Sunday, February 04, 2007

Women Who Rant Too Much...

I have come across a couple of comments on blogs recently that have irked me. Blogs that I really like, by the way, and so I won’t link to them as I don’t want to hold the bloggers responsible for the views of some idiot readers. The comments are about therapy. Firstly, the comment that only white, young, wealthy, middle-class and self-indulgent people go to therapy; secondly, that therapists are exploiting people’s misery. I have felt most irked, before remembering that I have my own blog and therefore have a right of reply, of sorts. How exciting. Normally these things bug me for a few minutes before I remember to breathe out the anger and feel compassion for my fellow man/woman/mindless numpty. (I have just had to add ‘numpty’ to my Word dictionary, as I use it in almost every post and don’t want to be constantly reminded that there might be a better word.)

Time to hit back.

It seriously hacks me off when people suggest that therapy is self-indulgent toss for those who have more money than sense. Here is a breakdown of my client group for the past 6 months:

  • Clinical depression, including suicidal ideation or suicide attempts: 17%
  • Potential relationship breakdown (long-term relationships involving children): 15%
  • Self-defined ‘breakdown’, (depression or anxiety) resulting in long-term absence from work and loss of income: 12%
  • Self-harm (cutting - requiring hospital treatment in one case): 9%
  • Significant attachment issues, resulting in an absence of any meaningful relationships (sometimes called pathogenic autism) : 9%
  • Bi-polar illness: 9%
  • Borderline personality traits or disorder: 6%
  • Potential paedophile behaviour: 6%
  • Carer stress: 6%
  • Anger management: 6%
  • Body dysmorphia: 5%

Childhood sexual, physical or significant emotional abuse was a factor in all of the above cases. Only one client presented with issues that the uncharitable among you would call ‘self-indulgent’. I gave her two sessions, assured her she was entirely normal and told her she didn’t need therapy in order to accept that fact. 80% of this sample had approached their GP before coming to therapy, and had been offered medication and, occasionally, 6 sessions of counselling. (6 sessions of counselling is the equivalent of putting a sticking-plaster on a gaping wound for these people.) Those with bi-polar illness were seen by a psychiatrist and prescribed medication but no therapy. Only one of the above sample, aside from those with bi-polar illness, had been offered an appointment with a psychiatrist and 3 sessions with a nurse-therapist: he was offered this because he admitted to driving around with a shot-gun in the back of his car and had made a suicide plan. The psychiatrist prescribed him Prozac and the nurse-therapist said that she wished she could give him longer term therapy, but her case-load made it impossible. I know that the NHS employs psychotherapists, but I have absolutely no idea of the eligibility criteria. Everyone I see would benefit from it, and none have been offered it. I don’t think any of these people could be described as ‘self-indulgent’, and I know that therapy has made a significant difference to their quality of life (and in the case of those with suicidal ideation has prevented them from further suicide attempts.)

Self-indulgent toss? You, anonymous commenter, have absolutely no idea of the depth of pain that some people manage in their day to day lives.

Do I, and other therapists, exploit people’s misery? If you agree that bakers exploit people’s need for bread and builders exploit people’s need for houses then perhaps we do. I think the real charge is that we make huge sums of money out of people’s unhappiness. That we are cynically exploiting people’s unhappiness to line our pockets with easy money. Let me disabuse you of this idea. Nobody goes into this profession to make money. There are much easier ways of making a much better living, and so we do it for very personal reasons. Perhaps I will blog about why we do it another time. But we don’t do it to make our fortune. Had I stayed in social work I would be earning half as much again as I earn now. I have friends in teaching who earn almost twice my average earnings. If I worked in the NHS I would be earning far more than I earn privately. God, I feel like I am moaning now about how little I earn, so trust me I am not. I earn a comfortable living. I agree that it is prohibitively expensive for many, many people. But in the serious absence of NHS therapy for those who want it, private therapists provide a much needed service. Surprisingly, there are many people on low incomes who choose to come to therapy because they feel its benefit. (And most of us offer a number of 'subsidised' places for those on low incomes.)

