Health: Far too long on the couch

Psychoanalysis may be a costly mistake.
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The Independent Culture
WHEN GEORGE had his first session with his psychoanalyst, The Beatles were just becoming famous and Harold Wilson had yet to be elected prime minister. When George finally stopped paying the bills, John Lennon was long dead. Margaret Thatcher had been running the country for nearly a decade.

Yet George felt no better.

Twenty-four years on the couch had left him so depressed and phobic that eventually he could not drive himself to see the analyst. A taxi picked him for his weekly session, waited outside with the meter ticking for 50 minutes, then brought him home again. One-third of his small and irregular income had gone on the therapy.

He was 65 years of age. "When I gave up, I was coming up for my pension. I thought to myself, `This is the end of my life and I've paid all this money and I'm worse than when I started'." But it didn't end there. After he complained about the length of time his treatment had taken, his analyst gave him several years of free sessions followed by a period of chats on the phone. Margaret Thatcher fell from power. John Major came and went. Tony Blair arrived in Number 10.

In all, the relationship continued for nearly 35 years. But for George relief did not come until nine months ago. His GP prescribed Seroxat, an antidepressant drug. "I'm a changed man," he says, now aged 75. "I'm much better than I was, confident, able to go out. It's given me a chance to live a little."

But this relief has also left him angry about decades spent with a psychoanalyst, whose principles eschew drug therapy, who never suggested a second opinion - a professional who never entertained the possibility that George was in fact clinically depressed, in other words affected by a chemical imbalance that talking alone could not resolve. George has a file of correspondence with his analyst and of unsuccessful complaints to the national body to which he is accredited. Interspersed among the letters are desperate notes hand-written over the years such as "Long-term psychoanalysis is the nearest thing to legalised mugging. Your brain is scrambled and your bank account damaged beyond belief." Another note asks: "Why is it that the sick and gullible are not protected from falling into this addictive trap?"

It is a question that those who recognise the benefits of the talking cure - but who worry about abuses and incompetent practitioners - are now asking of the Government. In opposition, Labour expressed considerable interest in creating a respected regulatory framework for therapists in the mental health field, to protecting people such as George. In government, despite lobbying, ministers are stalling. "We've drafted a bill for statutory registration of psychologists," says the British Psychological Society. "We have had meetings with Paul Boateng. The Government is saying you have made your case, but there is no parliamentary time. Meanwhile, in the rest of the business there are 67 different bodies, which cannot agree among themselves on training, examination or regulation. The combination of their confusion and a government lacking in political will means that anyone can call himself a practitioner."

The results of this neglect have been devastating for people such as George. His psychoanalyst may be a conscientious man. But George would have had no idea what he was letting himself in for back in 1964. He found himself with practitioner obsessed with a fascinating theory that is unproven. The analyst was trained in the school of Melanie Klein, which locates formative psychological experiences in the first few months after birth. Indeed this particular individual has pursued the Kleinian ideal into absurdity, focusing on foetal experiences. Most important, Kleinians place emphasis on transference, the notion that, for example, anger towards the analyst relates to a transfer of the patient's primitive experiences rather than anything the analyst might have done wrong. So when George complained about his treatment, it was seen as no more than a transfer of past distresses on to his analyst. His angry complaint was interpreted as a healthy development.

Reading the lengthy correspondence between the two men reveals that the analyst had extraordinary control over his patient. When George made a formal complaint about his treatment and sought compensation, the analyst persuaded him to withdraw it and promise in writing never again to pursue it. The analyst typed out the recantation on his own typewriter and got his patient to sign it. The Independent has a copy.

Other letters from the analyst left George terrified. On one occasion, the analyst commented on news that George had had a cancerous cyst removed from one eye. He said he was unsurprised, given George's anger which might, he said, become malignant, like a cancer, if not kept in check. This is the standard language of the analyst, finding psychosomatic expression of mental distress.

But to George it amounted to a threat that if he did not keep quiet he could contract cancer again. When George contacted The Independent, he also said that he felt he had been blackmailed.

His analyst had, he says, threatened to reveal a marital infidelity if he pursued his case. The analyst firmly denies blackmail. But he acknowledges that in a court he might have had to refer to the event to explain how he believes George's rage reflects suppressed sexual urges. The analyst thus inspires little confidence that he respects a central tenet of the patient-analyst relationship - confidentiality. Indeed, I was surprised to find him willing to speak in detail about his patient to me over the telephone without first seeking permission from George. It is a murky, confused story. Reality is not easy to find in a 35-year-old psychoanalytic relationship. I have not named the psychoanalyst, a man respected in his field, on the grounds of his own advanced age and because his patient declined to be identified. But I certainly would not want anyone I cared about to have attended a man whose practice is based on theories so powerful, yet so lacking scientific support.

You can understand why George now says: "I feel that I have been cheated not only out of the fees that I paid, but also out of a valuable lifetime wasted."

He has taken his case to Abuse in Therapy and Counselling, a support group in London. But, in the absence of firm government guidelines as to permissible practice, George can probably achieve little. All he may be able to do now, at the age of 75, is relish the benefits of at last having found the right antidepressant drug.

Abuse in Therapy: 0171-229 9793

How To Avoid Quacks

n Choose someone who has achieved success with at least one other person you know well.

n Ask the therapist for a note in plain English explaining what is entailed in the treatment, notably how long it might take.

n Agree a period after which your case will be referred to an independent second opinion for reassessment

n Seek the telephone number and address of an independent body to which you can complain if you are at all worried about the treatment.

n Try more than one therapist. Shopping around is hard when you feel ill, but it is essential.