IF you are unemployed, it is your own fault and all you need to find work is a little willpower, or even willingness.
That appears to be the current Government message. Last week, David Cameron launched an attack on the so-called "culture of entitlement" with a series of proposals designed to cut the welfare budget. They included measures to time-limit benefits, require claimants to gain basic literacy skills and put pressure on them to improve their medical conditions.
Such policies imply that joblessness is, at least partly, linked to motivation and personal choice. But there is another tool currently being used to push people back into work, one which underlines the notion that unemployment is a state of mind, and that is therapy. From "cognitive behavioural therapy" (CBT) directed at those too depressed to work, to motivational training courses for the unemployed, the theory appears to be: fix the attitude and you can make an employee out of a feckless layabout. The approach raises questions about the true causes of our unemployment crisis, and whether they are indeed rooted in a cultural mindset, or stem from something more tangible.
I have talked to several people who have been on the Government's work programme, which aims to help people back into employment. Unemployed gardener Eddie Toner, 56, from Edinburgh has been put on several courses since beginning the work programme nine months ago. One of them, he jokingly refers to as "The Eagle Has Landed", because participants were given photocopied hand-outs about a mother eagle who encourages her offspring to fly by pushing them out of the nest. Extracted from the self-help classic, Even Eagles Need a Push: Learning To Soar In A Changing World, it contains a line in which the mother eagle considers: "Why does the thrill of soaring have to begin with the fear of falling?" This is typical of the motivational thinking that is being delivered to some of the unemployed. For Toner, who after decades of work is facing a job market that looks crushingly lacking in opportunities, it seems "vaguely sinister". He calls these courses "amateur psychology". On another course, provided by Edinburgh-based company, Originel, he was given three days of training based on neuro-linguistic programming, a controversial technique involving modelling behaviour on successful people. None of it, he believes, is getting him any closer to finding that elusive job.
Being unemployed is now treated as if it were a disorder that – for the good of the nation – needs to be cured with positive thinking, to ease the financial burden imposed by the unemployed. There is growing concern about the economic costs of unemployment caused by mental illness. A recent report, by economist Lord Richard Layard of the London School of Economics, one of the minds behind the Labour government New Deal scheme to get people back to work, quantified the financial impact of mental illness on the Exchequer in terms of unemployment at "£8 billion in incapacity benefit claims". It also pushed for more therapy to be made available on the NHS.
Meanwhile, a therapeutic attitude to joblessness can be found in the motivational approaches devised to get the unemployed back to work. These include courses based on CBT, which aims to reduce emotional distress by challenging negative thoughts and replacing them with more constructive ones. It is a pragmatic approach which, according to Glasgow University psychiatry professor, Dr Chris Williams, "teaches people how to identify upsetting thoughts and then change them".
CBT is being touted as an essential element in solving two of society's big problems: the rising epidemic of depression, and long-term benefit dependency. Over the last two years in Scotland, nearly 2000 people have received some training in delivering CBT. The method is supported by impressive research, and it is used in almost every field of mental health. One 1997 study found that those exposed to CBT were more likely to find work than those who did not. CBT advocates claim astonishing results in treating depression and anxiety. According to Layard's latest report, after a course of around 10 sessions, half of anxiety patients will recover, mostly for life. Those suffering depression have a similar initial success rate, followed by a "much reduced" likelihood of relapse.
How we treat depression and anxiety matters in the battle to reduce the welfare bill, since these conditions have been responsible for 40% of incapacity benefit claims. However, the relationship between unemployment and depression is a complex one. Lose your job, and within six months you are likely to become depressed. But depressed people also often struggle with work. I talked to one man with depression, who lost job after job through being unable to cope, but was assessed by the private contractors working for the Department for Work and Pensions as "fit for work". He lost his benefits after refusing to attend his work programme appointment, saying: "I'm a million miles away from being able to work." As a result, he is now living off his partner: one less head on the benefits tally.
There is a danger in overplaying CBT's effectiveness. The method doesn't suit everyone with depression or anxiety, and the quoted success rate of almost 50% is achievable only by rejecting people who aren't considered likely to benefit from it. Stirling University's Professor Margaret Maxwell, who recently worked on NHS Living Life, a Scottish CBT programme, points out that the approach "requires a degree of literacy and self-motivation from participants". Current research also suggests it may be less effective in deprived populations.
The psychotherapeutic approach to tackling unemployment can be traced back to the 2006 publication of Layard's The Depression Report: A New Deal For Depression And Anxiety Disorders, which argued that psychological therapy should be made available to everyone in Britain, a tactic that would "pay for itself by the reduced expenditure on incapacity benefits from people being able to go back to work". It recommended the training of 10,000 CBT therapists. In 2008, Layard launched a programme, Increasing Access To Psychological Therapies (IAPT), to push through this training in England. A year later it was announced that "mental health co-ordinators" were to be installed in Jobcentre Plus offices UK-wide. In Scotland, these are placed in district offices, where they can refer benefit claimants on to other mental health services, including those based on CBT.
