The paper which was delivered to the Fourth Annual Conference of the Counselling Psychology Section of the British Psychological Society, held at Regent’s College, London, 18-19 September 1986.
Does counselling work?
This question matters to everybody who might spend time or money on counselling, and it seems at first sight to be a matter of fact, like: ‘Does this key fit that lock?,’ or ‘Is this the right bus for Clapham?’
Questions of this sort can sometimes be difficult to answer, but the principle is simple; we just have to see whether the key does open the door, whether the bus does get us to Clapham. In this paper we shall be contending that the question whether counselling works is not like these at all. It is more like asking: ‘Should the workers support socialism?,’ or ‘Is Jesus the only way to God?’ It is not at all a simply factual question but one which will receive different answers according to the ideology of the speaker. The proposition to be discussed is that psychology is not a unitary enterprise but one conducted in a number of different ways, and that our understanding of different approaches to psychology, counselling and psychological research is extended when they are related to the ideologies which appear in the Walsby theory of ideology .
Unlike other theories, which tend to regard ideologies as things to be got rid of, Walsby’s presents the major ones as functional constituents of any highly developed society. It distinguishes three ‘static’ major ideologies and three ‘dynamic’ ones; it indicates that we have to reckon with the continuing presence of these and their effects upon attitudes toward counselling among other things.
1. The first ideological position is that of ordinary practical life, largely unthinking and with a strong tendency to do what is convenient at the moment. What happens is not analysed, life is seen as very much a matter of chance and luck; certain charismatic individuals may for a while have a sort of ‘hot line’ to the sources of luck, but this can never be relied on for very long. So far as the structure of society is concerned the outlook is acceptant and fatalistic , goals tend to be personal, the area of moral concern seldom extending far beyond the immediate family and a narrow circle of close acquaintance.
At this point, sobering though it may be to face the thought, there is no attitude to counselling. The object here is to maintain the normal tenor of easy-going comfortable life for one’s immediate group; authority and convention are accepted as unquestioningly as gravitation; only if they interfere to an extent which makes resistance seem easier than submission will they be opposed. If a member of the family group starts to behave in disruptive ways this is tolerated so long as that is easiest. If the behaviour becomes intolerable then it is dealt with in the way that seems likely to cause minimum disturbance to the group, emotional disturbance to other members being one consideration. The sufferer is maintained in the group, or incarcerated, or subjected to treatment, or killed, the method selected being the one expected to be easiest overall, taking into account among other things the perceived likelihood of social disapproval and its consequences. With this ideology the dominating feature of behaviour is expediency, and if a counselling type of teeatment seems the best method of restoring the comfortable, accustomed course of life – if, for example, submitting the sufferer to therapy or a counselling programme satisfies troublesome authorities – then this kind of treatment is accepted; if not, not. At this point the concept of research into goals or anything else, the idea that there are problems to be solved and relevant information to be accumulated, is meaningless.
2. The second position involves the development of principle; not in the sense in which we speak of Aristotle’s three laws as principles of logic but rather in the sense that a Tory politician will speak of the principles of his party. Principles here are not abstract but tied to a particular social tradition and culture which is to be maintained by them. The actions of a person in a state of mental distress are here judged not so much by their effect on the immediate group as by their departure from socially-accepted norms, and as there is a standard of ‘proper’ behaviour so also are there proper ways to deal with those who, in one way or another, fail to conform to it. Some go into jail, others into therapy; the division between the two, being conventional, is never sharp and is constantly shifting. The previous attitude, of expediency, is not eliminated – principles can never decide every detail – but it comes to be suppressed, largely relegated to decisions considered trivial. At this stage the therapist or counsellor appears as the equivalent of the priest, a person of superior wisdom wielding social authority. The family solicitor giving his advice, the family doctor issuing his orders, these are the models to which the counsellor is expected to conform; the patient, correspondingly, is expected to obey. At this stage the object of counselling is adjustment of the individual to comply with society. Because principles are so important here, social adjustment itself is seen in terms of established standards of good and bad, rather than in terms of personal impact .
