Special education is a field where the mainstream approach is to think in terms of a biopsychosocial model, with the medical model as its established foundation (Jakobsson & Nilsson, 2011). The medical model coexists with perspectives that incorporate social factors: systemic, categorical, and relational perspectives, as well as a dilemma perspective (Jakobsson & Nilsson, 2011). Normality and deviance are problematized, even though the underlying framework is fundamentally based on a psychiatric discourse (Jakobsson & Nilsson, 2011). Diagnoses of children and adolescents have been examined more explicitly from a social perspective, where diagnoses are viewed as interconnected with knowledge production, regimes of truth, funding, and constructions of normality (Hallerstedt, 2006).
Virtually all research and interventions in the school setting are framed within a psychiatric discourse focused on improving mental health, such as reducing and preventing depressive symptoms in the DISA intervention (Kvist Lindholm, 2015; Garmy, 2016; Kvist Lindholm & Zetterqvist Nelson, 2015). This is a powerful discourse linked to voices in the debate calling for “mental health on the curriculum,” which fails to recognize that psychological thinking needs support from other subjects to be educational and to bring about more robust changes. Much of the health promotion carried out in Swedish schools is in dire need of robust evaluations, making it impossible to say much about whether the effects are negative or positive in the Swedish context (Garmy, 2016). In general, there are few studies that are randomized, examine long, term effects, and focus on behavioral changes as a measure. At the same time, there is a wide variety of programs in use; a survey of Swedish schools revealed 29 different programs, the most common of which were DISA and SET (SBU, 2010, 22).
One program that has been used repeatedly is DISA (Depressive Symptoms in Swedish Adolescents), which is based on CBT and focuses on reducing and preventing low mood and depressive symptoms. DISA was initially a program specifically designed for girls but has been expanded to include boys as well and is now often implemented universally in schools as a health promotion initiative (Garmy, 2016). One dissertation points to certain positive effects but notes that the program has been stigmatizing, especially when it was directed solely at girls, and that it has been burdened by a pathogenic focus (Gramy, 2016, 21). Another frequently used program is SET (Social and Emotional Training), which, like DISA, is a manual, based program (SBU, 2010). The fact that DISA and SET have shown some positive effects in certain studies is surprising when compared to an ethnographic study of these programs by Kvist Lindholm (2015). DISA and SET are riddled with paradoxes that become glaringly obvious when they are applied universally in a school setting. The problem arises because these interventions were designed for indicated health interventions (Lindholm, 2015). Some paradoxes that arise when they are applied universally in preventive health settings include: students who do not exhibit depressive symptoms or aggression problems may become more attuned to emotions, thoughts, and behaviors associated with such issues, and instead of promoting health, the focus often shifts to identifying deficiencies (Lindholm, 2015). Other problems that arise include an excessive focus on the individual, which obscures the fact that causes may stem from the environment, for example, something that isn’t working well at school (Lindholm, 2015). Other effects that have been observed include students adapting to the manuals rather than the other way around; the programs are taught in lessons that isolate them from the rest of the organization’s practices; girls have often been attributed low self, esteem, which frequently becomes a self, fulfilling prophecy; there was pressure to identify with negative thoughts; the focus could shift to problems that did not exist while real problems were ignored; several activities could strengthen relationships among students, but there were also instances of harassment among students in connection with DISA and SET (Lindholm, 2015). These programs are also embedded in a “crisis discourse” that can heighten feelings of anxiety about how easy it is to experience mental health issues (Lindholm, 2015; Ecclestone & Hayes, 2009). SET and DISA often lead to over, individualization and placing excessive blame on the individual because environmental factors are underestimated (Lindholm, 2015).
