Trauma & Art

Menopause: science and feminism

Part One

“The story I want you to remember is about value, agency, and voice and the knowledge to keep yourself in the best of health while demanding an equal seat at the table. That’s my manifesto.” Jen Gunter, MD

“It shouldn’t require an act of feminism to know how your body works, but it does. And it seems there is no greater act of feminism than speaking up about a menopausal body in a patriarchal society.” Jen Gunter, MD

Today’s post will be informed by Dr Jen Gunter’s book: The Menopause Manifesto. This is a topic I’ve been considering writing for some time, but kept putting it off. Actually, today’s post was going to be about psychometric tools, their pros and cons. However, my purchasing Gunter’s book brought this topic to the forefront. Her book is informed by science and feminism because as she notes feminism can help women see the biases in society and how these biases may have informed their own beliefs, which can enable them to reframe menopause not as a terminal event, but as another phase of life. I too can relate to a lot of what is discussed in the book, and also believe that it is time to finally de-stigmatize all natural developmental stages of life. Menopause is not an illness, nor should it be a death sentence. After all, we get to experience menopause and ageing in general only if we are lucky enough to still be around on this planet. It does have downsides like many other biological experiences, but it is one more evolutionary adaptation and part of the cycle of life. Gunter writes: “Menopause is not a disease. It is an evolutionary adaptation that is part of the survival of the species, like menstrual periods or the ability to suppress the immune system during pregnancy so the body doesn’t attack the fetus. Like these other biological phenomena, menopause is associated with downsides — in this case, its bothersome symptoms for some women and an increased risk of several medical conditions. But menopause also occurs while a woman is aging, so it’s equally important not to brush off every symptom as hormone related. It’s vital that women know about menopause, but also everything that is menopause adjacent, so they can understand what is happening to their own bodies, put that in perspective, and advocate for care when indicated.”

The absence of menopause from our discourse leaves women uninformed with serious consequences for their health and well being, reinforces ignorance and allows outdated beliefs form antiquity to continue influencing our way of thinking and view of women’s health, roles and value. I believe that knowledge can be empowering and that as a collective we have accumulated so much knowledge in so many areas and discovered so many amazing things that it is only fair for the wider public to be informed and educated, especially when it comes to things like our well being and the function of the human body. Gunter comments: “The absence of menopause from our discourse leaves women uninformed, which can be disempowering, frightening, and makes it difficult to self-advocate. Consequently, many suffer with symptoms or don’t receive important health screenings or therapies because they have been dismissed with platitudes like “This is just part of being a woman” or “It’s not that bad.” But the issues with menopause even go beyond these knowledge gaps and the medical neglect….”

There’s a chapter with the title The Knowledge Gap, in which Gunter claims that despite the universal nature of menopause, most women aren’t well informed about the symptoms, the physical changes, the medical concerns, or their treatment options, and that this information vacuum has been created by a toxic combination of medical providers being unable to meet the educational needs of their patients and medical misogyny, meaning medicine’s long history of neglecting women. She concludes that there is an additional matter of misinformation and even disinformation as the silence about menopause and the gaps in knowledge are exploited by various industries. The silence and taboo around menopause could be viewed as ridiculous if it weren’t for the negative consequences for so many women around the planet. The silence also keeps biases and inequality between the sexes in place and prevents women from receiving the medical care or support they need. Gunter writes: “The culture of silence about menopause in our patriarchal society is something to behold…. Apparently there is nothing of lower value than an aging woman’s body, and many in our society treat menopause not as a phase of life, but rather as a phase of death. Sort of a pre-death. What little that is spoken about menopause is often viewed through the lens of ovarian failure — the assertion that menopause is a disease that exists because women and their ovaries are weak.”

