Explain how your personal values fit with the values and ethics of the counselling profession, or, Musings of a foot soldier in the Happiness Army

In the following essay I will outline and clarify the extent to which my own values, principles and ethics correspond to those of professional counselling and psychotherapy. In doing so I will demonstrate how such personal and moral values dovetail with both my political convictions and my fidelity to the counselling profession. Secondly, and more controversially, I will argue that the principle of autonomy, so vital to counselling and democratic politics, has been undermined by a ‘therapeutic’ political culture that has reconceived personhood in terms of dependence and vulnerability.

I will maintain that certain values and principles, despite being consistent – in a psychotherapeutic context – with cultivating autonomy and the realisation of human potential, are, in the political sphere, antithetical to it. While this may suggest an ambivalence, on my part, towards ‘therapeutic values’ this essay is in fact as much concerned to defend those values against their misuse and corruption by political elites bereft of values of their own.

Before exploring the contrasting ways in which therapeutic values are interpreted and applied today, and the consequences for, in particular, individual autonomy and self-governance, it will be useful to provide a brief outline of the differences and continuity between the concepts of ‘values’, ‘ethics’, ‘morals’ and ‘principles’. According to Chippendale (2001), ‘Values motivate, morals and ethics constrain’. Underpinning this distinction is a characterisation of ‘values’ as our basic beliefs, as the essential drivers behind our deciding what is right or wrong, good or bad, important or unimportant. ‘Morals’ meanwhile imply judgement and the prescription of appropriate – or proscription of inappropriate – values, standards and behaviour. ‘Ethics’ represent the formalisation or systemisation of moral standards that, instead of being imposed externally, are defined in internal, organisational terms. Finally, ‘principles’ are deemed to be the fundamental or general truths that ‘inform our choice of values, morals and ethics’ (Chippendale 2001).

The British Association for Counselling & Psychotherapy (BACP), in its Ethical Framework for Good Practice in Counselling & Psychotherapy (BACP 2010: 2), summarises the relationship between values, principles and ethics as follows: ‘Values inform principles. They represent an important way of expressing a general ethical commitment that becomes more precisely defined and action-orientated when expressed as a principle.’ Thus, the moral force of a given set of ethics both depends upon and adds weight to principles that are themselves rooted in properly substantive values. It is with these themes in mind that I now turn to examine the issues arising from a consideration of my own values and those embraced and encouraged by the counselling profession.

‘Personal qualities to which counsellors and psychotherapists are strongly encouraged to aspire’, recommends the BACP, include empathy and sincerity, integrity and resilience, courage and humility (BACP 2010: 4). Such essential ‘moral’ qualities (to use the BACP’s own choice of adjective) certainly chime with my own. To that short list, I would add other commonly cherished, if similarly uncontentious, values, such as curiosity and passion, creativity and critical thinking, loyalty and dedication, honesty and dependability. Yet it is the, arguably, more contentious, multi-faceted concepts that give rise to important questions, not about the particular virtues they embody, but about the significance they hold for the relationship between psychotherapy and a therapeutic political culture.

Among these ideas, I would include equality and freedom, independence and empowerment, individuality and diversity, respect and tolerance. There is not space here to examine the specifics of all these values and principles, or their overall relevance to the counselling profession. Certainly, there is little doubt that they would all would be endorsed, accepting differences in interpretation, by the mainstream of the profession, but the two ideas I want to focus on here are among those most widely misunderstood: respect and tolerance.

The counsellor or psychotherapist (certainly in the client-centred, humanistic tradition of psychotherapy) is expected to demonstrate unconditional ‘respect’ for his or her client. This psychotherapeutic model of ‘respect’ derives, largely, from the ideas of Carl Rogers, one of the founding proponents of the humanistic approach to therapy, and for whom respect formed a key component of his concept of ‘unconditional positive regard’ (Sanders 2008: 58-64). Yet it is equally important to acknowledge that the idea of ‘respect’ can be understood very differently. In historical, cultural and broadly moral terms, to ‘respect’ someone is to hold him or her in high regard. Indeed, in certain contexts, respect implies deference (Harper n.d.). At the very least, outside its context-specific meaning in psychotherapy it is a truism that respect is something that has to be earned.

