Using a third party as psychological assistance has a long history, but it was arguably not until the 19th, and possibly even the 20th, century that science began to move away from more mechanistic treatments, towards more relational one-to-one work.
THE CATEGORISATION OF MENTAL CONDITION
In recent decades, various forms of individual counselling and psychotherapy have grown in popularity and acceptability. Many are based on particular theories of how an individual self is supposed to develop and behave. A famous example of a ‘bible’ of such thoughts, is the Diagnostic and Statistical Manual (or DSM), published by the American Psychiatric Association (APA). It seeks to formalise and categorise many of the labels that have developed over the years.
A MEDICAL MODEL
Even though there is some consensus in the medical community about what to call certain mental conditions, the role of talking therapies has an ambiguous and half-hearted place in the medical establishment. The emphasis is frequently on chemical assistance, with around one in six people in the UK, for instance, being prescribed antidepressants. Cynics sometimes reflect that a key beneficiary of the DSM is the US insurance industry, which at least then has a categorical basis on which to decide claims; and a key beneficiary of the prescription of anti-depresssants is the drug industry.
THE DEMOCRATISATION OF TALKING THERAPIES
Even so, many people feel increasingly comfortable seeking help from a counsellor or psychotherapist in working through any psychological problems. We are, perhaps, moving from a time when psychiatric interventions were forced upon people against their will, to a time where people are free to choose a form of talking therapy that suits them individually. I have certainly encountered older clients who, in early adulthood, were forced into institutionalised, non-consensual psychological interventions (some of which would now be thought barbaric); but who now, tentatively, want to talk through their lives and issues in a safe environment.
THE POPULARITY OF PRIVATE THERAPY
A problem with publicly-funded therapies in the UK is that, as the NHS itself admits, ‘you may not have much choice in who you see’, and waiting lists are common. This is not to criticise the work that is done. If you chance upon the right support for you, great things can happen.
The growth in demand for private counselling services indicates that individuals are perhaps further forward than governments in recognising the value, to mental health, of personal counselling and psychotherapy. If people are prepared to invest in a psychotherapeutic relationship, then they must be realising, or at least hoping, that the exploration of one’s own psychological welfare, with a trusted third party, is a useful undertaking.
Over the years, evidence for the efficacy of personal psychotherapy has been mixed. This is partly due to the subjective nature of happiness and fulfilment, and the associated difficulty of deducing a concrete, definable effect from a clear cause. Many clients combine therapy with medication, meaning that there is at least one potentially confounding variable. In addition, many clients come to therapy when things feel very bad, making it possible that, when things get better, they will attribute the improvement to the therapist who is with them at the time.
Nonetheless, there is some common ground on which academics agree that psychotherapy, where founded on a good relationship, is helpful. An example of a collection of definitions and background research (in this case, on the part of the American Psychological Association) can be found here: https://www.apa.org/about/policy/resolution-psychotherapy.
One feature, I believe, of the increasing democratisation of personal therapy, is that clients are free to recommend therapists to others, on the basis that they have had a good or helpful experience. The sharing of subjective evidence by known contacts can help to build trust, where otherwise one might be faced with a somewhat blind search. In that sense, finding a good psychotherapist can be analogous to finding a good plumber, electrician or builder. Beyond qualifications, it is the overall experience that matters, from first contact through to lasting support.
FINDING A MATCH
The evidence seems to show that, in talking therapies, the quality of the therapeutic alliance is very important. This means that a client should pay attention to whether they feel an atmosphere of trust, understanding and openness. If you come to therapy with trouble trusting, accepting the thoughts of others, and being open, then this may take time, but you can still get a sense of whether the therapist you are with is likely to help you build a helpful alliance. An alliance is a kind of partnership. You should feel able to talk as equals, and to explore with some kind of confident collaboration.
There are many different types of therapy, and so there is no one pattern of therapeutic relationship that works for everybody. I tend to work prioritising full acceptance of the whole of my client, a sincere and focused attempt to understand my client’s world, and very open and transparent communication. While this suits many, it does not suit everyone. Just as there are different styles of preferred relationship in ‘real life’, so there are different styles of effective therapeutic relationship.
HELPING IT WORK
The evidence also seems to reflect the benefits of positive client engagement with the process. Just as engagement in normal relationships makes them grow, so investment in a therapeutic relationship helps the process. This does not mean blind subservience to whatever process you are put through – those were the old days of encorced process, and we don’t want to go back there. But you can help your therapy work by ‘giving it a go’ (whilst also maintaining your own sense of what feels right, and sharing with your therapist if something feels wrong to you).
In the wake of the recent pandemic, there has been more demand for telephone and online therapy. I have certainly found that more than eighty per cent of my therapeutic relationships are now handled over a distance, and two thirds of them by simple voice call. A voice call has advantages. The client does not have to ‘present’ themselves to the therapist. They simply talk together. Also, a client has the option to go for a walk outside while talking, which many clients find therapeutic in its own right. I have been surprised at how well therapy has adapted to the change.
If you feel it may be time to start some counselling or psychotherapy, then try to choose a counsellor whose style you feel might work for you, and perhaps have an initial conversation to see how the relationship style feels. Then you can invest your time in seeing how it goes, but retain the right to stop if it feels uncomfortable, or if you need a break. In this modern, more democratic counselling world, the good news is that the client is more in control.