The two models of work in relation to Psychotherapy

Medical Psychotherapy Faculty Newsletter Autumn/Winter 2013

Western culture considers two different approaches to work. The first one is a Biblical curse, to work in order to earn a living. The second one is a path toward self development and leaving a mark in the world. For Marx, man is the product of his work.
Although throughout history the model of work as a curse has been very prevalent (finding its ultimate expression in slavery), artisans and other professionals have used their work to develop and express themselves and have found some joy in the results of their effort.
The locus of control and responsibility can either be internal or external. Kordopartgradout . The emphasis on accountability fosters the latter along with compliance (or rebellion) and detracts from individual’s responsibility and desire. This can have both advantages and disadvantages.
When Henry Ford streamlined the assembly line for his T model, he realized he was changing the model of work for his “car-makers” and compensated it with big salaries which allowed his employees to buy cars themselves. Leaving aside the quality of life of these workers, it has been proved that “cursed workers” in an assembly line can build cars effectively.
Both Medicine and Psychotherapy have traditionally been seen as vocational careers led by the professionals’ internal drive to better themselves. Are these professions suitable to be developed effectively under a Biblical model? Is it necessary or even appropriate?
It is clear that we are moving towards a model of external control in Medical work in general and Psychotherapy in particular. Continuous professional development requirements, revalidation, recertification, job targets and all sorts of red tape are increasingly shaping the work from the outside. If we add performance standardisation, salary reductions and loss of social status we can even talk of the proletarianization of Medicine.
I argue that the ‘drive for the excellence’ is fundamentally incompatible with a proletarianized job as illustrated by both the industrial revolution and the history of the USSR. Production models led from the above (or outside) can improve the quantity of the production, but only at the expense of both its quality and working conditions.
If we understand that the Psychotherapist works, not just with a technique, but with his own self, impingements on his capacity to deploy himself, be creative and feel proud of his work will affect the quality of his work and drive a wedge between him and his profession, leading him progressively to the Biblical model and thus to ‘burning out’.
A burnt out Psychotherapist who loses his empathy and compassion and deals with severe psychopathology in others is at risk of developing further layers of defensiveness and enter into a psychopathic management of the task (and people) as described by Menzies Lyth in her classical work, and/or develop some kind of mental illness themselves.
As a concluding note, I am not opposing all kind of external regulation of a job where vulnerable patients are at risk of both abuse and neglect, but I consider that thought needs to go into the form and extent of this regulation as well as the price that is paid for it. While some control might be helpful to counteract the most extreme professional misconduct, in many cases just respecting the clinician might be a more effective way of enhancing quality of work than trying to micromanage it. I understand this is a controversial issue and I would like to encourage contributions to this Newsletter discussing the various side of the argument.