Between collective and individual therapy

In the editorial board's discussions over this issue, we have often touched on the topic of mental health not only at the individual level but also in broader societal issues. Psychologists and psychotherapists Jakub Černý and Martin Novák have long been active in the Narativ association, which is dedicated to the development of collaborative and dialogic practice in our country. A joint interview with them discusses the mental health support system and introduces the approaches they apply in their therapeutic practice. They draw on research from theoretical studies, experiences of activism, and working with people with different social disadvantages.  

 

AJK      Could you both start by summarising your professional journey and how it has influenced what you are doing now?      

JČ     I currently work as a psychologist and psychotherapist in individual practice. It's a bit of a contrast to the collective work I did in the past but, paradoxically, I enjoy it. It complements my experience when I worked more in the social field, where we dealt more with social and structural levels. These are partly present in the current work but not as visible. It seems to me that the way we talk about mental health and therapy sometimes lacks thinking in systemic terms. But also, for example, questioning how we work with language and what it does to our shared reality. I'm very interested in questions of power, and how they translate into what happens to us. And these are topics that were not common in therapy in the Czech context until a while ago. I think that the dialogic collaborative narrative approach addressed these issues, which is why I naturally gravitated towards it during my studies and later became interested in various social issues. After some time in activism, I experienced burnout and went back to my resources in psychology and self-care and started to combine the two somehow. Today, I predominantly lean towards therapeutic work and, at the same time, Martin and I are working with organisations that are addressing the need for radical change, whether it's social or environmental.      

MN     Some of the things that Jakub talked about, we have in common. For example, the need to reflect on the broader structural context of therapeutic work, to reflect on power relations in the helping professions or how we treat language. I have worked for a long time in community psychiatry, at the intersection of psychiatric care and social services. I have also worked in this area as a researcher as part of my doctoral studies in sociology. I also have experience in activist settings where I have repeatedly noticed, for example, how we reproduce many different patterns of relating to ourselves and each other that belong to the world we want to define ourselves against or transform. This led me to explore themes of sustainability, care and mutuality. This is where my professional experience and my activist experience come together. It also led me to meet different collectives, which is what Kuba and I are doing. Now, after my PhD, I am slowly returning to psychological therapeutic practice. I meet with people either individually or with colleagues we work in a format called open dialogue with families, more precisely networks of people and relationships where there is a problem or a difficulty going on. 

      

AJK      You both mentioned that, at some point, it became essential for you to talk about issues of power, structural solutions, and the language that is used within psychology and psychotherapy. How does this manifest within your practice? Is there something inherent in the collective approach that individual therapy cannot offer? 

JČ     What Martin has called relational networks, I think, is one possible aspect of deconstructing individualism within that therapeutic framework, even though we are working with one person. For example, it is a way of looking at the narratives of clients, it is a way of asking questions that can stimulate reflection in relation to the social context. And, actually, from that perspective, we look together at what is happening with the person who is coming in, rather than having to have someone else present. 

MN     It seems to me that there are two dimensions to it. Firstly, I'm drawing on a dialogic perspective in practice, and in that approach (and not only in that approach), we think about the fact that when someone is experiencing a crisis or difficulty, it happens in the relationships within which that person lives. What they are experiencing, then, from our perspective, is not the product of an isolated individual mind, however much it may be something that the psychiatric perspective recognises as disorders situated in particular persons. It may be, for example, a way of coping with some difficult matters, either from the past or from the present, which may be somehow anchored in certain relationships. Hence the notion that it's important to work with family, for example, generally thinking about support networks. As a result, it can be anyone who is around and has the potential to support others. But it's important to say that it's definitely not about shifting care and responsibility to the individual or the person who is experiencing something but rather activating the support resources in the network that they are part of. That strikes me as one dimension of collective overlap. The other thing is structural issues. How does it happen that certain groups of people find themselves in difficult situations? What types of support are offered to them and what roles do they situate them in? I think it's an even broader thing, and I think it's important to connect the dots somehow. For example, asking who is available for what care and support and in what circumstances. It is also possible to accentuate these aspects in specific therapeutic work. 

     

AJK      I'd like to know. How is it possible in therapy to help a person who is facing something that they feel is beyond them, that they cannot change themselves? How can that be worked with?

