therapy

On love and fragility

A few days a go I came across this: an essay titled, essentially, ‘how to fall in love‘. It’s not the sort of title which I find particularly appealing, associating it, as I did, with a certain kind of magazine. But people kept linking to it so I decided to have a look. I confess I was expecting a load of nonsense about what to wear, how to compliment the other party and how to follow a date up to ensure a long-term relationship. I was pleasantly surprised, then, to discover that this was a little more substantial. The piece was based on a study which attempted to build intimacy between strangers by each asking the other 36 increasingly personal questions.

Now I found this more intriguing than I had initially anticipated. I am a psychologist, after all, and that means that I am interested in relationships. I am also fascinated by fragility. Many of the people I see clinically end up in my consulting room because life has become too much from them – too cruel, too lonely, too tough. I ask them to expose their vulnerability to me – to tell me what frightens them; what demons haunt them. I am always struck by the privileged position I have – trust is earned, not given, and many people have trusted me with their pain and fear.

But I am a human as well as a psychologist and I know that it is not just my patients who are fragile. We all are – perhaps that is the essence of our humanity. Life can be dreadfully painful. To my mind, therapy is one of the ways of understanding that pain and learning to live with it. I can’t eradicate your experiences, nor do I wish to, but if we can find a way to allow you to exist without those experiences sapping the joy from existence perhaps we have done enough. It is, of course, easier said than done.

But then I began to think about professionals and whose job it is to expose our fragility. We are no different from our patients, really. A lot of people I have seen clinically seem to have a notion that we who work in mental health don’t understand what pain is. That is often, in my experience, incorrect. Many of us don’t talk about it as a general rule, but that doesn’t mean that loss and despair haven’t touched us. Perhaps, when it comes down to it, loss is what it’s all about – loss of identity, safety, love, self.

One of the interesting things about clinical psychology training, as opposed to psychotherapy or counselling training, is that we are not required to have our own therapy. I have always been deeply unsure about this. I think it suggests some fundamental difference between professionals and patients, which, as I said, I think is trumped by our shared humanity. I think it deprives us of a chance to reflect on ourselves and the reasons we do what we do for a living, for, to be sure, it is an odd way to spend your days. We might talk about being interested in people, but there are plenty of ways to indulge that interest without exposing yourself to tales of horror; without sharing someone’s else pain so acutely. I think there’s much more to it than that. Therapy is a means by which you can get to know yourself better. In my line of work, self-awareness is of paramount importance – knowing why you respond to Patient A differently from Patient B; understanding why you can’t work with Disorder X; why you’re so desperate to help someone with Problem Y. I don’t think we all have a Messiah complex but I do think our career choices are often deep-rooted and under-analysed.

But not being compelled to have therapy of our own also stops us experiencing what it is like to be a patient. It’s not necessarily easy being the therapist, but I reckon it’s a good deal harder being on the receiving end. It is difficult to tell someone the things that you are ashamed of. It is hard to talk about the abuse and neglect you have experienced and to cry about the abandonment you have felt. It is not easy to build a relationship like this. It takes the most enormous courage and it deserves huge amounts of respect. And whilst no one’s journey is the same as anyone else’s, it is experiences such as these which can attune us more sensitively to the pain and longing of others, which allow us to build those connections so integral to therapeutic work. And that is why I believe that every psychologist should understand the process of exposing their vulnerability, their fragility and their pain and that they should be compelled to do so as part of their training.

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On the misuse of psychological therapy for dastardly ends

I have grumbled at length about the endless list of psychological therapies available and my feeling that many of them serve the interests of their inventors, as it were, more than the interests of the people who need some help. Similarly, I have written elsewhere about what distinguishes a psychologist from a psychiatrist. Of course, they’re not the only folk who reckon they can help if you’re having a tough time; lots of other people will happily have a go at helping, although they generally ask that you cross their palm with silver from the outset. There are counsellors and therapists and life coaches who will vie for your custom and they are all eminently Googleable (and many are very, very credible). It’s probably difficult to discern what differentiates any of these from the others and to understand what makes them different from psychologists. I have no expertise in this, so I will leave it to you to Google it if you wish, although I certainly can’t guarantee clarity. My concern is about the lack of regulation amongst these people, all of whom tell you they can make your life better. As someone who has more expertise in psychology, I shall write of what I know.

 

Until recently, anyone could claim to be a psychologist, whatever their qualifications or lack thereof. A couple of years ago that changed; now ‘practitioner psychologists’. such as clinical, health or educational psychologists, have to be registered by the Health and Care Professionals Council. If I want to practise as s clinical psychologist or a forensic psychologist or an occupational psychologist, I have to register with the HCPC. Unfortunately, for reasons that I don’t really know, the term ‘psychologist’ in and of itself is not protected. So all those people sitting on bright red couches on daytime television who tell you they’re psychologists? There are no professional standards by which they have to abide. They can tell you they did a course in any kind of chicanery and that they therefore have some expertise and you can’t do a great deal about it. The only time that you might be able to do something about it is if you find yourself in the sort of position Patrick Strudwick found himself in when he went undercover to find therapists providing reparative therapy to gay people (full details here). The therapist was struck off by her accrediting body (Strudwick had her on tape stating that he had ‘probably’ been sexually abused as a child and that this way likely why he finds men attractive) but, because ‘therapist’ is not protected, she simply registered with another body which is quite content to let people peddle ‘gay cures’, which are ineffective at best and downright dangerous at worst, never mind the ethical issues. Outraged? You should be.

 

Some time ago, I had a patient referred to me with OCD. Put simply, she was tormented by intrusive thoughts that she either had or was about to harm someone. Like a lot of people, she searched for private therapy and paid a fortune for it. This person’s style of therapy? They asked their patients, in groups, to hold knives against each other’s throats. They also asked those people to walk around town, on a day-to-day basis, carrying eight-inch kitchen knives in their bags. I have rarely been so horrified at another ‘professional’s’ practice. Obviously I researched this person. They had precisely no qualifications in psychology, medicine, psychotherapy or counselling. None. But they run a service which charges a fortune and none of their employees seem to have any recognised mental health qualifications either.  What they are doing is not regulated, nor is it bound to adhere to any kind of guidelines. There is no indication that the ‘treatment’ on offer is based on the best available evidence.  The testimonials appear to have been written by people who were desperate, and desperate people will often pay a fortune for any glimmer of hope.

 

I’m not a Philistine about these things: I accept that other professions can offer valuable input to distressed people and that sometimes psychology is not the best approach. But often it is a very good one. I believe patients should get what they need, but I am fiercely protective of them and cannot abide the idea that they are being exploited by someone who may well do them immense harm whilst invoicing them for fantastic sums. Putting a knife against someone’s throat? What if it had slipped? Carrying a weapon in public? What if she had been searched? There are consequences to that kind of thing. Of course, the fact that this person came to see me after she had paid for private therapy tells you all you need to know about how successful that therapy was. I don’t claim we eliminated the problem; but she certainly wasn’t putting herself and others at risk in the process of our work. This, though, is how such people earn a living. They seek out those who are at the end of their tether and they sell them nothing more than snake oil; albeit with an enormous mark-up. And there is nothing, nothing at all, we can do to stop them.