Have new blog for my PhD stuff: Madness and Theory
From now on, all my theory in that area will be published there. At the moment there is just the conference notes crossposted, some more will be added soon then we’ll see how it grows.
Everything else will remain on here.
If the Napoleonic code in 1804 was one of the first attempts to create a legal code that would introduce the notion of absolute ownership, and this in essence was an actual codification of an attempt to control the woman’s phallus, then can we allow capitalism to take a woman’s form as metaphor?
So what of late capitalism, in Mark Fisher’s book Capitalist Realism he suggests that Francis Fukuyama’s book The End of History was much derided but the message quietly assumed. I would like to play with this idea a bit further using the metaphor of Capitalism as a woman, and at that as an attractive woman who had been in an unhappy and antagonistic marriage with State Socialism.
We can see Fukuyama as the guy who realising she had won the divorce with what looked like a particularly fortuitous settlement, not least because it looked like she got all the kids (although Uncle China had an eye on the family), decided to fuck her. Unfortunately he suffered premature ejeculation and was widely laughed at. However others had always seen her beauty and progressed to sleep with her, many of these men, and women, were more virile.
Her orgasm increased, however due to the psychological attentions of so many abusive lovers she had a breakdown, many of these lovers tried to medicate her in an attempt to get her up and fucking again, but perhaps if we move the metaphor back to people, a woman who had been through so much abuse would require someone to treat her respectfully and listen to her, she may well be full of self-hatred form earlier abusive relationships, thinking she was worthless and deserving of such treatment. Of course, in a professional relationship, but the best care would come from those who don’t want to sleep with her lest the relationship become abusive once more, perhaps those who don’t find her particluarly attractive but respect her rights as a human being. But most of all from those who see her as just one woman among many, all of whom are equally worthwhile.
Can you make a living out of madness, out of being mad, not curing it?
Taking into account such a possibility I am currently trying to get a certificate of attendance from my psychiatric unit as evidence of a life skill at prospective interviews.
To show how tough one is (in case the burly working classes don’t know and to assess your outward signs of your salvation) when ill one must carry on working so that:
1. One may be less productive throughout the duration of the illness
2. Make the duration of the illness longer to continue this lower productivity.
3. Pass it on to your colleagues so they may continue the above tasks after one basking in how hard working we all are and isn’t that a priori what makes us meritous and proves we’re better than the next man (as we get paid more and in a meritocracy based on pay logically then if you’re paid more you’re better).
Thus the rationality of the work ethic is again proven.
Continuing the book readings I have been putting on, next up is a book reading by Mark Fisher aka k-punk, upstairs @ the Open House on Springfield Road in Brighton, next to London Road station. From 7.30pm on Thursday 26th November, entrance £2.
Mark will be reading from his new book ‘Capitalist Realism’
Here is publishers blurb:
It is easier to imagine the end of the world than the end of capitalism. After 1989, capitalism has successfully presented itself as the only realistic political-economic system – a situation that the bank crisis of 2008, far from ending, actually compounded. The book analyses the development and principal features of this capitalist realism as a lived ideological framework. Using examples from politics, films, fiction, work and education, it argues that capitalist realism colours all areas of contemporary experience. But it also shows that, because of a number of inconsistencies and glitches internal to the capitalist reality program – endemic mental health problems, the proliferation of new forms of bureaucracy – capitalism in fact is anything but realistic. How can capitalist realism be challenged, and can we begin to imagine the unimaginable: an alternative to capitalism that is not some throwback to discredited models of state control?
Capitalist Realism includes striking new readings of Children Of Men, the Jason Bourne films, Supernanny and the fiction of Le Guin and Kafka.
Mark Fisher writes for The Wire, frieze, Sight & Sound and New Statesman. He teaches philosophy at the City Literary Institute in London and is Visiting Fellow at the Centre of for Cultural Studies, Goldsmiths, University of London. His weblog, k-punk, is highly regarded.
