Can talk therapies help?

There is no them and us when it comes to mental health problems. Every one of us has either suffered from some form of depression, anxiety, obsessive compulsive behaviour or other disturbing, debilitating disorder, or else we have a close friend or family member who has.

"One in six of us will have a mental health problem in the next 12 months. Whether we know it or not, someone we love, some family member or friend is in mental distress at this very moment," says Jim Lucey, psychiatrist, medical director of St Patrick's Mental Health Services and author of The Life Well Lived: The Therapeutic Journey to Recovery and Wellness (Transworld Ireland Publishers).

Prof Lucey is one of a growing number of psychiatrists and psychologists who value the role of talk therapies in helping people get to grips with emotional and mental distress so as to live life to the full again.

Interestingly, as a psychiatrist, he also clearly states that it is more helpful to identify people’s distress as “subjective problems experienced in ordinary life rather than as clinical labels derived from lists of symptoms”.

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Value of listening

“There is a great value in listening to people’s stories,” Lucey says. “All knowledge begins with history and we can all be transformed in the process. Our human capacity to reshape our futures is vast and we can learn to live, love and work again.”

It is interesting to reflect: although there is a lot of talk about looking after our mental health – with many celebrities speaking out about their own suffering – most people still don’t share their therapeutic journey to recovery.

“Therapy is still widely misunderstood. Many people still view the experience of going to a therapist as somewhere between the confessional and the court room. Modern therapy is about discovery, about the search for a way to live well again,” says Lucey, whose book aims to get people talking about their therapeutic journeys.

At the moment, going to a psychotherapist is like going to a specialist without having seen a GP first"

People don't understand therapy as a process, according to Declan Aherne, a clinical and counselling psychologist and the head of counselling at the University of Limerick.

“They will instead talk about what it meant to them, whether they felt listened to, understood, safe and not judged.”

Dr Aherne is a member of the Psychological Society of Ireland, which is currently establishing a division of psychotherapy. While organisations such as the Irish Association for Counselling and Psychotherapy (IACP) and the Irish Association of Humanistic and Integrative Psychotherapy (IAHIP) already provide directories of accredited counsellors and psychotherapists, the society wants to register psychologists with qualifications in psychotherapy.

Members of the IACP and the IAHIP don’t have to be qualified as psychologists or psychiatrists to become psychotherapists, although this doesn’t lessen their expertise or skill sets.

Direct access

However, Aherne believes we need more direct access to psychotherapy on a countrywide basis.

“What we really need is an equivalent to [medical] general practitioners for psychotherapists in the primary care system so people can come to a professional therapist to work out the best approach for them,” he says. “At the moment, going to a psychotherapist is like going to a specialist without having seen a GP first.”

Krystian Fikert is a psychologist and chief executive of My Mind Counselling and Psychotherapy Services, a low-cost self-referral psychotherapy and counselling service with centres in Dublin, Cork and Limerick.

"We have 80 mental health professionals working in 10 languages, offering 15 different psychological approaches which they explain in the biographies on mymind.org," explains Fikert. My Mind also publishes short videos on mymind.org, in which therapists explain their work and their approach.

“Trust is the number one priority in the therapy process and there is no progress without trust,” says Fikert who adds that self-referral is central to the way My Mind works.

Even as grief, trauma and abuse bring with them great pain, they do not inevitably bring despair"

“We realise that when a client is really ready for therapy and is finally moving towards starting the process, they are very open and ready for this work. Their feedback is very positive then compared to someone who is dragged in or asked to engage with a therapist. In the [latter] case, there is frustration, lack of co-operation to work with the mental health professional.”

Therapy challenged

Aherne says clients will often be challenged by their therapist, which may lead them to give negative feedback about the therapist. “We have seen numbers of students come to therapy double in the last 10 years,” he adds, “but sometimes, people want a quick fix. They may want a therapist to collude with them in their avoidance of emotions.

“But, paradoxically, what you want to get away from is what you have to turn to and face. In therapy, we learn that the very thing we think is going to destroy us, won’t destroy us once we bring it into view and look at it.”

