from an article I read at :
Research by the University of Warwick and the University of Manchester finds that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money.
Chris Boyce of the University of Warwick and Alex Wood of the University of Manchester compared large data sets where 1000s of people had reported on their well-being. They then looked at how well-being changed due to therapy compared to getting sudden increases in income, such as through lottery wins or pay rises. They found that a 4 month course of psychological therapy had a large effect on well-being. They then showed that the increase in well-being from an £800 course of therapy was so large that it would take a pay rise of over £25,000 to achieve an equivalent increase in well-being. The research therefore demonstrates that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money.
Governments pursue economic growth in the belief that it will raise the well-being of its citizens. However, the research suggests that more money only leads to tiny increases in happiness and is an inefficient way to increase the happiness of a population. This research suggests that if policy makers were concerned about improving well-being they would be better off increasing the access and availability of mental health care as opposed to increasing economic growth
Spread the word!! - getting your own therapy makes great financial sense.
Great news!!
Fascinating! Agreed - must spread the word! Thanks for posting this and the link David
Thank you for posting this David. As well as being interesting, although not that surprising to therapists, the article is an excellent marketing tool.
Evidence
Hi David,
You refer to this article:
Which you quote from:
Research by the University of Warwick and the University of Manchester finds that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money
This article uses the term psychological therapies. I assume this term includes counselling, psychotherapy as well as (and distinction from) psychological therapies (sometimes also described under the catchall term of "psychotherapy") that come out of behaviourist models (of which there are three waves that come from: behaviourism, cognitive behaviourism and mindfulness).
The three waves of behaviourist therapies have an increasing and significant body of evidence both in terms of testable theory from Skinner boxes, CBT to mindfulness. This is unlike other forms of "talking therapies" which, to a greater or lesser extent (counselling to a lesser extent, psychotherapy heavily dependent), upon a relationship between the therapist and the client.
It is the non-behaviourist therapies that have, as I understand, no evidence base (so far as would be acceptable in a clinical model of describable intervention for a specific diagnosis with a measurable outcome). And it is these therapies that, I would understand, as being termed "counselling and psychotherapy." (Of course this does not mean that counsellors or psychotherapists cannot and do not employ behaviourist treatments in their practice when they see fit to do so but these approaches are not exclusive to these practitioners.)
Now, I am in no way suggesting that counselling and psychotherapy are not useful. I am just pointing out that it makes a nonsense to regulate them in a clinical context because the do not fit the clinical model of efficacy.
Norbu
The three waves of behaviourist therapies have an increasing and significant body of evidence both in terms of testable theory from Skinner boxes, CBT to mindfulness. This is unlike other forms of "talking therapies" which, to a greater or lesser extent (counselling to a lesser extent, psychotherapy heavily dependent), upon a relationship between the therapist and the client.
Hi Norbu,
It is no longer widely accepted that the clinical model you mention has any relevence to counselling or psychotherapy as practiced now.
It is true that there is a huge amount of evidence that CBT in particular is effective, and it has been done in a way that had convinced NICE that CBT was the therapy of choice. Criticisms of this research are that much of this evidence covers short term interventions, and ignore the typically higher "drop-out" rates that occur with behaviourist therapies. This is, in fact, a way of sifting your clients so that only the most motivated are measured, which will greatly skew the data, of course.
The studies that have been done comparing CBT with other therapies have been unable to demonstrate any significant difference in effectiveness. NICE now is more open to other modalities of therapy, although it is a little uncomfortable with the vagueness, the lack of clear definition, and, yes, the subversiveness of therapies generally.
A problem with studies which look at improvement measures for specific diagnosed conditions is that most counsellors don't diagnose. This is indeed one of the tick-box criteria mentioned by the HPC, that the ability to diagnose should be a box ticked by "psychotherapists" as opposed to "counsellors." However it seems to be true that the ability to diagnose is independent of the success of the therapy. Those who begin with a diagnosis are no more successful with clients than those who don't. Sheldon Kopp wrote as an American psychotherapist that DSM style diagnoses were really just to convince the insurance companies that something medical and reimbursable was going on, and when I did sessional work involving DSMiv diagnosis with a clinical case manager it had that surreal "what shall we call this" quality. The clinical diagnosis has little to do with the way the therapy is done, or the measurable outcome.