Let’s not beat around the bush: Fisher’s compulsively readable book is simply the best diagnosis of our predicament that we have! Through examples from daily life and popular culture, but without sacrificing theoretical stringency, he provides a ruthless portrait of our ideological misery. Although the book is written from a radically Left perspective, Fisher offers no easy solutions. Capitalist Realism is a sobering call for patient theoretical and political work. It enables us to breathe freely in our sticky atmosphere.
What happened to our future? Mark Fisher is a master cultural diagnostician, and in Capitalist Realism he surveys the symptoms of our current cultural malaise. We live in a world in which we have been told, again and again, that There Is No Alternative. The harsh demands of the ‘just-in-time’ marketplace have drained us of all hope and all belief. Living in an endless Eternal Now, we no longer seem able to imagine a future that might be different from the present. This book offers a brilliant analysis of the pervasive cynicism in which we seem to be mired, and even holds out the prospect of an antidote.
I have put up podcasts from the first three shows of the Contemporary Arts Show on Podomatic.
The first, orginally broadcast on 03/05/09, includes an interview with the artist Matt Robinson about his exhibition at the Phoenix Gallery for Brighton’s Fringe Festival 2009
The second contains a live performance from a Safehouse Collective Ensemble, compromising, Gus Garside, Annie Kerr and Dave Allen
The Third has an interview with academic Dr Katy Shaw, senior lecturer in literature at Brighton University on David Peace, author of GB84, Red Riding Quartet, Damned United and Tokyo Year Zero
I would like top thank all the guests for their sheer brilliance. I would also like to apologise to all listeners for my nerves. In later shows I learnt to write a script!… However again the guests are superb and that’s what the show’s about.
> Sent: 18 October 2009 17:44
>
> Subject: Why we are going on strike
>
> We think it’s fair to say that you our customers are not interested in why we
> are once again striking.It is also fair to say that some of the problems we are
> going through does not affect you either.
>
> What you are interested in is you getting your mail and whatever mail you send
> getting there within the allotted time depending on what service was paid for.
>
> But we do think that it is fair to inform you of part of the reason as to why
> we are striking as it affects you in a big way.
>
> But before we go on let’s get one thing out 1st,it’s not about a pay rise,far
> from it,a pay rise if we are to be truthful is in the mix but is not as a high
> priority as other concerns we have.
>
> Please just take a minute to see what we have to say.
>
>
> What’s affecting you then?
>
> In 2007 we signed an agreement with Royal Mail called the Pay & Modernisation
> deal,in that deal there are, amongst other things, a new working practice
> called ‘absorption’.
>
> This is one of YOUR biggest problems,whether you are a domestic or business
> customer!
>
> Before the deal any postal workers rounds that weren’t covered due to staff
> sickness,holidays,or general shortage would be covered by other postal workers
> on overtime.
>
> There would be no shortage of posties willing to do this,so there was never a
> major problem getting the mail delivered.
>
> But now we have ‘absorption’,what this now means is that any rounds now that
> does not have a postal worker allocated to it is now absorbed by the rest of
> the postal workers in the office.
>
> With Royal Mail insisting that mail volumes are falling they are under the
> impression that we know have a lot of spare time in which to absorb other
> posties work.
>
> This is not the case,not only have we lost 60,000 staff in the business in the
> last few years (our CEO Adam Crozier has publicly admitted this) but we now
> have a large proportion of part-time workers which affects the way the mail
> pipeline works.
>
> Mail is being delayed regularly and in vast amounts around the country in the
> name of absorption,so managers can report that absorption has happened and the
> savings have been made,some posties have to leave part of their round in the
> office,they also are being forced to ‘cut off’ or stop their deliveries as they
> have run out of time.
>
> Royal Mail drivers have been taken off their packet routes to help absorption,
> hence packets are left undelivered for days.
>
> This is a mass abuse of the deal we signed in 07,and posties are being bullied
> and threatened with taken off pay if they either refuse to do this or happen to
> cut off.
>
>
> Later deliveries
>
> A few years back Royal Mail ceased the 2nd delivery and you now only get one,
> but the truth is Royal Mail did not stop the 2nd delivery they cancelled the
> 1st.