At this stage of development neither psychology nor counselling is recognised as a specialised function. They are both parts of government, of education, of religion, of medicine, of philosophy. The psychologist as scientist is more likely to be seen as a comic or evil than as a benevolent figure, and practical psychology as properly belonging to the master politician – part of his role, part of his charisma. Likewise the good teacher, the good policeman; good practical psychologists both.
In Walsby’s theory a major feature of the transition from one ideology to the next is the repudiation and repression of the characteristic features of the previous one, the assertion against them of the newly-developed features. This second stage strongly emphasises principle and repudiates expediency (while continuing to behave expediently over a wide range of actions which, being regarded as trivial, do not disturb the repression). But the principles now asserted are not precisely formulated, the tendency here is not to think critically and develop one’s own principles, but to accept the conventional, socially-approved ones – loyalty, patriotism, honesty and so on – and oppose these to that restriction of concern to the interests of oneself or one’s immediate group that dominates the first phase. Here duties are taken seriously, among others the duty of securing for the mentally-disturbed the best (i.e. most socially-approved) form of treatment.
This ideology finds expression in (among other things) the established, authoritarian, paternalistic or maternalistic religions; as one appearance of the importance accorded to principle the effort is made to establish a firm distinction between the sacred and the secular, the sacred corresponding closely with the socially-accepted while independent thinking, enquiry, research that goes deeper than the accumulation of facts, are decidedly secular. In any conflict between the words of the authorised masters and research findings it is the words of the masters which will carry more weight.
At this stage research into the outcomes of therapeutic activities tends to be accepted or rejected as it confirms or disproves accepted attitudes; the religious conception of orthodoxy versus heresy is relevant.
3. In the third position the dominant features are precision (strictly, the search for precision) and multiplicity (the two are of course associated; precision often requires the breaking-down of a whole into its parts). Here concern with broad general principles is supplanted by the search for exact laws, the effort is to establish standards more accurate and enduring than the shifting ground of social convention. Here science appears, science in the sense of a search for precise knowledge and certainty; therapeutic ability ceases to be a matter of personal wisdom and experience and becomes something to be learned from textbooks, a technique. It is particularly at this stage that the patient comes to be regarded as a ‘case,’ to be treated not in accordance with the traditional wisdom gathered over long years, and still less in the easiest way that comes to hand, but according to precise rules which are expected to produce predictable results. It is here that chemotherapy, with its connotations of accurate dosage and its connections with physical science, bulks largest.
The search for precision leads to the avoidance of broad, sweeping generalisations; here goals tend to be limited and specific. The conception is of a number of problems to be solved (rather than of applying socially-approved remedies) and consequently it is here that research comes into its own, the assumption being that the big, general issues can be dealt with by breaking down each of them into a number of small, precisely-formulated problems. Here ‘building-brick’ science appears, expecting to produce knowledge by layer upon layer of observation and experiment, with all variables tightly controlled and a careful avoidance of broad, general conclusions.
In relation to the natural world this ideology appears particularly as the assumption that the physical universe is constituted of a multiplicity of independent particles, in religion as the multiplicity of churches, chapels and theologies presented by non-conformism, in politics as classical Liberalism with its conception of society as composed of independent competing individuals, and in the academic world in the production of monographs and papers on highly specific subjects.
Here psychological research is seen as requiring control groups, randomization of assignment, standardized measuring instruments and highly specific statements of aim.
Here therapy or counselling is seen as the effort to correct this or that specific disability, as it were to break down the totality which is a person into parts and to deal with each one separately; only in this way can precise goals be established and precise results be presented.
This is the last of the three ‘static’ ideologies, all of which tend to accept authority and convention, although it is only the first that does so unthinkingly, the second tending to require that they justify themselves on traditional grounds and the third that they be precisely specified.