Gunter notes that menopause is puberty in reverse, a transition from one biological phase of ovarian function to another. She claims that although we manage to discuss puberty without framing it as a disease and framing being a child as the gold standard for health, we fail to do this when it comes to menopause. She adds that “Even though menopause is a universal experience for every woman with ovaries, who lives long enough, unlike puberty menopause is shrouded in secrecy. There is no menopause curriculum in schools, and providers rarely discuss it in advance.” Menopause doesn’t happen in a vacuum. This is the title and theme of one of the chapters in the book. Actually, as I discussed in the several previous posts nothing occurs in a vacuum. Our lived experience is situated and the result of many intersecting threads and causes. To begin with, Gunter explains that one of the complexities of menopause is that it happens as we age, and thus, sorting out hormone-related from age-related issues can be hard. For instance, she picks the issue of sleep disturbances during menopause to show how teasing out the root causes can become a medical Gordian knot. She suggests that the medical provider and the patient must ensure they’ve considered all the contributing factors and how they may be interrelated before assuming a symptom that develops during the menopause transition or during post-menopause as simply or truly hormonally related.

Then there are other layers of complexity.  As we age our health and how we age is not only related to the changes in our ovaries, but to everything in our macro-environment, like our diet, levels of exercise, stress, personal relationships, whether we’ve had children and if we have breastfed, etc. Additionally, we need to take into consideration various social determinants of health, like the socio-economic conditions in which people are born, grow up, live and work, which all affect health and quality of life. Gunter thinks of these factors as the microenvironment. She writes: “They produce unfair and preventable differences in health status via many mechanisms, such as lack of access to adequate medical care and education, unsafe work conditions, crowded living conditions, racism, and poor nutrition. How these socioeconomic factors affect health is complex because these are often intertwined and may be additive. Social determinants of health are linked to the age of menopause as well as many of the symptoms and health conditions associated with menopause.” Finally, another very important social determinant of health is exposure to childhood adversity, known as ACEs / Adverse Childhood Experiences (See more on ACEs in post 15/08/2019).  Gunter writes: “There’s a growing body of literature that shows adverse childhood experiences lead to many negative health outcomes by triggering a dysregulated stress response that affects the developing brain as well as the endocrine and immune systems.*** This is known as the toxic stress response, and it can have profoundly negative complications. Exposure to four or more adverse childhood experiences increases the risk of many conditions intertwined with menopause such as heart attack, stroke, sleep disorders, Alzheimer’s disease, diabetes, depression, and breast cancer. Trauma literally rewires the brain and the body.”

***In this week’s Being Well podcast (https://www.rickhanson.net/being-well-podcast-understanding-and-managing-stress) /Rick and Forrest Hanson discuss the various biological mechanisms involved in stress, how our endocrine system and nervous system respond to stress, the amygdala response, and the challenges presented by chronic exposure to it. They talk about the cumulative effects of chronic stress and allostatic load and why zebras and other mammals in the wild, for instance, don’t get ulcers….

The book also contains a brief history of menopause and how the word menopause was coined. Both narratives help us understand current realities. Gunter highlights the fact that medicine, like everything else, primarily existed to satisfy the needs (and hence secure the patronage) of the male elite who were likely not interested in the aging female body. Menopause was not recently uncovered due to increases in life span, as some like to believe, and symptoms of menopause have been recorded in Western medicine since the 1500s.  The loss of menstruation as a woman ages and an understanding that this signified an end of fertility is noted in ancient Chinese and Greek medical writings. Gunter writes: “Missed menstrual periods in ancient Greek medicine — the foundation that led to ancient Roman, Persian, Arabic, and then to modern Western medicine — were considered concerning as they were a sign of a potential fertility problem as well as a dangerous buildup of fluid. This helps to explain much of the ancient medical obsession with menstrual periods— many of the 1,500 pharmaceutical recipes in the Hippocratic corpus, 80 percent of them are related to menstruation.” Gunter claims that according to the thinking of the time, men were in balance with the world; however, it was believed that women absorbed excess fluid from their diet as if women were walking defective plumbing.

I will not refer to all the historical figures mentioned in the book.  One person mentioned is Dr Liébault, who was considered to be ahead of his time in many ways, Gunter writes: “While Liébault was clearly a medical Renaissance man with his observations about women’s health, most physicians of the day were hampered by their belief that women were an inferior version of men as well as by their lack of knowledge of female anatomy and a complete lack of understanding of menstruation.” In a nutshell, for many centuries menstrual blood was considered toxic, the cause of a vast array of illnesses and even though Western medicine was aware of the medical concerns experienced in the menopause transition, symptoms were viewed primarily as a consequence of retained toxins. Gunter adds: “Many medical textbooks from the time of De Gardanne were like his — short on medicine, but dripping with patriarchy.”  There were notable exceptions like the English physician, John Fothergill, who challenged these notions in his paper On the Management Proper of the Cessation of Menses in 1776. For him menopause was a normal progression.  Similarly, in an 1857 text, Dr. Edward Tilt, also didn’t view menopause as a disease.

