Why psychotherapy?

In some ways this is a continuation of my previous post What is psychotherapy?1  However, I think it is also pertinent to ask why anyone might wish to engage the services of a psychotherapist, especially when this can potentially be a long term and, consequently, an expensive commitment.

It might also be worth asking whether there is actually a demand for psychotherapy in the first place.  This is a difficult question to answer.  On the face of it the answer seems to be definitely yes.  A number of national surveys suggest that around six million people in England are currently experiencing some form of ‘common’ mental health problem, including anxiety and depression.  And some national research commissioned by the British Association for Counselling and Psychotherapy (BACP) a couple of years ago reported that the majority of people in this country are favourable towards the idea of talking therapies.2

Furthermore, a quick trawl on the web will soon show that there are a lot of mental health discussion forums, with many people sharing some very intimate details of their mental suffering.  A lot of people seem to be really struggling, and finding the demands of everyday life, of work, relationships, bringing up children, of loss, of growing old and lonely, just too much to bear.

However, the very same on-line discussion forums also suggest that psychotherapy is not necessarily uppermost in people’s minds – be they the one who is suffering or the one who is giving advice.  Yes, ‘therapy’ is sometimes mentioned or suggested.  More likely than not, however, the advice is see one’s GP, to consider medication (which amounts to the same thing), or simply to acknowledge the other’s person’s suffering.

Now there is nothing wrong in any of this, and in many ways such discussions are in themselves therapeutic, at least up to a point.  However, this does suggest that psychotherapy is not necessarily on that many people’s radars. Furthermore, statistics suggest that it’s not on that many GPs’ radars either.  Yes, GPs do refer patients with a variety of mental health problems to the IAPT (Improving Access to Psychological Therapies) service, which is a national psychological therapies services commissioned by the NHS.  However, apart from the fact that the therapies on offer are very limited in terms of both the type of therapy and its duration, the actual referral rates are very low compared to the potential demand. 3.

So why psychotherapy?  As I pointed out in my What is psychotherapy? post, the psychotherapeutic relationship engages with something very fundamental within the individual.  Different people have different names for this ‘something’: the ‘soul’, the ‘self’, the ‘ego’, the ‘spirit’, one’s ‘innermost being’, and so on.  However, whatever terms one uses, it is clear that this is a very special kind of relationship.  One of my clients once described it as an ‘experience like no other’, and in many ways I think this is a good way of putting things.

In one sense, you could say that psychotherapy is about baring one’s soul to another – and you would be right.  However, there are different ways to bare one’s soul, and to whom one might choose to bare it to.  There are also a number of pitfalls – some obvious, some not so obvious, in baring your soul to just anybody.

Just to give one example, and without going too much into the theory, there is the whole question of what Freud identified as transference.  Now, transference is actually a very complex phenomenon, and is not simply about treating your therapist (or your GP, boss at work, or even your partner) as if he or she was your father or mother.  This is the ‘pop-psychotherapy’ notion of transference, and whilst it does contain some truth, things are more complicated than that.

However, it is certainly true that in any close, intimate relationship (and psychotherapy is very intimate, albeit in a very special, boundaried way) one’s sense of time and space often becomes confused – and so too can the other person’s.  By this I mean that thoughts, feelings, and ways of relating that you might have thought that you had left behind long ago can suddenly appear and, sometimes, wreak havoc in the relationship.

Of course, it could be argued that intimate relationships are the one place where you can act in such a way; to behave, in fact, as you did when you were a child.  After all, there is no way, for example, you could get away with behaving like this at work.  Except, of course, this is precisely what happens all the time in the workplace, in politics, in sport, in fact in all walks of life.  The past, the distant past, is always intruding on the present, on the here and now, sometimes with catastrophic results.

Now, as Freud was quick to discover, transference can actually be a very powerful therapeutic ‘tool’ – as long as it is handled carefully.  Some therapists, in fact, would argue that transference is the essence of psychotherapy; in other words, allowing the past, in the form of the client’s childhood memories, thoughts and feelings, to be present in the here and now of the therapeutic relationship, so that such memories, thoughts and feelings can be explored and ‘worked through’ in a contained and safe environment.

Transference is certainly very powerful – and herein lies the danger.  Most people have no idea what’s going on ‘behind the scenes’ in any relationship, intimate or otherwise.  In other words, they are unaware of the powerful, unconscious forces at work that structure any human relationship.  And these forces are particularly prevalent in more intimate, close relationships.  This is why so many such relationships can get into deep water so quickly.

This is not to say that psychotherapists occupy a privileged position  that enables them to ‘see behind the curtain’ so to speak, and to have direct access to the unconscious.  However, they are at least aware that there are such forces at work in the therapeutic relationship and are thus able to handle things more sensitively and carefully than would, say, a friend or even a loved one.  This is why it is so essential that a psychotherapist undergoes a rigorous and often long training, which includes having their own therapy.

So why psychotherapy?  Because it’s probably the one opportunity that you will get to bare your soul without getting seriously burnt.

  1. http://www.therapeia.org.uk/wp/2012/09/07/what-is-psychotherapy []
  2. BACP (2010) Attitudes to Counselling and Psychotherapy Report. Lutterworth, BACP. []
  3. Something around 10-15% per annum of the number of people thought to be experiencing a common mental health problem []