These stages are very different one from another, any two of them being even in some ways contradictory; adherents of any one tend to repudiate the other two. But one thing is common to all of them; they all assume that counselling has a definite objective. It may be the re-establishment of the previous condition, it may be a return to conformity, it may be the elimination of particular disabilities, but each of these approaches assumes some standard, established by powers outside the therapeutic relationship, by which the outcomes of counselling may be evaluated. In the context of any one of these, the authoritarian/conventional group of approaches, the concept of therapy in the sense of cure, with its implication of an accepted norm, is valid and relevant.
It is time now to move on to the second, the ‘dynamic’ group; where the first group tended toward an acceptance of authority and convention these favour criticism, independent thinking, reform and (toward the extreme) revolution or subversion; their most familiar appearance is on the political field, but they also appear in other areas, research in psychology and counselling among them.
4. The first of the approaches constituting this second group begins by repudiating the conception that the function of therapy is to ‘cure’ this or that particular disability, assuming instead that the function of the therapist or counsellor is to permit or encourage the development as a whole of the person being treated. On this assumption there can be no fixed objective standard by which success is to be judged and accordingly the concept of cure becomes largely irrelevant; what is now sought is open-ended development. As a corollary to this the concept of ‘the patient’ comes into question. If there are no objective, universal standards, then it cannot be said that this or that person is in need of treatment; it can only be said that there are individuals, some of them happier and displaying a wider range of behaviour than others but all, potentially at least, capable of development. And as ‘the patient’ disappears from the scene, so also does ‘the therapist,’ at least in the sense of an authoritarian figure, possessing arcane knowledge, whom the patient is to obey. Now the assumption is of two social equals, the one hoping to benefit from the specialization of the other, and it is recognised that the relationship is, partly at least, reciprocal; they are investigating a problem together and the (former) therapist may learn as well as the (former) patient.
At this stage the process comes to be seen as more interesting than its outcome. At stage 3 the concern was to obtain specific results, and to that ideology the idea of counselling as an open-ended process of development not aimed at any foreseen end looks like an evasion, a ‘flight into process.’ And, conversely, those who accept the fourth, the developmental concept, tend to speak of the preceding outlook with its lack of interest in process as a ‘flight into outcomes;’ it is one aspect of the reciprocal repudiation that is prominent in relations between ideologies.
Part of this repudiation has to do with the notion of connectedness. This particularly applies in the social sphere where, at this fourth level, there is an awareness of how the therapist is personally involved, of how the client’s family may be involved, of how the community may be involved in the process. Here humanistic counselling first appears, with its emphasis upon the difficulty of evaluating outcomes and, indeed, even of specifying them. If the whole process of social evolution or progress as well as personal development is involved, the question arises – ‘What is concluded, that we should have the right to come to conclusions?’
At this stage psychology has taken another turn. People at this level are often quite undecided whether to redefine science or repudiate it. Those who want to repudiate it point to the multitude of research studies conducted in the empirical tradition  and use dismissive words like “scientism” to describe them. Those who want to redefine it point to the wide diversity, of things which are actually done by scientists  as opposed to the formal requirements laid down in the textbooks.
5. Matters get even more difficult when we come to the second of the dynamic outlooks. This second group of attitudes is associated with criticism and reform; when attention is turned towards the type of reform required it is quickly found to be connected with the emergence of a particular concept of individuality. Individuality here is not, if we may use a paradox, purely an individual thing; it is a social phenomenon and its development entails tension with the society from which the individual emerges: To declare oneself an individual is to declare that one is more than just a member of society – but to declare it to society. It is at this point in the range of approaches to therapy that Freud’s work stands, with its constant awareness of tension between individual impulses and social constraints, constraints intimately connected with the development of individuality. As psychoanalysis was coming into recognition there was a continuing splutter of attempts to relate it to Marxism, an undertaking irrelevant if not repugnant to any authoritarian approach. Here the therapist, far from being a representative of social authority, tends to come into conflict with it, even to the extent that his work may be seen as subversive or obscene.