The French physician Dr. De Gardanne coined the term la ménèspausie as a combination of two Greek words, μήνας or mois in French (month in English), and παῦσις or cessation in French (cessation in English), which he states is taken from παύω that he translates as je finis or je cesse— I stop or I cease in English. Gunter asks: And how might the word menopause affect what we think of the experience? She claims that the first problem is the word pause, which in today’s world feels negative given the general societal view that women should hold back or that they should diminish as they age. Another issue is that the end of menstruation is a symptom, not the cause, and focusing on the final menstrual period ignores the fact that many women have symptoms and health conditions associated with menopause starting years before menstruation ends. She also thinks it’s misogynistic to tie a description for one-third or possibly even one-half of a woman’s life to the function of her uterus and ovaries. We don’t define men as they age by their physical changes. The term menopause came to be before science knew hormones existed. Gunter writes: “It was never meant to signify a pause. It was invented by a man who felt women should cover their arms and not wear blush— whose book on the subject contributed nothing valuable to the body of knowledge except it left a term that ties women forever to menstruation.”

Concerning language and the terms used it is important to remember that words influence our thoughts. Gunter writes that language isn’t a passive descriptor, but rather, it’s an active participant. She cites Dr. Lera Boroditsky’s  work and TED Talk “How language shapes the way we think” at: https://www.youtube.com/watch?v=RKK7wGAYP6k

What I didn’t know and found interesting is that in many cultures the word menopause is not used at all. For instance, in Dutch the word is overgang, meaning the passing way or road from “A to B.” In Finnish the term is vaidhevoudet, change of year, in Swedish it’s klimacterium, change or stages of life, and in Japanese the word is kōnenki, which translates to change of life. Gunter mentions research that suggests that women who live in cultures that use terminology that references a change of life instead of menopause tend to be less bothered by common symptoms of menopause. Also, words influence our perceptions and medical terminology is constantly changing as new information is gathered, so as Gunter notes: “the idea that it’s too difficult to change the word menopause just doesn’t fly.”

I will write a bit more on this topic and book in the next post. For the time being I will end this piece today with a sentence from the book: “The story I want you to remember is about value, agency, and voice and the knowledge to keep yourself in the best of health while demanding an equal seat at the table. That’s my manifesto.”

Continued……..

Intersectionality, class, politics, counselling and the freedom of inquiry

“A working class hero is something to be / As soon as you’re born they make you feel small / By giving you no time instead of it all / Till the pain is so big you feel nothing at all…” (song lyrics written by John Lennon and sung by John Lennon at: https://www.youtube.com/watch?v=iMewtlmkV6c)

Part One

Today I will mostly be drawing on Counselling, Class and Politics written by Anne Kearney in 1996 and edited and commented on by Gillian Proctor and other authors in 2018, so the focus will be on social class and the field of psychology and counselling, but a lot of what is discussed in the book could apply to many of our identities and positions, and also, in relation to other social contexts and disciplines apart from psychology and counselling.  In this piece the focus will be on social identities; especially class, and the importance of taking contextualization and intersectionality into account. The term intersectionality was coined by Kimberlé Crenshaw, lawyer and activist, who used it to describe how our political and social identities and the contexts we find ourselves in are combined to create both privilege and discrimination. The dynamic combination of our different identities advantage and disadvantage us. Although this would seem reasonable and easy to understand it is often the case that social discourse and social reality are de-contextualized to fit schemas, serve belief systems and the interests of social groups, and generally keep the status quo intact.

