New Internationalist

A Consumer’s Guide To Therapy

Issue 132

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MENTAL HEALTH [image, unknown] Choosing a therapy

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A consumer's guide to therapy
Life is tough - even for New Internationalist readers. The question is whether we need some kind of therapy to help us cope. This two-page guide helps you decide whether you need help, profiles the main therapies on offer, and assesses their costs and benefits to you, the consumer.

There can be no bard and fast rules for assessing whether you need therapy. Obviously we all feel anxious, depressed, even panic-stricken, now and then. But when these feelings become actually disabling, then it’s time to take yourself seriously. The following are three main types of psychological distress that can seriously interfere with your daily life.

. Patterns of irrational behaviour that you feel powerless to change and which make your life a misery: such as a horror of dirt or disorder that makes you wash or tidy up constantly; compulsive eating or dieting; choosing, time after time, an unsuitable lover or job that you know is unsuitable.

. Beliefs or perceptions at odds with those of other people: such as a suspicion that a group of people are talking about you or ganging up against you; voices coming from the television set when it’s switched off; a rash on your arm that no-one else can see.

. Persistant emotional reactions far out of proportion to anything that is happening to you: such as profound depression with no obvious cause; acute nervousness or anxiety; panic attacks accompanied by breathlessness and palpitations.

It is important not to feel guilty about seeking help, arguing that ‘other people must feel far worse than I do’. For one thing, if they do feel worse than you and if they are indeed not getting the kind of help they need, then it is the system that delivers help that needs changing. And it is political action, not self denial, that will achieve that change. And secondly, there is no way of measuring the extent of a person’s emotional distress - you may feel twice as bad as someone with twice your problems.

Another thing that might make you hesitate is the feeling that you should be able to cope on your own, with the help of friends, your political will or your religious beliefs. There is no question that a lot can be done with a bit of introspection and a lot of love and support. But it is rare to find in yourself or your friends the kind of skill, honesty and commitment that might be needed to tease out the more deeply-embedded knots and tangles of your emotional life. Even the closest of friends tends to shy away from the truth: because they are afraid of, and do not want to take responsibility for, its effect on you.

One last word of warning: perhaps the most important thing to bear in mind is that all the advice you get - on these pages and elsewhere - could be complete and utter rubbish. The person writing this is no more qualified to give advice than your doctor, psychiatrist, therapist or co-counsellor is to give you help.

If you do decide to pursue this kind of help, do not expect your therapist to be perfect. He or she probably had a dreadful angst-ridden sex life, excema behind their knees and a spider phobia. They are in no position to save you. But they do have something to offer. And there is no doubt that most of them care about what they are doing and seriously want to help.

What they offer is outlined below. It is not enough. Nor should it be. You have to do the rest.


The Family Doctor

[image, unknown] About two-thirds of all visits made to family doctors are for emotional rather than medical problems. But in six years of medical training many doctors received just one month of psychiatry and no formal therapeutic or counselling training whatsoever. Doctors are taught to concentrate on symptoms and to treat them with drugs, though individual doctors may take an interest in the psychological reasons for a patient’s insomnia, for example, or palpitations. Despite their lack of training family doctors diagnose, and treat with drugs, mental illnesses as serious as schizophrenia as a matter of course. The large variety of psychoactive drugs - including new preparations with long-acting effects - mean that the large majority of people in mental distress are never referred to a psychiatrist or psychologist at all and never see the inside of a mental hospital. Their doctor either simply writes out a prescription and sends them home, or chats to them for a few minutes and tells them to come back in a few weeks if they are not feeling any better. And then writes out a prescription. If you want something else you will have to insist on being referred to a psychiatrist or produce a symptom for which a drug has not yet been invented.

COST AND AVAILABILITY
In countries with a National Health Service, the treatment is available to everyone with access to a doctor.

DANGERS
Reliance on drugs as a form of treatment can cause side effects, drug tolerance and addiction. It can also make you feel that any achievement you make is a result of the drugs rather than your own power. And it can prevent you loQking for the causes of your distress in your own life and relationships. Drugs can never cure mental illness.

NI ASSESSMENT
Someone to use only as a last resort for help coping with short-term distress, but a useful way of gaining access to standard psychiatric or therapeutic help.


The Psychiatrist

[image, unknown] Psychiatrists are qualified medical doctors with additional training in psychiatry - a training which concentrates largely on the chemistry and physiology of the brain rather than the personality of their patients. Most work in mental hospitals and on the psychiatric wards of general hospitals where, in addition to the range of drugs available through your family doctor, the psychiatrist can also treat you with electric shock. Apart from some occupational therapy (for those not too drugged to participate) this is usually all that is offered in the way of therapy on a mental ward. Some psychiatrists dabble in their own personal brand of talking therapy and others take additional training in psychotherapy or psychoanalysis.

COST AND AVAILABILITY
Except in the US, where the large number of psychiatrists are consulted almost as freely as doctors, most people only see a psychiatrist when they are admitted to a mental ward or referred on as an outpatient by their family doctor. Private consultation costs are on a par with those of any other private medicine.

DANGERS
Up to 40 per cent of patients taking the drug most commonly prescribed for schizophrenia suffer irreversible brain damage. Electroshock treatment also damages the brain. Hospitalisation exposes you to both of these dangers and, if you are compulsorily detained or considered incapable, you may not be able to refuse these treatments.

NI ASSESSMENT
Avoid psychiatrists at all costs. If you want psychotherapy find a therapist. If you want drugs go to your doctor. Shock treatment and hospitalisation are pointless and dangerous.