This is not a matter of semantics. Nor is it a criticism of the idea of ‘respect’ as applied in Rogerian psychotherapy, where unconditional positive regard is intimately and appropriately bound up with congruence and acceptance, empathy and openness, providing ‘an environment in which the individual can identify their own life goals and how they wish to determine them’ (Bennett 2003, Iberg 2001, Sanders 2008: 51-57 and 65-73). Nonetheless, the criteria by which politics should be judged are very different. Indeed it is the very question of judgement that is at stake here.

‘Non-judgmentalism’ is a key value in the therapeutic environment, central as it is to empathy, acceptance and congruence, and to ensuring counsellors and psychotherapists are unimpeded in ‘fostering a sense of self that is meaningful to the person(s) concerned’ (BACP 2010: 2). Yet it is singularly ill-suited to politics, where aforementioned principles like equality and freedom, independence and empowerment depend on debate and critical evaluation (both of which are principles I strongly advocate). Indeed, as Furedi (2011a) observes, ‘the precondition of a working democratic public sphere is openness to conversation and debate.’ He continues: ‘Reflecting on our differences with other points of view, letting people know where we stand and what we find disagreeable in their opinions… that is the very stuff of a vibrant democracy’ (2011a). Nonetheless, the contemporary political imagination has become estranged from making value judgements, the corollary of which is a form of non-committal relativism that has allowed for the ‘therapeutic’ turn towards non-judgmentalism.

Furedi (2003, 2010, 2011a, 2011b) has explored in detail the rise of a therapeutic culture and the ways in which non-judgmentalism has moved from the therapy room and into public life. ‘In contemporary public debate’, he notes, ‘the important connection between tolerance and judgement is in danger of being lost. The word ‘tolerance’ is now used interchangeably with the term ‘non-judgmental’ (2011a). What is becoming increasingly apparent is that non-judgmentalism, in the political sphere, has usurped the classical liberal idea of tolerance.

‘Respect’, however, is perhaps not beyond being reclaimed as a genuinely liberal principle. [T]he traditional liberal idea of tolerance’, writes Furedi (2010), ‘upholds the notion of respect – not, however, the idea of unconditional affirmation, as respect is understood today, but the liberal notion of respecting people’s potential for exercising moral autonomy.’ And it is our ‘moral autonomy’ that is diminished by a therapeutic political culture. The ‘cultivation of vulnerability’ such a culture entails is reflected in ever-expanding categories of mental illness and the increasing psychologisation of everyday life. As Black (2010) argues, such trends are indicative of a crisis of meaning ‘born of the atomisation of the social world’.

How resilience in the face of this social atomisation might be forged is beyond the scope of this essay. Suffice it to say that it is indeed resilience, in myself and others, that I hold in high esteem, as both a citizen and a counsellor. What I have sought to do here is defend therapy against (and distinguish it from) the ‘therapeutic turn’ in politics, and argue that ersatz therapeutic values in politics undermine the very autonomy counsellors seek to uphold for their clients. Included among the BACP’s appropriately robust ‘Ethical principles of counselling and psychotherapy, alongside ‘fidelity’ (trustworthiness), ‘self-respect’ (self-knowledge and self-care), ‘beneficence’ (promoting wellbeing), ‘non-maleficence’ (avoiding harm) and ‘justice’ (impartiality), is ‘autonomy’, which is neatly summarised as ‘respect for the client’s right to be self-governing’. It seems fitting, then, to end this essay by highlighting what, for me, is not merely a ‘personal value’, but rather the most important of all moral, ethical, professional and political principles (BACP 2010: 3-4).

