Who needs therapy? A growing band of practitioners hold out the promise of happiness. But can they deliver; or they engaged in collective navel-gazing
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The Independent Culture
WHEN the American comic novelist Peter de Vries wrote, "Psychoanalysis is a permanent fad", he wasn't joking. In the past couple of decades the quest for ways to deal with our psychic pains and our emotional disturbances, with life itself, has become ever bigger business, with an exponential rise in the number of us turning to therapists for help. The sober traditional psychoanalysts and therapists, who have continued to make cautious claims for what may be possible, have been joined by a galaxy of arrivistes who offer us stripping down, acting out, regressing and re-structuring techniques with, in some cases, grandiose and extravagant claims for what can be achieved, such is their eagerness to sign us up for their path to psychic nirvana.

The growth in the search for mental and emotional well-being has been closely observed by clinical psychologist Tony Roth, at University College London. He has teamed up with UCL's professor of psychoanalysis, Peter Fonagy, to review the efficacy of different therapies for the Department of Health. (Their findings are being published in the autumn.) Roth observes: "More and more people are asking for therapy and, at the same time, GPs are diagnosing more people as having emotional problems and referring them to a counsellor or therapist." Another colleague at UCL, senior lecturer in clinical psychology Dr Val Curran, points out that therapy is becoming the preferred treatment on the NHS for a very wide range of complaints from severe depression and personality disorders to obsessive compulsive disorders, behavioural problems, phobias and anxiety related symptoms. And Adrian Furnham, psychologist and author of All in the Mind: The Essence of Psychology also sees a greater demand from the public and more supply than ever and declares that what we are seeing is: "The American idea that happiness is a matter of choice percolating into Britain."

But why do we need to choose happiness when it seems that earlier generations managed to survive without the help of talking therapies or drugs? Are we more unhappy? Is life harder? Or are we becoming a nation of self-obsessed navel-gazers?

Part of the answer is certainly that we expect more from life. As we have become more materially comfortable, health and happiness are increasingly seen as within our grasp - almost a birthright. And while it may be a truism that psychotherapy is the religion de nos jours, it is true that today's therapist hears the problems that parish priests have always heard.

David Smallacombe, director of the Kensington Consultation Centre (which offers therapy and trains therapists), has witnessed the growth in the mind business. Life has always had its ups and downs, he argues, but in previous generations people had greater support systems: an extended family, a church, a religious faith. "The idea that it may be possible to get help through therapy has become more acceptable as we have learnt more about psychology. The American interest in psychotherapy has influenced us, of course, but from the Sixties and Seventies we were encouraged to question things. At the same time people have seen from their own or their friends' experience that to seek help doesn't mean we have to swallow American psychobabble unthinkingly. In Britain we are treating going for therapy as we might going to a doctor when we have a physical pain. People seem to be more comfortable with exploring their own beliefs and feelings especially where there's something that can be done that might make them feel happier." Resistance and ridicule from others still persist, but he asks: "Why should we feel that this is self-indulgent or somehow wrong?"

It is also true that pharmaceutical advances of the past few decades have encouraged doctors - and patients - to believe there are "cures" to life's many difficulties. Their experience with earlier panaceas such as tranquilisers have made many doctors cautious about prescribing drugs. Yet, as new compounds become available that address the problems of their predecessors, such as addiction, which doctor would deprive a depressed or anxious patient of such a lifeline?

Objectors to a wholehearted embrace of psychological aid point to the fact that many who seek it are highly functional and competent people who not only consider themselves "normal" but are seen that way by the world. These same people, however, can often feel their lives blighted by unrelenting low-level depression, anxiety and an outlook where bleakness and unhappiness are too often present. Some accept these difficulties as life, others have the sense that they are burdened by unresolved problems which are preventing them from living to their full potential. And, knowing it is available, they - women and increasingly men - are looking to some kind of therapy to help them help themselves.

Making this choice is not easy in our culture, where it may be quite acceptable to drown our sorrows in gallons of alcohol, indulge in all kinds of hedonism to make us feel better, but where the idea of exploring the inner terrain is likely to bring forth a belly laugh, a sneer, or remarks like Samuel Goldwyn's quip: "Anyone who goes to see a psychiatrist ought to have his head examined." For some people, the alternative to the "muscular school of chin up and buckle down", according to Adrian Furnham, can have damaging results. He talks of the emotional pain he has heard pouring from a British public school boy, taught from a young age that keeping his feelings to himself is the way to be a man. As an adult, in despair and desperation, he goes into therapy although it is against everything he has been taught. "Happiness is linked with physical health and predictive of longevity. As unhappiness can kill you it is hardly a trivial aim."

Perhaps not, but an essential question then is, does therapy work? Furnham points to a very large American study drawing on 475 individual small studies for its data and which concluded that patients benefited very substantially from psychotherapy in the long term, but interestingly the findings also showed that no well-established, reputable therapy was better than another. In other words, Furnham says, the commitment to trying to improve things, the comforting quality of the therapist's attention, taking time for oneself, and valuing oneself, can all have a healing effect. Tony Roth, from UCL, drawing on his work in the UK, talks emphatically about the value of cognitive and behavioural therapy, widely used on the NHS. These methods have been evaluated in this country and elsewhere. Psycho-dynamic therapies - longer-term talking therapies such as analysis - have been studied to a lesser extent. However, Roth stresses: "Absence of evidence is not evidence of absence of efficacy. And the fact that we do not know certainly doesn't mean other therapies are not good. But because we don't have firm data it is important that people are careful of the therapies they choose." The lack of a central register of therapies and therapists is a concern. "I worry that the fragile may be drawn to the fringe approaches with their promises of transformation," he says.

Dr Curran, too, sees problems arising from the view of counselling as a panacea for almost any trauma or affliction. She particularly worries about the mushrooming of counsellors in GPs' surgeries. "Counsellors need not have any training and budget-holding GPs may take someone who will not cost a lot but who seems able to do the work," she says. "You might for instance get the vicar's wife who's done a couple of weeks at night school and who may well be a sympathetic ear, but who would not be able to spot suicidal depression or a psychotic condition necessarily. I think the lack of regulation is dangerous. People need to be very cautious when choosing a counsellor about the training they have."

Finding a suitable therapy and therapist can seem a daunting task. There are a baffling number available, and often the more obscure and arcane, the greater the claims made. It is important to bear in mind that different approaches suit different personalities: and it may not always be that people who like to talk will benefit most from talking therapies - they may be the very ones to gain from more holistic, body-centred treatments such as bioenergetics or psychodrama. The directory opposite is intended to help you find your way around the therapies available. It is divided into sections to distinguish between those treatments based on psychoanalysis that uncover the past, those with a behavioural bias aimed at uncovering and changing damaging patterns of behaviour, and the humanistic-holistic model which works with the body as well as the mind.

That therapy should be considered the instant fix for any tiny hiccup of the soul is something few practitioners want to see. But equally they share Furnham's dislike of a cultural stoicism which considers those who feel the need for help foolish, frail or freakish. Certainly anecdotally a great many people talk of how they have been benefited, often in a profound and enduring way. One woman expresses the sentiment of many people I have spoken to when she describes the coping tools therapy has given her: "There is now a dialogue in my head which comes into play when there's a problem that helps me sort it through." Nobody is suggesting that those who feel no need of therapy, or no interest in what it offers, should try it, but for those who are interested in looking further here is a directory of the many of the different types and approaches that are available to help us cope with the human condition.


Angela Neustatter is an author and journalist who has written extensively about social and humanitarian issues, specialising in psychological health. She has written seven books