Help yourself to help others

Depression is, sadly, booming in the West - and so are the courses that train how to treat it.
The following quote is part of a suicide note left by J Timothy Hogan from Massachusetts on 10 May last year, published in The Independent on Sunday in January: "No one who has not experienced a severe episode of depression can really understand what it is. It's like a woman trying to explain childbirth to a man... You can explain, but the other person can't truly understand. So it is with depression. It is real and totally disabling."

According to the self-help charity, Depression Alliance, around four million people in Britain suffer from depression at any one time. Since only half of depressed people consult their doctors about their condition, the true figures could be frighteningly higher. The World Health Organisation has recently announced that depression is now the leading cause of "disability" - that is, causing people to be unable to go out and work - in the world.

The profile of depression and general mental health problems would seem to be booming now. Everyone seems to have experience themselves, or at least knows of someone who has been more than "a little down". And with this boom has come a proliferation of counselling training.

There are roughly 545 organisations offering training for several thousands of people in counselling in the UK alone, although there are no legal minimum qualifications necessary to practice in the UK. Dr Ernesto Spinelli, academic dean of the School of Psychotherapy and Counselling at London's Regent's College, says that when he started at his school 10 years ago, there were roughly 20 to 30 students on one academic programme. There are now several programmes with up to 500 students at any one time.

Many graduates of the school move on to work in the private sector; most on short-term contracts. This is a result, Dr Spinelli says, of increasing pressures from medical insurance companies. "These companies will offer payment for maybe 10 counselling sessions, but then will not pay out any more. With full psychotherapy, treatment usually lasts a lot longer, but the financial priorities are driving more short-term treatment."

Counselling training is seen as more "informal" than full psychotherapy. Courses last a year or two less than psychotherapy courses, but it is actually very difficult to distinguish between the two spheres.

Due to its less formal perception, people often seek counselling rather than psychotherapy. "For many people, being asked to undergo psychotherapy is very scary. However, suggesting someone goes for counselling is less so. Due to the high profile of counselling in disaster situations, the profession is far more involved in the public sphere, making it less intimidating for people," says Dr Spinelli.

Psychotherapy is a much more intensive and much longer sphere in which to train. Graduates take five years to train; six years if one counts the introductory year. The fees vary from college to college, but an average level is around pounds 1,000 to pounds 1,500 a year - although some courses are significantly more expensive.

A large chunk of these courses involves students undergoing therapy themselves by professionals, which can involve up to five sessions a week. If you are not prepared to face up to your own personal demons, then it is unlikely you will be able to deal with anyone else's.

As well as this, there are sessions involving infant observation. Trainees are required to visit the homes of volunteer mothers and simply sit and observe the interaction between mother and baby, attempting to understand how the needs of the mother and external stimuli affect the child, as this is generally accepted to have a major bearing on future emotional development throughout people's lives.

Applicants come from all walks of life, but are linked by a common thread. Jennie McDonnell, of the British Confederation of Psychotherapists, says: "It is unusual to find an applicant who has not experienced some form of mental health problems. But it is a genuine interest in the internal world and the meaning of the human experience that marks out those who seek to become psychoanalysts.

"Many have been successful in other careers, and come to this profession later in life. We have an opera singer here training at the moment, and (former England cricket captain) Mike Brearley is a successful analyst. What they have in common is a gift for thinking about the internal process."

The call for psychotherapy would appear to be waning over the last decade as the "Quick Fix Culture" forces the NHS to look for faster, less expensive treatments. Philip Stokoe, of the London Centre for Psychoanalysis, says: "Twenty years ago there was a long waiting list here. They used to close the list when it reached 30 because it wasn't right to keep people waiting longer than a year. These days, it hardly has a waiting list."

This is not because psychoanalysis does not work, but because it generally takes several years to reach the root causes of a problem. And who can wait that long, in these stressful times ?

The image of psychotherapy and counselling has also taken rather a hammering in recent times as the profile of mental health has grown. In a recent interview with Michael Parkinson, Woody Allen, the doyenne of self-analysis, said he had given up on it, admitting it had only helped "a little bit". This view is fair enough, coming from one who has first-hand experience. However, there is, in some quarters, a general mistrust of the process, with many preferring to dismiss it as hocus-pocus.

However, this is a result of a lack of understanding and a fear of psychological truths and their implications. As Jennie McDonnell says: "For some people, the idea of looking at your own life is very frightening, and attitudes such as those will always exist." Understanding people is the key. A little more of it and maybe there will be fewer J Timothy Hogans to mourn.

Contact the British Association for Counselling on 01788 578328, or the British Confederation of Psychotherapists on 0181-830 5173. The Depression Alliance is on 0171-633 9929