be charity shops, which provide funds for good causes while at the same time allowing people to buy goods at a low price (and feel that they are making a positive social contribution). By contrast, homophobia could be defined as a ‘bad’ social structure because it impedes the abilities of large sections of society to attain their wants while not really providing anything positive for anyone. True, homophobic people may experience some sense of satisfaction or superiority from their behaviours but these are wants that could be achieved in much less destructive ways. Instead of being homophobic, say, a person could learn to excel at a sport or a creative activity. That way they could feel good about themselves and allow other people to feel good about themselves too.
Another parallel that emerges through this framework is the value and importance of equity in the capacity to attain wants. At the social level, this is social justice: that all members of society have an equal capacity to achieve their desires. Research indicates that such equity is associated with greater wellbeing of society as a whole,5 and we can see something similar at the individual level where people seem to function best when all their different ‘parts’ are able to express their wants. That is, rather than one aspect of the person imposing its wants on the others, there is an ‘internal democracy’ in which all the different parts can be heard. So, for instance, in an inequitable internal configuration (an ‘inner totalitarian state’) a person’s desire for social acceptability might repress and silence all their other wants. But in an equitable internal configuration the person can also acknowledge those desires outside of social acceptability: for playfulness, for example, or to act in vulnerable or angry ways.
Highlighting these parallels is not only a means of drawing together social and psychological change processes. It can also help us to focus on – and deepen our understanding of – mechanisms of change that function across both planes. At the social level, for example, it would seem that genuine dialogue is one very important means by which greater synergies can be achieved. People express their wants and through this process they can come to find ways of meeting more of everybody’s wants more of the time.6 Similarly, at an intrapsychic level dialogue between parts of the self – through two-chair dialogue, say – has been found to be effective in facilitating positive psychological change.7 But what is dialogue and what are the factors that can facilitate and inhibit it?6 By drawing parallels between the social and individual planes we can develop our understandings at both levels concurrently and we can also develop hypotheses by extrapolating from one plane to the other. For instance, if dialogue at an interpersonal level requires trust between people, how might we foster that between our intrapsychic ‘parts’?
Conclusion
Many of us in the counselling and psychotherapy world are acutely aware of the impact that social and political factors can have on a person’s wellbeing. We want to help our clients out of their distress and know that social disadvantages and inequities can play a major part in keeping them there. We want to see social change and social justice but, to date, our theoretical models have tended to see such processes as parallel – rather than integral – to our psychological work.
The framework presented here is one fairly simple means by which we can draw social and psychological change process into a unified whole. Here both social and psychological factors can stop people from actualising their wants, and both social and psychological change processes can help people achieve greater wellbeing. This helps us to keep our clients’ social and political contexts always in mind in our therapeutic interactions with them and to develop our understanding of change in an integrated way.
Mick Cooper is Professor of Counselling Psychology at the University of Roehampton and a Fellow of the BACP. He has written a range of texts on relational approaches to therapy, most recently Existential Psychotherapy and Counselling: Contributions to a Pluralistic Practice (Sage, 2015).
References
1. Cooper M. Socialist humanism: a progressive politics for the twenty-first century. In: Proctor G, Cooper M, Sanders P, Malcolm B (eds). Politicising the person-centred approach: an agenda for social change. Ross-on-Wye: PCCS Books; 2006 (pp80–94).
2. Jackson JS, Brown TN, Williams DR, Torres M, Sellers SL, Brown K. Racism and the physical and mental health status of African Americans: a thirteen year national panel study. Ethnicity & Disease 1995; 6(1–2): 132–147.
3. Cooper M. A hierarchy of wants: towards an integrative framework for counselling, psychotherapy and social change. Glasgow: University of Strathclyde; 2012.
4. Rogers CR. A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework. In: Koch S (ed). Psychology: a study of science vol 3. New York: McGraw-Hill; 1959 (pp184–256).
5. Wilkinson R, Pickett K. The spirit level: why equality is better for everyone. Harmondsworth: Penguin Books; 2010.
6. Cooper M, Chak A, Cornish F, Gillespie A. Dialogue: bridging personal, community and social transformation. Journal of Humanistic Psychology 2012; 53(1): 70–93. doi: 0022167812447298
7. Greenberg LS, Rice LN. The specific effects of a Gestalt intervention. Psychotherapy Theory Research and Practice 1981; 18(1): 31–37.