Critical psychology is a collection of psychologists and schools of thought that challenge “mainstream psychology,” which they argue lacks sufficient reflection and analysis regarding power, politics, and society; it draws much of its theoretical strength from critical theory, which has primarily been rooted in social theory (Walkerdine, 2002; Fox & Prilleltensky, 1997). Critical psychology can be viewed as an umbrella term. Critical psychology originated with the anti, psychiatry (reform) movement of the 1960s. A peculiar view held by some researchers in the field is that psychoanalytic psychology should be regarded as critical, overlooking the fact that psychoanalysis enjoyed strong hegemony in the United States during the mid, 20th century, which crumbled due to the psychopharmaceutical revolution (Scull, 2022). Critical psychology often has a left, wing and sometimes a feminist emphasis, drawing on sociology and social theory in general to strengthen the analysis (Walkerdine, 2002). Books on critical psychology bring together both sociologists and psychologists; critical psychology can be seen as occupying a borderland between sociology and psychology, but in a different way than, for example, social psychology (Walkerdine, 2002). Under this umbrella are community psychology, social materialist psychology, phenomenological, narrative, and existential psychology, and integrity therapy, among others. It draws on social scientists such as Habermas, Beck, Elliott, Marx, Foucault, Fanon, and others. The field is quite small, with only a few journals.
Community psychology is very similar to critical social work: concepts such as empowerment, diversity, social justice, individual well, being, civic participation, “sense of community” as a theoretically defined concept, collaboration, and community strength; it operates at the community level rather than solely clinically, with “bottom, up feedback” and pluralism in scientific methods (Trickett, 2009). A common theoretical framework used is ecological systems theory, which allows one to choose the level where one can have the greatest impact, sometimes at the community level and sometimes at higher levels. First, and second, order changes involve altering one thing that, in turn, creates changes in another. A leading figure in this field is Kurt Lewin, who argued that, in psychology, both research and action are necessary. Within critical psychology, there is criticism of mainstream psychology for being overly individualistic and thus blaming. One goal is to build “capacities” within the community (Trickett, 2009). What community psychology lacks are sociological concepts and understanding, even though it focuses on the social.
Social materialist psychology shares the same starting point as the other fields discussed above. It is critical of diagnoses based on a lack of validity, arguing that psychotherapy relies too heavily on talking, is too individualistic and idealistic, and thus ignores material factors (Moloney, 2013). It is skeptical of “individual differences” in vulnerability, instead focusing on the situation and the individual’s life history (Moloney, 2013). Change is possible by identifying resources in one’s surroundings, much like the problem, solving approaches already used in social work. The problem is attributed to society rather than the individual (Moloney, 2013).
Social materialist psychology is the approach that could most closely be viewed as sociotherapy rather than psychotherapy, since this orientation in so many ways grounds its thinking in the social context. For example, they view depression as embodied inequality, yet at the same time do not wish to be merely an inversion of “mainstream psychology” (Moloney, 2013).
Phenomenological psychotherapy is about staying present, remaining within, and reflecting on experiences; delving “deep” into what we are actually experiencing; and fostering an openness to experiences, much like other therapies. This therapy has also been integrated with existential psychology by several practitioners. A criticism of this therapy is that experiences are not everything; it can also lead to rumination, which can become a problem.
Feminist therapy can be seen as a blend of psychotherapy and sociotherapy. It incorporates sociological concepts from feminist theory, such as the double shift, the internalization of self, hatred, marginalization, structures, oppression, and emotional detachment. At the same time, it also draws on ideas from cognitive behavioral therapy. The goal is to raise awareness so that clients can see that their personal problems have a societal connection, just as Mills believed sociologists should do. This ties into the central tenet of feminism that the personal is political. Some interesting examples include training oneself to become more assertive as an act of resistance against being socialized to not speak one’s mind as a woman. Some feminist therapies incorporate CBT , but at the same time, they aim to encourage the person in therapy to become politically active as a feminist as part of their healing process.
Narrative therapy focuses on stories and discourses about ourselves and the world. It also has a postmodernist and social constructivist foundation. The postmodernist notion that there is no single truth can be questioned, and sociotherapy would certainly incorporate a linguistic dimension into its analyses, but it need not adhere to a postmodernist view of truth. The goal of narrative therapy is to create a more productive narrative, to bring dominant narratives to light, and to rewrite these narratives and find alternative ones. This can be done, for example, by looking for exceptions to the narrative, or by making “thin narratives” thicker, which creates more space for understanding why one struggles with something. Thin narratives are often a problem for people who experience high levels of anxiety or depression, as they cause rumination to become very one, sided. Narratives are linked to one’s identity and sense of self. Criticism of this therapy is that it focuses too much on talking and not enough on action (Moloney, 2013). Sociotherapy could employ habitus and agency analyses to highlight which actions are linked to this as well. And exercises that aren’t based solely on reflection, talking, and thinking.