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.
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.