JČ     One dimension is relational where you have to put things into perspective. Asking about the different voices that are present in that person's life and kind of inviting them to see that we're in different kinds of relationships. That there are different voices, for example, that are more restrictive and some that are more liberating. Asking what it would be like to invite more of those liberating voices into one's inner relational network. These are possible ways to work with this on an individual level. Or deconstructing where certain beliefs come from. To look at it as a more discursive issue. Where does it originate that I have to be perfect, to do everything perfectly, where is the root of that. We need to deconstruct those views but in terms of the structural, I think that's possible too. I think the only thing that can make a change is to stop placing some exaggerated blame for a given problem. He or she will see that the picture in question is more complex, more complicated, which can lead to a decentralisation of one's own role in it. To not see oneself as the hero of the story who will rout it all. But otherwise, I think, as therapists, we have a bit of a limited role that is also indirect. It's okay to talk about how not everything can be worked out in therapy. There might be some things concerning non-therapeutic platforms. Maybe it's a bit corny but we can encourage people to join unions, for example. I would like to point out that therapy is not the only place where people can get relief. 

MN     I'm thinking about what you said, Kuba, about the limited role of psychotherapy. I concur with that. I even think that our profession as an institution sometimes serves to normalise inequalities and legitimise the social structures and processes that enable them. Sometimes, in practice, it can look like in individual therapeutic work, we help cultivate some skills to come to terms with the ordering of the world, which I think is very problematic. Of course, it can be helpful in the moment but it seems to me that part of our role should be a more sophisticated critical insight into that context. What is the role of our profession in things being the way they are and whether or not they are changing? If I went deep into fantasy, I would actually like to live in a world where institutionalised forms of care such as psychotherapy might not exist. Where ways of helping and caring would be more based on mutuality and solidarity, without experts and the complex apparatus that defines the field for their work.

 

AJK      That sounds like a grand utopia but it's a wonderful idea. The question I would now like to ask is slightly related to this. I wonder how the much-emphasised topic of care and self-care in recent years is reflected in your profession? 

JČ     I think it's a big part of the therapeutic discourse. I see the emphasis on care but I think it also relates a little bit to what Martin was talking about earlier, which is what self-care means in some broader sense. A person is better off when they take care of themselves. But it's also a question of whether they have the resources and capacity to do that at all. I think it's also very much a class thing, not a generational thing at all. The other thing is where does it have a limit. How much to teach a person to shift attention to themselves and to the fact that their conditions, which are not favourable, can be managed by self-care. To some extent, this can be liberating in that it must necessarily at some point run up against the requirement of abusing one's own performance. Then there is a point, I think, where it starts to become about certain privileges. I can't afford to deconstruct performance in my life if I'm supporting children and don't have the means to just be and relax for six months. In therapy, I may start to realise that I really need something like that and then it really comes down to the fact that only some people can afford that kind of rest. Challenging performance can also lead to insecurity within the securities we have in life that exploit and use us in the long run but also make us able to function. It's good to discuss with people how they sleep or how they take care of themselves but I think there's really a degree to which we can bump up against a system of privilege. And that's where something that we put more emphasis on during therapy comes in, and that's the collective aspect of care. It's not caring for myself if I don't have the structural conditions to do so. This also applies to burnout, to specific kinds of professions that even though they do a lot of work in society, they are not sufficiently rewarded for it. And that's where I think it's good to recognise the limit of self-care in the therapeutic space. That's where therapeutic practices stop. 

MN     In some of the situations that perhaps more and more people are finding themselves in, the question arises as to how much psychotherapy, and ultimately perhaps self-care in a psychological sense, makes sense at all or how much of it is even possible. I have experience working in social services and sometimes when we worked in a team made up of different professions it was obvious that psychological support did not exist or was not yet in place. The first thing to do is to make sure that there is somewhere to spend the night and something to buy a meal with. I may be putting this in a bit of an extreme way but I think these are situations that many of us can easily get into. And in those situations, it seems more important to take care of basic material things. Some collective action towards changing material conditions can be much more caring and supportive in some situations than psychotherapy alone could be at that moment.

JČ     Would like to highlight that. It can have a therapeutic effect as well. I think there's some research on that as well where people have taken on some creative organising for their interests, and their experience of that has been liberating and transcended some type of mental health difficulties or burdens that they felt before. Of course, there's a downside to this where the activism itself uses the types of practices that we criticise in a given society and can lead to burnout.

I would like to say something else in defence of therapy. I think that personal liberation is not necessarily exclusive of some collective liberation. Ideally, they should go hand in hand, and that's why I think therapy is important. 

Text: Anežka Januschka Kořínková

 

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Image captions

All images: Jakub Černý a Martin Novák, photo: Lenka Glisníková