People go to therapy for all sorts of reasons. Often, it will be because you are unhappy, and want to be happier. However, if you look at the range of diagnoses on offer, you may notice that, often, there is a subtle focus: your behavioural deficits. I want to argue in this article that this difference in focus is unhelpful. Moreover, I suspect that, by focusing on defining the client as deficient, mental health professionals miss a trick, and act against the client’s best interests.
THE REASON PEOPLE SEEK PSYCHOTHERAPY
I suggest that the overwhelming reason people seek therapeutic help, is because they are suffering (and, by implication, want to be happier). When I have used psychotherapy in the past, it has almost always been because of unhappiness, whether through loss, or endemic depression, or prevalent anxiety. As a trained therapist now, I notice the same pattern. People seek my help if their issue is making them unhappier than they feel they should be.
In contrast, people do not generally seek therapy for bad behaviour per se. If it makes them unhappy, then yes they do… but very few clients have turned up and said: I am extremely happy, but I have noticed that I behave badly towards others.’ Perhaps they should! – but they don’t.
So, in general, people seek therapy to cure unhappiness.
THE REASON PSYCHOTHERAPISTS LABEL BEHAVIOURAL DEFICITS
Anxiety Disorder. Attention Deficit Disorder. Bipolar Disorder. What do these terms have in common?
They all include the idea of disorder: that, somehow, the client is disordered in mind or body; that the client is not as they should be; that something is wrong with the client’s behaviour.
An exception is depression. Although some professionals talk of depressive disorders, most people seem to leave depression as an implied state, and not so much as a behavioural disorder. Perhaps this is because depressed people tend not to be viewed as making a nuisance of themselves; their frequent absence and quietness may protect them from such labelling.
I suggest there are three main reasons why professionals seek deficit labels for mental health issues:
It fits the business model of the drug and insurance industries. The professionals need to justify their existence, not to the client, but to the people buying their goods and services for the client. ‘Making people happier’ is just not good enough. ‘Curing a deficit’ is what is needed to justify funding.
It fits the business model of a ‘profession’. Profit is easier to make if you can (a) specify what it is you do, and (b) make yourself the only person who can do it. What better, in the field of mental health, than to come up with a list of behavioural deficits, and then create an expert team specifically trained to cure or mitigate those deficits?
It fits the desire of control regimes to control individuals. Often, concepts such as population productivity are cited as reasons to invest in mental health services, as if happiness were not enough, and producing goods and services were an end in itself.
A CHOICE: HAPPINESS THERAPY VERSUS DEFICIT THERAPY
I’ll put my cards on the table: I believe that deficit therapy is frequently pernicious, destructive. I believe it limits clients when we should be enabling each other. I believe that current patterns of diagnosis are limiting and insulting to human potential. I believe that disorders are often cited to make professionals look good, rather than to help clients.
In contrast, I am more in favour of offering therapy as a tool to enhance the client’s personal happiness. The wish to be happy is such a motivational force, that professionals are silly to underplay it.
THE FUTURE OF PSYCHOTHERAPY
I think a radical overhaul is required. Instead of deficit labelling, we could redefine almost all of the labels in terms of ‘obstacles to happiness’.
Instead of a ‘don’t do that’ message, I would like to see an ‘I would like’ invitation. What would the client like to do next? Where would they like to go? How do they see themselves being happier? What are the obstacles to that happiness? What understandings, experiences and techniques might help the client to achieve happiness?
Imagine a world in which, for instance, instead of ‘I have an anxiety disorder,’ a client says ‘I have a wish to be calm, because I think it may make me happier.’ Where, instead of ‘I have attention deficit disorder,’ a client says ‘I have a wish to focus more, because I think it may make me happier.’ Notice how the positive framing brings light to how the client wants to develop, and not how the professional wants to control the client.
Most people seek counselling and psychotherapy to become happier. The current framework of mental health diagnosis has a different focus: profits for insurance companies, drugs companies, the mental health profession, and government.
I would encourage us all to get rid of deficit labels, and instead develop forward-looking terms which take as their inspiration the client’s wish to be happier. There is no greater motivation in therapy than a client’s wish to be happy. The language of psychotherapy needs to reflect this.