Levelling the Land: The Topography of Inequality
Ashley Stokes, Learning Mentor at Sheffield Hallam University (Casual Worker)
Before I start, I want to thank Alison O’Connor for writing her post on equality, and for inspiring the creative urge in me to flesh out my thoughts and share my experiences.
It is poetically melancholic that I walk through my estate, into more affluent suburbs, to the detached house of my counsellor, to explore the damages that inequality brings. I come from a background of poverty, and I pay a counsellor for the opportunity to make sense of the effects these experiences have had on me and my family. This includes how these experiences have shaped me in such a way that makes it difficult for me to work. The issue is that I need money to pay for counselling, but it is counselling, itself, that allows me to feel capable enough, resilient enough, and optimistic enough to work, to get the required funds to pay. I have encountered a few hiccups, from practical limitations such as a lack of access to a car limiting my options, to the psychological, such as my identity being heavily rooted in constantly changing obsessions, and a struggle accepting that work may just be a means to an end. This cocktail of practical and psychological hindrances has meant my working life has often been unstable, with frequent job changes, and a struggle persevering with the stress of full-time work. Regardless, I am lucky enough to navigate roles that do not feel like a threat to my survival. But I often reflect on this situation, and I always reach the same conclusion: if seeking counselling has been financially troublesome for me, what is it like for people who struggle even more? I am lucky that I can sometimes find work, and with periodic help from universal credit I have kept my head above water. So, what is it like for those who need counselling just as much, likely more than I, but cannot access it? I see this in my world, and I imagine you all do too, and on a much greater scale.
It is precisely this dilemma that exposed the strings of my mind for Alison to strike chords with, of both the major and minor type. So, after reading and reflecting on the post over the past months, I decided to discuss the cost of private counselling with my counsellor. And their reply, understandably so, was that one must balance their outgoings; and counsellors invest time and money into their career, and thus provide a valuable service worthy of its cost. I expected this reply, but I have found it hard to suppress the sour taste in my mouth since. I should not feel so bitter. I am lucky in many ways. At first, it was easy to target my frustration at the human level, to think this sour taste was a gift from a specific individual. But I soon realised my counsellor is constrained to the system in which they operate. This is not their fault. There is an entire landscape in which this happens, with people who could benefit immensely from counselling, those known personally, those imagined, but who nonetheless cannot find the means to access it, and practitioners wishing not to be caught in such internal ethical turmoil. This disorientation that all involved must feel, navigating the topography of inequality, is another symptom, of many, that our current system needs to change.
There is a second dilemma, another mountain in this daunting landscape, which occupies more of my mind lately. How do those people who are under-represented in the counselling profession access the resources to train to become one? Here I speak from experience. The jobs I am intrigued by, and the career path I wish to pursue, are all locked behind costly accreditation processes. In my case, I was very fortunate to stumble into university. I could lie and say this was an educated move, but I did it to momentarily escape my estate. I also acquired a Master’s degree, one I pursued for the same identity issues I face now (obsessive interests that constantly change, shaping who I think I am and my corresponding thoughts about the future). I learnt many things during my Master’s, but I no longer belong to this field. Herein lies the problem. How can I fund my studies if my income pays for counselling to be stable enough to work in the first place? I understand that, personally, I must grapple with the permanence of decision. But this feeling of confusion, as before, led me to reflect. How many others have a desire, or a set of skills suited to becoming a counsellor, but are limited in their capacity to pursue this route? Who is available to ask for guidance? Do charities offer support or funding for those wanting to become counsellors? I imagine these problems are likely more complex than I understand and that, to my untrained eye, I must only be capable of seeing the tip of the iceberg. This is one reason, of many, that I decided to write this post: selfishly, to learn and to find answers!