Not everyone approves. The psychologist Oliver James, author of Britain On The Couch, talks disparagingly of sending "the depressed, wounded worker back to work with a false smile sticky-plastered to their face". Another critic, Professor Andrew Samuels, former chair of the UK Council of Psychotherapists, questions the wisdom of "implying that unemployment and poverty are the kind of problems you should be taking to a shrink", and warns against treating the unemployed as "second-class citizens whose poverty reflects their lack of moral fibre."
Glasgow University's Williams argues that the method has achieved dominance because it is effective and highly adaptable. But even if it works – and relatively cheaply – psychotherapist Jeremy Weinstein warns that in focusing on the cure, we risk ignoring the underlying problem. The link between depression and social inequality is well documented. Lynne Friedli, author of a 2009 WHO report on depression, argued that marked improvements in mental health in the UK would depend on first tackling the gap between rich and poor. Richard Wilkinson and Kate Pickett, authors of The Spirit Level: Why More Equal Societies Always Do Better, also argue that the solution is not "mass psychotherapy aimed at making everyone less vulnerable", but reducing inequality.
The truth is, of course, that unemployment is related to real economic cycles, and the current job shortage is linked to the recession. So it could be argued that the unemployed are being encouraged to wallpaper over reality with positive thinking. Eddie Toner recalls that during one course, the leader told participants: "All of you should have jobs now." Toner's response was: "You're having a laugh."
When Maria Miller, minister for disabled people, said last February that there was "no shortage of jobs", the Guardian newspaper pointed out that there were 2.68 million people chasing 463,000 jobs: six for every vacancy, or more in some areas of the country. A TUC report earlier this year calculated that in West Dunbartonshire, the hardest-hit area for joblessness in the UK, 31 people were chasing every vacancy. Hardly "no shortage". But would it really be more heartening to hit the unemployed with the truth – that there are few jobs to be had?
Ironically, some unemployed people find motivational courses demoralising. Matt Dobson, a 26-year-old graduate, recalls going on a Dundee-based course run by Goals UK, and finding it far from confidence-building. "Out of all the people I spoke to on the course," he says, "not one said that they had found it helpful." Some participants, he recalls, had difficulties with literacy or drugs and many had never worked. They were encouraged to admit their problems, which he believes some found humiliating, particularly when those issues were alcoholism or illiteracy. Goals UK insists, however, that participants aren't obliged to share, that "sharing in a well-facilitated group is very effective" and that its staff are trained to be sensitive.
And clearly, some people are helped by these courses. Originel, in Edinburgh, claims a 24% strike rate in getting people in to employment. And though its method is founded on neuro-linguistic programming, it describes its approach as providing an environment in which "people get a sense of self-worth through helping each other". Goals UK, a London-based company, boasts a 70% success rate for getting young Neets (not in education, employment or training) into work. The story of its founder, Philip Collett, is a fabulous success tale and testimony to the possibilities of CBT and motivational self-help. As a young man he was homeless and troubled but, while living in America in the late 1980s, he came across cognitive behavioural therapy and other motivational techniques and turned his own life around.
Collett believes the problem is not too much CBT or motivational training, but too little. "There is nowhere near enough being done of what we do," Collett says. "Instead, we just beat the unemployed with more sticks." His words echo those of Layard, who also believes that, in the NHS, there is not enough CBT getting through. There is, he said, following the publication of his recent report, "huge resistance, not so much in the public but among NHS managers".
In fact, it is not the tool of CBT itself that is a problem, but rather the way it fits into a wider message about contemporary life. In her book, Smile or Die: How Positive Thinking Fooled America And The World, Barbara Ehrenreich discusses the motivational courses for the unemployed as just one aspect of the grip that glass-half-full thinking has on her country. She is part of a growing backlash against this attitude. Oliver Burkeman's recently published The Antidote: Happiness For People Who Can't Stand Positive Thinking, for instance, argued that research is undermining the notion that positive thinking does bring success or happiness. Researchers are discovering that simply cultivating an attitude of "accentuate the positive and eliminate the negative", is not going to put us on the superhighway to national wellbeing – in fact, it may well make us feel worse. Just as simply telling people to believe they will find jobs won't create those jobs, and may well leave them feeling even less able to fly.
Last week, David Cameron complained that "1.4 million people in this country have been out of work for at least nine of the past 10 years". And it's true that getting the long-term unemployed back to work is an issue that long predates the recession. Many of those involved in attempts to do so are very sincere. Eleanor Cannon, director of Originel, points out: "On a national level this may be a political issue, but actually this is about individuals, and helping people regain their self-respect is key to getting them back to work."
But the current reforms already seem to be failing. The work programme's success rate at getting claimants back into employment staggers along at 22% – well below the Government's 36% target.
One of the major contractors delivering it, A4E, is not meeting its minimum targets. In Scotland, long-term unemployment among 18 to 24-year-olds has shot up by 1155% in the last five years (from 415 in December 2007 to 5210 in April, according to the STUC's labour market report).
Is more therapy the answer? Perhaps for some. But at best, this is emergency treatment, not preventative care. We need to look further than the sticky-plaster smile.
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