References

BACP (2010) Ethical Framework for Good Practice in Counselling and Psychotherapy. Lutterworth: BACP Bennett, P. (2006) Abnormal and Clinical Psychology: An Introductory Textbook. Maidenhead: Open University Press Black, T. (2010) ‘Why More and More People Feel ‘Mentally Ill’’. Spiked [online] 29 July. Available from < http://www.spiked-online.com/index.php/site/article/9356/> [25 March 2012] Chippendale, P. (2001) On Values, Ethics, Morals & Principles [online]. Available from < http://www.minessence.net/articles/Articles.aspx> [25 March 2012] Furedi, F. (2003) Therapy Culture: Cultivating Vulnerability in an Uncertain Age. Oxford: Routledge Furedi, F. (2010) ‘The Truth About Tolerance’. Spiked [online] 29 December. Available from < http://www.spiked-online.com/index.php/site/reviewofbooks_article/10034 > [25 March 2012] Furedi, F. (2011a) ‘Don’t Blame Tolerance For This Multicultural Mess’. Spiked [online] 7 February. Available from < http://www.spiked-online.com/index.php/site/article/10163/> [25 March 2012] Furedi, F. (2011b) On Tolerance: A Defence of Moral Independence. London: Continuum Harper, D. (n.d.) Online Etymology Dictionary [online]. Available from [25 March 2012] Iberg, J.R. (2001) ‘Unconditional Positive Regard: Constituent Activities’. In Rogers’ Therapeutic Conditions: Evolution, Theory and Practice Volume 3: Unconditional Positive Regard. ed. by Bozarth, J. and Wilkins, P. Ross-on-Wye: PCCS Books, 155-171 Nolan, J. (1998) The Therapeutic State: Justifying Government at Century’s End. New York: New York University Press Sanders, P. (2008). The Person-Centred Counselling Primer. Ross-on-Wye: PCCS Books Williams, J. (2003) Relativism, Social Theory and the Politics of ‘Difference’. Unpublished PhD thesis. Keele: Keele University

CBT & TA

In what follows, I compare and contrast the main theoretical features of two approaches to counselling (or psychotherapy) that, while they share unmistakable similarities, appear to encompass markedly divergent theoretical sources: transactional analysis (TA) and cognitive behavioural therapy (CBT). Firstly, I will outline the principal theoretical characteristics of each ‘school’ of therapy. I will then proceed to examine the validity of the widely held claim that TA and CBT are complementary approaches to counselling and psychotherapy. I begin by focusing on TA.

Transactional analysis was developed by Canadian-born psychiatrist Eric Berne, in the late 1950s (ITTA 2012). Also trained as a Freudian psychoanalyst, Berne parted company from the mainstream of orthodox psychoanalysis when his phenomenological commitment to advancing a theory of ‘ego states’ saw him seek ‘observable behavioural clues’ to personality (Stewart and Joines 1987: 17). ‘An ‘ego state’’, Berne wrote

may be described phenomenologically as a coherent set of feelings related to a given subject, and operationally as a set of coherent behaviour patterns; or pragmatically, as a system of feelings which motivates a related set of behaviour patterns (Berne 1961: 17).

As well as being proffered as an advanced theory of communication, child development and psychopathology, TA’s reputation also rests on its theory of personality, to which the ego-state model is key (Stewart and Joines 1987: 3). Indeed, as Berne himself insisted, ‘If you can’t break it down to ego states, it is not Transactional Analysis’ (Berne 1973: 71).

Largely as a consequence of TA’s absorption into the often reductionist ‘pop psychology’ movement of the 1960s and 70s, there remains a commonly held misconception that Berne’s P-A-C (Parent, Adult, Child) ego-state model is synonymous with Freud’s conceptualisation of superego, ego and id (Stewart and Joines 1987: 18; Harris 1967; Gildebrand 2001: 28). For Berne, however, it was essential to stress that ego-states are not ‘unobservable, theoretical states’, but ‘phenomenological realities’ (Stewart and Joines 1987: 17; Totton 2010: 13; Berne 1961: 4; Steiner 2006). Rather than ‘universal’ categories, in the sense that superego, ego and id were for Freud, ego-states are ‘eminently observable’ manifestations of the re-enactment of thoughts, feelings and behaviours originating in specific childhood experiences (Steiner 2005; Stewart and Joines 1987: 17).

