[Clinical Psychology, issue 38, 9-14, 2004]

Therapeutic psychology and the ideology of privilege
David Smail, Nottingham

I don’t suppose many readers have heard of Sophie Tucker, let alone remember her. She was a blonde, brassy, vaudeville star of the early 20th century; a kind of pre-incarnation of Madonna, I suppose. Anyway, in the course of an interview about her notoriously colourful life, one of her pearls was: ‘I’ve been rich and I’ve been poor, and believe me rich is best’ (quoted in C. Wright Mills’s The Power Elite – published in 1956 and still in my view about the most intelligent and perceptive account of the power structure of modern Western society).

There are of course various cultural bromides that challenge Sophie’s view: ‘money is the root of all evil’, ‘money can’t buy you happiness’, too much of it will close the gates of heaven to you, etc. etc., but on the whole I can’t think that many of us would argue with her. Quite apart from anything else, just about the entire structure of today’s apparently thriving capitalist society is built around that premise, and most of us, I’d guess, if not exactly aspiring to riches, would prefer not to be poor. Any assertion that poverty is not necessarily a bad thing is a bit like maintaining that having only one leg need be no more inconvenient than having two.

However, a society in which there is a huge preponderance of losers over winners (and which is run and controlled by the winners) has to find ways of problematizing Sophie’s simple materialist insight.

One is to discredit materialism itself. The ultimate intellectual conjuring trick—for a society ruthlessly obsessed with the bottom line—is to maintain that sordid considerations of wealth and possession are not only tasteless and vulgar, but actually totally misrepresent the spiritual essence of humanity; we are above crude physical ‘reality’, we create ourselves as autonomous beings, write our own ‘texts’, etc., etc. From this kind of standpoint, interest is just about the least pure of motives, and, having acquired the taint of immorality (as in self-interest), is something we don’t like to mention. When I suggested recently to a class that an element of Freud’s preference for fantasy over reality as an explanation for child abuse might have been that it made it easier for him to earn a living, a student responded indignantly that I might just as well accuse Freud of knocking old ladies over the head for their money.

Another line of attack is to challenge Sophie’s insight itself. I have, for example, several times heard or read that many Third World people have a simple happiness and sense of solidarity that contrasts radically with the stress and angst of life in the West. However that may be, it doesn’t as a way of life seem attractive enough to inspire much cultural emigration. In contrast, there are plenty of signs that the West does as much as it possibly can to export its misery to relatively invisible Southern parts and to keep occupants of poorer countries firmly where they are while we stay firmly where we are.

But in any case, to question whether poverty does ‘necessarily’ make people unhappy is to open up a field for endless debate and research such that pressing questions of ‘social exclusion’, etc., can be diverted into a kind of academic limbo of speculation, assertion and refutation. The fact that a near-unassailable case for the disadvantages of poverty can indeed be made (Wilkinson 1996), will not, I fear, lead to a rush on the part of those who govern us to distribute wealth evenly among the populace. Reasons can always be found to disregard reason.

Another ploy, and one which concerns those of us who practise some kind of psychological therapy much more closely, is to turn people outside-in. That is, to suggest that the material contingencies that work to immiserate us actually are, or are indissolubly related to, internal, psychological processes. It is not, for example, poverty that’s the problem, but the psychological processes that poverty may engender – e.g. ‘lack of self-esteem’. There is enough truth in this kind of view for us to become somewhat careless about where it leads to. For once a material condition is reduced to a psychological one (or indeed where ‘reality’ becomes reduced to ‘discourse’) an element of voluntarism tends to creep in; we may not be able to choose to be rich, but can we not exercise choice in the ways in which we interpret our condition? Might there not even be a world of spiritual autonomy that can be tapped and encouraged therapeutically?

Psychotherapy no doubt does often offer an ethical advantage over some other approaches to people in distress in that it usually (though not always) treats them humanely and with respect. But this is not usually the ground on which most therapies are professionally established and put forward as explanatory theories and curative practices. That is to say, I know of very few therapists (though there are a couple - e.g. Lomas 1999, Gordon 1999) who would justify their role solely on the grounds of its being a decent way to relate to people. The trouble is, as soon as therapeutic schools start to formalize and professionalize their procedures they nearly always—advertently or not—enmesh themselves in interiorizing philosophies of one kind or another. There are in fact very few approaches to psychological therapy that don’t in some measure subscribe to individualist, idealist and/or what I call magical voluntarist positions. All such approaches have their foundation in a general cultural assumption that is in fact very hard to shake off—i.e., that fundamentally we are all individuals who just happen to find ourselves in societies. I suspect that it might be more accurate to say that fundamentally we are social creatures who just happen to feel as individuals.

