Britain on the Couch: Therapy comes to the rescue of the me generation

Today's patient has higher aspirations and a greater drive for individualism

THE SPREAD of therapy is often put down to self-indulgence but the truth is simpler: more people are in need of it.

Depression has risen three- to ten-fold (depending on which studies you believe), even allowing for our greater tendency to talk about our problems. Compulsions such as alcoholism, illegal drug abuse, eating disorders and gambling have mushroomed. The number of crimes of violence against the person recorded by the police rose from 6,000 in 1950 to 253,000 last year, only partly caused by increased reporting. Given thatthree-quarters of violent men are depressed, and half of them abuse drugs or alcohol, this is also indicative of the rising tide of misery.

But how else, apart from being more numerous and prone to seeing therapists, would the depressed, compulsive or violent patient of 1950 have differed from a patient today with the same symptoms: the depressed mother with small children, her alcoholic husband or her violent brother, all of whose presenting symptoms would be identical in either era? In what ways are we really different beings, in our thoughts and emotions?

The short answer is that today's patient has much higher aspirations and a greater drive for individualism, both often contributing to their ending up on the couch. One of the most important surveys showing this, by Joseph Veroff, compared answers to identical questions asked of 2,000 Americans in 1957 with 2,000 in 1976.

Whereas in 1957 the tendency was to see yourself in a role - a wife or mother, or in terms of your class or educational background - even in 1976 you were likely to describe yourself using psychological words (eg "introspective", "outgoing"). This was especially so among the young, who placed great emphasis on their uniqueness as a source of satisfaction.

Inflexible moral concepts, such as good and bad, right and wrong, were far less likely to be used to define self or others in 1976. Intimacy and relationships were regarded as the prime cause of both satisfaction and unhappiness. Both problems and successes were attributed to internal, psychological aspects of self rather than to external ones, such as social roles.

There was a substantial increase in emphasis on achievement and power- seeking as work goals. Long before the term "wannabe" was coined, young people had become much more aspirational. They relied on work as a hoped- for source of satisfaction, especially young women. But in this they were often disappointed.

Whereas 38 per cent of young women in 1957 had said they were "very satisfied" by their work, only 29 per cent reported this in 1976. Both sexes reported "wanting more satisfying work" and "lack of achievement" as sources of dissatisfaction but especially young women (13 per cent reported work as a major cause of dissatisfaction in 1957 compared with 25 per cent in 1976). There was also increased conflict at work, and more competitiveness and distrustfulness, which Veroff put down to "the constant pressure for more individuation, more achievement and more evaluation of performance in comparison with others". Veroff also made explicit the possible effect of raised aspirations, especially among the most privileged groups: "In the process of becoming very ego-involved in work, the more educated come to expect too much from that role. Do they develop such high expectations for individuation through a job that job gratification may be possible only in rare settings?"

Although dissatisfied by her job, 1976 woman also rejected the traditional female role. Given the choice, more women than men would prefer to be "excellent" at their work role than as a spouse or parent, and would work even if they did not need the money. There have been numerous other comparative surveys like Veroff's, extending the evidence to the present, with similar results. Female dissatisfaction with both the role of homemaker and their job prospects is rife.

A recent British survey found that career aspirations were outstripping job opportunities at an alarming rate. Of the 18-34-year-old single women, 55 per cent wanted management responsibility and 67 per cent sought "greater possibilities for advancement". Yet, despite these high hopes, fully 42 per cent reported no promotion opportunities in their present jobs. These statistics are a classic recipe for relative deprivation: high wants and sense of entitlement, yet poor prospects of their fulfilment.

In 1991, an international survey of 85 leading European analysts of social trends showed that they regarded increasing acquisitiveness, increasingly high and specific aspirations and increasing individualism as the key trends in their countries. Trends such as the decline in the birth rate, and studies showing that much higher proportions of people now approve of keeping possession of a lost article found in the street, were taken to be signs of increasing self-interest and desire to look after number one.

In reviewing this body of evidence, one authority concluded: "People have become more demanding. Consequently, pay is not enough: people today - and especially, young people - expect work to be interesting and well paid.'

Along with these differences in values, today's patients are also more likely to have suffered a number of traumatic childhood experiences that were rare in 1950, such as divorce (up from 12 per cent to 40 per cent) and parental alcoholism. But change in values is probably the most significant cause of the increase in unhappiness, not changes in child care alone.

Do therapists, listening to their Bridget Jones or Woody Allen patients, bear these crucial social changes in mind when evaluating what they hear? I suspect not. Most practitioners have been trained in a highly individualistic tradition.

Therapists must help their patients to develop more realistic expectations, rejecting the Cosmopolitan or Loaded magazine hype in favour of the reality of what they are individually capable. Sifting through the media diet of junk consumer individualism and helping patients to find the unique potential that each personal history represents should be a major component of therapy.

These issues will be discussed with Oliver James at a public seminar in London on 26 September. Tickets from the Institute of Group Analysis (0171-431 2693), 1 Daleham Gardens, London NW3 5BY