>
> We now start our rounds at the time that we started the 2nd delivery years ago
> and now, Royal Mail want even later start times. So while today, if you’re one
> of the lucky ones, you might meet your postman before you go to lunch, you will
> soon be meeting him just before dinner. We are aware that this causes big
> problems for businesses all over the UK more especially those that work from
> home.
>
> But that does not seem to matter to Royal Mail, later start times and later
> deliveries are all down to modernisation, or in other words, new sorting
> machines being brought in which, would you believe, take even longer to sort
> the mail.
>
> This will also affect our own work/life balance and there are childcare issues,
> and school run problems, already rising because of it.
>
> You may also be aware before we went to Single Daily Delivery, you could pick
> up any packets or signed for letters left in the morning around 2 hours or so
> later at your local office. That, as some of you may be aware has changed, some
> places you have to wait 24 hours, most 48 but there are some where you can’t
> get the packet for nearly 72hrs.
>
> That’s if your office is local instead of on some industrial estate somewhere,
> and of course if it does not close before lunch.
>
> This is Royal Mail modernisation.
>
>
> If you don’t like your job,then leave
>
> This is what we read about all the time from alleged customers on the Internet
> news stories comment sections, and, regrettably Royal Mail management.
>
> But who says that we don’t like our job. You will find that most posties love
> their job, but are finding it harder and harder to provide the service they
> want and their customers expect, not just because of the work levels, but more
> so the bullying and harassment by managers at all levels of the business.
>
> Why should we have to put up with the constant B&H and worsening of our terms
> and conditions, when all we want to do is get on with our job and provide a
> service to our customers.
>
> We will not be hounded out of a job we love in the name of profit, or be made
> to feel guilty because we decide to defend our current Conditions of service,
> instead of allowing them to be decimated because of the inherently unfair bonus
> culture of Royal Mail.
>
>
> National strike
>
> The 1st strike was in London N18 Edmonton against introduction of part-time
> duties by executive action on 7th March. Cowdenbeath DO was the first among
> many in Scotland to strike against Executive Action on 27th March. The whole of
> London took action throughout June, and over 500 other offices around the
> country either went out on strike or requested a strike ballot.
>
> Previously to all of this some Mail Centres around the country took strike
> action over their closures, and the lack of real consultation.
>
> London, since June have taken over 16 days of action.
>
> During all that time we have repeatedly asked Royal Mail to negotiate with our
> Union about, not only the problems that you have so far read about and will
> read about below, but more importantly the fact that previous agreements are
> either being ignored or abused.
>
> It has now come to the time where enough is enough and now we have,
> unfortunately, the national strikes.
>
>
> No more efficiency changes this year
>
> This is what Royal Mail have claimed but this is not the case,there are many
> cases on the site where Royal Mail are still pushing ahead with with their
> changes. Including later start times,full-time positions going to
> part-time,Pegasus 2 revisions (flawed computer program),night staff being moved
> to days,full-time staff to prep part-time staff walks,more hours to go from
> delivery offices…
>
>
> You the tax payer
>
> You are being mislead by the media and the Government regarding Billions of
> pounds of tax payers money being used to prop up Royal Mail and our
> pensions,this is not the case and a blatant lie by all.
>
> For many years the treasury have taken our profits from us for their own gain,
> add nearly 13 years when due to tax reasons Royal Mail did not pay into our
> pension scheme, and yes the treasury got that money as well, you the tax payer
> owes Royal Mail Billions of pounds.
>
> Any money recently received by Royal Mail from tax payers has been a loan and
> has to be paid back at commercial loan rates which means that the tax payer has
> once again benefited from us.
>
>
> Privatisation
>
> This is a simple one,the Government have said that they will take over our
> pension deficit only if we get part-privatised.
>
> The crux of this,is that you the tax payer will pay for our pensions,but a
> private investor will not have to so they will just get the profits. Our Union
> Leader remarked on this at the Labour Conference by saying the Government were
> Privatising the Profit and Nationalising the debt.
