McDonaldization of Therapy
Strawbridge, S. (2002) ‘“McDonaldization” or “Fast-food therapy”’, Counselling Psychology Review, 17(4): 20–4.
Second to extra-therapeutic ‘client factors’, the quality of the therapeutic relationship, ‘being-in-relation’, is widely recognized as the most significant factor in successful therapy. There is, nevertheless, an increasing tendency to emphasize ‘technical expertise’ and pressure to package and manualize ‘treatment’.
This paper argues that this tendency is best understood in the context of a wider social-historical process first described and termed ‘rationalization’ by Max Weber. It draws on the recent work of George Ritzer who argues that the process of rationalization has continued to intensify. He has developed the metaphor of the fast-food restaurant, built on principles of efficiency, calculability, predictability and control and coined the term ‘McDonaldization’ to characterize the tendency. Increasing areas of social life are subject to ‘McDonaldization’ through, for example, shopping malls, packaged holidays, hotel chains and digital television. Even areas such as education and medicine are subject to this process. The stress on grades and league tables in education focus attention on what is quantifiable in the end product, rather than the quality of the experience, and health care is increasingly impersonal and technological. Both clients/consumers and workers are systematically disempowered in this process. The tendency to standardize, package and manualize therapy is considered as another manifestation of ‘McDonaldization’.
This paper is a development of ideas first outlined in ‘Counselling Psychology in Context’ jointly authored with Ray Woolfe and forming Chapter 1 of the second edition of the Handbook of Counselling Psychology, London, Sage.
‘McDonaldization’ or ‘Fast-food therapy’
I believe that counselling psychology is at a crossroads. We have now an established presence within the British Psychological Society and clear pathways to qualification, chartering and employment. Nevertheless, success has confronted us with a fundamental dilemma. This can be expressed as a choice between two modes of being, encapsulated in Martin Buber’s distinction between the ‘I–it’ and the ‘I–thou’ (1958). This translates into seeing ourselves, as practitioners, as either ‘technical experts’ or ‘persons-in-relation’.
There is, of course, a wealth of evidence emphasizing the therapeutic significance of the practitioner–client relationship. Roth and Fonagy (1996) clearly confirm this and Hubble, Duncan and Miller (1999), in their extensive analysis of outcome research, identify client variables and extra-therapeutic factors as accounting for as much as 40 per cent of improvement in therapy and the therapeutic relationship as accounting for 30 per cent. Placebo/expectancy effects and specific techniques each account for 15 per cent. Nevertheless, flying in the face of the evidence, the pressure, on us and other therapists, is currently very much in the direction of technical expertise and an increasing reliance on technique. ‘Doing-to’ is substituted for a relationship in which ‘being-with’ a person is paramount; ‘I–thou’ is ousted by ‘I–it’. Writing from a psychoanalytic perspective, Peter Lomas (1999) has expressed similar concerns about the emphasis on technique over relationship and explored some of the ways in which what he terms ‘the retreat from the ordinary’ damages the therapeutic process.
No doubt as professions – in their very nature – make claim to expertise, this seeming ‘ordinariness’ of ‘being-in-relation’ is part of the problem. Nevertheless, Carl Rogers, who did much to establish the significance of relationship in therapeutic processes stressed that therapeutic relationships are not different in kind from other relationships in everyday life. What can be overlooked is the intrinsic value of meeting when depth of contact can be established in the relationship. Rogers emphasized the extraordinary therapeutic potential of this ordinary human capacity and we owe much to his careful work in researching its nature and potential and for identifying key therapeutic factors as acceptance, empathy and congruence.
Differing therapeutic approaches now draw upon this understanding and one might expect this to lead to a focus on research into the relationship and an exploration of the issues that arise when this is considered in some depth. For example, whilst there are strong affinities between the approaches of Rogers and Buber there are also significant differences that have implications for practice (see, for example, Kirschenbaum and Henderson, 1990: 41–63; Friedman, 1992). Too often however the relationship is considered superficially and reduced to a pre-condition for the application of techniques: the ‘technical expert’ over-shadows the ‘person-in-relation’.