The book consists of two parts Kearny’s original work before she died and commentaries from people who have been influenced by her work from both sides of the therapeutic experience. In the introduction of this recent second edition Kearny’s family write: “Perhaps the most important thing we can end on is to recognise and value how Anne encouraged and facilitated those she worked with to be receptive to change and to think about that complicated set of connections between the world outside, the world we live in and how we make sense of the two – emotionally, practically and politically. We hope that this dialogue continues and, in so doing, it will genuinely reflect her wish too. Anne Kearney’s family April 2018”

Some things to initially consider are: Τhe available literature shows that the field has been for a long time and to a great extent white and middle class in its culture and discourse and defenders of the status quo. And although social class has been studied in many disciplines it seems that in the literature of psychotherapy it is often an avoided topic. There has also been a preoccupation on deficient psychologies of the working class that practically leads to class-based oppression, poverty and inequality to be rare in research in the discipline. The issues of how the social positions we grow up in later on shape our views, identity and sense of belonging, and also, how we navigate inner and outer conflicts when we move up the social ladder or enter this profession.

Some questions that arise are: Why does this social position and lived experience often find resistance or is not included in the conversation? Why does the field of psychotherapy and counseling find it difficult to understand that the external world and societal realities also shape who we are, what we become or what we experience?  As I was reading material for this post I came across another important question: Why do people from less privileged backgrounds (both clients and professionals) lack a sophisticate discourse for the impact of coming from a more disadvantaged (economic) background? Why are these topics often not welcome in educational or academic settings?

This last question takes me back a decade ago when I grappled with issues discussed in Todd B. Kashdan’s [professor and researcher of psychology] recent article: 10 Principles for Embracing Productive Conflict (March 7, 2022) in an educational context. In this article Kashdan claims that in (higher) education there should be opportunities for curiosity and the exchange of perspectives and that we should desire for students to think and be courageous enough to share their thoughts, unvarnished and uncensored. Because in order to understand the complexity of human behavior and society, we need to articulate hard questions and respectfully consider alternative views, and worrying about whether we can ask questions and challenge others’ views is antithetical to education. He continues that in higher education we need to confront a lot of hard questions and problems, such as, racial, social, class and campus climate problems. Concerning the latter he refers to surveys that indicate a rise in the number of college students reluctant to share views on controversial topics in the classroom due to fears that other students or the professor would criticize their views. Kashdan discusses how a wholesome educational experience should be committed to freedom of inquiry, freedom of conscience, and civil discourse, where all topics are open to contemplation and an evaluation of the existing evidence, and where questions can be asked and discussed. Some questions to consider:

How do you protect dissent? How do you create a place where people can ask provocative questions without being cancelled and others can respond with subsequent questions and concerns? How do you establish a culture that permits and embraces minorities, whether defined by number, power, status or demographics?

Kashdan writes: “What truly determines whether freedom of inquiry exists in a university is how people respond when the minority points out dysfunctional beliefs and practices the majority holds.” And to support this he has developed a proposed charter composed of 10 principles for higher education institutions interested in building academic, intellectual and social communities. Summarily, these ten principles are:

A, If you can think of a question, you can ask it. The only dangerous question is the belief that dangerous questions exist. B. Encourage others to speak by letting them know that you will work hard to react with charity, curiosity and the assumption of positive intent. When speaking, you should receive the same receptivity.  C. Reduce the impact of how much you like or dislike people when it comes to making judgments about the content of their messages and how you treat them. Know that likability is often irrelevant to the legitimacy of ideas. Separate the message from the messenger. D. Resist treating individuals as representatives of their groups. There is often more heterogeneity within groups than between groups. E. Balance the pressures for conformity with a willingness to explore alternative ideas and perspectives.  Being open and curious does not imply any commitment to changing views. F. Broaden definitions of diversity to go beyond what is visible to include categories of class and socioeconomic status, adversity, neurodiversity, and individual differences in temperament and personality. G. Resist the temptation to label people as simply “bad” or sexist, racist, homophobic, elitist…. Instead, engage in the task of grappling with the quality of their ideas and solutions. H. Be aware of cognitive biases that afflict everyone. Hold the same standards for evidence whether it agrees or disagrees with your initial and preferred positions. I. Rely on evidence as much as possible, even if this leads toward answers that conflict with your assumptions and preferences. J. Each person needs to commit to learning and growing and be willing to let go of ideas that are no longer working or that fail to survive empirical scrutiny.

Counselling, Class and Politics

As I mentioned the book consists of two parts: a) Kearny’s original book and b) a commentaries section.

