There is something mystifying about the world of therapy and it could be holding the profession back.
For people who would like to begin seeing a therapist, the maze of therapeutic approaches to wander through is dizzying. Finding a suitable therapy and/or therapist is not as straightforward as it could be.
While there are understandable ethical, historical and conceptual reasons for the general confusion, more could be done to make the path into therapy more accessible. As a profession on the whole, the talking therapies – counsellors, psychotherapists, psychologists or psychoanalysts – haven’t been successful at describing our work to the public and helping demystify it more.
The ethical imperative therapists have to protect the privacy of clients and patients is an important factor in this. Explaining what we do must privilege the confidentiality that is fundamental to the work. The meaning of discussing or publishing case histories is tricky and is something therapists must remain thoughtful about. And yet there must also be ways to talk about the work without jeopardising client privacy.
A significant historical aspect to this stems from theoretical differences between the great thinkers in psychoanalysis that resulted in a proliferation of the psychoanalytic movement into the profession of many parts we see today. Differences in theory and method have, not always justifiably, led to the perplexing array of therapeutic approaches and accreditation bodies we witness today. Not only are these differences confusing to the public, they are also befuddling to those within the profession.
'an instrument to soothe distress, to contain pain, to effect change, talking within a robust therapeutic relationship can be enormously powerful'
Mention must also be made of the difficulties that are faced in explaining the conceptual differences between the various approaches. When I am asked what kind of therapy I practise, I don’t find it straightforward. It is important not to over-simplify what is a complicated picture – the world of human emotion. If describing the human experience wasn’t so demanding, then we probably wouldn’t have the same need for therapy professions in the first place.
And yet, for all the ethical, historical, conceptual difficulties and differences that account for the profession’s relative lack of accessibility or clarity, there is much more that unites the profession than divides it. The divisions within the psy-professions are fascinating. Viewing the history of our overlapping institutions and schools of thought mirrors the conflicts and contradictions we see in any individual. The psy-professions are made up of human beings after all.
Even so, I wonder if the similarities between counselling, psychotherapy, psychology and psychoanalysis outnumber the differences by far. The differences are more important for those within the profession to untangle. For those outside the profession, people seeking some support, the similarities could provide a more cohesive public message instead of what must feel like an intimidating set of confusions.
This message might include the idea that the school of thought a therapist works from is less important than the quality of relationship that the therapist provides for the client. This is about a presence over any theory. And it is a crucial integrity rooted in a wish to help people in distress, people suffering somehow, unfulfilled or confused, inhibited or stuck, depressed or anxious, sometimes suicidal, people maddened somehow because of the circumstances of their lives.
Therapists provide a welcoming place for all of these experiences. The great, now sadly late, John Berger describes the concept of hospitality as something which is “an incredible human capacity. And the first rule of hospitality is to accept the presence of somebody”. Startling in its simplicity, yet rarer than we might first imagine, this is a quality integral to the work of any attentive therapist.
“ attention is the rarest and purest
form of generosity
People may be courageously turning to therapy to ask hugely significant questions – should I stay in my marriage? Should I let go of my religious beliefs? How can I reconcile my sexuality? How can I face what has happened to me? Why do I feel so stuck? Why does life feel so painful? How can I change the way I feel? How can I go on? All of these questions are enormous. And all can begin to be worked through with a reliable and compassionate therapist, irrespective of their chosen approach.
Most of us will know what it feels like to be treated by another person in an emotionally supportive way, even though it might be difficult to say what it is about that person’s attitude towards them which relieves their distress. This offers some insight into what happens when a client meets with a therapist. As an instrument to soothe distress, to contain pain, to effect change, talking within a robust therapeutic relationship can be enormously powerful.
Sigmund Freud called psychoanalysis the ‘talking cure’ – a cure achieved literally by talking. In the therapy room, a person can speak about their experience without interruption and without censure. The therapeutic relationship prizes an unusually focused, rigorously intense conversation that seeks to understand the experience of just one of the people in the relationship. And it allows anything to be said. Nothing the client feels will be judged.
This form of attention paid by the therapist to the person’s experiences is very particular to the profession. It scarcely happens outside the therapy room. The French philosopher Simone Weil once wrote that “attention is the rarest and purest form of generosity”. By this definition, our relationships to the world, to one another and to ourselves, are becoming increasingly miserly. More than ever in the modern world, we have the experience of being constantly interrupted. Often we distract ourselves – the same person as the interruptor and the interrupted.
With a therapist however, gaps are left alone. And again and again, the therapist will witness the same spaces that are usually taken up by interruptions outside the therapy room – when left alone by the therapist – will result in clients talking about themselves and their experiences in surprising ways and will connect to new ways of thinking and feeling. Different narratives and conversations emerge, and with them new possibilities.
When a person in distress can sit with a therapist who is experienced in being with such discomfort, and is capable of staying with it, someone who is trained at carefully listening and sensitively responding to such sorrow, the anxiety often lessens. After taking in and reflecting on the client’s story, the therapist will look to offer something about the patient’s experience that the client may not have thought about themselves. Over time for the client, the hope is that the intensity of their symptoms will reduce and along with that the temptation to act out in ways that are self-destructive or destructive to others will also diminish.
And beyond symptom remission, many therapies will hope to facilitate within the client the presence of strengthened psychological capacities and resources. This could mean more fulfilling relationships, a greater toleration of a wider range of affect, more effective use of talents and abilities or a more robust or grounded sense of one’s self. All of which may contribute to a life more fully lived. Most therapists would look to foster these capacities in their clients.
For many people, the thought of going into therapy can be frightening. Addressing fears, uncertainties, anxieties or confusion is difficult. For this reason, it is important for the therapeutic professions to make themselves as accessible as possible for those considering it. Otherwise, people who could be helped could be lost to the possibilities therapy provides.
Even though the work is often tough and offers no guarantees, therapists can help people as they face life’s difficulties. For many clients who find their way into therapy, the work can be many things – it could prove to be soothing or enriching, containing or liberating. Even given the differences within and between the therapy professions, conveying this message better and demystifying the work that we do is something that could unite us all.
Simon Rutter is a psychotherapist and writer. His writing is often engaged by the effects of the social world on the individual's welfare, being particularly stirred by the ways in which the 'psy-sciences' (psychology, psychotherapy, psychoanalysis and psychiatry) can impact upon people's lives in oppressive ways. You can read more from Simon in his blog here