Integrating psychodynamic and cognitive approaches

The evidence I think supports a framework in which psychodynamic and cognitive behavioural approaches together make for effective delivery. To oversimplify, it appears that psychodynamics are useful in order to understand a human problem and to inform the creation of a facilitating environment, whilst cognitive behavioural approaches provide tools for intervention and change. This makes sense of the way in which cognitive behavioural interventions display better outcomes than psychodynamic interventions on the one hand, and of the evidence that the way in which interventions are applied is of more significance for positive outcomes than the nature of the intervention itself. The quality of ‘argument’ between worker and client is informed by psychodynamic insights and the focus of the ‘argument’ by cognitive behavioural approaches.

At the same time as my understanding was becoming more flexible and responsive to the evidence, I was also taking a particular interest in attachment theory. The next group of posts reproduce an article I published about this time in my career.

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Integrating different approaches

Closer to the front of my mind at the time was the realisation that my adoption of a rather conventional ‘psychodynamic v cognitive behavioural’ paradigm was unnecessary. It was as if the hostility of much of the cognitive behavioural world had ‘suckered’ me into adopting an equally unhelpful hostility to cognitive behavioural approaches that were in truth better evidenced. Surely the truth was that each added to each other. In fact of course, there was in practice no choice between the way of looking at the work that I had adopted and the delivery of cognitive behavioural programmes. No-one went on an alcohol education group or a Priestley / Maguire programme for a number of sessions in isolation. Programmes of this kind were at that stage always delivered in the context of often a 2 year community supervision order, and the individual supervisory process that sat alongside the programmes was always in theory at least, seen as an important part of the change process. Its job was seen as reinforcing the learning that had taken place in the group programme.

Freed from the need to take sides between psychodynamic work on the one hand, and cognitive behavioural programmes on the other, my notion of change became less one dimensional. Looking back, this process can almost be seen as discarding another layer of that passionate certainty that goes with adolescence – a maturational step. It took me into a new phase in which I became interested in how different dimensions of and approaches to work could be integrated to lead to a more effective model of working. This sense of the importance of integration has informed the second half of my professional career and it will recur in a range of guises in what follows.

Struggle to integrate psychodynamic work into offender supervision 3

My irritation at such trivial dismissals of what seemed to me to contain so much wisdom, led me to resist many of the alternative approaches to work with offenders that became fashionable. However, when I felt that the kind of group work my team had been running was not sustainable, a different kind of accommodation began with more cognitive and behavioural approaches to the work.

As I describe this shift in thinking from the distance of 30 years, it seems so obvious that it is almost strange to write it down in this way. The first stage was to decide that there was no point in letting the best be the enemy of the good. If the kinds of ‘in depth’ work we were doing could not in practice be sustained, why not do something that was still useful although limited that could be sustained. After all, there was evidence that approaches such as alcohol education groups were useful even if not life changing.

Maybe other perspectives about change were in the ‘atmosphere’. Why imagine that change was a singular intense process akin to the bereavement process? The metaphor of chaos theory, with the fluttering of the butterfly’s wings in the Amazon changing the weather patterns in Europe, found expression in the Sunday supplements. Why should personal change, reduction in re-offending etc not be brought about as much by a combination of all kinds of small factors, such as the butterfly wings of a 6 session alcohol education group as by a deep therapeutic experience?

Struggle to integrate psychodynamic work into offender supervision 2

I think that I was also aware of a not entirely honest process of re-writing and describing social work history to suit a dismissal of psycho dynamically informed ideas about change. From the time of my entry into the profession, psychodynamic approaches to the work seemed to attract hostility and I always felt at odds with the prevailing fashions in this respect. The fashionable argument was that social work and probation in particular had been dominated by a kind of Freudian psychodynamic ideology. Shoplifting as a sexual offence was the sort of interpretation that was mocked. A more materialistic approach was preferred – shoplifting was about money and a reflection of poverty and inequality. It was in fact not easy to find these quasi-Freudian practitioners in the probation service at a time when there was a significant tradition of mature recruits often from the forces – not the most obvious recruiting ground for the psycho-analytically inclined.

The material realities of what actually happened between probation officer and client did not really come into the equation when such a neat theory of historical progression in which the radical new could rebel against the ‘establishment’ old, was available. There was the other convenient component of this theory of the new, that I mentioned when discussing the importance of history taking. This, encouraged I fear by many of those interested in psychodynamic work and adopted wholesale in popular descriptions of counselling on TV, saw psychodynamic work as a search for the unconscious feelings and wishes that were believed to drive neurotic and troubled behaviours. This search was characterised it was believed by an attempt to interpret current behaviour in the light of past traumas, which if brought to consciousness would release the individual to a life of greater maturity freed from the destructive problems that had brought them to trouble or breakdown. This was the extension of the shoplifting as a sexual offence ‘joke’ to the ‘shoplifting was caused by being fed on the wrong breast as an infant’ joke!

