I like therapy. I like it for all the reasons you’re not supposed to like it. I like the free, never-ending tissues. I like the neutral walls and the conservatory style wicker chairs that are so soft and pliable that they are almost unsupportive. I even like the awkward bits: at the beginning, when you don’t know where to put your coat or whether there’s a specific chair that the therapist favours; and at the end when you pay them, and it all feels slightly seedy.
I like it when you hear the muffled monotone of the poor chap next door as he recounts his undoubtedly more worthy problems, and how the voice of this stranger makes you feel less alone. I like how rebellious it feels when you pick up the odd phrase through the wall: ‘My mother…’ or ‘When I was a lad…’ and how this unintentional snooping adds to the atmosphere of anonymous intimacy.
I like it when the cleaner barges in with her industrial, clattering hoover and says, ‘Ooh, I’m sorry,’ while the therapist smothers a look of blatant irritation with a smile.
I like therapists, especially when they do things they’re not supposed to do, like agreeing that your work nemesis is an arsehole, or talking about the dark periods of their own lives, whether that involves divorce or drink or binge-eating pop tarts. I like it when they are human.
I like therapy because you don’t know how you really feel until you enter a beige box with a smiling, benevolent stranger who asks you how you are, and in doing so, gives you permission to let that unfathomable, chained up sadness off its leash to run around until it tires itself out.
I like it because it’s human contact, and it’s hope, and it’s borrowed strength.
Therapists like their therapeutic techniques. They like their CBT and their MBCT and their self-compassion Ted talks. They like their cycles and their diagrams. They like making irregular garbed messes of minds into symmetrical flow charts and neat cycles. They are the kind of people who enjoyed simplifying equations in school. They are modern cartographers: they like to draw the landscape of your mind using the words you give them. By the end of session one your mind is less like a bothersome tip and more like a map of a middle earth – with thin ice and quicksand and ditches and caves and mountains with summits labelled ‘happiness’, ‘stability’, ‘success’ and ‘love’. They like to populate these landscapes with characters: imps and Dreadful Iffies and angry parents and critical school masters. They seem to find your mind fascinating, and to love their jobs.
There are lots of different types of therapy on offer, and I seem to have gone through the lot. I’ve been to CBT and person centred and group. I’ve lay on a couch and sat on a hard-backed chair and mindfully walked across a hospital meeting room.
Perhaps I am ludicrously needy, or perhaps therapy doesn’t really help me at all. After all, if it did, why would I need to keep returning? The truth is, it almost always helps. It’s just that it doesn’t always heal. I’m fine with that, but therapists, usually, aren’t.
They like to be seen as teachers of depression management techniques, rather than shoulders to cry on. The ones I have met do not like it if clients suggest that it is the therapist’s patience or understanding or warmth that brought an improvement in their mood. They like the focus to stay on the diagrams on the whiteboard and the thought-challenging exercises. To credit the therapist rather than the therapy is to demean their professional pride: to imply that they are easers of pain rather than enablers of recovery.
These disparate views of the goals of therapy can lead to the relationship becoming dysfunctional. The therapist pushes their ‘teaching’ agenda, the client is swept along, feeling the need to agree that the skills they are learning are life changing in order to keep hold of the truly helpful thing: contact with an empathetic and knowledgeable other who knows exactly what not to say.
I recently attended a twelve-week group course for the self-management of depression, teaching Cognitive Behavioural therapy techniques. On session two, the teacher nipped out to get more photocopies of a handout. In her absence, a woman in the semi-circle admitted she had not done the homework, which was to list our negative thoughts and challenge them using logical alternatives. One by one, we all admitted to the same thing. Confessions of our non-engagement with the homework we were set became a running joke, and we whispered about it in mock disgrace before the sessions started and during the coffee break. We guarded each others’ secret from the therapist with loyalty, unblinkingly allowing others to lie about their efforts.
Despite our hatred of the exercises we were set, we all kept attending until the end. On the last session, we all told one another that our mood had improved since we started the course, and we said this with sincerity. It would be difficult to credit CBT techniques as the cause of this improvement, given our minimal engagement with them. Amongst ourselves, we all attributed our improved moods to the support of the course leaders, and one another. In one woman’s words, ‘It’s reassured me that I’m not the only one who can’t do life.’
But it was not easy for me as a service user to make this point. Unfettered honesty was not encouraged through official feedback channels.
At the end of each session, the therapist would go round the circle and ask us, one by one, how we felt it had gone. We were told to answer honestly. Members of the group, who gave mixed reviews in private, only gave positive reviews to the therapist. We could hardly have been blamed for this. It’s unrealistic to expect a bunch of people, suffering from an illness which is characterised by a lack of confidence, self trust and assertiveness, to deliver inconvenient truths to a passionate authority figure to whom a debt of gratitude is owed.
New ways of giving feedback that encourage brutal honesty need to be developed. They should be anonymous, and the acceptability of criticising the service needs to be emphasised and even encouraged. Service Users should be trusted to know what, if anything, has caused their depression to fade, and should be asked about this. And the psychological community should have the guts to accept it, whatever we say. Maybe then it will start to be acknowledged that something as touchy feely and unscientific as human support can be the primary catalyst for recovery.