A greater reason, however, is my growing frustration with the individualisation, stigmatisation, and hyper-medicalisation of mental wellbeing. No doubt, these perspectives are birthed by the obsession with oppressive and impersonal market solutions to our every problem. Yet, the pluralistic tribe are likely united in the understanding that solutions actually ought to acknowledge the unique environments in which each individual exists. This is why it seems, at least to me, that the pluralistic approach is best equipped for facilitating this change in the realm of therapy. The practice recognises that ‘psychological difficulties may have multiple causes’ and it is precisely this stance which allows the approach to consider adjustments for clients with socioeconomic disadvantages, and to continue the fight for social justice. A respect of Otherness is only as useful as its capacity to help others. In this sense, the capacity to help those with socioeconomic disadvantages is rooted not just in the therapeutic approach that is used, but in the landscape too. What I mean by this, is that a dialogue with a client about whether a CBT, or person-centred, or another approach may be preferred is brilliant, but in what way does this address a client’s socioeconomic background? These discussions lose their effectiveness if the client cannot overcome their limitations in accessing this service to begin with.
To refer to my own experiences, I can also highlight how the socioeconomic tapestry from which a client is woven influences the therapeutic process itself. Often it feels like I cannot ‘waste’ my time during therapy. There is an invisible metronome forcing me to make sense of my feelings faster. I must make progress in those special 50 minutes, simply because I am paying so much for them. There is also a paranoid perversion of trust. When I mention my financial situation, but my counsellor cannot reasonably adapt (other than less frequent sessions), how can I shake the fear that I am nothing more than a source of income to them? These are certainly reflections of how I interpret the world and are in no way critiques of our client–therapist relationship. What I do want to highlight, however, is that it is the system that we are both constrained to that creates these problems. I feel pluralism can solve these, largely due to its squashing of one-size-fits-all methods. To me, it ought to follow that, formally, the same occurs with one-price-fits-all systems.
But what would this look like? The comments on Alison’s post are full of uplifting and inspiring ideas. Small changes may include a more formal framework for working with people with socioeconomic disadvantages. A component of this framework may include fostering discussion about income with clients and using this to discuss flexible pricing. This does not have to be a means-testing, bureaucratic nightmare, but simply another way of identifying potential causes of psychological distress and pre-empting potential hurdles in the therapeutic process. This may work in tandem with the brilliant suggestions of a co-operative, pooling funds to allow practitioners to offer their services to clients with financial hardships. With pluralism pioneering this adaptability, the formal adjustments when working with clients with socioeconomic disadvantages may be normalised in the practice, and another step could be taken to levelling the land.
Topographical alterations require seismic changes, made possible with, yes, intense, sudden happenings, but also with an accumulative tectonic creep: gradual adjustments, as a collective, over time. Pluralistic therapy can facilitate this. This is where the comments of Alison’s post were most uplifting to me. I am young and naïve, but I cannot shake the optimism when I see such examples of collective human compassion. I was gifted with a warm feeling of connection with others, even simply as a client of therapy, and everyone’s brilliant contributions communicated that we are a collective with a shared goal in mind. This shared goal, to me it seems, is no less than fighting for a more caring world, where therapy is accessible to all, and greater equality protects so many lives from the damages our current system creates. David Graeber, in The Utopia of Rules, wrote that ‘the ultimate, hidden truth of the world is that it is something that we make, and could just as easily make differently.’ This is an idealistic perspective, and one not intended for use in the realm of counselling. But when I experience the passion of likeminded people, with a collective interest in creating a more caring society, it just feels like the making of something different has already begun.
Image reproduced, with permission, from: https://twitter.com/clinpsych_ind / https://t.co/lRnSxZg92l
3 thoughts on “Levelling the Land: The Topography of Inequality”
I read your post with interest and would like to say l do offer clients a lower fee payment if cost is the problem. However l am also conscious of the huge stigma around personal finances for people and my offer is genuine and not subject to any criteria other than whether it is difficult for them to pay the full fee. There are also agencies here in Cornwall that offer 6 free sessions with a possible extension and a low cost agency that costs whatever the client can afford between £5 and £15 for unlimited number os sessions with regular reviews. As a counselling tutor l strongly encourage my students to recognise that clients come with their environmental. socio-economic, political and educational background and that they may not always see us we would like them to. Thank you for your article.
This is something I constantly struggle with in private practice and try to offer concessions for those on low income, keeping my fees as low as I can whilst still trying to earn a living wage, I balance this with sessional work with MIND, I think subconsciously this is my way of trying to remain ultruistic ? but asking for payment of fees from clients is something I don’t think I will ever feel comfortable with. Thanks for sharing.
Thank you for sharing Ash. Not only was this extremely thought provoking and honest but it also gave me hope for a better future.