Entry for 27 November 2009:
A clear emerging trend at the New Savoy Conference on Psychological Therapies in the NHS was a greater focus on Wellbeing (WB), of particular interest for us in the Counselling Unit because of ongoing discussions about the possibility of a departmental restructuring plan that might have us as part of a Department (or something) of Health and Wellbeing. We heard about WB in the inspiring opening talk by Cary Cooper (current President of BACP). We heard about WB in a speech from Andrew Burnham, Secretary of State for Health. Lord Layard talked about WB. There was a workshop on WB, which I attended. There was a session on enhancing WB in children and young people. And finally there was a session on WB in older adults. So WB was a major focus on the conference. However, it was much harder to tell exactly what was meant by WB. On the one hand, all mental health problems were being put under the heading of WB, which simply amounts to a trendy repackaging of Business as Usual. On the other hand, some presenters tried to go beyond relabeling distress as (absence of WB) by pointing to early intervention and prevention.
The detection/prevention angle seems to me to be a more legitimate use of the term WB, but left me with two thoughts. First, I was left with a large sense of déjà vu: Haven’t we been here before? Wasn’t this the main point of the community psychology movement of the 1970’s? When I was in graduate school, a lot of very bright people like Seymour Sarason, Julian Rappaport, George Albee, and many others spent a lot of time talking and writing about things like primary prevention (preventing problems from emerging in the first place), secondary prevention (identifying emerging problems in at-risk populations and addressing them before they get worse), and, in distant third place as not very good at all, tertiary prevention, which is pretty much business as usual: Working with individuals with full-blown problems, presumably to keep them from getting even worse or recurring in the future.
Second, over the course of the conference, it became clear to me that most of the people talking about WB were of the first variety, the repackagers. That is, we (and I do include myself) don’t really have a clue about how to do prevention. We are experts at psychotherapy/counselling, that is, the poor cousin, the tertiary brand of prevention; this is what we do and this is what we are good at. Turn us loose on prevention programs and we are out of our depth and more likely to do more harm that good. For example, early identification programs can end up stigmatizing kids through singling them out for intervention. Even more disturbing is what happens when psychologists or others try to intervene without doing the proper research beforehand. Again I speak from experience, having worked for several years in Toledo on an ill-conceived school-based anti-violence program.
One of the few presenters who illustrated what I would consider to be a well-grounded approach to WB was Sube Bannerjee, Professor of Mental Health and Aging at King’s College London, who gave a wonderful talk on developing programs for people with dementia, based in part on research on the trajectories by which people end up in care homes for dementia. However, based on what I heard at the conference it seems to me that what is really called for are well-targetted systemic interventions to prevent the worst effects of dementia. I think that there is a role for us, but it begins to look like Dot Weak’s and Pam Courcha’s research on teaching Pre-Therapy Contact Work to nurses and caregivers makes more sense than conventional counselling or psychotherapy.