The true cost of coun­selling: who ben­e­fits from it?

While we may not need coun­selling for mi­nor events, dis­tress needs to be lis­tened to

The Irish Times - Tuesday - Health - - Health Counselling - Ge­orge Win­ter

Last June cho­rus mas­ter Ian Moore, a mem­ber of The Clas­sic Buskers mu­si­cal troupe, ap­peared on stage in Shanghai. He wore a tutu – as the role re­quired – with no un­der­wear. Par­ents in the front stalls cov­ered their chil­dren’s eyes and some fled. Moore – plead­ing jet­lag – apol­o­gised for his sar­to­rial lapse. Pri­vate Eye re­ported: “The tour’s pro­mot­ers have of­fered coun­selling to those who need it ‘to al­le­vi­ate their dis­tress’.”

Mean­while, Ja­panese tourists af­flicted by the Paris Syn­drome – when the City of Light doesn’t meet ex­pec­ta­tions – can phone their em­bassy’s 24-hour hot­line for treat­ment op­tions, in­clud­ing coun­selling.

Need to grow up

For all I know, some peo­ple – for ex­am­ple, up to 20 per cent of women de­velop a mi­nor or ma­jor de­pres­sive dis­or­der in their first year af­ter hav­ing a baby – ben­e­fit from coun­selling. How­ever, those in­ad­ver­tently glimps­ing more than a busker’s ac­cor­dion or dis­ap­pointed by a stale crois­sant don’t need coun­selling; they need to grow up. Yet many sub-con­tract out their prob­lems to pri­vate coun­sel­lors or psy­chother­a­pists who as­sume – for a price – the role once filled by friends, fam­ily and the wider com­mu­nity.

Death, for ex­am­ple, is part of life, and the bereaved may be best helped by those shar­ing their love and con­cern. To­day, coun­sel­lors may un­der­take the task. As Prof Si­mon Wes­sely writes in the Bri­tish Jour­nal of Psy­chi­a­try (2003), con­tend­ing that psy­cho­log­i­cal de­brief­ing af­ter trau­matic events is a waste of time: “Peo­ple are more re­silient than we given [sic] them credit for.”

Pos­i­tive ef­fects

At least coun­selling, for those who can af­ford it – a 2015 sur­vey of mem­bers of the Ir­ish As­so­ci­a­tion for Coun­selling and Psy­chother­apy (IACP) re­vealed that the av­er­age charge per ses­sion is ¤44.36 – is harm­less.

Or is it? In the jour­nal Clin­i­cal Psy­chol­ogy and Psy­chother­apy (2013), psy­chi­a­trist Prof Michael Lin­den ac­knowl­edges that: “There is am­ple re­search on the pos­i­tive ef­fects of psy­chother­apy.” But he ad­duces ev­i­dence show­ing that “the rate of un­wanted ef­fects is be­tween 3 per cent and 15 per cent of the cases, which is sim­i­lar to that of phar­ma­cother­apy”.

Sim­i­larly, a 2009 study in the Aus­tralian and New Zealand Jour­nal of Psy­chi­a­try con­sid­ers: “The elephant on the couch: side ef­fects of psy­chother­apy.” It judges psy­chother­apy “an ef­fi­ca­cious cor­ner­stone of cur­rent prac­tice” but notes that psy­chother­apy’s po­tency could lead to un­der-ap­pre­ci­ated risks, high­light­ing the “tacit as­sump­tion by prac­ti­tion­ers and pa­tients that psy­chother­apy is largely de­void of risks”.

And an ar­ti­cle in the June 2016 is­sue of Coun­selling and Psy­chother­apy Re­search is omi­nously ti­tled: “It was al­most like the op­po­site of what I needed: A qual­i­ta­tive ex­plo­ration of client ex­pe­ri­ences of un­help­ful ther­apy.”

Ten par­tic­i­pants “re­counted ther­apy episodes char­ac­terised by an ab­sence of ne­go­ti­a­tion, col­lab­o­ra­tion and care; piv­otal mo­ments when they knew that they would not re­turn; and on­go­ing neg­a­tive ef­fects.”

The par­tic­i­pants were them­selves ex­pe­ri­enced coun­sel­lors or psy­chother­a­pists.