A.Kearny’s 1996 book is very rich in themes and each of her chapters contains many valuable exercises, questions and role-plays (suitable for counselors, trainers and trainees, supervisors, and all of us really) to help us understand the impact of class and our own class upbringing and alert us to the culture of counselling and how this culture often perpetuates middle-class assumptions and values and renders certain other realities invisible. Kearny argues that counsellors are, like everyone else, political beings with a political ideology they might not be aware, that has direct and indirect consequences for clients. Throughout the book she raises the issue that counselling is informed by a set of political values and beliefs that are part of the dominant political ideology of the society in which counselling is being practised. The titles of and areas she explores in her eight basic chapters are: counselling and ideology; social stratification; social class and counselling; political socialization and counselling; Rogerian counselling and politics; regulation, professionalisation and accreditation; the role of the counselor (whose side are we on?). As I said her book is rich in ideas and it’s structured in a way that assists exploration and discussion in class, training and supervision sessions; therefore, it is only possible for me to briefly touch upon some basic points of her work in the space of this post.

In the first chapter she discusses how as well as there being individual differences between people, there are also other group differences: differences that derive from the social section of society to which we belong. She explores how many mainstream assumptions have now been challenged by the criticisms of mainstream practice put forward by feminist counsellors and transcultural counsellors, who have asserted that “‘neutral’ attitudes claimed by ‘mainstream’ counsellors were, in fact, far from neutral, and certainly not neutral in their consequences for female clients and clients from different cultural backgrounds than their counsellors.” A third set of arguments claiming the non-neutrality of counsellors and the existence of a particular ideology has come from groups of disabled people, who basically, claim that in physical and practical ways, disabled people are frequently excluded, not only by the physical impairments they deal with in a built environment that is planned and organised by non-disabled people, but also because counsellors continue to operate with a medical model of the world and simply attribute all the difficulties disabled people experience to their impairments. But in reality, Kearny writes: “the disabling process is a set of ideological beliefs about impairment, and, to the extent that counsellors fail to challenge that ideology, they are part of the process that disempowers people with a disability….”

In relation to class, Kearny claims that the issue of class is almost never referred to in counselling at any level (in training courses, in training manuals, or in books about counselling); however, she suggests that class differences are not merely ‘equal but different’, but involve huge disparities of income, wealth, power and status, which are so taken for granted that we fail to take into account their impact on every aspect of our lives and those of our clients. She writes: “The social differences between groups also represent different ‘ways of being‘, different attitudes, different aspirations, a different sense of identity and so on, in almost every sphere of our lives.”

In the second chapter she introduces different types of stratification by which people in a society are divided into groups, social class as a form of stratification system, social mobility, and more specifically, the impact class has on counselling. She discusses how most people remain greatly unaware of the political, economic and social processes that form the scaffolding of their lives. We mostly take the framework within which we live and the ideology that justifies it as a ‘given’ and we don’t often question, challenge, or are even aware of it. She says it’s like being a child in a family setting. As children we take the framework, the roles, the assumptions, and the ideology of our particular family as ‘given’. It’s only when we get older and can observe how other families might operate, that we realise that there are many ways to do things. She writes: “… the framework of our family life is often not apparent to us until we step outside it and see it in all its relativity. The same applies to broader cultural frameworks: they are often not even perceived because they create the order and the meaning structure of our lives. In each of these examples, what we are also taking as a ‘given’ is the distribution of power as it takes place in our society, both because it is seen as ‘given’ and because we (if we are members of a relatively powerful group) have a vested interest in not recognising and / or challenging power inequalities.”

