in Thinking about psychiatry



I was at a course the other day and someone piped up from the back:

‘In an ideal world everyone needs a counsellor, that they can talk to every week about their problems’.

I expect that quite a lot of people would agree with this statement, but not me.

Different psychotherapies (‘talking therapies’) are easily confused and I’m not talking about directed therapies such as cognitive behavioural therapy, family therapy or behavioural therapy.  These therapies are aimed at specific psychiatric conditions, are goal directed and administered by trained practitioners.  

Counselling on the other hand is difficult to define, and tends to be performed by those with limited training and aimed at people without strictly classifiable mental health problems.  As such it seriously encroaches on normal experience and the implication of the statement above is that people going about their everyday life need professional help to deal with common problems of everyday living.   

There is little evidence that counselling helps, and some evidence that it actually makes people worse.  There is a danger that attending a counsellor for a problem will introduce the expectation of experiencing distress and in some way validate it.  Some people regard simply attending counselling as a mentally healthy thing, but is airing your problems suitable for everyone, and could it be that people attend counselling as a proxy for real action?  Counselling is popular and this is given as justification for it continuing to be available, but what people want and what’s in their best interests is not always the same thing. 

An argument could be made that the counsellor is taking the place of the parish priest in these godless times.  With many of my patients I feel that what they really need is some good friends, who can offer support, sympathy and real world feedback.  Friends are also a lot cheaper.

From Will Self