Psychotherapy

 

In 2000 I was asked to write a series of articles about psychotherapy for the Week-end FT. The aim was to survey the major therapies available and to give the reader a sense of what each one was like. I thought of it as a sort of ‘Rough Guide’ to psychotherapies. The column was called ‘Psych Yourself Up’ and the article that introduced it is printed below.

All the therapies are ‘talking therapies’ and I have divided them into two kinds according to the underlying philosophy.

  • Analytical therapies, of which Freudian Psychotherapy┬áis the best known, seek to help you understand the problem as well as to fix it within a particular therapeutic framework. Analytical therapies are listed here.
  • Cognitive and behavioural therapies seek to help you learn how to deal with the problem rather than eradicating it. Cognitive and behavioural therapies are listed here.
  • The articles about the individual therapies can be accessed either from the menu above or from the access pages.

You are miserable. You want to be happier. What can you do?

There is a huge range of ways to alleviate your condition. Drink, recreational drugs and sex are among the most popular. Unfortunately, although the initial effects can be exhilarating, these three often turn out to be temporary palliatives rather than reliable stand-bys . The misery can return even before the hangover is gone. Prozac has more durable effects. But today’s happiness pill may turn into a chemical crutch tomorrow.

Friendship, marriage and children are safer in the long term. They bring lasting happiness to millions. But for millions more the happiness fades into boredom. Infidelity can spice up a lacklustre marriage but it may precipitate its replacement with something much worse.

Religion is a safer option. It is certainly both enduring and popular. Christianity, now approaching its 2000th successful year, offers eternal happiness to billions. But the small print of this offer demands Faith, something that you may not have and you cannot buy. However, if you lack Faith but possess a modest supply of money, there is another option. You could try what many regard as this century’s successor to religion, psychotherapy.

Where does psychotherapy come from? Where is it going? What problems can it deal with? How effective is it? What is the cost in money and in commitment? What is it like? Unfortunately answering these questions is not simple. Just as Buddhists have different history, concerns and practices from Mormons; so psychoanalysts would answer our questions differently from hypnotherapists.

Each of the twenty-some accepted schools of psychotherapy and counselling currently on offer provides different answers. They will be dealt with school by school in our rough guide to psychotherapy starting two weeks today with Freudian Psychoanalytic Psychotherapy.

The different therapies also share history, practices and underlying assumptions. They offer a spectrum of approaches differing in treatment style, intensity and in underlying goals. This article begins the rough guide by scanning quickly through that spectrum.

Although not the oldest, that honour probably belongs to hypnotherapy which Freud practised early in his career and which is still used today, psychoanalysis, Freud’s invention, defines one end of the spectrum. It provides a standard against which the the practices and beliefs of other therapies can be compared.

The activity of psychoanalysis, all too easily caricatured, takes two sentences to describe. The patient, or analysand, lies on a couch and says whatever comes to mind – without censorship. The analyst, usually out of sight, listens and occasionally comments, for 50 minutes a session, 5 sessions a week for three years or more.

So what is going on? The Freudian view is that our neuroses, with their accompanying misery, arise from unresolved conflicts in our mental processes – many of which we are unaware of. The conflicts are caused by events or patterns of behaviour, often desires that we repressed or were unable to gratify, in our past. The conflicts in our unconscious processes are revealed by patterns in what we say, and avoid saying, on the couch. The analyst’s comments clarify and interpret these patterns.

This aspect – paying a professional to listen to our woes – is central to all the talking therapies, from psychoanalysis to counselling. Many believe that this common ground is much more important than the differences in the aims, beliefs and practices of the therapies which we touch on here.

The main difference in aim is whether the problem is to be eradicated – which takes time – or simply brought under control, which can be very quick indeed. Psychoanalysis takes so long because the aim is to master neurosis by revealing and resolving the conflicts on which it is based. Psychoanalytic psychotherapy works less intensively – typically with two or three times a week – towards the same goals. Simpler therapies aim to resolve problems more quickly – and some would say more superficially – by learning new behaviour or thought patterns.

The differences in beliefs are enormous. The big-name therapies originated from followers of Freud who modified his theories. However differences of this kind are unimportant in themselves. Their main effect is on the language and strategies of the therapist. Aspirin, which is based on a chemical derived from the bark of the willow tree, will alleviate a headache whether you think you are infused with the spirit of the tree-god, or whether you understand its biochemical effects on the chemical messengers of pain and inflammation. Hypnotism is still one of the most effective treatments of hysterical and psychosomatic disorders even a century after the French Royal Society proved that claims that it was mediated by magnetism were false. And Freud’s, model of the mind does not have to be any more than a useful metaphor for therapies based on it to work.

Differences in practice are crucial for many people considering therapy. The practices determine what it will feel like, what you will have to do. Apart from saying that these include role-playing, group discussion and mesmerism, in addition to free association on the analysts couch, we shall leave the details for now.

But considering the range of therapeutic practices does raise a question. Why, apart from picking the most palatable therapy, would anybody opt for the commitments, in time as well as money, of psychoanalysis? There are less demanding cures on offer, such as the aptly named “brief therapy” which, according to some claims, can resolve most problems in a single session. Why would we use a therapist at all, rather than pouring our heart out to a friend?

It’s a free choice based on the perceived benefits – and costs – of each option. “Many people come into therapy because they are frightened of jeopardising their friendships” say Meg Errington, a Freudian psychotherapist who practices and teaches in London. “You pay the therapist to put up with you at your worst”, she says.

This raises a final question. Should you try to choose the right school of therapy, or the right therapist – perhaps based on a recommendation from a friend or a GP. Over the coming months the rough guide will give you a chance to survey the therapies, but for those of you in a hurry, Errington has a reassuring answer to this question. “If you choose the right therapist, that will be the right school” she says.

 Posted by at 15:46