I am not able in the space available to argue my case in what I hope would be persuasive detail, but what I would like to do is outline just a few of the ways in which I think we need a fairly fundamental revision of our concepts and language if we are to do greater justice to an understanding of personal distress and to rid ourselves of the fallacies of individualism and idealism.

My suggestions here are just that—suggestions. I certainly don’t myself regard them as in any way fixed and final; I’m not trying to establish any new ism. What I do hope to achieve is a contribution towards nudging us out of some ways of thinking that have, it seems to me, become sedimented in broadly ‘clinical’ approaches. I’d also like to say that I’m making no great claim to originality here, though I can’t always remember where the ideas came from!

Figure 1 suggests how some of the principal approaches to therapy, developed over the past century, might be plotted in a space defined by the two dimensions ‘individual-social’ and ‘idealist-materialist’. Even where there are apparent exceptions to the individualism of therapeutic approaches, the concepts, language and procedures of therapy tend to retain the idealist element that allows ‘magical voluntarism’ to survive. Even though psychologists may recognize the importance of outside influences, they still see what actually moves people as interior motivational or cognitive structures that can in principle be identified by ‘insight’ and directed by conscious will. In order to get back to its familiar idealist ground, then, psychology feels a need to translate social influences into psychological mechanisms (like attitudes, beliefs, ‘senses’ of empowerment, self-esteem, etc.) so that it can still treat them with the conventional things it knows best (CBT, etc.).

Figure 2 suggests how things might look if we took seriously the influence of a material environment on an individual embodied subject capable, certainly, of reflecting on his/her position, but quite possibly not capable of very much more (we can represent our predicament to ourselves and others - ‘ideality’ - but we may not necessarily have the power to alter the circumstances that beset us). Understandably enough, psychology tends to restrict its operations to the sphere of ‘ideality’ and works on what it sees as the causal mechanisms there. ‘Motivation’ from outside (the impress of power) is translated into internal operations that can be brought under the control of language. This is to ignore both the true sources of influence and the nature of the interaction between them and the physical structures with which they interact – i.e. the body. Individuals thus becomes dissociated and disembodied, linguistic constructions susceptible to operations of will and imagination having little to do with reality, and which, because they are largely self-creating, are opened up to moral and aesthetic critique.

The notion of power, barely considered in conventional therapies, is of course absolutely central to the view I am trying to put forward. Rather than the person being a self-creating, self-choosing, autonomous subject at the centre of his or her own psychologically constructed world, he or she may be seen as a locus in social space-time through which power flows.

Figure 3 suggests how the influences within a stereotypical family will be shaped by the proximal powers in their personal world, which themselves mediate the influence of much wider and more pervasive distal powers.

Powers can be of various kinds:-

Embodied, very proximal but subjectively dominating.

(control of meaning,
language, perspective
and horizon)

Operate at variable distance in social space-time, ranging from the personal to the institutional; degree of influence and subjective prominence tend to be negatively correlated.


The flow of power, I suggest, is mediated most effectively by interest. The more I think about it, indeed, the more important the notion of interest becomes, and the more surprising I find it that psychology has had so little to say about it in any analytical detail (in fact, virtually nothing).

Interests could be said to be satisfied, frustrated or mystified by powers. Powers may be received (by interests) or resisted (by counter-powers). Reception affords by far the most efficient transmission of power (it is, for example, a particular strategy of modern consumer capitalism to reduce as far as possible inhibitions standing in the way of self-indulgence and greed—what might be called the deregulation of pleasure).

Interests cannot be satisfied without power, nor can powers be resisted without counter-power.

Powers may thus (for example) be applied to satisfy their own interests (security and/or advantage) or the interests of others (protection, love, altruism).

Rather than people being little self-contained bundles of motives that push them into association from within, they become component parts of a hugely complicated social structure in which they are pulled and pushed from without. The best analogy I can think of is to conceive of individuals rather as neurons in the central nervous system, where the ‘electrical impulse’ of conduction is replaced by power and the ‘neurotransmitter’ by interest.

Figure 4 given an indication of how this might work in the highly simplified case of an interaction between proximal institutional power and individual interests and powers.

One final point: contrary to how it might seem, I’m not trying to erase the individual from the psychological frame. That might or might not be possible for an anthropologist or a sociologist, but for a psychologist concerned with human distress, the individual embodied subjectivity is the point and purpose of the whole enterprise. For it is subjective experience where pain is suffered. What defines what we understand as broadly clinical psychology (though, like ‘therapy’, that is such a misleading name for what we do) is essentially an ethical concern – a view that our common humanity enjoins us to mitigate suffering in others as in ourselves. But we can only achieve that end, in my view, by looking beyond individuals themselves.


Gordon, P. 1999. Face to Face. Therapy as Ethics. Constable.

Lomas, P. 1999. Doing Good? Oxford University Press.

Wilkinson, Richard. 1996. Unhealthy Societies. Routledge.