According to Berne, the Child (‘archaeopsyche’) and Parent (‘exteropsyche’) ego-states ‘are fixations of early reactions and experiences or unaware internalizations.. of significant others’ (Erskine and Moursund 1988: 21). That is to say, they encapsulate thoughts, feelings and behaviours either ‘replayed from childhood’ or ‘copied from parents or parental figures’ (Stewart and Joines 1987: 12). By contrast, to be in the Adult (‘neopsyche’) ego state is to be in the ‘here and now’, seeking a balanced negotiation of ‘internal and external forces' and 'attempting to deal objectively with external reality’ (Berne 1957: 301, cited in Heathcote 2010: 258-259).

The Parent and Child ego-states are subdivided into Controlling Parent/Nurturing Parent and Adapted Child/Free Child. In turn, each of these four functional subdivisions is divided into positive and negative variants (Stewart and Joines 1987: 21-26). From this model follows the analysis of transactions between ego-states. Berne (1964: 15) defined a transaction as ‘a unit of social intercourse’, or, ‘an exchange of strokes’, where a ‘stroke’ is a ‘unit of interpersonal recognition’ (Steiner 2005). Such transactions may be ‘complementary’, wherein ‘the ego-state addressed is the one which responds’ (Adult to Adult, Parent to Child, Child to Parent, and corresponding subdivisions and variants); or it may be crossed, ‘in which the ego-state addressed is not the one which responds’ (Stewart and Joines 1987: 60, 63).

Counterproductive transactions can take the form of recurring, and self-sabotaging, patterns of communication: ‘games’. Because these games evoke emotions ‘learned’ in childhood (‘racket feelings’) they are deemed ‘maladaptive as an adult means of problem-solving’ (Stewart and Joines 1987: 6, 209). People engage in games, according to TA, to ‘further their life script’ (Stewart and Joines 1987: 244). This ‘life-script’ is understood as something akin to a self-fulfilling prophecy or ‘unconscious life plan’, formed in childhood but maintained thereafter in order to prevent re-experiencing the unmet needs and fear of abandonment present at the time of the script’s formation (Berne 1961: 123; Stewart and Joines 1987: 100, 101-102).

TA advocates behavioural diagnosis as a means by which to detect ego-states, games, and so on; it is also employed to reveal a tendency towards ‘discounting’ (‘selectively ignor[ing] information… relevant to the solution of a problem’) and ‘redefining’: misrepresenting reality to ensure it conforms to the life-script (Stewart and Joines 1987: 39, 5, 173). Similarly, ‘drivers and miniscripts’ (‘’I’m OK as long as I… am perfect, please others, etc.’’), brought into play via the negative Nurturing Parent ego-state, can be exposed as further indicators of dysfunctional, self-defeating patterns of behaviour (Stewart and Joines 1987: 164, 167).

The avowed therapeutic goal of TA is to strengthen the Adult ego state, to allow for ‘one’s full contactful capacity for engagement in meaningful relationships’ (Erskine and Moursund: 21). The extent to which this objective is consistent with that of CBT is the subject to which I now turn.

CBT is not a single therapy, but instead a generic term for at least sixteen approaches to psychotherapy (Kinsella and Garland 2008: 2; Neenan and Dryden 1999, cited in MacInnes 2003: 53). Its origins lie both in the behaviourism of Pavlov, Watson and Skinner, in the early part of the 20th century, and in the Rational Emotive Therapy (RET) pioneered by Albert Ellis in the 1950s (Rachman 1997; Sanders 2002: 22-24; Ellis 1975).

From a behaviourist perspective, human personality and behaviour – however complex – can be understood in terms of conditioning and ‘basic learning principles’ (Sanders 2002: 24). Consequently, emotional distress and behaviour disorders are ‘viewed as learnt maladaptive patterns and not as symptoms of a presumed underlying cause’ (Davies-Smith 2006: 28). For Ellis, meanwhile, the source of self-defeating behaviour lies in our ‘cognitions’: thoughts, beliefs and assumptions. This ‘cognitive principle’ can be traced to ancient Stoic philosopher Epictetus’ maxim, ‘Men are disturbed, not by things, but by the principles and notions which they form concerning things’ (Westbrook, Kennerley and Kirk 2007: 5). The subsequent synthesis of behavioural and cognitive principles arose from an understanding that behaviour is ‘crucial in maintaining – or in changing – psychological states’ (Westbrook, Kennerley and Kirk 2007: 5).