All attempts to show that the ability to diagnose is a predictor of the outcome of therapy have failed. All attempts to demonstrate that one type is therapy is per se better than another have failed. What has shown consistently across all therapies to be a predictor of outcome is the subjective measure of participants of the quality of the relationship.
Skinner's methods are no longer used, are they?
Hi David,
It is no longer widely accepted that the clinical model you mention has any relevence to counselling or psychotherapy as practiced now.
Had it ever been "accepted" that clinical models had any relevance to counselling or psychotherapy? And surely that means it's impossible to regulate clinically.
It is true that there is a huge amount of evidence that CBT in particular is effective, and it has been done in a way that had convinced NICE that CBT was the therapy of choice.
That's because it fits the clinical model: diagnosis, causal theory, definable intervention and measurable outcome. In contradistinction to counselling and psychotherapy.
Criticisms of this research are that much of this evidence covers short term interventions, and ignore the typically higher "drop-out" rates that occur with behaviourist therapies. This is, in fact, a way of sifting your clients so that only the most motivated are measured, which will greatly skew the data, of course.
I understand this is one reason why clinical psychologists are increasingly interested in mindfulness (third wave behavioural therapy).
All attempts to show that the ability to diagnose is a predictor of the outcome of therapy have failed.
I take this to mean that where a study has compared therapists who diagnose and those who don't there is not difference in therapeutic benefits delivered. However, to show there is no difference you still need to compare like with like so a diagnosis would then have been given by a third party where a therapist is unable to give that diagnosis. Am I right in assuming this?
A problem with studies which look at improvement measures for specific diagnosed conditions is that most counsellors don't diagnose. This is indeed one of the tick-box criteria mentioned by the HPC, that the ability to diagnose should be a box ticked by "psychotherapists" as opposed to "counsellors."
Yes you would have a problem in comparing like with like if there is no diagnosis! Unless, of course, a third party does the diagnosis in the study.
Those who begin with a diagnosis are no more successful with clients than those who don't.
I assume in this study there was a diagnosis given by a third party to enable like being compared with like? I might suspect that those who don't diagnose would have better outcomes as they are more likely to be dealing with a person not a set of symptoms!
Sheldon Kopp wrote as an American psychotherapist that DSM style diagnoses were really just to convince the insurance companies that something medical and reimbursable was going on, and when I did sessional work involving DSMiv diagnosis with a clinical case manager it had that surreal "what shall we call this" quality.
I guess that's not a surprise!
The clinical diagnosis has little to do with the way the therapy is done, or the measurable outcome.
That's part of the problem... or isn't it?
All attempts to show that the ability to diagnose is a predictor of the outcome of therapy have failed.
I've no doubt you're right but there are two possible/probable reasons for this depending on the design of the survey: 1) You can't measure the outcome if there is no diagnosis? 2) or if the survey design includes comparisons between diagnosed cases but that they are diagnosed by a third party (in the group where the therapist does not diagnose) compared to those diagnosed by the therapist, this, indeed would indicate that ability to diagnose has very little to do with what is really going on.
All attempts to demonstrate that one type is therapy is per se better than another have failed.
Again, how can you compare therapies that don't diagnose?
What has shown consistently across all therapies to be a predictor of outcome is the subjective measure of participants of the quality of the relationship.
This is very interesting and makes a lot of sense but what about MBCT (Mindfulness Based Cognitive Therapy) where there is "no relationship" constructed as a part of the therapy. It's a psychological treatment but it's mindfulness training delivered to a group.
Skinner's methods are no longer used, are they?
Did Skinner ever develop any therapies? However all beahviourist theory and therapy has built upon work done by him and others.
I personally believe that behaviourism is very limited in its value apart from it being a theoretical base for cognitive behavioural theory out of which second and then third wave behavioural therapies have emerged. From my point of view there is very little that works outside of the application of wisdom and love. In the case of a wise and loving therapist, this I believe, is what does the "healing." In the case of the third wave of behaviourist therapies (mindfulness based therapies) it's about teaching a participant skills that enable them to develop these elusive qualities. And the fact that this has come out of clinical/behaviourist approaches is a bit like finding gold buried under a poor man's house.