It has to be recognised, however, that while in his discoveries and his theorising Freud was operating by an reformist or revolutionary ideology, when it came to organisational matters he showed the authoritarian tendencies we (following Walsby) have presented as characteristic of the second ideological position. This is sometimes regarded as a personal oddity, Freud presented as being, for all the revolutionary effects of his work, himself a Victorian paterfamilias, but it goes deeper than that and the explanation of it lies in what has been said above. The innovator who attempts to establish his work or to have it accepted as authoritative has no option but to behave much as Freud did, for establishment and authority are features of the authoritarian/conventional group of ideologies, not of the dynamic group. Freud’s effort was to found a school of psychoanalysis with himself at its head and it was a determined, long-continued effort, It ran counter to the reformist, even subversive, implications of his work and, as is well known, many of the people who made substantial contributions to psychoanalysis found themselves compelled to break with Freud in order to maintain the individual liberty necessary for such work. The presence in Freud of two clearly distinct ideological tendencies emphasises that a person is not to be simply identified with any one ideology. Ideologies are social products rather than personal ones; people do not so much have certain ideologies as behave in certain ideological ways, and the people who have developed the more sophisticated ideologies do not consistently act in accordance with them but use the simpler ideologies for the simpler affairs of life – and the organisation of a school is a simpler matter than original research into the human psyche.
The emphasis of this fifth ideology is again on process, but now on process of a particular sort, not (as in the previous one) on smooth, gradual, evolutionary development but on discontinuous process, contradiction and revolutionary change, progress through step-jump transitions , qualitative leaps. Counselling comes to be seen as a process involving or entailing such a developmental leap, and the tendency at this level is to see just one such leap as the aim. So there is a great emphasis on the concept of a breakthrough; the expectation is that the person being treated will suddenly burst through the limitations that have been hindering development. In practice there is always more than one breakthrough, but each one feels like the final one .
At the previous stage the idea, held by the authoritarian / conventional group, that counselling entails bringing the patient into line with society, was replaced by the idea of open-ended development. Taking this ‘open-endedness’ seriously entails the conception of society being reformed to comply with the developing individual; successful counselling produces reformers. At this fifth stage it comes to be held that it is not enough to treat people, that the existing social structure is the cause of the sufferings people undergo and, therefore, this structure itself needs treatment. And the only therapy capable of overcoming the resistance it offers is revolution. Successful treatment of individuals now does not bring them into harmony with existing society but, on the contrary, turns them into revolutionaries (though not always directly political revolutionaries); people who are not revolutionary are suffering disabilities and need treatment. The counsellor or therapist, who began as an authoritarian figure enjoying social approval, now produces work which causes him to be seen by the establishment as a disturbing influence to be discountenanced and, in the extreme case, actively suppressed; the treatment of Wilhelm Reich seems to have been influenced by this attitude.
6. The third of the dynamic approaches is the resolution of this tension in favour of the individual, but now an individual conceived as very different from the individual member of a family group and, almost incidentally, of a society, with which the series started. The individual of this phase is, in the fullest sense of the term, a social individual. The tension between individual and society being here resolved in favour of the individual, present society comes to be regarded as an impostor which, by preventing the free development of individuality, prevents also the establishment of a real society. It is authoritarian society that causes all the troubles and sufferings and disabilities of people and the only effective course of therapy is its abolition. On this conception existing society offers no goals worth striving for; the only result any constructive effort can have is to strengthen an oppressive system. This is of course the ideology of anarchism, and here the counsellor or therapist merges with the anarchist .
Having sketched, in the briefest possible outline, the different attitudes toward therapy arising from the different major ideologies, it remains to say something about the relations between them. The standard approach here would be to ask which was the right, or the best, approach to therapy, but Walsby’s work suggests that this question is about as useful as asking whether top or bottom is right, or whether animals are better than plants. The dynamic ideologies have developed out of the social complex of which the authoritarian/conventional ones were a part, and this cannot reasonably be regarded as a mere accident. The later condition was implied in the earlier one, and this being so a return to a society which operated wholly on the authoritarian/conventional ideologies, with corresponding therapies, would be a return to the conditions from which emerged the reformist/revolutionary ones.