With an ever-expanding range of therapies on offer, Lucey says the introduction of mindfulness techniques into therapy has been one of the most helpful and hopeful developments of this era.

"All modern therapies aim to be more mindful, more focused and more flexible. Even as grief, trauma and abuse bring with them great pain, they do not inevitably bring despair," he writes in The Life Well Lived.

Associated stigma

However, all therapists are still aware of the stigma associated with admitting to suffering from a mental health problem. Some psychotherapy clients even suggest that the celebrity disclosures don’t make them feel any less vulnerable. In fact, in some cases it can make people feel more exposed, less equipped and possibly more propelled to speak out without adequate support.

Modern therapies need to more available, more affordable and more reliable and we need to raise our expectations of their value in mental healthcare"

Lucey doesn’t want people to tackle the stigma of mental health problems by sharing their personal experiences of therapy if this makes them feel vulnerable. “More education about mental wellbeing and better therapy are preferable options in the battle to defeat stigma than a campaign of self-disclosure,” he says.

He adds that “compassionate listening and intelligent kindness” are the key attributes of a good therapist. When the therapist brings these attributes to the therapeutic relationship, the process itself helps the person overcome feelings of guilt, shame, blame, stigma and self-stigma – all the emotions which become entwined into the mental health problems.

“In mental health distress, the burden of guilt and excessive self-criticism is the most dangerous of all,” says Lucey.

Still, the person in therapy must also bring something to the process. According to Lucey, the person must engage with therapy and have a willingness to learn.

Moving forward

And it’s not just about why the mental health problems arose but how to move forward from here.

"Recovery requires hope and imagination and each person creates their own path to wellness," Lucey writes in The Life Well Lived.

In the book, he examines various therapeutic approaches through personal histories which he constructed with people who came to him for therapy. However, he clearly acknowledges that these therapies remain unavailable to many people who need them.

“Modern therapies need to more available, more affordable and more reliable and we need to raise our expectations of their value in mental healthcare,” he says.

Fikert agrees wholeheartedly.

“We want to normalise access to mental health professionals. It should be like going to the doctor so that therapy is as acceptable to a farmer in Offaly as it is to a student in Dublin. This is still not the case as there is much more expertise and access to therapy in the cities than in rural Ireland.”

The transformative power of peer support

The transformative power of peer support programmes for people recovering from mental illness are highlighted in a new study from the School of Nursing at Trinity College Dublin. Researchers carried out in-depth interviews with 26 people who went through a programme of peer support recovery with the mental health charity, Grow.

The study found that while medical treatment and mental health professionals can be a vital start to recovery, mental health problems can also be resolved through peer and community support and everyday social interactions.

Interviewees described how they escaped from the alienated isolation of mental illness through participation in the “small compassionate social body of a weekly mutual support group”.

The interviewees first spoke about negative life experiences such as bullying, abuse, bereavement or family disharmony which resulted in a slow build up of distress, leading to emotional chaos.

"Over the last 20 years, I have heard many harrowing stories of suffering, abuse and neglect which have led people to seek help from the weekly friendly Grow peer support group," says Rob Stephen, national chairman of Grow.

“I am continuously amazed and inspired at how a random group of strangers from very diverse backgrounds can meet weekly to discuss and ultimately solve their own personal problems,” he adds.

The researchers describe this process in three stages. Firstly, “the dialogues of terror” in which people describe how emotions of terror, rage and despair impacted on their thinking and behaviour, resulting in personal isolation.

Secondly, “the dialogues of healing” where people found themselves developing trust, becoming hopeful and experiencing a sense of value, belonging and responsibility within the group.

And, thirdly, “the dialogues of becoming” which has a focus on healthy life choices and social involvement such as studying, volunteering, and working.

The research findings and personal stories of recovery from mental health problems are published in Narratives of Recovery from Mental Illness (Routledge).

Mike Watts, Trinity research fellow and co-author of the book, says, "This study challenges perceptions about the competency of people with mental health problems around their own recovery and highlights how peer supported empowerment and risk taking is so powerful in helping and supporting people find niches in the community so they can move beyond the peer support community."

Dr Watts hopes the book will be a source of hope for people struggling with emotional distress.