Ellis developed the A-B-C model (activating events, beliefs, emotional and behavioural consequences) to explain how irrational beliefs (B), not adverse events (A), are largely responsible for precipitating distressing emotional consequences (C) (Ellis 1962; Ross 2006). This cognitive approach was elaborated by Aaron Beck in the 1960s and 70s (Beck 1967, 1976; Beck at al. 1979). Beck identified ‘cognitive distortions’, or, ‘thinking errors’ (e.g. selective abstraction, arbitrary inference, dichotomous thinking) as the vehicles for ‘negative automatic thoughts’ (NATs). In the case of depression, these spontaneous negative cognitions are directed towards the self, the world and the future (the ‘negative triad’) and take the form of ‘hopeless and self-critical thoughts’ (Jarvis and Russell 2002: 37-38).

‘Dysfunctional assumptions’, or, ‘rules for living’ describe the second level of cognition (Kinsella and Garland 2008: 8). Often inferred from behaviour, dysfunctional assumptions are encapsulated in conditional, ‘if… then…’ statements, such as, ‘If people get to know me, then they will find out how useless I am and reject me’ (Westbrook, Kennerley and Kirk 2007: 8-10). These rigidly held assumptions may have evolved ‘in order to maintain self-esteem and a sense of safety’, and yet ‘living up to’ them, as a protective measure, will ensure that low self-esteem lies dormant at the third level of cognition: negative core beliefs (‘I am a failure’, ‘people are not to be trusted’) (Kinsella and Garland 2008: 8-9).

Through thought-challenging and behavioural experiments (to test the validity of cognitions), these maladaptive core beliefs can be modified, according to CBT, leading to a reduction in self-defeating behaviours and excessive emotional arousal (Kinsella and Garland 2008: 104). This is the goal of CBT.

Notably, despite their roots in, respectively, Freudian psychoanalysis and the behaviourist reaction to Freud, TA and CBT overlap considerably (Sanders 2002: 15; Westbrook, Kennerley and Kirk 2007: 2). Thus, by ‘playing games’, according to TA, ‘we are following outdated strategies’ (Stewart and Joines 1987: 244). This is surely comparable to the notion that dysfunctional behaviours are determined by maladaptive core beliefs. Furthermore, ‘drivers’, ‘miniscripts’, ‘redefining’ and ‘discounting’ all appear to correspond to the dysfunctional assumptions evident at the ‘second level’ of cognition, as conceptualised in CBT.

A shared orientation towards psychotherapeutic practice is also demonstrable, through the role of the contract between therapist and client, a cornerstone for both TA and CBT and their collaborative, goal-oriented approaches (Stewart and Joines 1987: 260-265; Beazley Richards 2008). That a therapeutic approach entitled cognitive behavioural transactional analysis (CBTA) has begun to emerge in recent years only confirms the continuity between the two theories (Beazley Richards 2008). Moreover, just as advocates of CBTA believe that TA should be included under the therapeutic ‘umbrella’ of ‘cognitive behavioural therapies’, Steiner (2005) argues that TA ‘is essentially a cognitive behavioural theory of personality’ (Beazley Richards 2008).

Notwithstanding its adherence to behavioural diagnosis, TA ‘retains an interest in the psychodynamic aspect of the personality’ (Steiner 2005). However, the influence of Freudian theory on CBT is less readily acknowledged. Briers (2009: 4) credits Beck with ‘giving Freud the slip’, after the latter (working as a ‘classical’ psychoanalyst) first became aware that patients were behaving in accordance with pre-conscious automatic thoughts. Yet Beck himself has noted Freud’s ongoing influence on cognitive therapy, in relation to, for instance, ‘modes of cognitive processing’ (Beck 1993: 19). We can concur with Freud – and Berne – that, in terms of the psyche, ‘a great deal occur[s] behind the scenes’ (Steiner 2005). Yet, for the purposes of this essay, we can also conclude that, just as TA remains to the fore in exposing and modifying negative core beliefs concealed by self-sabotaging life-scripts, CBT also remains centre-stage in its endeavour to strengthen the Adult ego-state.