Such a reversion is unlikely to be envisaged by the people encountering this essay; more plausible to them is perhaps the idea that the critical ideologies favouring independent thinking are coming to displace the authoritarian/conventional (or at least that it would be well if they were to do so), but this concept is as one-sided and inadequate as the other.
The dynamic ideologies are preoccupied with social relationships, seeing these as the significant restrictions upon individual freedom. But the reformist / revolutionary movement, in therapy as in other fields, is itself a feature of society, in fact of sophisticated, highly-developed society, and the maintenance of this requires a degree of control over the environment (organic, inorganic, human and social) that is not to be achieved casually or incidentally. The presence of a reformist/revolutionary movement, in psychotherapy, in counselling or in other connections, presupposes the direction of effort and attention toward the environment – that is to say, away from matters internal to the social group, such as restrictions upon liberty of thought and political action. Therapists and those they treat have to be fed, and the people concerned to keep society supplied with food are not the reformers but those who, having their attention turned outward, toward the environment, tend to accept the limitations imposed, upon them and others, by society. If the reformers and revolutionaries oppose this activity they are trying to cut away the ground on which they stand. We have to expect a continuation of the broad outlines of the present state of affairs, with the people supporting critical independence, both counsellors and clients, in a minority and a smaller minority as they become more extreme in their views. It can be said, both of societies in general and of specialised undertakings such as psychology, that any with a preponderance of reformers or revolutionaries, and hence with the greater part of their energy and attention directed inward, toward criticism, reform and revolution, would be unable to maintain themselves against their environment. We may ourselves feel sympathy for the dynamic ideologies, but elimination of the authoritarian/conventional approach is not one of the available options; its maintenance, in counselling as elsewhere, is a condition for the continuing existence of the critical and reformist. It is the authoritarian/conventional ideologies that establish and maintain, both in society generally and in specialised social activities such as psychology, counselling and psychotherapy, the substance which the dynamic ones strive to reform and revolutionise.
Is this all we can say? No, because it is evident from our outline that research into the outcomes of psychotherapy, like psychological research in general, is highly concentrated into one ideological framework – that of the third of the positions mentioned above. Why is this?
Walsby’s theory posits relations of magnitude between the groups respectively identified with the different ideological approaches, the tendency being for numbers to diminish as one moves along the range in the order in which we have presented them. He did not directly speak, in this connection, of different approaches to research in psychology or counselling, but if these approaches are, as we have suggested, each the appearance, in this specialised field, of one of his major ideological groups, then we would expect the third to bulk largest in the universities, the research institutes and the professional journals, and this is what happens. The first and second do not engage in research (except in the sense of looking up facts already established). They are present and preponderant, but do not appear as distinct functions, having to be sought rather in the daily life of staff and students and in that “practical psychology” constantly used (nearly always in an unconsidered way) by instructors in lecture rooms and laboratories.
This general tendency for numbers to diminish as one moves along the range does not “just happen.” It operates through particular features of the behaviour of the different groups, and some of the features supporting the prominence of the third group can be specified. This group is much concerned with measurement and anything that exists can, in principle at least, be measured; this approach to psychology has not only humanity but the whole of animal behaviour as its field of study. It tends to break a problem down into a number of smaller ones, an approach which tends both to multiply research papers and to produce definite solutions which can be claimed as successes.
The fourth ideology tends to produce, in the psychological field, a concentration upon human beings and an insistence that they must be treated as persons, the behaviour of each of them (sometimes of each family) taken as a whole, not broken down into separate parts. This has the result that no firm or final solutions can be hoped for. The third approach can hope to build up a corpus of reliable knowledge, of established facts, but the fourth is dealing with subject-matter that cannot, even temporarily, be fixed without falsifying it. This is one of the features tending to keep this approach less influential and prominent in academia than the third; the number of academics, as of people generally, willing to engage in an activity where results are always questionable and transient is smaller than the number seeking definite achievements. And with the fifth and sixth approaches this tendency is still more marked, with a consequent further reduction in the size of the group pursuing the activity.