I think I understand the criticism of ‘therapy culture’; I blogged about it recently. I dislike the hurry to remedy any negative emotion and the implication that we should treat emotional dis-ease as an illness. Personally I blame the self-help industry (all those dreadful books and motivational seminars) which truly is a child of late modern capitalism. Create a hitherto unrecognised need, and then persuade people to part with vast amounts of cash to meet the newly acquired need. I loathe the self-help industry with a vengeance, and so do most serious psychotherapists, actually. The discourse of self-help implies:

  • Emotional distress is unacceptable and should be treated as an illness requiring treatment.
  • We all have an absolute right to be free from emotional pain, discomfort, disappointment or disillusionment….
  • …and we therefore have an absolute right to have the world meet our need for self-gratification. I have a right to have my needs met.
Yuch! We have many rights, but this isn’t one of them.

Ian Craib’s The Importance of Disappointment is a fantastic critique of this cultural trend.

I do think that we need to differentiate between this and the very desperate circumstances and personal despair that drive some people into psychotherapy. So please think again before making casually offensive remarks about those who seek professional help and those of us who provide it.

PS. Some people come to therapy because they simply want to explore who they are, what they want from themselves and others, and how come they feel/think/act the way they do. I don't include them in the 'self-indulgent' bracket. I think it is just fine to explore one's internal world to find a place of self-acceptance. Just to say.


The Moon Topples said...

Ms. M: I doubt the bloggers in question would mind if you posted replies to the offending comments. Discussion is healthy, as you psychodoodles are always saying.

I think the tendency to decry your profession is akin to yelling "witch!" in olden days. Something has happened that someone does not understand, and this frightens the person. Taking a moment to reach out or explain may not always pay off; but when it does, it'll certainly be worthwhile for both of you.

Ha! Now I'm giving advice to a therapist! Guess I'll slink back to my little fiction contest where I undoubtedly belong.

Caroline said...

Ms M - you words have moved me.
Perhaps if more people understood the vital role that therapy should/could play, then they'd not be so quick to attach stigma to it. The latest figures suggest that one in ten teenage girls self harm and yet we're still not asking the right questions and trying to find out why these children are needing to express themselves through self inflicted punishment.
Bullying at school, physical or sexual abuse and sexuality are being pinpointed. Perhaps people would suggest that to give therapy to these children would be ‘indulgent’ but early intervention can prevent so many problems in later adulthood. One in ten teenagers are learning to self harm in response to issues that they can’t find the words to communicate. Therapy would allow them to find those words and to explore their internal world that is causing them conflict.

Self-indulgent toss? Therapy. Talking. Saying the words that need to come out. Not all of us have the luxury of supportive others/families and therapy provides a time and space to express. It can't be hurried and six sessions is laughable.

There are, of course, like every profession therapists who do not commit to their work. That’s still not exploitation. Exploitation is such a pathetic and dim-witted use of a word. Therapists earn a living out of providing a needed service to people requiring help. Just as doctors do. Just as paramedics do. And like you have said there are easier ways of making money for you.

So to the anonymous comment giver, you ignorance and inability to empathise astounds me. Take off your pink coloured blinkers and see the real world. It's not a very nice place sometimes and bad things happen regardless of class.

And Ms M. I think that your career choice is a noble one and I’m sure that you’re damn good at your job. I feel quite strongly about this. In fact my novel stems out of the experiences of a child when people didn’t ask questions and didn’t recognise emotional distress as an illness requiring help. That was in the 1980s. I had hoped that we’d moved on from then. This rant lacks structure! Sorry ...

Self-indulgent toss? My arse!

Ms Melancholy said...

Hi Mr Moon - these were very throwaway comments as part of a wider comment on an entirely different subject matter. I am not shy, but trust me it would have been inappropriate to launch into this long rant there! I am always willing to take good advice though, so please don't slink...

Caroline - it is interesting isn't it that as a society we are taking an increasing interest in developmental psychology but don't appear to know what to do with it? I am looking forward to reading your book, which is going on order today along with Amy Winehouse and Nouvelle Vague whom I discovered over at On Grub Street

Caroline said...

Oh Ms M - I wasn't plugging! Please don't buy my novel. I'm now worried about the inadequate therapist in it! Bugger.

And on a lighter note. I am working my way through my box set of This Life. I love Warren and you appear to me as his therapist. I hear your voice, but I can't see you.

Today is all about topics that don't link together ;-)

nmj said...

I agree with it all, Ms M.