>
> The tax payer will have the debt, while the private investor will get the
> profit!
>
> We, us the humble posties do not need to tell you what happens after a company
> is privatised, you only need to look at your utility bills, train fares and
> your bank statements for that.
>
>
> Mail volumes
>
> We agree that mail volumes are down,but not as much as Royal Mail say, we
> accept the recession has had an effect, but again, not as much that Royal Mail
> has said.
>
> With 60,00 jobs gone, bigger rounds,over 1 Million new homes built in the last
> few years with more to come, a few letters less in our post bag, when you add
> the mass increase in packets due to e-commerce,there is no leeway in our duties
> like Royal Mail think.
>
> Add the fact that Royal Mail now count the mail differently with an un agreed
> and flawed process,then you have false traffic figures.
>
> What is in the boxes that they send the mail down to Delivery Offices, is very
> much under estimated and has been shown to be so by royalmailchat members
> counting individual boxes.
>
>
> Independent report on Royal Mail
>
> Last year the Government requested an independent report on Royal Mail (The
> Hooper report) this found many flaws with the way the business is being
> run,including lack of transparency by the business with its figures and the
> fact that Royal Mail management were not up to the job.
> We are not against modernisation
>
> WE ARE NOT AGAINST CHANGE – We signed up to the Pay and Mod Agreement. RM
> ignored Phase 4 till we started local strikes.
>
> WE ARE AWARE THERE WILL BE JOB LOSSES – 60,000 gone in recent years.
>
> WE ARE NOT ASKING FOR A PAY RISE PER SE – We had a pay freeze this year which
> was imposed against the spirit of the 2007 agreement.
>
> WE ARE NOT AGAINST MODERNISATION – But we haven’t seen it in deliveries unless
> you count longer routes with heavier bags.
>
> WE OFFERED A MORATORIUM ON STRIKES IF ROYAL MAIL DISCUSSED CHANGES – Royal Mail
> refused saying it was a stalling tactic but now they want it when un agreed
> systems are in place.
>
> WE ARE NOT AGAINST WORKING HARD – The Union suggested having independent
> organisations help both sides come up with a fair and balanced way of measuring
> workload and standard – Royal Mail refused.
>
> The 2007 agreement allowed local units to have innovative attendance patterns,
> and these were agreed in some units with full Royal Mail involvement. Yet
> without consulting the CWU (as per the agreement) they unilaterally enforced
> change on these working arrangements.
>
> The agreement also allowed a local earnings package,this has been taken away by
> Royal Mail.
>
>
> We are and we will strike against – Bullying and Harassment such as
>
> • Being suspended for pointing out H&S concerns.
>
> • Being sent home without pay when we can’t complete a delivery in the time
> allotted especially if managers are not willing to walk test us or check
> individual posties frames to see how busy they are.
>
> • Genuine overtime being struck off when you go over your contracted hours on
> a busy day.
>
> • Being sent home without pay when you can’t do the half hour flexibility
> when asked – even though personal reasons are meant to be taken into account as
> per the 07 agreement.
>
> • When you do the 1/2hr flexibility not being able to claw it back or be paid
> it on overtime as per the 07 agreement. Or being given it back in 5 minute
> chunks.
>
> • Changing our start and finish times on a weekly basis without negotiation.
>
> • Using a flawed computer program to work out rounds with un-agreed walk
> speeds.
>
> • No independent H&S review after accidents at work – Staff being blamed for
> accidents without thorough and external review of all pertinent matters by an
> independent body.
>
>
> Spanish practices do not exist
>
> The reality in modern delivery offices is that the posties slogs their guts out
> everyday under the gaze of managers ready to sack them for the slightest
> indiscretion.
>
> Many many part-timers are bullied by managers into doing unpaid over time day
> in day out.
>
> All OT has to be OK’ed by management and most posties are too intimidated to go
> see their manager to ask for it.
>
> A lot of our guys do hrs of OT per week for nothing.
> Give the Public a service – Yep that’s Royal Mails job and guess how they do
> that
>
> 1. Close 3,500 Post Offices.
