Going wrong?

It’s something of a paradox, but it would appear that there is quite a discrepancy between what people say they want in terms of talking therapies and what they actually (don’t) do about it.  There is plenty of research which strongly suggests that many people would consider some form of talking therapy.1

At the same time, however, there is a growing amount of evidence, especially in relation to the IAPT (Improving Access to Psychological Therapies) programme, which suggests that many distressed individuals are not seeking help via the talking therapy route.  To be more precise, according figures from the NHS Information Centre, which publishes quarterly IAPT figures, less than 15% of people who are calculated to have some form of common mental health problem, e.g. anxiety or depression, are being referred to IAPT by their GP or mental health professional. 2  This is somewhat surprising bearing in that IAPT is a free (at the point of use) service and its therapies (mainly CBT or variations of) are endorsed by NICE (the National Institute for Health and Clinical Excellence).

Why would this be?  Of course, there is nothing unusual about people saying one thing and doing another.  What’s more interesting, perhaps, is how this works for them, i.e. the discrepancy between what a person says and what they actually do.  With regards to (not) seeking help for psychological suffering and distress,  I think one has to start by asking by asking how such suffering functions in the life of particular individuals (and this will be different for each person), and how expressing dissatisfaction about such suffering (including the expressed desire to do something about it), helps a person sustain their distressed state of being.

Of course, it’s not quite that simple.  In other words, it’s probably true, but not sufficient, to argue that people get a a certain kind of satisfaction from suffering.   This is apart from what Freud recognised as the gain from illness, i.e. in the practical sense that being ill (either physically or mentally) can have certain advantages, e.g. not having to work, not having to act in a responsible manner, etc.  But I would argue that even to recognise this, which I suspect many people do, regardless of their familiarity with Freud and psychoanalysis, is to raise more fundamental questions for the individual.  They then might have to start wondering why on earth they might enjoy suffering – especially when it causes real problems in their lives and in their relationships with others.   Another way to pose the question is to ask how a person’s symptom(s) (and in some cases delusions) work for them, what function they have for them.  And again, this is probably not something many people feel comfortable about asking.  To do so might be to open up whole Pandora’s Box.

Apart from anything else it might start calling into question just how rational human beings really are.  It might, God forbid, even raise the possibility that there are forces at work in the human psyche that are not totally under rational and conscious control.   And then where would we be…..?

All good reasons, perhaps, not to seek help, not to try and find the words to express one’s suffering?


  1. A fairly recent example is research conducted on behalf of the BACP in 2010: BACP (2010) Attitudes to Counselling and Psychotherapy Report. Lutterworth, BACP.  Interestingly, this research also suggested that a sizable majority of people (65%) would be prepared to pay for therapy. []
  2. http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/nhs-specialist-mental-health-services/improving-access-to-psychological-therapies-key-performance-indicators-iapt-kpis-q1-2011-12-final-and-q2-2011-12-provisional []

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