The pressure on counselling psychology to move in the direction of technical expertise comes in part from its success. It has, I think, two related sources. The first can be thought of as internal – linked to the development of the discipline and its increasing sense of connection with psychology, as distinct from counselling and psychotherapy. The espousal of the ‘scientist–practitioner’ identity is significant here. Despite developments in theory and research that challenge the more traditional view of science, what Donald Schön (1987) and others have termed the ‘technical-rationality’ model still dominates and is favoured by the demand for evidence-based practice. Research tends to be constrained by notions of good design often inappropriate to complex life situations (Spinelli, 2001: 5). There is an inbuilt bias towards the cognitive-behavioural tradition which best fits the model and can, therefore, make the strongest claim for a distinctively psychological form of clinical practice (see, for example, The British Psychological Society, Division of Clinical Psychology, 2000). This is encouraged by the emphasis on efficacy studies, characterized by ‘randomized control trials’, though, as Seligman (1995) argues, these may not be the best way to evaluate the effectiveness of therapy and, indeed, exaggerated claims may be made about the significance of results or the adequacy of the design (see, for example, debates initiated by Bolsover, 2001; and Holmes, 2002).
The second source of pressure is more external – linked to success in the increasing employment of counselling psychologists in a range of settings (most significantly the NHS and EAPs) where there is a heavy demand on resources coupled with a justifiable expectation of accountability. This favours the traditional and limited view of evidence-based practice. There is also a strong tendency to promote short-term problem or solution focused work and standardized, manualized and even computerized treatments to the exclusion of more flexible and creative approaches (which stress the specificity of each therapeutic relationship) and longer term in-depth work. This pressure is difficult to resist, but understanding it in the context of a wider social process may both underscore the importance of resistance and provide it with a useful theoretical framework.
This wider social process was first identified and termed ‘rationalization’ by Max Weber in his seminal analyses of ‘modernization’ (see, for example Brubacker, 1984; Whimster and Lash, 1987). Rationalization is characteristic of modern industrial capitalist societies and involves the application of rational decision-making criteria in increasing areas of social life. The traditional or ‘technical-rationality’ model of science is linked with the general form of reasoning ‘zweckrationalitat’ or ‘instrumental rationality’ central to rationalization. Instrumental rationality is concerned with calculable expectations and, within the general sphere of instrumental rationality, the selection of the most adequate means to achieve a given end can be assessed in terms of its ‘objective rationality’ – that is, scientifically. Instrumental rationality is distinguished from ‘wertrationalitat’ or ‘value rationality’ which is oriented to consciously upheld values. As instrumental rationality comes to dominate, in the process of ‘modernization’, values and ends are effectively excluded from the framework of rationality. Freed from the external constraint of values (historically the ‘protestant ethic’) productivity, the hallmark of industrial capitalism, coupled with scientific and technological progress, becomes an end in itself as opposed to a means whereby independently established human needs may be satisfied.
The overall effect is to construct a complex ‘iron cage’ of bureaucratic rules and regulations geared to calculable economic efficiency. At the beginning of the twentieth-century (1904–1920), Weber wrote:
No one knows who will live in this cage in the future, whether new prophets will arise, or there will be a great re-birth of old ideas and ideals, or, if neither, mechanized petrification, embellished with a sort of compulsive self-importance. For of the last stage of this cultural development, it might well be truly said: specialists without spirit, sensualists without heart; this nullity imagines that it has attained a level of civilization never before achieved. (1974: 182)
It seems that ‘mechanized petrification’ could well be on the cards. George Ritzer (1993) argues that the process of rationalization continues to intensify. He coined the term ‘McDonaldization’ to characterize the highly controlled, bureaucratic and dehumanized nature of contemporary, particularly American, social life. The fast-food restaurant – built on principles of efficiency, calculability, predictability and control, where quantity and standardization replace quality and variety as the indicators of value – serves as a metaphor for the general mania for efficiency. Increasing areas of social life are subject to ‘McDonaldization’ through, for example, shopping malls, packaged holidays, hotel chains and digital television. Perhaps more seriously, areas such as education and medicine are subject to this process. The stress on grades and league tables in education focus attention on what is quantifiable in the end product, rather than the quality of the experience, and health care is increasingly impersonal and technological.
Ritzer (1998: 59–70) has also considered the organization and experience of work and linked his perspective to Harry Braverman’s (1974) analysis of the labour process. He recognizes that the ‘deskilling’ and degradation of labour is characteristic of rationalization. Work has been increasingly rationalized through bureaucracies, scientific management assembly lines and so on. Now the process of ‘McDonaldization’ is leading to the creation of more and more ‘McJobs’ – jobs characterized by the five dimensions of ‘McDonaldization’. Work is highly routinized, thinking is reduced to a minimum and even social interactions (e.g., with customers) are scripted (see Hochschild, 1983). Higher-level skills (such as planning), creativity, critique and genuine human contact, are effectively excluded so both producers and, in the service industries, consumers are systematically disempowered.