>
> 2. Reduce the service at 1000s of others.
>
> 3. Allow the Government to withdraw some of the services you used to be able to
> get at POs.
>
> 4. Ceased Sunday Collections (now for anyone to get anything on Monday you need
> to send it before 1230 on Saturday.
>
> 5. Cancelled Bank Holiday Collections.
>
> 6. Cancelled 2nd Delivery
>
> 7. Made the 1st delivery later than the 2nd ever was.
>
> 8. Laid off 60,000 workers through various means.
>
> 9. Close delivery offices and amalgamate them into Super DOs on industrial
> estates miles from bus routes.
>
> 10. Bring in a complicated and expensive postage system. (Pricing in
> Proportion).
>
> 11. Increase handling fees for Import from £4 to £8.
>
> 12. Increase the surcharge of underpaid items to £1.
>
> 13. Increase stamp prices above inflation.
>
> 14. Agree a price with DSA competitors to use our network which means we
> subsidise them to the tune of 2p per item.
>
> 15. Take 5 years to spend half of the 1.2billion the government loaned them,
> but we are still yet to see the machines in use on a UK wide basis even though
> trials are going well according to Royal Mail.
>
> 16. Removing Mail Cycles and replacing them with cars and then claiming they
> are doing everything to reduce carbon emissions.
>
> 17. Half day closing for all Callers Offices and a delay of up to 72 hours
> before you can collect parcels/letters after getting a “Sorry you were out
> Card”
>
> All of the above is not exhaustive, but we are, thank you for taking the time to
> read it.
>
>
>
>
> Please send this on to all your contacts ta very much.
I had an interesting moment. I was reading up on some theory, Habermas to be precise, and I had one of those moments where a lot of what I’d read previously slotted into place. Not just course work but pleasure reading. That moment where you get the point of not just what you are reading at that moment but the connections with all those other things – to be specific in this instance but not exclusive histories of social/ communal-religious puritan groups such as the Shakers and Weber/ modern thought – that you have read piecemeal in the past because they looked interesting. But of course unless you live in ‘I can be a purely objective scientist’ fantasy land, at least in the social sciences – Habermas again has something to say about that to do with the necessary use of the ordinary language being studied – you sometimes think how it relates to the evolution of your own thought, your beliefs (or you should – the ‘is’ and the ‘ought’). But that was not the breakthrough, it was a breakthrough, a minor one of sorts in my own theoretical preferences, but not the one this post is about.
As I was thinking to myself, ‘now I understand all those things I’ve read’, one of my voices spoke up: ‘You mean, we’ve read.’ At first I had my normal paranoiac/ telepathic moment – that’s someone telepathically linked to me letting me know they’ve read up on this too, stop fucking preaching (a weakness of mine) – but then I realised, no, for the first time, that I was aware of, or rather, or perhaps, the first time I was aware that, my voices were telling me they were a part of me.
Then I looked out of the window and a guy was walking past giving me the evils – did he know I was being so foolish? But no, he was the same guy who had been delivering leaflets while I was walking my son to sleep earlier, he was delivering pizza menus. He put one through my front door. I don’t eat pizza.
[edit] Rereading this I got a voice saying ‘Oh jeez, we’re not’ but was it telling me it was separate or was it the voice’s own terrified realisation that they are a part of me?
One of the most inspiring presentations for me at the Intervoice First World Hearing Voices Congress was that given by Professor Richard Bentall. His paper entitled ‘Why Relationships Matter: The Crucial Role of the Therapeutic Alliance in Helping People with Psychosis’ presented the results of research he had done into the therapeutic alliance and the results they had come up with.
The abstract to the paper talks of the history of therapy post-Second World War, immediately after the war the only therapy available was psychonalysis, considered to be costly and of limited efficacy, however during the post-war years there was a period of intense therapeutic innovation following two separate traditions: a technical tradition (behaviour modification, associated in the UK with Hans Eysenck and in the US with B F Skinner) which placed its faith in psychological theory, and an interpersonal tradition (associated with Carl Rogers) which emphasised the importance of therapeutic relationships. Prof. Bentall suggests that it is widely assumed that the technical approach triumphed, hence the popularity of CBT, it is cheap and gets results. But in this paper he asks whether such faith is justified, not that CBT treatments aren’t effective, but that research suggests that non-CBT therapies are too and that “Although further technical treatments may lead to improvements in psychological treatments for psychosis we neglect the interpersonal aspects of treatment at our peril”.