If your GP refers you to an NHS therapist you will wait for a year, typically, and then you will get 6 sessions of CBT. Hardly ideal.

I haven't read the comments which angered you, but I wonder if those who decry therapy as middle class & self-indulgent have suffered horribly themselves and dealt with it on their own & think others should do the same? Or maybe I am giving them the benefit of the doubt & they are just not very sentient or aware . . . People can be so blinkered, it is frightening.

Ms Melancholy said...

Lovely Caroline - of course I will read your novel! It must be very scary for you though, having it out there and just waiting for critical reaction. It is the artist's dilemma, methinks. It is hard to portray therapy in fiction form, I think. They end up being a stylised representation, which I think is absolutely fine. I am thinking of Dr Malfi in The Sopranos - as a therapist she would be far too intolerant, but I think it is nonetheless an excellent portrayal of the dilemma we face when we work with someone whose value base we just don't share. I liked Milly's therapist in This Life - the faceless blank screen. Again a stylised version but I just loved those scenes. I will buy your book, as will lots of others!

Nmj - you are probably right that the person who made this throwaway comment has a particular reason for his/her intolerance. Either they have overcome great despair themselves or perhaps they have just never known it? I can't even remember where I read it, but that doesn't matter as it represents a view that is all too common place.

There is a lesson for me in not writing long posts very late at night, though! I would have been a little more measured had I waited until morning!

That's so pants said...

Hi Ms M - I thought I was quite open minded but I will admit to you that since I've been reading your blog I have realised that I too have had an exraordinary prejudice against therapy and therapists. I say this because when I read your posts on psychotherapy I find myself thinking Ms Melancholy does say some very sound things, always with a great deal of surprise. What I am saying is that, to me, you seem like an exception in what I perceive to be a very bizarre world. I have no direct experience of any kind of therapy and I admit I am one of those people who has a 'just get on with it' mentality. The way my mind works is of anthropological interest to me only and I quite enjoy mental turmoil. I even like feeling a bit sad sometimes. I do however have some experience of psychotherapists as we have had two in my small residential building. Both have been given to hysterical verbal outbursts and nonsensical and sometimes threatening use of the communal notice board. Both seemed unable to comprehend even the most basic elements of co-operation, perceiving this to be whatever was required to meet their own needs. They are the only two people who've ever caused trouble in this very quiet and genial environment. To me at least the profession is let down by people who are not even in charge of their own anger management. I also think you have against you the Oprahfication of emotional wellbeing which has trivialised serious mental conditions by having Dr Phil spend an hour counselling two sisters who have fallen out over unauthorised use of curling tongs. In my extended family we have both schizophrenia and autism and I know how devastating both these conditions can be and how little real support has been offered to my relatives who are trying to care for their frequently dangerous loved ones. Reading what you write does actually inspire some faith in the profession so we can only hope that the image of psychotherapy is slanted more towards practitioners like you rather than the Dr Feelgoods of chatshow TV.

Ms Melancholy said...

Lovely Ms P - welcome as ever. I think this is a very complex debate, actually, and we can't do it justice here. I have an intolerance of certain kinds of therapy (and therapists) too and in my experience these tend to be the counselling end of the scale where there is a 'let your feelings out and get your needs met' philosophy. They would find me hard and I find them flakey. It's actually the psychodynamic end of therapy where you get the really solid practitioners. I think there are far too many flakey training courses churning out people who do encourage self-indulgence. Like the women at your housing co-op. I do feel strongly about defending the solid core of good practitioners who take their job seriously. I think you would really like the Craib book, by the way. And anything by Andrew Samuels or Suzy Orbach who are both very political and critical of the 'cult of the individual' philosophy. Thank you for taking time to comment. I genuinely appreciate it. Best wishes, as always x

nmj said...

This is slightly away from the subject, but just to say I have already ordered the Faulks novel Human Traces that you recommended - from the library. I know little about psychoanalysis & I see Charcot & Salpêtrière feature, he too is in Blanche & Marie.

Ms Melancholy said...

I hope you enjoy it. The pscyhoanalysis stuff is almost background, but that is what I liked about it. Just a darn good story! (And I am just loving my new found HTML skills. Many thanks to your clever readers!)


Hello Ms Melancholy - that was an interesting and very strongly worded post.