References

Beazley Richards, J. (2008) ‘Cognitive Behavioural Transactional Analysis’ [online]. Available from: http://www.psychologytools.org/assets/files/ TA_CBTA.pdf [27 June 2012] Beck, A. T. (1967) Depression: Clinical, Experimental and Theoretical Aspects. New York: Harper & Row Beck, A. T. (1976) Cognitive Therapy and the Emotional Disorders. New York: International Universities Press Beck, A.T. (1993) ‘Cognitive Therapy: Past, Present and Future’. Journal of Consulting and Clinical Psychology. 61(2), 194-198 Beck, A. T., Rush, A. J., Shaw, B. F. and Emery, G. (1979) Cognitive Therapy of Depression. New York: Guilford Press. Berne, E. (1957) ‘Ego States in Psychotherapy’. American Journal of Psychotherapy. 11(2), 293-309 Berne, E. (1961). Transactional Analysis in Psychotherapy: A Systematic Individual and Social Psychiatry. New York: Grove Press. Berne, E. (1964) Games People Play. New York: Grove Press Briers, S. (2009) Brilliant Cognitive Behavioural Therapy: How to Use CBT to Improve Your Mind and Your Life. Harlow: Pearson Education Davies-Smith, L. (2006) ‘An Introduction to Providing Cognitive Behavioural Therapy’. Nursing Times [online], 102(26), 28-30. Available from: [20 June 2012] Ellis, A. (1962) Reason and Emotion in Psychotherapy. New York: Lyle Stuart Ellis, A. (1975) A New Guide to Rational Living. Englewood Cliffs, N.J.: Prentice Hall Erskine, R.G. and Moursund, J.P. (1988) Integrative Psychotherapy in Action. London: Sage Gildebrand, K. (2001) ‘Transactional Analysis’. Counselling and Psychotherapy Journal. 12(5), 28-29 Harris, T. (1967) I’m OK, You’re OK. New York: Grove Press Heathcote, A. (2010) ‘Eric Berne’s Development of Ego State Theory: Where Did It All Begin and Who Influenced Him?’ Transactional Analysis Journal [online]. 40(3-4), 254-260. Available from: [19 June 2012] International Transactional Analysis Association (ITTA) (2012) ‘History of Eric Berne, Founder of Transactional Analysis’ [online]. Available from [18 June 2012[ Jarvis, M. and Russell, J. (2002) Key Ideas in Psychology. Cheltenham: Nelson Thornes Kinsella, P. and Garland, A. (2008) Cognitive Behavioural Therapy for Mental Health Workers: A Beginner’s Guide. London: Routledge MacInnes, D. (2003) ‘Evaluating an Assessment Scale of Irrational Beliefs for People with Mental Health Problems’. Nurse Researcher. 10(4), 53-67 Neenan, M. and Dryden, W. (1999) Essential Cognitive Therapy. London: Whurr Rachman, S. (1997) ‘The Evolution of Cognitive Behaviour Therapy’. In Clark, D., Fairburn, C.G. and Gelder, M.G. Science and Practice of Cognitive Behaviour Therapy. Oxford: Oxford University Press, 1-26 Ross, W. (2006) ‘What is REBT?’ REBT Network [online]. Available from: http://www.rebtnetwork.org/whatis.html [21 June 2012] Sanders, P. (2002) First Steps in Counselling: A Students’ Companion for Basic Introductory Courses. Ross-on-Wye: PCCS Steiner, C. (2005) ‘Transactional Analysis: An Elegant Theory and Practice’. The International Transactional Analysis Association (ITAA) [online]. Available from: [18 June 2012] Steiner, C. (2006) Detailed History and Description of Transactional Analysis [online]. Available from < http://www.ericberne.com/transactional_analysis_ description.htm > [24 June 2012] Stewart, I. and Joines. V. (1989) TA Today: A New Introduction to Transactional Analysis. Nottingham: Life Space Publishing Totton, N. (2010) The Problem with the Humanistic Therapies. London: Karnac Westbrook, D., Kennerley, H. and Kirk, J. (2007) An Introduction to Cognitive Behaviour Therapy: Skills and Applications. London: Sage