The mental health stigma has faded, but quacks are thriving

Therapy is no longer a dirty word, but the lack of regulation means we still don’t know where to turn, writes Donal Lynch

IS there still really such a terrible stigma around getting therapy? If you went by recent celebrity interviews and the amount of awareness campaigns out there, you would think Irish people are still in chronic denial about how messed up they really are. But the reality on the ground feels somewhat different.

You have a whole generation of 30- and40-somethings who aren’t shy about looking for help. They come from a confessional culture and they already speak the language of therapy. They’ve been into mindfulness for years (even though they’ve never quite got the hang of it). They are quite ready to blame their parents. They know full well when their black dog needs curbing.

Most of my friends are quite open about the fact that they’re just hanging on by their fingernails and we’ll casually pass on therapist tips to each other the way previous generations might have recommended a builder.

Far from stigmatising your ‘cry for help’, friends and family are generally thrilled that you’re finally whinging to a professional instead of to them. Therapy is now just middle-class maintenance.

The real problem, then, is not the supposed ‘stigma’ but finding someone suitable to talk to. Just as we were always warned about drug ‘pushers’ before realising as adults that it’s you who’ll have to do the pushing if you want drugs, so therapy is not really about having the ‘bravery’ to reach out for help, but having the dogged tenacity to search for the right help.

Last week, the Irish Association for Counselling and Psychotherapy pleaded with the Government for formal recognition and registration of the profession. This might appear like high-minded intervention but they’re just minding their turf. They know that in this gap between the demise of the stigma and the beginning of real regulation, there has sprung up a whole cottage industry of quacks, and it’s only a matter of time before there is a scandal.

Currently anyone can set themselves up as a psychotherapist. There are hucksters and charlatans out there who have spent more time on their website than they have on their qualification.

The genuinely qualified professionals tend to have epic waiting lists (I inquired last week for a friend of mine, who is in dire need, and was told 14 weeks, minimum). There is emergency care for people who are suicidal or with acute psychiatric problems but there isn’t much for the individual who’s functioning, but only just.

For the average person seeking maintenance or solace, it’s fairly confusing. The catch-all advice is “talk to your GP” but GPs tend to be fairly clueless about the strata of sub-specialisation of mental health professionals which are not trivial.

They wouldn’t send you to a cancer specialist with back pain, but they will send you to someone who deals with depression and anxiety when your real problem is something quite different. I’ve known people who’ve gone through the ignominy of exaggerating the severity of their problems just to have a better chance of being seen sooner.

Professional regulation is probably more crucial in this area than most because of the huge trust needed to establish a successful therapeutic relationship. Some people get lucky and have a great rapport with the person they happen upon, but most of us can initially only go by the therapist’s professional reputation.

You want to feel that they had to do more than work for a couple of years and get a diploma from a commercial body above an English language school.

I once had a medical doctor recommend someone to me whose only degree was in theology and who seemed only a few YouTube videos away from being a life coach (shudder). I had to really search for someone who had been to an actual university to study something like psychology — these individuals are relatively rare in Ireland.

I know one person who in tough times will go off to see “my woman”. In the old days this would have meant a mistress or a prostitute, in 21st-century Ireland it obviously means a shrink.

The confidence is all the more important because of the inherent weirdness in talking to a stranger about your internal workings. You’re always aware that, however compassionate a therapist seems, they’re just being professional and you’re on the clock.

You could be showing them on the doll where it happened but if time’s up they will check their watch and kick you out. Many of them ask you to pay in cash there and then, which feels a bit grubby after you’ve just spilled your guts. And it’s impossible to completely suspend personal judgements about them. I once saw a therapist who arrived wearing socks and sandals and I spent the hour wondering how sage his advice could really be if that was his choice of footwear.

I know of people who have set up their “practice” in what is clearly their living room. I have had some brilliant help but I envy friends who have fallen in therapist love. It’s completely superficial but I yearn for a Freudian grandfather, someone whom I could picture Woody Allen or Tony Soprano weeping in front of, preferably someone with a beard and a book-lined study.

If you aren’t already mad, therapists will drive you mad with how little they say. There are no notepads or ‘breakthroughs’ like you’d imagine from the movies. I’ve tried to explain that what I really want is advice, the more meddling the better, but to a man, they have maintained their cryptic, Sphinx-like dispassion.

At the end of the day, no matter how much therapy you get, the hard, unglamorous heavy lifting of self-improvement is still up to you. The older I get the more I wonder if therapy hasn’t been so de-stigmatised that we’ve lost the ability to rely on our own internal resources. It surely helps to talk but sometimes you can turn around and realise that you’ve spent thousands of euro and nothing has really changed.

The novelist Douglas Adams said that he tried therapy but “after a while, I realised it is just like a farmer complaining about the weather”. Perhaps when our acceptance of therapy has bedded down, and everyone has their own psychologist, the vogue for being neurotic and openly damaged will fade and we’ll realise that Douglas Adams was right; navel-gazing only goes so far. “You can’t fix the weather,” he added, “you just have to get on with it.”

‘I once saw a therapist who arrived wearing socks and sandals’