In All’s Well That Ends Well He­lena ob­serves: “Our reme­dies oft in our­selves do lie.” But those seek­ing reme­dies else­where should re­mem­ber that al­most any­one in Ire­land can start a coun­selling or psy­chother­apy busi­ness.

The Gov­ern­ment has launched a con­sul­ta­tion process, and in its Po­si­tion Pa­per on Statu­tory Reg­u­la­tion 2015, the IACP, rep­re­sent­ing al­most 4,000 mem­bers, wel­comes reg­u­la­tion but ac­knowl­edges dif­fi­cul­ties, such as abun­dant def­i­ni­tions and per­cep­tions of coun­selling and psy­chother­apy: “For ex­am­ple, var­i­ous es­ti­mates – up to 400 – of the num­ber of types of psy­chother­apy ex­ist.” On this ev­i­dence there seem few er­rant threads in life’s rich ta­pes­try that can’t be mended by tar­geted psy­chother­a­peu­tic needle­work.

Es­tranged from our­selves

So, are coun­sel­lors and psy­chother­a­pists nec­es­sary? The an­swer is prob­a­bly yes. So­cially stunted, we pre­fer look­ing at screens to con­vers­ing with hu­mans, and we risk be­com­ing es­tranged from our­selves. So de­spite dopey rea­sons for coun­selling – a busker’s gen­i­talia in Shanghai; a rude waiter in Mont­martre – it’s lit­tle sur­prise that some peo­ple may en­gage the ser­vices of coun­sel­lors and psy­chother­a­pists who are pre­pared to lis­ten, re­spond, and not say “Sorry, gotta take this” when their mo­bile bur­bles.

This point is un­der­lined by Ir­ish men­tal health ac­tivist Dr Terry Lynch in his Be­yond Prozac: Heal­ing Men­tal Dis­tress (2004). Lynch cites our dis­ap­proval of so-called “neg­a­tive” feel­ings in con­ver­sa­tion.

He notes that those who reg­u­larly ex­pe­ri­ence such feel­ings soon re­alise that so­ci­ety has lit­tle in­ter­est in their dis­tress and ex­plains that “be­cause there is such cen­sor­ship of feel­ings and ex­pres­sions in our so­ci­ety, there are few peo­ple who will be able to help them in their great emo­tional dis­tress”.

But isn’t that the job of med­i­cal pro­fes­sion­als? Un­for­tu­nately, many GPs, un­der­tak­ing the bulk of men­tal health treat­ment, pre­fer the pre­scrip­tion pad to pro­longed con­ver­sa­tion. And psy­chi­a­trists?

“Their at­ten­tion,” writes Lynch, “is on form­ing a di­ag­no­sis rather than ex­plor­ing life is­sues, prob­lems and feel­ings with their pa­tients.”

Lynch is right. This era of ev­i­dence-based medicine sees many psy­chi­a­trists em­brac­ing the term “sci­en­tific psy­chi­a­try”, the bet­ter to pro­mote their view that men­tal ill­nesses are di­ag­nos­able disor­ders of brain chem­istry best treated by med­i­ca­tion. But this view can be chal­lenged.

For ex­am­ple, ad­dress­ing what he calls psy­chi­a­try’s “chem­i­cal im­bal­ance fraud”, neu­rol­o­gist Dr Fred A Baugh­man Jr, writing in Eth­i­cal Hu­man Psy­chol­ogy and Psy­chi­a­try (2008), slates psy­chi­a­try’s all-too-cosy re­la­tion­ship with the phar­ma­ceu­ti­cal in­dus­try, even dis­miss­ing it as “not a le­git­i­mate branch of medicine de­serv­ing sci­en­tific-fis­cal par­ity”.

Coun­selling and psy­chother­apy is not without its short­com­ings, but its con­tin­u­ing role in our dys­func­tional so­ci­ety says more about us than we might care to ad­mit.

The role of coun­selling in our dys­func­tional so­ci­ety says more about us than we might care to ad­mit


Many peo­ple sub-con­tract out their prob­lems to pri­vate coun­sel­lors or psy­chother­a­pists who as­sume – for a price – the role once filled by friends, fam­ily and the wider com­mu­nity.

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