The Analyst

[image, unknown] An analyst is someone who will talk to you in depth. There are three main types who differ according to whether they practise within the framework of Freud, Jung or Klein. What they have in common is the belief that mental illness is caused primarily by unconscious urges or half-forgotten events in early childhood and that only by discovering, understanding, accepting and perhaps even reliving these events will we be able to function happily as adults. All analysts have had an analysis of their own on the principle that a person needs to understand him- or herself before s/he can help others. The patient is encouraged to talk about dreams, fantasies, suspicions, emotions and the analyst tries to remain anonymous to encourage this outpouring, intervening only to direct the patient along what appear to be fruitful lines of thought.

COST AND AVAILABILITY
Almost all analysts work privately. If you have the money (between $20 and $60 an hour) you can usually track one down via your family doctor. Most prefer you to come six days a week and insist on at least twice a week for 48 weeks a year. A complete analysis seldom takes less than two years; often as long as five.

DANGERS
Apart from bankruptcy, the worst danger is that you will come to believe your analyst is infallible because almost anything can be explained by Freudian theory - even your arguments and objections. Watch out for the hidden agenda: homosexuality, for example, is considered sick and immature by most Freudians.

NI ASSESSMENT
Your time, money and effort are probably better spent on ordinary psychotherapy, a holiday in the sun and on concentrating on different ways of expressing yourself - through painting, music or writing, for example.


The Psychotherapist

[image, unknown] ‘Psychotherapist’ is a ragbag term for someone providing therapy who is not a doctor, psychiatrist or analyst. It is useful to classify pyschotherapists into two main groups. The first consists of those with a formal qualification in psychology, social work or psychiatric nursing. Most of this group work in mental hospitals providing therapy to outpatients (and some inpatients) referred to them by doctors and psychiatrists. But some operate on their own, in addition to, or instead of, their work with the health services. The range of therapies they offer is quite broad: some concentrate on physical symptoms, teaching relaxation to people with panic attacks; others on behaviour, teaching social skills to the lonely or developing reward and punishment regimes for people with dangerous or disabling patterns of behaviour, others concentrate more on emotions and past history, talking, rather as an analyst would; some prefer to work with groups of patients, rather than individuals. They are not medically trained or allowed to prescribe drugs. But what therapy they do offer is usually based on theories that are generally respected by the medical profession.

The other group of psychotherapists is a very mixed bunch, often known as ‘alternative’ therapists. Because they are not recognised by the medical profession they all operate privately. Anyone can practise psychotherapy - with or without training. But the majority of the ‘alternative’ therapists have followed some kind of training course and operate according to principles recognised - if not by doctors - by substantial numbers of psychologists. As a general rule the first groups of psychotherapists tends to emphasise the containment, control or easing of problems, whereas the emphasis of many ‘alternative’ therapists is more on expression and catharsis. There are a bewildering number of alternative therapies - psychodrama, est, transactional analysis, acupuncture, gestalt - each based on a particular theory of what creates mental health.

COST AND AVAILABILITY
It is possible in the UK to obtain free psychotherapy via a sympathetic doctor or psychiatrist. But most people have to resort to the private sector - via personal recommendation or small ads - which costs between $20 and $60 an hour - less if you decide to do group therapy. You will usually be expected to attend once a week.

DANGERS
It is very important to find out exactly what kind of therapy you are being offered and about the training and experience of your therapist - particularly with someone operating privately. Once you have this information, pick up one of the myriad book on the subject to discover if what is available suits your needs: not everyone wants to experience the primal scream. Remember your therapist is not perfect. It’s how you use his or her skills that counts.

NI ASSESSMENT
If you are willing to work hard, be scrupulously honest, and choose both therapist and therapy with care, this is probably the best choice for the majority of those who feel they need help.


Self-help

[image, unknown] Many people are suspicious of the standard therapeutic situation, because it is really a relationship between unequals: between the therapist - who has the training, reveals nothing of his or her problems and is assumed to be healthy - and the patient who wants help, who reveals all and is assumed to be sick. Much of the comfort people receive from their therapist (whether family doctor or analyst) derives from this sense of being controlled by or cared for by someone more powerful. It has been argued that we are unlikely to achieve autonomy and independence through such a false, unnatural and dependent relationship. If this is what you believe you have two choices: either to equalise the relationship by finding out as much as you can about the drugs and other therapy you are being offered: or to choose a self-help therapy. Go-counselling is one kind of self-help therapy. Those who want help attend a short course to learn basic therapeutic skills. Then they are on their own. In a cocounselling session two members of the group get together and take it in turns being therapist. There are many other kinds of formal and informal self-help therapies (see Also worth reading): women’s groups, for example, can organise themselves to give support of this kind. The crucial things are demys tify the therapist’s roleand take turns in caring for one another. By doing this, cocounselling has been shown to be particularly appropriate for incorporating with consciousness-raising and liberation struggles of all kinds in many parts of the world.

COST AND AVAILABILITY
Obviously self-help therapy is available to anyone and, apart from any initial training course you might want to attend, is free. Cocounselling is a worldwide movement with centres as far apart as Bangladesh and Belgium. Initial training costs about $40, though most groups will waive the fee for children and the penniless. To get in touch with your local coordinator contact Harvey Jackins, 719 Second Avenue North, Seattle, Washington 98109, USA.

DANGERS
In any self-help group the main problems are individuals’ commitment and willingness to take responsibility. If these things are not carefully organised before you start there is the danger of some people giving a great deal, making themselves very vulnerable and needful, and then finding noone around to support them. The cocounselling set-up mitigates this danger by being very strict about reciprocity and aiming to maintain a wide network of contacts for every member.

NI ASSESSMENT
Not for the very disturbed. Try ordinary psychotherapy first, then graduate to self-help. Otherwise highly recommended as a valuable, exhilerating political and emotional experience.


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