The true cost of counselling: who benefits from it?

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

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.

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/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 amy 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

For those who can afford counselling and psychotherapy – a 2015 survey of members of the Irish Association for Counselling and Psychotherapy (IACP) revealed that the average charge per session is €44.36 – at least it 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/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/psychotherapy business. The Irish 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 engage the services of counsellors/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.