Sarting his paper Prof. Bentall gave a partial history of therapeutic treatments, arguing that the history is split between technique an empathy. He mentioned that clinical psychology was developed after the war in the hope that it would address the mountain of need in the asylums, in the US this was through the establishment of a PhD programme at the Boulder Conference of 1948, whilst in the same year clinical psychology training started in the UK with a 13 month training course at the Institute of Psychiatry.
Psychology was to be split between the technical approach pioneered by Skinner and Eysenck and the interpersonal approach of Carl Rogers. The early technical approach is exemplified by studies such ‘Extinction of psychotic speech in a patient, Helen, at the Saskatchewan Hospital in Canada’ (from Ayllon & Michael, 1959. The psychiatric nurse as a behavioral engineer. Journal of the Experimental Analysis of Behavior, 2, 323-334). Studies such as these showed that patients minds could be changed by behavioural modification. The high water mark came with the success of the token economy a reward system of systematic reinforcement that returned speech to previously mute patients. Although now considered unethical or too simplistic this was no mean feat and showed that behaviour modification could be very successful (‘The Token Economy’, Ayllon & Azrin, 1968)
Some psychologists, such as Carl Rogers, however, grew dissatisfied with the purely technical approach. Rogers rejected therapies such as psychoanalysis which he saw as too directive, he believed that patients had the capacity to heal themselves given the right circumstances and he believed that empathetic understanding, congruence and unconditional positive regard were the necessary and sufficient conditions for successful therapy. Rogers argued that research was necessary to prove his theories, both process research (what happened in the therapeutic session) and outcome research (the efficacy of the therapies). Thus he carried out one of the first RCTs of therapy with psychotic patients. The result was failure, both in terms of implementation of the project and the results (Rogers, Gendin,
Keisler & Traux, 1967). Although this may have been partly due to internal disagreements within the research group, it looked like the triumph of the behaviourists.
But others have rexamined these findings since, in 1977 a large scale controlled trial of the token economy took place. The token economy was compared to milieu therapy and TAU (treatment as usual). The discharge rates were 97%, 75% and 45% respectively (Paul & Lenz. 1977).This showed the efficacy of the token economy but it also showed that therapy was not without its merits. Other large scale tests have shown similar results (Dickerson et. al, 2005). Previously in 1966, Traux who had worked with but also disagreed with Rogers, showed that Rogers had unconsciously been using social reinforcement in his therapy. At the same time as the first large scale study of the token economy Hall, Baker et. al (1977) showed that social reinforcement – not the tokens themselves – was the successful ingredient in a token economy. The integration into an interpersonal, social community was a deciding factor. Empathic, genuine relationships are the more powerful reinforcers.
From as far back as 1936, Rosenzweig had suggested the Dodo conjecture (from Alice’s Adventures in Wonderland – ” All have won, all must have prizes”) that all therapies are equally efficacious. Again in 1977 Smith and Glass undertook a meta-analysis of psychotherapy outcomes that supported this conjecture, as have subsequent studies (Wampold, 2001). The effect size of psychotherapy versus treament as usual was .8, whilst the effect size between different psychotherpies was considered not significant.
So although the technical approach’s efficacy could not be denied, empathic genuine relationships definitely had an effect on the successful treatment of psychosis. Rogers may have had a point. It is therefore not unsurprising that CBT (Cognitive Behavioural Therapy) would ascend as a treatment. Bentall then turns to this treatment.