Norbu
Hi Norbu,
you don't compare like with like, because of the difficulties with deciding what "like" looks like. Instead, you compare your entire output.
Core offers a facility so that you can compare your outcomes with various types of client in terms of ethnicity, sex and age, and also presenting problem, so you can look at how your outcomes are always better with middle-aged white men, for instance.
I think that the way mindfulness has been brought in as a therapy is a great idea: meditation plus therapy has always been a great way to move on.
Had it ever been "accepted" that clinical models had any relevance to counselling or psychotherapy? And surely that means it's impossible to regulate clinically.
Exactly. But it isn't stopping them trying! Actually, clinical regulation of the profession takes place in supervision, where a part of the supervisor's job is to guide and support the practitioner in their work with clients. But that, of course, isn't good enough for the government, who want regulation by an independent body (influenced heavily by them).
Blimey!
Core looks like it could cause a bit of an upset! I don't know about the system but it could really stir things up if you start to compare the outcomes of one practitioner with another.
When it comes to teaching mindfulness (which is teaching meditation) this could be very interesting. This is because MBCT or MBSR group training does not depend on developing a therapeutic relationship between trainer and participant.
Clearly some trainers are going to be more effective than others. (I guess there has to be some kind of measure of confidence in the statistics used but) it will be phenomenally difficult to work out what causes a difference of outcome between one trainer and another.
I wait with a great deal of interest as this "intervention" becomes more popular!
Norbu
but it could really stir things up if you start to compare the outcomes of one practitioner with another.
Oh, it's been happening for a while. Of course it takes some time for results to be significant statistically between, say, two practitioners, and it hasn't been adopted in schools of counselling that I know of, but comparing 100 person-centred counsellors with 100 psychodynamic psychotherapists is relatively straightforward, and you already know what the results are.
In fact, many believe (with a fair evidence base) that using outcome measures EVERY SESSION and bringing the results into the sessions makes therapy much more productive. It cuts down the unspoken relationship which is one of the tricky things to bring out in one-to-one therapy. For instance, its really difficult to say "I hate you" to a therapist (or a client, come to that!) and using outcome measures gives the client that opportunity to have their say. That is a conscious example, there are unconscious things that happen as well, of course.
Let's cut to the chase, Norbu! I've read some of your stuff on here, I know where you're coming from. I would assert that the outcome of therapy depends on the quantity and quality of the energy that manifests in the counselling space, and on the ability of counsellor and client to have a good enough relationship (and technique) in order open up the darkness sufficiently for that energy to get in to do its work. It is basically a form of healing, like Reiki, where the counsellor just works with the client on allowing the tight defences to loosen enough for the energy to get in and do its stuff. The research done by the early therapists, reported by Rogers in "client-centred therapy," was eloquent about the success of therapy conducted in total silence, but that's often overlooked now.
Meditation/ mindfulness work in exactly the same way, I would suggest.
And I would never ever go to a therapist or supervisor who did not have a fair few hours as a client in their past, and now have a definite established spiritual practice -- I've tried it and it taught me not to do it again. But I've been lucky, by and large. I'm convinced that the more personal and spiritual work the counsellor or meditation teacher has done, the more effective the therapy/meditation will be for the client/novice.
As Jung famously said, "we don't become enlightened by imaging figures of light, we become enlightened by making the darkness conscious." For conscious, read mindful, if you like!
I'd like to know how they intend to regulate that. Probably want to co-opt an Archangel to the standards committee.
...erm... I'm not sure about Archangel Michael, I expect he's already quite busy.
My personal view is that some much of what is said is merely a game to allow some kind of reconfiguring to take place. I do think there is some kind of energetic activity going on. I think it comes out of things like integration, embodiment, congruence, harmonics, resonance... This can be within and individual, activate between two or more people. And yes a lot of the healing process is about coming to lovingly accept and transform that which we have run from or project as negative, internally or externally.