She goes on to explain how often counsellors (and people generally) tend to believe that they are ‘not political’ because they may not have a strong preference for one party over another, are not politically active in their community, or aren’t interested in discussing or reading about politics.  I believe that it isn’t really possible to operate in the world without a set of beliefs and values about the world, whether we are aware if this process or not, and also, that these sets of beliefs (ideologies) cannot be neutral because they value some things, events, or people over others; they view reality in certain ways, and they ‘rule in’ certain possibilities and ‘rule out’ others. The editor of this new edition, Gillian Proctor, writes: “Anne was clear about the dangers of the counselling profession acting as though politics were irrelevant or pretending that counselling or counsellors could be politically neutral. Way before the current focus on intersectionality in identity politics, Anne was reminding us that each of us simultaneously occupies many social positions and these cannot be treated in isolation.  Kearny writes: “having no political ideology of which we are aware is not at all the same thing as not having any political ideology. On the contrary, our ‘unaware’ ideology seems to me to be the most potentially influential ideology, as far as clients are concerned. This is so, I believe, because: a) anything that we as counsellors allow to be unexamined (like our sexism or racism, etc) is much more likely to influence our relationship with a client than something we become, and remain, aware of and b) a major reason for believing ourselves to have no ideology could be that this is an accurate reflection of the ideology dominant in our culture / class etc, and as such, taken for granted and never challenged. That ideology, to the extent to which it does reflect current external and dominant beliefs, will be hierarchical, individualistic and regard self-interest and competitiveness as ‘natural’ and ‘normal’ – beliefs that may well be damaging to some clients.”

In the third chapter she first discusses class and family structure and refers to research that suggests, for instance, that many working-class families have a rather different structure from that of many middle-class families. Some differences being that of the role and proximity of the extended family or the marriage roles. She provides a list of questions and demonstrates the importance of taking class into consideration when doing couple or family counselling, for instance. This chapter also explores the connections between language, gender, class and counselling – a lot of ideas, which will be very briefly touched upon here. Kearny describes how language is not a socially neutral means of communicating because it is influenced by many social factors, such as gender, age, race / ethnicity, and many other variables. Gender differences in language use have been well researched, so we know that the differences between how men and women use language, for instance, directly reflect the power and social differences between women and men. Also the content of what is expressed is not processed the same by everyone. Kearny writes: “the content of what is said between people is processed differently by men and women (Tannen (1992).” Different cultures also frame verbal communications very differently, and even within each culture, where there are many different sub-cultures, there will be ‘framing differences’ that may cause misunderstandings and misinterpretations.

Finally, Kearny suggests that all these differences are massively reinforced by class differences.  Research has found that different groups of people use language differently (not referring to accent, pronunciation or vocabulary).  Different codes are used. A code is a particular way of using the language: for instance, we use a different way of speaking depending on who it is we are speaking with. Kearny describes how language is not a single unitary system of words connected by syntax; there are different language codes within the language and each of these codes is differently ‘powered’ by the social group with which it is associated. This has implications for the counselling process, and may disempower working-class clients and may result in their not feeling heard, and / or their feelings being misunderstood or misrepresented to them by the counsellor.  She provides several examples, which I will not mention here. She claims that the speech code is not neutral in its effect on how counsellors, hear their clients, nor on how client hear the counsellor because they hear them with all the social power imbalances attached to our speech codes as counsellors.  She writes: “If speech patterns are imbued with different amounts of power, as I believe they are, then it must be the case that those power relations enter into counselling relationships. As counsellors, in other words (whether our origins are middle or working class), we do not ‘listen with a neutral ear’; we listen to clients whose speech patterns have a direct effect on the power relationships.”

The next chapter deals with another aspect of class and explores poverty, the causes of poverty, the impact poverty has on people’s lives, the ideas we have about poverty and how these ideas impact on counselling, as well as, the kinds of counselling available to poor people and the political implications of that. Kearny writes: “It has been shown in most recent books on counselling that social characteristics have a direct impact on the counselling process. Gender, or ethnicity, or any other social grouping may influence counselling (see Chaplin, 1990; d’Ardenne & Mahtani, 1989). I agree with these writers that this is so, but I also believe that they leave out of their accounts how social class intersects with race, gender and these other groupings.” She also discusses how one of the features of class that receives very little attention in counselling literature is economic factors and how little attention is paid to the way in which poverty, for example, might have / have had, an effect on a client’s experiences of the world even though it is easy to understand from our personal experience how important financial factors are in our lives and our experiences of childhood. She does clarify that even though class and poverty are very closely related it is not suggested that middle-class people never experience poverty, or that all working-class people do so, and she also takes into account that that there are degrees of poverty and that it can be a relative concept, and that the same income may be experienced by some people as poverty and others as sufficient for their needs. Additionally, she provides some numbers and statistics, which I will not go into here.

