Who do you turn to in times of trouble?
Psychiatrists, psychologists, psychoanalysts, counsellors, therapists? The list of people who can help you when life gets difficult and you are struggling to cope goes on and on. Wikipedia currently lists over 155 different types of psychotherapies, but do you really know what each therapy does? What the therapists set of skills are and what issues they are qualified to deal with?
When a friend in trouble turns to you and you send them on to that specialist you have heard works wonders, are you actually referring them responsibly? It's essential to know because the wrong advice could have serious consequences.
So who works best for which particular problem?
The first big distinction amongst therapists is between psychiatrists and all other therapists offering any kind of mental and emotional advice. These are the heavy hitters: the professionals to guide you when you need serious help.
Psychiatrists train first of all as medical doctors and then specialise in the vast variety of mental health disorders and diseases that affect many of us at different times and stages of our lives. Schizophrenia, manic depression and acute clinical depression are serious physical illnesses and cannot be dealt with by the 'talking therapies' or be managed by close family. Counselling or psychotherapy just will not do it; time will not make a difference, and the illness will not just 'pass'. This is where a psychiatrist can make all the difference, and with proper management symptoms can improve and even normalise.
Although the precise biochemistry in these cases is still not properly understood, the brain's neurochemistry is disturbed for one reason or another. Brain chemistry controls behaviour, so symptoms usually include disturbances in emotions, thoughts, moods and behaviour. The only recognised way to treat these illnesses is with medication, and often with intensive and sometimes long-term hospital care or very skilled management in the community.
Psychiatrists know what to do and how best to do it, and in the UK they are the only professionals that can prescribe mood- and mind-altering (as well as any other) drugs.
Second in line, if you were to categorise the various therapies, would be the clinical psychologists, who are equipped to diagnose and treat emotional and behavioural problems. They can deal with serious mental illness and psychosis. They have years of training: a degree, followed by another two or three years at post graduate level and are skilled at assessing personality, intelligence and measuring psychological functions in a variety of ways. A clinical psychologist usually has a defined skill – dealing with children, or adolescents, or adults – and may specialise in a certain area: addictions, eating disorders, learning disabilities, depression, marital problems, sexual problems, interpersonal conflict management or relationship difficulties in general.
Make sure the person you go to for help is experienced in your particular issue. Ask around for referrals. Your doctor can offer advice, and if you feel able to talk about your problem to friends you may find they have used a clinical psychologist for exactly the same issue themselves.
Counsellors or psychotherapists (counselling psychologists)
This is who you turn to when life overwhelms you. When things seem unmanageable and are causing stress and distress that you can no longer cope with. Counsellors and psychotherapists tend to deal with life traumas and difficulties rather than pathological mental problems. They advise and guide on marital problems, sexual abuse, anxiety, relationship difficulties, eating difficulties, exam stress, bereavement, job anxieties, a difficult child - the problems that many of us deal with through the course of a long life. The terminology, counsellor or psychotherapist, means pretty much the same thing, and the terms are used interchangeably.
What is counselling? It comes in many shapes and forms, but basically involves a series of one hour sessions where you build a safe, trusting relationship with your counsellor, enabling you to talk in depth about your problems and together find coping mechanisms to deal with them. Counsellors don't tell you what to do, but help you work it out for yourself, examining your ways of thinking, and any root causes that may have triggered the problems in the first place.
A counsellor will, on average, have trained for between 4 to 6 years, often part time, and during that period practitioners look in depth at their own lives and deal with their own issues through personal therapy. The Tavistock Clinic, The Westminster Pastoral Foundation and The British Association of Psychotherapists are all organisations with respected training programmes and there are many other accredited institutes that regulate the industry. Check the letters after their names - the more letters the more training and the greater their experience.
Psychoanalysis emerged in the 20th century, courtesy of those two greats, Freud and Jung. But do you actually know much about their individual theories and the differences between their approaches?
Freud is the grandfather of the 'talking therapies' and the originator of the concept of psycho-analysis. He believed that we each have an 'unconscious mind', created by our early life experience and driven primarily by sexual urges, and that these unsconscious mental forces are at the root of all adult life issues.
Jung was his protégée, but he came to disagree with Freud's interpretation of the mind, adding a third dimension to the concepts of the ego and the individual unconscious - 'the collective unconscious', which he declared common to all human beings. Jung believed that there was an inherited collection of knowledge and images that each of us arrives with at birth. He talked of archetypes, universal figures and relationships (mother/child: father/child), meanings that are the same for all of us, whatever our race or sex, and believed that dream analysis was the way to access the collective unconscious.
In the first half of the twentieth century these theories came to dominate ways of thinking about human behaviour, and non-medically trained therapists began to be trained as psychoanalysts, developing 'talking cures' for mental difficulties. In a vast amount of writing Freud constructed ideas about the way the mind works that he insisted were true, and for many years they were taken as fact. Patients were required to attend treatment sessions for an hour every day, five days a week and often for years at a time.
Today, however, we realise that the mind does not work the way Freud supposed it did, and that his psychoanalytic models have no basis at all in science. Psychoanalysis lacks any evidence-based research as a treatment for mental issues. It still has its fervent advocates, however, and the training is rigorous and professional, guided by the Institute of Psychoanalysis. Practitioners will usually study for a minimum of 4 years, with three of those years also spent on the couch of a colleague, investigating their own psyche thoroughly.
How to find the right therapist?
The best way of finding a therapist is usually through personal recommendation. But if you are starting from scratch, the Yellow Pages will have a list under Psychotherapy or Counselling. Professional bodies may also have a list of qualified therapists in your area. All of the older established therapies have a code of ethics, professional associations and training programs. You can call them for advice and you can also ask for advice from your doctor. A good counsellor or therapist will know when you need medical care too, and when medication might help.
Therapeutic alliance: It's all about the relationship
Whatever your choice of therapy for mental healing, the relationship you build with your therapist is key to your recovery.
In Chicago in the 1940s a psychotherapist called Carl Rogers developed 'person-centred’ psychotherapy. Research showed that the outstanding success of his technique was principally down to the interaction between the therapist and the client, and the therapists ability to listen with focus, warmth and empathy to their client. Success was not based on the expertise or knowledge of the therapist as was previously thought, but instead almost entirely on the relationship between the therapist and client. This understanding became central in the wider development of psychotherapy and is at the heart of most of the therapies we recognise as effective today.
So, take your time, and explore your options thoroughly until you find a therapist that works for you, and a therapy you are prepared to commit to.
Ask for a first appointment that will enable you to get a sense of the person you will be working with, and an understanding of whether that therapy will suit your needs. Listen carefully during that session. It's not about what the therapist says they do; it's not about their knowledge and experience, or even the organisation they belong to. What it is about is the quality of the relationship you sense you can build and the quality of the therapists ability to empathise and create trust. Those are what make the difference.
Your choice will play a huge part in the success of your recovery. Make sure you choose carefully.
Written by health advocate Sara Davenport, founder of one of the UK's largest breast cancer charities, Breast Cancer Haven. With over twenty years' experience in holistic health, Sara's digital dose of wellness teaches you to listen to your body, tweak your lifestyle and improve your health.
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