Some interesting things may come out of work looking at meditators and neuroscience. Perhaps work looking at energy fields (electromagnetic radiataion) will also gain more funding in time. Then you might be able to correlate outcomes with these patterns. Perhaps we won't need Archangel Michael's help in regulation then.
When it comes to "mindfulness," I do believe that it is a very good programme, but I think it is probably not much good if it isn't taught by an experienced practitioner. Even fairly gross things like phraseology and body language can give the game away. But I'm also pretty sure that energetics of the space is held by a strong practitioner and the resonance of their presence is a most significant influencing factor on the outcome for participants in the group. Then this is magnified by the group "consciousness" as well.
What is amaising is that "mindfulness" has become accepted within cognitive behaviourist model and testable under clinical parameters as an intervention. It is the most wonderful of trojan horses but its contents must remain hidden for a while yet I think.
Sometimes it is felt and it is something that is just completely outside of normal references - whatever it is.
Norbu
but I think it is probably not much good if it isn't taught by an experienced practitioner. .... But I'm also pretty sure that energetics of the space is held by a strong practitioner and the resonance of their presence is a most significant influencing factor on the outcome for participants in the group. Then this is magnified by the group "consciousness" as well.....Sometimes it is felt and it is something that is just completely outside of normal references - whatever it is.
Absolutely. A "view" is needed for the mindfulness practitioner to really become integrated behind the therapy, I think.
I agree about the "Trojan horse." Therapy IS subversive, at its best and most effective.
Hi David,
Therapy IS subversive, at its best and most effective.
I think this is a very interesting point. Having a Buddhist inclination I tend to avoid making statements about what "IS." There are two reasons for this. The first is that there is always and exception to any case or set of conditions that is being described and secondly, on philosophical grounds, language cannot function ontologically (that isn't the way you're using the word here I know - from a Buddhist philosophical perspective, the only ontological function language can have is to designate an object of negation - to set up a straw man).
Now, having said this much, I am happy to use language nominally for a function in this respect. In this respect I prefer to use the words "wisdom and love" as having a deep causal function. From my point of view, when we are talking about subversion we are talking about the fact that healing takes place when a delusion is broken or dissolved. From my point of view "dissolving" an obstacle is preferable to "subverting" it although often subversion is part of the process but this, in my opinion, is obly incidentally so.
And in some cases "subversion" is the most skillful means available but if a practitioner's motive is based on a dualistic model of control upon a blocked or delusional state of consciousness than needs to be subverted, then there is likely to be trouble. In my opinion, there is a way through this with power. This is about bringing a non-judgmental curiosity and openness of mind with qualities of compassion, loving kindness and empathetic joy into the dynamic. Key to this is a well-developed mindfulness practice of the practitioner. This is about the practitioner watching their own sensations, feelings and thoughts with the same qualities. They are working on their own experience, they are not trying to influence the "other" party. Via a process of entrainment, a dynamic arises that results in a natural process of unfoldment for all parties, including the "scarob" beetle that flies into the window.
So long as the consciousness of subject and object is maintained - self and other - there is just manipulation and nothing really changes. When division that arise out of designation is let go then there can be space for a shift.
Norbu
Hi Norbu,
thanks for your reply.
It helped me to realise that therapy isn't subversive. Therapy seeks to allow the client to explore their own lives, and to shine a light on what they are doing, so that the client can come to make their own choices about if, and what, they want to be different. Often, that choice comes about with a lightening-flash of insight, rather than a list A vs list B kind of choosing, but both have their place.
A lot of ruminating, sleeping on, brooding, journal writing and thought goes on both during and between sessions (not so much sleeping, but you get my drift.)
It sounds like mindfulness to me, but not always with any formal "sitting."
Having reconsidered, ruminated, slept on, brooded, journal wrote and thought about your comments 
, It's clear to me that if there is anything subverting the consciousness of the client, its the consensus reality thought of as "normal" in our culture.
Hi David,
It's clear to me that if there is anything subverting the consciousness of the client, its the consensus reality thought of as "normal" in our culture.
Yes I think that's often the way it is for us. Else, it's habitual processes and patterns expressed by an individual, which is powerfully shaped by consensus reality and social conditioning. Yes, it is these mindless habits, social and individual, subvert and enslave.