Caroline says that "not all of us have the luxury of supportive others" and this seems fair and true, but it doesn't go quite far enough (for my liking).

Even with the loving help of "supportive others", it is still sometimes necessary for the person suffering mental health problems to seek neutral assistance. In fact, it is often essential that they do so; not just for their own sake, but for the sake of those shellshocked "others" who, in spite of their most loving efforts, are often pitifully equipped to deal with such alien turmoil. Their very closeness to the person themselves, in fact, often serves only to jeopardise the recovery process - as they are too quick to give credence to the smallest signs of improvement because they so dearly want it to be true. This doesn't help anyone.

In these circumstances, it hardly seems self-indulgent to seek therapy. On the contrary, it would seem self-indulgent not to.

I like what Ms Pants says about rather enjoying mental turmoil. This chimes sympathetically with my own grimly dark outlook on these matters.

I also like her barb against "Oprahfication", which often sees me hold my head in my hands. It cheapens your profession, Melancholy, and serves only as mindless and (probably) harmful titillation. But you know this, I think.

Ultimately, however, I think it should be recognised that some people are horribly unable to simply get on with it. And it seems only proper that these people should be helped - I don't think anyone would disagree with that, though, would they?

Sorry - just one thing about the self-indulgence or otherwise of those in therapy: if someone has sought therapy solely to satisfy a self-indulgent need, it seems very likely to me that in all probability they need some therapy anyway.

It's a win-win situation, Melancholy, and it keeps them off the streets.

Kind regards etc...

Ces said...

Ms. Melancholy, thank you for visiting my blog and for the lovely comment.

The combination of cheap talk and free blogging sometimes end up with idiotic posts and stupid comments but we ignore those until they refer to what is near and dear to our heart.

Now I wonder if the same commenters who think that all sorts of therapy are self indulgent would think that going to an opthalmologist because they have visual difficulties and need glasses is also self indulgent? Therapy for mental and behavioral issues especially for able-bodied individuals may seem like self-indulgent acts because the public do not see them limping when they walk, until the day comes when one points a revolver on his head and blow up his brains to pieces in his bedroom would people then say, "If only he sought psychiatric help" or "if only I knew he needed help."

Even among clinicians, mental health was always relegated to the "cuckoo ward". In the trauma center where I worked, a mental health patient was always regarded as a non-emergency unless he was threatening to kill the nurse. One day one of my fellow nurses assigned in triage said that the patient in Room 5 was "mental" and needed to see the pyschiatrists. A few months later, I was in the shock trauma room when the paramedics brought a white female with overdose. It was my fellow nurse.

Ms Melancholy said...

Sorry - just one thing about the self-indulgence or otherwise of those in therapy: if someone has sought therapy solely to satisfy a self-indulgent need, it seems very likely to me that in all probability they need some therapy anyway.

Mr PE - you say some very sound things, and this is one of them. If life is to be at at all tolerable we have to come to terms with disappointment. I also agree with you, and Ms Pants, about the strange pleasure of our shadow sides. I like to think that my job is helping people to open their eyes to their shadows, not to actually do anything with it. I also want to thank you for resisting whatever joke it was you had in response to this post: tell me later!

Ces, thanks for the visit - I enjoy your blog. That is a very salutory tale indeed and reminds us that we make the 'us and them' division at our peril. Mental health is a continuum, and we should not take for granted our place on it. Best wishes, Ms M.

Anonymous said...

This is a response to the comment which gave rise to Ms M's latest rant.

Ok, so are we to assume that GPs, surgeons and the like also profit from other peoples misery? Has anyone EVER seen a poor dentist?

As a practitioner myself I would admit that most of my patients are white and middle class. They are not self indulgent. They are not prepared to wait for NHS treatment, often the NHS has no treatment for them. They can afford to pay so why not?
The reason people from lower socio-economic groups don't come as often is because they can't afford it! (No shit Sherlock) The problem here is that the NHS cannot provide the treatment of choice or necessity to everyone. This is because the NHS is sinking under the weight of "management".
As some one once said "good health is wasted on the healthy"

PS Very new to this lark, so appologies if this is on twice.

Atyllah said...