Each major ideological group, in psychology as elsewhere, has its own approach, its own problems, its own evidence and its own justification. The enterprise of psychology, taken in its fullness, is the totality of these. People are physical objects responding in a measurable way to stimuli, they are emotional beings intimately related one to another in unquantifiable ways, they are members of society who suffer from its limitations. No one approach is, in any general or overall sense, better than the others, each of them is the best one by the standards of the ideology advancing it and each of them tends toward the benefit of human beings, either directly or by way of facilitating the operation of the society in which they live. Psychology is a universal concern taking different forms in different ideologies. Each form articulates the ideology producing it, to the adherents of each ideology its own form appears as the real or essential form.
The expressions, in the field of psychology, of the first two ideologies are merged in with.the general life of society, it is the third which is the first one to appear as a distinct function; after the fourth psychological theorising tends to get taken up into theories of society generally (witness Freud’s concern with Civilisation and its Discontents). The main disputation specifically in connection with research in psychology takes place between the third ideology and the fourth. One of us has been deeply involved in this controversy , and it would be wrong to pretend otherwise, but the point being made here is that neither of these ideologies (nor any one of the others) possesses exclusive validity. There is more than one type of useful result, more than one research tradition, and more than one way of studying human beings.
Psychology, the study of the reasons why human beings (and, in some applications, animals also) behave as they do, is a universal interest and is therefore a field within which each major ideology finds expression. To the extent that any one tends to exclude the others it is restrictive, limiting the value of psychology. And what is true of psychology is true also of psychotherapy. Even though some approaches to research in psychology would discountenance use of the term, to the extent that they are directed toward human well-being they are all, in a broad sense, psychotherapeutic. If we want a substantial answer to the question whether counselling works we have to take each and all of them into account.
1. There are succinct accounts of this theory, with further references, in Zvi Lamm’s paper ‘Ideologies in a hierarchical order; A neglected theory‘ and in George Walford’s paper ‘Systematic Ideology,’ in Science and Public Policy for February 1984 and February 1983 respectively. Also in Walford’s An Outline Sketch of Systematic Ideology 1977, pamphlet, privately printed, available from the author.
2. Material relevant to this appears in the work of Brim, McClosky, Harvey and others, with comments in Chapter Four of John Rowan’s book The Social Individual (Davis-Poynter 1973).
3. This ideology is well described in Peter Viereck (1950) Conservatism Revisited (London: John Lehmann) and also in Michael Fogarty (1957) Christian Democracy in Western Europe (London: RKP).
4. A good account of this concept is to be found in Chapters One and two of Tom Boydell & Mike Pedler (1981) Management self-development Gower, Press, Farnborough. See also Chapter Nine of John Rowan’s The Reality Game, Routledge & Kegan Paul, 1983.
5. John Rowan (1982) ‘The concept of a breakthrough’ Self & Society Vol.10 No.6.
6. Sidney Jourard (1968) Disclosing man to himself says – ‘I prefer to see psychotherapists as responsible anarchists.’
7. The epitome of this sort of thing is Garfield & Bergin (1978) Handbook of psychotherapy and behaviour change: An empirical analysis, New York: John Wiley & Sons which runs to some 1024 pages of research studies. See also Brown & Lent (1984) Handbook of counselling. psychology, New York: John Wiley & Sons.
8. Ian Mitroff (1974) The subjective side of science: philosophical inquiry into the psychology of the Apollo Moon Scientists, Amsterdam: Elsevier; see also the very interesting treatment in Mitroff & Kilmann (1978) Methodological approaches to social science: Integrating divergent concepts and theories, San Francisco: Jossey-Bass.
9. Peter Reason & John Rowan (1981) Human Inquiry: A sourcebook of new paradigm research, Chichester: John Wiley & Sons.
10. John Heron & Peter Reason and others (1981) Co-counselling: an experiential inquiry, Bath University: Centre for the Study of Organizational Change and Development.
from Ideological Commentary 24, November 1986.