![Sample our Social Sciences journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/110822/TOC-Subject-Sample-2021-Social-Sciences.jpg"})
ABSTRACT
This paper examines how psychotherapists deal with social suffering in its work-related forms. Based on the results of a qualitative empirical study in psychosomatic hospitals in Germany, I show how psychotherapy can lead to a normalization of overburdening demands at work, and ultimately a de-thematization of social factors. I argue that psychotherapists transform social suffering into suffering related to the self by re/interpreting the links to society that figure in the patients’ subjective theories of illness. The reason for this transformation lies in the logic of the profession necessary to legitimate the claim that the patients’ suffering falls within the purview of psychotherapy. Therapists have to disregard ‘the social’ in this manner since there are no medical diagnostic tools that would explicitly refer to work. The result of this professional re/interpretation is a form of therapy that medicalizes and personalizes social suffering, thereby intensifying, rather than tempering, a self-referentiality on the side of patients that is forgetful of society and already weighs on the individuals seeking treatment. To develop this argument, the dimension of work and its significance for psychotherapeutic etiology and diagnosis is considered. The study used and its results are explicated then in terms of three strategies of re/interpretation. Finally, the social-theoretical implications of this re/interpretation are discussed.
Acknowledgements
The author would like to thank Nora Alsdorf, Ute Engelbach, Rolf Haubl, Daniel Loick, Ferdinand Sutterlüty, and Stephan Voswinkel for helpful discussions and suggestions, and Markus Hardtmann and Endre Danyi for helping me with the translation from German into English.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes on contributor
Sabine Flick, PhD in Sociology, is a research associate in the Department of Sociology at the Goethe University Frankfurt and in the Institute for Social Research in Frankfurt, Germany. Main areas of research: work and mental health/self-care; therapy and society; work-related suffering and psychotherapy; and psychosomatics. Recent publications: Eigentlich bin ich ganz anders, ich komm’ nur viel zu selten dazu – Selbstsorge und Authentizität in entgrenzter Arbeit (in Abenteuer und Selbstsorge’; psycho_logik. Jahrbuch für Philosophie, Kultur und Psychotherapie, Band 10, ed. S. Grätzel and J. Schlimme, 2015 [SelfCare and Authenticity in postfordistic labor]); Paradoxien der Psychotherapie. Psychotherapeut_innen und die Kultur des Therapeutischen (in Freie Assoziation 2013, 364: 111–28 [Paradoxes of psychotherapy. Therapists and therapy culture]); and Leben durcharbeiten. Selbstsorge in entgrenzten Arbeitsverhältnissen (Frankfurt: Campus, 2013) [Working-through life. Selfcare in postfordistic labor].
Notes
1. The recent development in the UK and the use of psychotherapy in job centers is an additional dimension in the argument developed here (cf. Loewenthal Citation2015; Lees Citation2016).
2. Only in the field of psychological and medical anthropology have ethnographic studies recently investigated the knowledge systems of behavioral therapy and psychoanalysis. However, these studies do not explicitly examine the various interpretations of social suffering employed by therapists (Davies Citation2009; Luhrmann Citation2001).
3. A quick look at the publications listed in PubMed strengthens this reading of the development: whereas there are 180 articles listed on workaholism, and around 550 on workplace bullying, burnout is leading with over 6000 articles (own research).
4. In Germany, for instance, the inability to work is regulated by the Social Insurance Code. The inability to work is covered by the state insurance if the insured can no longer practice her profession due to her physical or mental state, or if she risks worsening her condition by continuing in her line of work (Bley, Kreikebohm, and Marschner Citation1995).
5. In addition to the author, the researchers involved were Nora Alsdorf, Rolf Haubl, and Stephan Voswinkel. Ethical approval was obtained from the Ethics Committee of the University Hospital Frankfurt, reference number MC 46/2014, received 13 March 2014, the active Ethics Committee of Goethe-University in Frankfurt, as well as the Ethics Committee of the Hesse medical association. The co-operating hospitals have been other hospitals in Hesse, Germany.
6. The patients work mostly in the service occupations in lower-income groups, only two are medical doctors, one is working in finance.
7. Six to 12 weeks is the average duration of clinical treatment financed by health insurance providers in Germany. Additional topics were the concrete professional context of the patients and the possibilities of their reintegration into working life.
8. Most of the professionals in psychosomatic clinics in Germany are either physicians with specialist training in psychotherapy, or they are psychological psychotherapists who graduated in psychology and then received training in one of the three methods of psychotherapy recognized by health insurance providers in Germany (Strauß, Hohagen, and Caspar Citation2007). The methods covered by health insurance in the two clinics in question are psychoanalysis; analytic depth psychology (which operates according to the same psychodynamic paradigm as psychoanalysis); and cognitive-behavioral therapy.
9. The supervisors are trained with a psychodynamic-systemic approach.
10. In contrast to most countries in the world, in Germany and Austria health insurances cover the costs of psychoanalytical treatment. Additionally, a very specific aspect of health care in Germany is the presence of many psychotherapeutic (and psychosomatic) hospitals providing thousands of hospital beds for psychotherapy (and psychosomatic rehabilitation) (Strauß Citation2015).
11. Toward the end of a patient’s stay, the therapists bring up the so-called ‘reintegration into working life’ on behalf of the health insurance providers. These conversations break with the traditional therapeutic setting and usually include social work in the clinic. The outcome of most of these conversations is the recommendation for a gradual reintegration into the workplace. The idea is that the patient will initially return to work for only a few hours per day. This recommendation, however, is out of touch with the actual working conditions of most patients: either their concrete occupation does not permit a reduction in hours, or colleagues, superiors, and the patients themselves undermine it (Voswinkel Citation2015).
12. All names have been changed.
13. On the concept of resilience and its political effects, see Brunner (Citation2014).
14. In almost all of the patient files we examined, the treatment report included descriptions of the patient’s ability/inability to set boundaries and the recommendation to improve it in subsequent outpatient therapy.