Prof. Bentall cites a series of papers cataloguing the successes of CBT in the treatment of psychosis; for psychotic patients who have not responded adequately to anti-psychotic medication (Cather et. al, 2004; Durham et al. 2003; Tarrier et al., Kuipers et al. 1998; Sensky et al. 2000; Turkington et al. 2003; Valmaggia et al. 2005); for remitted patients at risk of relapse (Bach & Hayes, 2002; Gaudiano et al, 2006; Gumley et al. 2003); acutely ill patients (Drury et al, 1999; Startup et al. 2004; Tarrier et al. 2004); and people thought to be at ultra high risk of an acute psychotic episode (Morrison et al. 2004). Bearing in mind the results of these studies, Bentall became involved in SoCRATES (the study of cognitive realignment therapy in early schizophrenia).
The SoCRATES study involved giving patients on 1st or 2nd admission for schizophrenia a randomised choice of CBT, counselling or routine care. They were given at 6 weekly assessments then followed up at 9 and 18 months. The results of the 18 month follow up showed a that both counselling and CBT had an effect over routine care however there was a highly significant centre affect between the three locations used in the study, Liverpool, Manchester and Nottingham. Some locations were significantly more effective than others. At the time this was not explicable.
There were other meta-analyses that suggested that CBT was superior to TAU in treatment of positive symptoms but had no effect on relapse (Pilling et al. 2002); that CBT was superior to TAU in the treatment of positive symptoms but there were lower effect sizes in larger trials (Tarrier & Wykes, 2004). In 2008, Wykes et al undertook a meta-analysis of 33 studies and confirmed the superiority of CBT over TAU for positive symptoms (33 studies, ES = .40), with some effect on negative symptoms, mood and functioning (13-23 studies, ES = 0.35 – 0.45). The most rigorous blinded studies showed ES = .22 for positive symptoms. So the evidence of the efficacy of CBT looked strong. But Prof. Bentall said there were still questions begging.
So he returned to the dod bird conjecture. Other papers have also shown the benefits of non-specific therapy. A 2000 paper by Sensky et al. suggested that befriending and CBT had similar effects during the treatment phase, only CBT was still more effective a year later. Papers in 1999 and 2000 by Tarrier et al. reported that CBT was superior to supportive counselling at a years follow up but there was no difference at 2 years, both were superior to TAU. Another paper by Tarrier from 2004 found CBT was superior to TAU but not supportive counselling.
Bentall suggested looking at non-specific factors that may account for this the effects of therapy. He pointed out two: the expectation of a postive outcome by the patient (Greenberg et al. 2006); and the therapeutic alliance – the affectional bond between the patient and therapist and their shared willingness to work towards mutually agreed goals (Horvath & Symonds, 1991; Martin et al. 2000).
Bentall was involved in a study with Dunn and Morrison (2006) looking at the therapeutic alliance, taking 29 patients receiving CBT for psychosis and looked at homework compliance. They found a significant relationship between the therapeutic alliance and homework compliance. Bentall returned to the Socrates study, he had asked for therapeutic alliance data to be taken at session 4 and session 10. There was a significant concurrence between therapists and patients as to the perception of the therapeutic relationship. But Bentall had no idea what the statistics meant. He turned to a colleague Day a specialist in statistics; conventional methods of analysing the therapeutic alliance are compromised by the possibility that the observed relationship between the alliance and outcome is inflated by unknown confounders.They developed a novel structural mean models (SMM) method of analysis method that eliminates this risk (Dunn & Bentall, 2007; Bentall et al. in press). The SMM analysis showed that the large centre effects in SoCRATES, the differences in outcome between Liverpool, Manchester and Nottingham, are entirely accounted for by the therapeutic alliance.
The therapeutic alliance has been shown to affect other outcomes in psychosis. Bentall argued that good collaborative relationships with patients are a universal good. However in conclusion Bentall pointed out the disparity in research. Research on psychological treatments for psychosis are at an early stage, in recent years there have been just 23 trials. In comparison between 2001-2003 there were 397 drug trials published in the five leading psychiatric journals. Bentall stated he remained positive about psychological interventions such as CBT and Commitment therapy but that the warm supportive relationships are therapeutic in themselves. Again he decalared them a universal good.