Dimensions of ‘McDonaldization’
- Efficiency – the discovery and implementation of the best way to do virtually everything: fast-food restaurants provide more efficient means of obtaining meals than cooking at home from raw ingredients. All the tasks performed by employees are efficiently organized and the same is true of the things done by the consumers.·
- Calculability – the emphasis on things that can be counted and quantified: the time associated with work tasks is carefully calculated and quantity becomes the measure of value: we have ‘Big Macs’ not ‘Delicious Macs’.
- Predictability – the emphasis on standardization: The settings, the food and the behaviour of the staff are much the same in one situation as another.
- Control and use of non-human technologies – the careful control of people, both workers and consumers, increasingly by the introduction of non-human technologies: human skills are taken away from people (deskilling) both by detailed scripting of behaviour and by the introduction of technologies (the frying machines ‘decide’ when the fries are cooked).
- Irrationality of rationality – rationalized systems, seemingly inevitably, bring with them a series of irrationalities (what Weber termed unintended consequences?): ‘McDonaldized’ systems tend to have a negative effect on the environment and dehumanize the world. It is this dimension that gives the thesis its critical force. (After Ritzer, 1998 and 2002)
And Counselling Psychology?
Even this brief outline suggests insights into the labour market, dominated by medicine, into which counselling psychology is increasingly drawn. The deskilling of work in general has broad political implications, to which I cannot here do justice, but it is of particular concern to a profession that defines its practice in terms of human relationships. We might learn much from Michael Apple’s (1985) analysis of education from this perspective, but for now it is only possible to note some of the means whereby, in therapy, complexity is minimized, process routinized and thinking and human contact reduced, for example by:
- The strong emphasis on training in techniques (despite the significance of the therapeutic relationship);
- Attempts to operationalize competences (e.g., through national occupational standards);
- The demand for quantification in efficacy studies (without due regard to the adequacy of the measures or the quality of the experience);
- The consequent stress on diagnosis and problem specification (as opposed to the subjective experience of distress);
- Attempts to package delivery through therapy manuals; and,
- The use of computers to deliver some such packages.
Of, course, in the food business as in other areas of life, there is resistance to ‘McDonaldization’. This may take a number of forms. ‘Rib joints’, for example, are difficult to find (advertised by word of mouth), may seem shady or suspicious, are housed in seedy premises, have staff who may seem deviant and their ‘regulars’ can be disdainful of newcomers (Holley and Wright, 1998). Alternatively there are high-class exclusive restaurants with cordon-bleu chefs who use only fresh organic produce. I wonder how many of us have our origins in the therapeutic equivalent of ‘rib joints’ and now run expensive cordon-bleu outfits? I, personally, find this an uncomfortable analogy! But, to return to the crossroads, if we choose the road of ‘being-in-relation’ as I hope we will, I believe an important question for us, as a professional group, concerns the extent to which we can resist ‘McDonaldization’ within the mainstream of therapeutic services available to the majority of clients.
I personally enjoy metaphors and I like bits of theory that can be used playfully. It is in this spirit that I offer this bit of theory and I hope that others will take it up, play around with it and use it as a tool to reflect upon and intervene in the circumstances of their own practice.
Finally, in the spirit of McDonalds, now that you have finished the meal I offer you a freebie in the form of a joke:
The QM Goes to a Symphony Concert
A company president was given tickets for Schubert’s Unfinished Symphony but was unable to attend. He gave the tickets to his quality manager. Next morning the president asked the QM if he had enjoyed the concert and was handed the following typed memorandum:
For considerable periods of time the four oboe players had nothing to do. The number should be reduced and their work spread over the whole orchestra, thus eliminating peaks of activity. All twelve violinists were playing identical notes. This means unnecessary duplication and the staffing of this section should be cut drastically. No useful purpose was served by repeating, with the horns, the passage that had already been played by the strings. If all such redundant passages were eliminated the concert could be reduced from two hours to twenty minutes.
If Schubert had attended to these matters in the first place, he would probably have been able to finish the symphony after all.
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