The important thing is that we now know that poverty affects people’s health (through poor nutrition, poor housing,  poor health care and jobs that damage health), access to resources, their life expectancy, their educational achievements, their aspirations, standards of dress, leisure activities, level of stimulation, self-esteem and attitudes to themselves and other people. Poverty also carries with it a great deal of social stigma and blame; it is something we are taught to be ashamed of, and it is disempowering. In terms of counsellors attitudes she believes that although most counsellors would probably reject the idea that the poor are responsible for their own poverty, it is unlikely that we will have escaped some of the commonest assumptions that are contained in the social ideology of opportunity to succeed. Finally, unemployment and all that comes with it disproportionately affects working-class people. In relation to health care and counselling  Kearny writes: “poverty affects the poor in terms of whether counselling is accessible to them or not, and where it is; the client has no choice of counsellor, no control over the duration of the counselling and no control over the choice or type of counselling available. Obviously, it is better to have some counselling than not, but the limitations of what is available to poor clients is another example of the way in which class differences impact on counselling issues.”

In relation to the process of choice Kearny supports that a number of social factors contaminate this process and may impede it. She begins her discussion by exploring the term as it is used by economists, who make a distinction between ‘choice’ and ‘effective choice’; by the latter, they mean a choice that we actually have the power to implement. She thinks this is relevant for counselling because one of its goals is to enable the client to make informed choices. Kearny writes: “If we do not operate with the awareness that there are social as well as personal obstacles that limit the effective choices clients can make – and enable the client to recognise which are social and which are personal obstacles – we are in danger of becoming one of those obstacles ourselves. I believe that class position is a major factor in determining the range of effective choices a person can make, and that the range is much narrower for working-class people than it is for others. There is nothing absolute or inevitable about this in the nature of things, but in our present political system, it is the case that there are constraints placed on the effective choices working-class people can make…..”

In the fifth chapter Kearny discusses political contexts and socialization and counselling and examines another set of influences that has an impact on the counselling process: that is, the specifically political ethos of time and place. She talks about ways that counsellors are trained, regulated and organised; what political priorities predominate in our culture at any given time, and what status, role and function the current political climate imposes on counsellors as a social group. She is also concerned about the fact that political models or political views framed in non-political ways are almost never discussed and that new trainees absorb the notion that ideas about counselling and political ideas are separate. Kearny writes: ‘I believe that every single individual trainee, counsellor and supervisor, like every other person in the world, does have a political model that they carry about in their heads and that shapes and directs (among other things) their practice as counsellors, trainers and supervisors. Furthermore, I believe that each of us does have a model that exerts this influence, even when we are not aware of holding one in our heads – and even when we know we do have a political theory but we believe we keep it separate from our counselling activities. I recognise that different people hold their political models with different degrees of awareness, but I am claiming that there is no possibility of not having some internal representation of the world that can be made explicit (though it may be, and often is, a confused and contradictory model). In other words, I believe there is no politically neutral fence available for us to sit on…”

In this chapter she also discusses democracy, children’s political socialization and how we are conditioned to be mistrustful of all political education and to see it as an attempt to impose a partisan political model on otherwise politically neutral people. Kearny writes: “Nothing could be further from the truth. Children as well as adults are continually exposed to political ideas …… with no acknowledgement that these are political ideas…”

All of the chapters are design to be interactive and to invite discussion and self reflection. Below are a few questions in relation to counselling from this chapter that I wish I had engaged with in the past to make more effective choices:

If you wanted to know whether your course is run along democratic lines, what pieces of information might you need? Do you know the political ideology of your trainers? Is this an important piece of information? How might the political framework of your course influence the training you receive as a counsellor or supervisor? Do you, as a group, feel that you have the right to this kind of information?…..  

To sum up, there’s not much that I want to add to this longish post other than say that although the book was written in 1996 and is to some extent situated historically it could provide the basis for an important discussion in psychology / counselling educational contexts.  Ultimately, it is important to try to understand people, including ourself, as the intersection and dynamic interaction of all our identities, lived experience and social and historical circumstances. This is far from easy and it requires courage and effort, but even acknowledging it is a first step.

**The next two book chapters include an interesting discussion around Rogerian counselling. I hope to write a bit about that in the next post, and also, include some ideas from the commentaries.

Continued….