To what extent can counselling help with economic depression?
One of the things there is consensus about where I work in healthcare is that counsellors can do something about depression.
But depression has more than one contemporary usage and we seem now to be mixing them up. A lot of my clients are suffering with economic depression. Debt, unemployment, bankruptcy and service withdrawal have been stalking the surgery over the last year and their impact is growing. In Scotland, clinical depression is twice as prevalent among the poor (CPAG, 2011).
I have a client whose main motivation for attending is a warm place to go; others whose appointments have to be arranged to coincide with days they must use the costly local bus service anyway; a man whose ability to eat is based on his ongoing volunteering at a local church... Meanwhile, the news tells me that most of us will have an effective 10 per cent income cut over the next year, the poorest being again differentially more severely affected.
When I listen to these clients’ stories I leave with a sense of heaviness. What help is counselling with this?
Perhaps my heaviness comes from censoring myself. We live in one of the 10 richest countries in the world, which lectures other governments on how our democracy is the correct solution for their social problems, while the gap between the rich and poor here steadily increases. Our government blames the poor for not finding work, or describes them as a ‘feral underclass’ if they steal. I don’t say any of this to my clients…
It seems to me that non-directivity and solidarity are not easy to combine. I guess if I were more congruent I would be angry at what I hear. Would this help? It would help me, but what about my clients? There’s a great risk of being patronisingly naive, maybe even contradictorily disempowering.
However, one of the ways I may help with depression is to engender hope. There are some studies that suggest hope is the business in counselling; clients often improve even before they reach their first appointment. Hopelessness is one of the most prevalent and pervasive symptoms of depression.
What gets people up again? Recognition; caring from others; a sense of agency in adapting to their situation or in changing it… I think this is the challenge for me now. If, as I believe, currently policy is happy to create an underclass, we need to work with our clients to boost their resistance to that definition of themselves.
It will not be pretty to hear but I must not censor. The narratives I hear will have more monotony, more fractures, more anger, more envy (including of me) and more bitterness. Each individual has the potential to ask themselves ‘can something good come of this’? And I believe they can only do this if someone has first heard what they believe is preventing them.
What I need, like my clients, is recognition. I can’t imagine the current ethos of instrumentalism will recognise my efforts, any more than it wants to see inside the heads of my clients (unless they are rioting).
I know I need help and encouragement to think and write in this way, and that in writing this I make class-based analyses and appeals. My hope is that I can find this amongst the counselling community, but I need to hear congruence from others – that they are disgusted or angry about what is being done to our society and they are intent on opposing the effects of this on the most vulnerable
© British Association for Counselling and Psychotherapy 2011.