Having reconsidered, ruminated, slept on, brooded, journal wrote and thought about your comments...
I hope not too much ruminating! At least, in the cognitive behavioural model of depression, rumination is heavily implicated. Mindfulness is a lot about not ruminating.
It sounds like mindfulness to me, but not always with any formal "sitting."
Clearly there are similarities that bring similar qualities of mind to the process but perhaps the key element of mindfulness is bringing attention to bodily sensations and developing a little distance from "thinking." (Modern living leads to too much attention on language/conceptual processing.) As I understand it, language based thinking locks up many other brain functions. When we relax our attention on language based thinking other neurological functions can get on with their job. This is best achieved with the adjuvant of qualities of mind like gentleness and curiosity.
Becoming more aware of the bodily sensations (these are largely proprioceptive and probably also related to sensations that arise from the autonomic nervous system) has an effect on what comes into the field of awareness. What comes into awareness can be painful sensations, emotions or experiences. The practice is about approaching what is painful in experience non-judgmentally and with gentleness and curiosity. But always going back to the body for an anchor and to relax held tensions. So this acts to settle the mind and release further somatic memories. (I believe this is very much how it works, but this is a little outside mainstream clinical psychology.)
And, I believe, it is the experienced practitioner that leads the practice that models a mindful state of mind in the guided practice. It works, I believe, because participants are affected via gross and subtle entrainment processes.
Any narrative content that comes up in enquiry (dialogue phase of training) is only of interest in the context of the training as a means for encouraging the participants to look at sensations and emotions that might be associated with it. This is quite different from therapy.
However, I do think there may be potential for an exciting cross fertilisation between developing mindfulness methodologies and therapy processes. As ever, any system has to define itself against other systems and I hope that the behaviourist pedigree of Mindfulness Based Cognitive Therapy doesn't become too much of an authodoxy.
I suspect that mindfulness practice could perhaps have its greatest benefit in the therapy process where therapists develop mindfulness practice and then bring that into their practice as a therapist. For example, when you listen or sit with another it's possible to pick up all sorts of stuff and sometimes this is best mediated by observing bodily sensations. Developing a mindfulness practice increases potential for this type of sensitivity. In addition the mindfulness practice keeps intuitive sensitivity grounded.
Norbu
Yes, Norbu,
Agreed, particularly the bit about levels of entrainment - a great way of describing the process.
BUT
I hope not too much ruminating! At least, in the cognitive behavioural model of depression, rumination is heavily implicated. Mindfulness is a lot about not ruminating.
This is a redefinition of a perfectly good word by so-called psychologists who have no idea what it means! Ruminating is where bovines move about their last good meal inside their digestive systems, so that it can be re-enjoyed and further digested in a relaxed way. For cows, ruminating is the essence of mindfulness!
I notice that "brooding" also has a negative connotation. Without any trace of irony, Wikipedia links it to rumination. In the Western Mystery Tradition "brooding" is used to describe a reverie over a symbol, out of which a meaning is "Hatched."
Why all this redefinition? Aren't there enough good words already?
Hi David,
Why all this redefinition? Aren't there enough good words already?
Thus, it ever was.
I notice that "brooding" also has a negative connotation. Without any trace of irony, Wikipedia links it to rumination. In the Western Mystery Tradition "brooding" is used to describe a reverie over a symbol, out of which a meaning is "Hatched."
The interesting thing is that social conditions change and with changing social conditions language changes. I suspect that depression is not so very common in hunter gatherers for example and hunter gatherers live in quite a different world to we human beings today.
For cows, ruminating is the essence of mindfulness!
I think that much of what mindfulness is, is behaving more like an animal in a relaxed state. At least, a great deal what is damaging about thinking is imagining conditions that cause stress. Much of what healing is about is letting go of the patterns of destructive thinking and letting the body get on with the job of nourishing itself.
I think the art of wholeness is choosing to think when it's useful and being able to let go of thinking when it isn't. Two skils are needed for this: knowing when thinking is useful or not useful; and then being able to think or not think as appropriate. This does imply an intelligence that is not dependent on thinking but can know when to employ thinking as a tool when it is useful.
Norbu