Struggle to integrate psychodynamic work into offender supervision 1

In the 1980s, alcohol education groups seemed to be the favoured option for tackling offending behaviour that was linked to alcohol misuse. I had been thoroughly uninterested in them until the realities of delivering more ambitious psycho dynamically informed group work seemed to be too demanding for my team to sustain. My lack of interest was not I think without some reason. When I thought of the complexity and depth of problems that lay behind the offending of most of my cases as a young probation and social work practitioner, how could I take seriously a proposition that six to ten meetings which included essentially rather simple educational content, would turn people’s lives around. Also it seemed that people offended under the influence of alcohol for reasons of some personal intensity, concerning feelings of self worth, ambition, shame, anger etc. Group work input that told people about the physical and psychological impact of units of alcohol seemed a ludicrously over simple response.

Drawing from psychodynamic approaches – sex and the unconscious

Sex

Nothing has been more susceptible to ridicule than the Freudian preoccupation with sex and its manifestation through symbols. Occasionally probation officers have tentatively made links with some criminal behaviour, most notably shoplifting by middle aged women. It has however become less and less respectable to take such connections seriously.

Where rapists and sex offenders are encountered, emphasis is placed on issues of power and aggression rather than sexual feeling. Certainly in the world of offenders, potency is a crucial subject, or rather impotence is a central experience of their place in the world, and the need to achieve a kind of potency that integrates sexual and social identity seems to me a vital aspect of probation work. I apply the term ‘potency’ to both male and female clients, though I am treading dangerous ground here with some.

One of the most striking phenomena in the development of the Probation Service over the past thirty years has been the growing importance and presence of women staff. Focus on the styles of management has involved tensions between what are perceived as ‘macho’ cultures and ways of exercising effective power that are more ‘feminine’. Women managers have grappled with these tensions, and those that have had the courage to eschew a kind of anti-culture, a ‘sisterhood’ that in practice depends on male power for its existence, have had to tolerate some isolation and frustration.

The kind of practical down to earth no nonsense probation officer is likely to see these sorts of reflections and connections as so much eye wash. Poverty and unequal material comforts are much more central for them. Decent welfare benefits and employment opportunities are much more important than fanciful Freudian self indulgent preoccupations with sexuality. The irrational and unconscious are overlooked in favour of a rational materialism that finds an echo in enforcement rules in national standards of supervision. ‘Overlooked’ is probably too weak a word for the exclusion of the irrational and libidinous aspects of people from formal policy making – there is more than a hint of repression at work.

The unconscious

Taking an interest as I do in some modern literature, it is striking to me how much the concept of the unconscious has become a literary concept. This era of ‘what works’ being cognitive / behavioural highlights the absence of interest in the unconscious in probation work. Literature takes its existence and power for granted – the unconscious is woven into almost any writer’s way of understanding peo

 

Psychodynamic approaches and tackling offending

Fighting crime

It is time to recover this slogan from the politicians. One of the dangers of the use of educational techniques in social work is that we transform the offender from ‘patient’ into ‘student’. The probation officer finds the ‘teacher’ role an attractive one. The guru, Miss Jean Brodie, the favourite college tutor – these tantalising images seem to offer the prospect of working in harmony with the offender towards a better future, with the teacher holding the authority and knowledge that s/he imparts to the lower status student. As with schools however, the difficult pupil becomes a threat to this positive fantasy. Schools are tempted towards over-selectiveness and exclusion; probation led groups are similarly tempted. Where the difficult offenders are contained in the group, the leaders can feel the fights are a sign of failure – ‘if only those fights could be avoided, the group would be able to do some real work’ can be the feeling.

A different framework is possible:

  • The fighting of adolescence is essential and healthy in the normal growth to maturity – it is how people learn.
  • The evidence about poor prognosis of offenders who conform to their ‘treatment’ in prison and on probation suggests that fights can be a sign of hope not failure.
  • A fight with the probation officer is after all evidence that the officer matters, and is likely to be more memorable in years to come than in a relationship marked by bland conformity.
  • An offence, by its nature, represents some kind of fight with society, better to have it out than for it to continue as a secret life of the offender

This should not be seen as a rejection of educational techniques in work with offenders but as an example of the way we should approach such techniques as social workers not as aspirant teachers. After all, for most of the offenders, ‘ordinary’ teaching has not been enough.