Yes, yes, yes, Ms M! The people who make offensive comments do so either from a position of complete lack of understanding, knowledge and compassion and with an EQ of about 2. Or they do it from a position of intense pain and absolute denial. It is easy to knock that which we fear the most and about which we understand little.

Ms Melancholy said...

Hi anonymous - thanks for de-lurking.
You certainly gave me a smile when you referred to Ms M's latest rant. I forgot to mention the class/ethnicity issue didn't I? Yes, most of my clients are white British, although not exclusively. Clients from minority ethnic groups tend to be middle class professionals, though. I do see quite a number of working class clients, however, who find the money once a fortnight despite living on low incomes. I think this is due to the location of my practice and the fact that it is based in a complementary therapy clinic that has a high number of working class clients generally. Thanks for commenting and please feel free to call in again.

Atyllah - I think you are right, but also people have a misunderstanding of the purpose of therapy and assume it's intention is to encourage people to 'indulge' in their emotional world. The purpose of therapy is to enable people to manage their emotional world, which is an entirely different matter.

Liz said...

I see so many folks who could use a good therapist. Heck, I could use a good therapist...but I don't go. Mostly because I don't take the time to do so and I should. Thinking specifically about the black community here in the US, there are such high rates of depression and suicide, and yet there are certain cultural (and financial barriers) to seeking therapy, particularly with men. Black men are supposed to be tough, they're supposed to "man up". I think that's why it's important for the profession you're in to become more diverse.

Miss Tickle said...

I can only say thank Heavens that the possibility of seeing a therapist "privately" does exist. Otherwise I don't know if I'd still be here. Melodramatic and entirely true.


Ms Melancholy said...

I couldn't agree more Liz, that the profession needs to be more diverse...

Miss Tickle - I'm glad you chose therapy x

swimmer6foot4 said...

Well, Ms. M. what a tremendous blog - and what a wonderful set of responses. I wholeheartedly agree with so much of what has been written so far and could, quite easily, reflect on that warm glow but ... I can be a grumpy old bugger when I want; so I thought I would focus on that where either I disagree with you or where I think it possible that you might clarify what you've written; areas open for misinterpretation.

Like you I loathe much of the self-help industry. And I agree that the discourse of some self-help implies:
* Emotional distress is unacceptable ...
* We all have an absolute right to be free from emotional pain ...
* ... and we therefore have an absolute right to have the world meet our need for self-gratification. I have a right to have my needs met.

However, not all self-help groups/movements hold to these tenets. The so-called "12-step fellowships", such as Alcoholics Anonymous, that have developed over the past 70 years embrace the "shadow" of pain, distress, grief and sorrow; it is no wonder that Jung was so instrumental in the establishment of the AA movement. My clients that have previously gone along the Anthony Robbins/NLP path often need the first three sessions or more - just to debrief and allow themselves to feel again. However, clients who have experienced the 12 steps and 12 traditions of AA (and its sister organisations, such as Al-Anon, DA, SA, etc) often have an enormous emotional vocabulary and awareness of boundaries that, I feel, many therapists might only dream of grasping!

You wrote to Ms P: I have an intolerance of certain kinds of therapy (and therapists) too and in my experience these tend to be the counselling end of the scale where there is a 'let your feelings out and get your needs met' philosophy. They would find me hard and I find them flakey. It's actually the psychodynamic end of therapy where you get the really solid practitioners.

I am of the opinion that the biggest difference between counselling and therapy is forty pounds an hour! If I see a client over a three-month period and they are charged fifty five pounds a session, this is seen (in the eyes of one of my agencies and some supervisors) as "therapy". Yet if I see a client over a three-year period and they are charged only five pounds a session, (and I am fortunate enough to be able to offer this to many of my clients) much of the therapy world would, sadly, consider this to be "counselling". Sadly, this false distinction also contributes to the idea that therapy is for the sophisticated and middle classes whilst counselling is for the uneducated/poor/sick/dispossessed. I consider that pychodynamic therapeutic processes exist just as profoundly within so-called counselling settings as within so-called therapy ones; ditto with "flaky" processes. I don't care two hoots whether my client considers himself within counselling or undergoing therapy; as long as the work gets done. What do you feel?

I am glad you recommended Andrew Samuels to Ms P. If it is not contradictory to say this about a man who lectures about the dangers of the cult of the individual, I am a big fan of Professor Samuels (who, incidentally, never went to university!)

