Deciding about therapy
38. The talking cure
Many people enduring the stressful after-effects of awful events report that counselling or psychotherapy has helped them access resources to cope effectively with challenges. Further glowing accounts of resultant improvements emanate primarily from practitioner bodies; a more modulated Wiki consideration of outcomes, subtitled Criticisms and Questions, suggests benefits occur in about half the cases, on a par with the placebo effect. Most people have to do without qualified input though, due to lack of service provision, or lack of access to it, yet tend to manage somehow.
In the absence of some kind of therapeutic space, however, understanding and coming to terms with damage might be sacrificed. The quality of life of those who survive adversity varies quite a lot, depending on what happened and what happens next. Many traumatised people describe feeling dead inside and may go to their graves languishing in a miasma of anxiety without resolving anything. The resilience of others, who bounce back from horrors with little or no structured intervention, is now being studied to enlighten new helping techniques.
Taking time in an accepting setting to examine any serious disruption seems to bestow an empowering effect, whether done in a strictly therapeutic environment or not. Such outcomes are routinely cited to promote the use of professional services. Not all therapists are well versed in treating trauma though, and traditionally have pathologised the victim, often to avoid conflict with their colleagues. These ‘experts’ are all too human, having often entering the field in sympathy after getting through their own terrible times. Chapters 7, 8 and 9 of Judith Herman‘s book explores what can be expected, good and bad. Further knowledge of the territory can be gleaned from many sources e.g. dvds of programmes such as In Treatment.
Thomas Szasz, in, The Myth of Mental Illness, and other works, challenged conventional assumptions about the value of treatments. Elsewhere, In his rich narrative, If You Meet The Buddha On The Road, Kill Him, his book about being a psychotherapist, Sheldon Kopp claimed to operate as an entrepreneurial psychotherapist. Fee payment allowed clients to interact with him on an equal footing, an arrangement he contrasted with coerced psychotherapy, where patients involuntarily would have to submit to evaluation by carers whose roles were largely more similar to those of prison officers.
The third type he identified, bureaucratic psychotherapy, straddled extremes of simple persuasion to split therapist loyalty, between client, and parents, school, and/or management. In reality, proof of depraved abuses, and of highly-ethical dedication to clients’ best interests, is found in each of a myriad of extant approaches. Unfortunately, complicated cases fail more, despite Dante’s dictum: “He who sees a need and waits to be asked for help is as unkind as if he had refused it.”
Yet one size doesn’t fit all. When the standard motivation counselling methods weren’t working to keep impoverished youth in education, in 1974 New York, psychologists first devised the more practical alternative of life skills coaching, thus obtaining strikingly better results. In Outliers, Malcolm Gladwell shows how success requires the right inputs of opportunities and resources, both in cash and kind, a lack of which is to blame in virtually all cases of falling short.
It’s also important to bear in mind that from therapists’ point of view, other people’s troubles earn their livelihoods and build their careers.The best inoculation against chronic traumatic stress is having voluntary close relationships refined from enduring mutual support. After therapy is deemed complete, the professional closes the diagnostic file and moves to the next customer. They’d better care about who’s there for you outside the office.
Responding to perceived flaws in her fields, psychiatry and psychotherapy, Anne Wilson-Schaef designed a new holistic therapy called Living in Process, as per her books, including Beyond Therapy. Protesting against the reductionist scientific paradigm and noticing addictions everywhere, she emphasised an experiential approach to bring openness to whatever arises, however paradoxical. One of her primary bugbears concerned the inability of psychotherapists to resist concocting and imposing techniques, formulas and standardised frames of reference onto a client’s reality, rather than giving it organic room to breathe and define itself towards more straightforward resolution.
Ideally, word-of-mouth recommendations, credential checks and personality/beliefs match give a better chance of positive results. Helpers need to be honest, warm, and realistic, opening up options and regularly reviewing progress. If doubts arise, trust intuition, especially if questions are aggressively confronted. In such encounters of unequal power, only one participant is authorised to officially label the other as hostile or disordered.
Whether opting for therapy or not, people can do a lot for themselves. In 1979, Janette Rainwater wrote ‘a guide to becoming your own therapist’ called, You’re In Charge, specifying many useful exercises and tools. More recently in the same vain, Philippa Perry gives instruction on self-development in, How To Stay Sane. The publishers, The School Of Life, set up by Alain de Boutain, distributes all kinds of insights on positive changes. Pub psychologist Nash Popovic also disseminates comprehensive wisdom.
There’s an infinite stream of material available on all kinds of issues and services. Discerning and practising relevant quality options, while focusing primarily on rebuilding the universal foundations of a healthy personal life, tends to work best.