Note to Ms P. (who writes) "The way my mind works is of anthropological interest to me only ..." Not at all! It is of great interest to me too, which is why I devour your blog!

Reading the Signs said...

Ms M - I worked for some years as a bereavement counsellor. The work was for a voluntary organisation so no money was exchanged. There was, however, an exchange - and I'm not sure how to express this so as to do it justice. I felt that when we came to a place of real meeting an exchange of truth took place that made me feel privileged to be with them at that point in their lives. In my own (good) experience of therapy I have also felt this exchange, which is a place of meeting and of being alongide each other. I recognise it as a place of healing and don't believe there is anyone who doesn't need to be in that place at some point in their lives.

I gave up that work because it also took too much of my physical strength, inner substance, and I had to choose between that and my other work. Paradoxically, though, in the long term it gave me a different kind of strength and courage. I am the richer for it.

Ms Melancholy said...

Mr Swimmer, thanks for coming back...

I will take your word for it on the 12 step process, as I am unfamiliar with it. Anything that includes Jung's concept of the shadow side is fine by me, though: that is precisely my point about a lot of the self-help industry, in that it doesn't allow for the existence of the shadow ( we have to chant or affirm it away.)

I knew I would come a cropper making unfair generalisations at some point, and you are right to point out that there is not always a chasm between therapy and counselling. I know there are many counsellors who work skillfully with the relationship. However, I also supervise people straight from college who think that counselling is about holding people's hand and making the world better for them. So the difference for me is that a 4 or 5 year training course usually weeds those people out before they can be let loose on the general public. I think counselling courses are generally getting better, however. I know what you mean about the class divide and it is obviously tosh (although I have never heard it expressed so clearly around the fee) but for me there is a difference between some counselling and psychotherapy - there is such a difference in training and personal work required that that is hardly surprsing. I suspect we will keep talking abou this. I do hope so...

Ms Signs - you have summed it up beautifully, and I think Swimmer's point would be that some counsellors are very good at that too (whilst some therapists are not so good also). If we can truly be alongside someone in their distress, we actually don't need to do much else. Thank you for pointing that out!

trousers said...

I've only scanned so far and will read in more depth at some juncture - but a fine and well constructed rant at first glance!

I wonder how much of the misconception is down to media portrayal and stereotyping as well. The stereotypes, including those perpetuated by the posters you are responding to, undoubtedly exist - but for such cliches to be presented as the whole picture (when life on the front line is hardly cosy or indulgent) is seriously misleading. Not to mention insulting.

Ms Melancholy said...

Hello Mr Trousers! I think we have brushed shoulders over at the Duckpond, haven't we? Why don't you have your own blog? I insist that you start one immediately...

trousers said...

We have indeed met over at the pond. Why don't I start my own blog? I've thought about it, and I know what it would be called. But not until (if ever) I'm ready!

Rachel said...

Thank you for that. I have battled for years with a critical voice in my head telling me I am 'self-indulgent' for trying therapy, or for writing, which is also my personal therapy.

I will refer myself, and my inner Critic to your post in future, when that voice starts up again.

Ms Melancholy said...

Hi again Rachel - sometimes it is an important part of the process that we feel 'self-indulgent' don't you think? It tells us a lot about ourselves and our coping style. But not so good if it prevents us from allowing ourselves to pay heed to important emotional responses. You, if I may say so, are a very fine example of how one can genuinely manage trauma (and I hear that you have used therapy...) if we give ourselves the resources to do so. Not just one major trauma in your life, but two. And not a hint of 'self-indulgence'about your recovery process. I hope you don't mind me being so personal, Rachel. I have read most of your blog and I am moved by your story...

Dandelion said...

"I know that the NHS employs psychotherapists, but I have absolutely no idea of the eligibility criteria."

You have to have good ego strength, and not be drug-abusing or self-harming, among a list of other things.

Emotional distress is unacceptable and should be treated as an illness requiring treatment.

Maybe not, but it does cause rather a lot of social ills, via its impact on behaviour.

Also, I'm sure you will know what kind of things people will do (to themselves and to others), to be free from intolerable emotional pain. We may not have a right, but it would seem we have a rather creative and compelling drive in that direction. Just thought I'd mention it.

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