Thursday, 14 August 2014

Two-thirds of Britons with depression get no treatment

According to an article in the Guardian today,  there is no chance that the disparity in the NHS between  treating physical and mental health will diminish any time soon:

Professor Simon Wessely of King's College London, the incoming president of the Royal College of Psychiatrists, said there would be a public outcry if those who went without treatment were cancer patients rather than people with mental health problems. Imagine, he told the Guardian, the reaction if he gave a talk that began: "'So, we have a problem in cancer service at the moment. Only 30% of people with cancer are getting treatment, so 70% of them don't get any treatment for their cancer at all and it's not even recognised. ... If he were truly talking about cancer", he said, "you'd be absolutely appalled and you would be screaming from the rooftops."

A larger proportion of people with psychosis, who have severe mental illnesses such as schizophrenia, are on treatment, but even that figure is still only 65%, according to Wessely, who added: "That doesn't mean they are getting the right treatment or anything like that, but getting something. For most mental disorders it is still the exception not the rule to be recognised, detected and treated.

Sunday, 20 October 2013

Finding and Choosing the 'Right' Therapist for You

Looking for counselling or psychotherapy?
How do you go about finding a suitable therapist or counsellor? Definitely search on Google for 'Oxford counselling' or 'Oxford psychotherapy' and see who is out there. But then how do you choose?

The difficulties a lay-person encounters in finding a suitable practitioner

At the last count, there are now more than 400 different psychotherapeutic approaches, and this number does not even includevcounsellors, counselling psychologists, psychologists, psychiatrists. The taskvof finding and choosing a psychological practitioner is clearly a minefield. 
At the end of the day, a lot comes down to the person as well as their approach or particular technique. 

If you have had a previous bad experience, it is hard to know how much was due to the therapist's particular style and way of working, and to what extent counselling or psychotherapy simply is not for you or cannot help you. Because of the wide variety and contradictory assumptions of the diverse approaches, it is impossible to generalise from one therapeutic experience to the whole rest of the field. Chances are that a completely different therapist who would work for you is just around the corner.
Unfortunately there is not one clear principle or belief that can be considered a consensus amongst therapists. Some of the most cherished beliefs of one approach are negated or even considered detrimental by another approach. There is more disagreement and variety amongst counsellors and therapists than amongst other helping professions. That means you are likely to have a completely different, possibly opposite , experience with another therapist.

It is therefore helpful for you as the customer to inform yourself as widely as possible as to what kind of therapeutic work is available in your local area, whilst taking into consideration the competing claims and often prejudiced accounts which different therapeutic approaches give of each other.

However, whilst informing yourself is without doubt helpful, it may not be sufficient to enable you to come to a convincing decision.

There are so many approaches, variables and parameters to take into account, how can you find the 'right' therapist for you?

Difficulties in finding a practitioner...
  • fragmented field of psychological therapies
  • many approaches with often contradictory principles, confusing to the lay-person
  • professional jargon and pathologising language
  • biased and self-serving advice, hyped marketing promises
  • differences between approaches not well understood (there are strengths and weaknesses of each approach - needs an unbiased, balanced evaluation)
  • prejudices and misconceptions about therapy through the media
  • counselling and psychotherapy have received criticisms and scorn (both warranted and unwarranted) from some health professionals
Over the next few months I will write up some of the main considerations that I take into account when making a recommendation - follow me on Twitter for news of updates ...

Tuesday, 17 September 2013

Why are so many self-help instructions so useless?

What supposedly helpful, calming, centering, growthful, beneficial, mindful practices do you pursue, or have in mind pursuing?

Without enrolling in a three-year course, locking yourself away in some retreat, or spending thousands of pounds, what kind of practice might work for you?

I have just spent some time - I’m hesitating to say: waste - on researching various self-help and mindfulness practices that are available out there, on the net. I’m trying to find something that I can actually responsibly recommend to my clients.
I must say, it is becoming a rather upsetting and frustrating endeavour.

I can't find much I can wholeheartedly get behind. So here is my first blog post of my own, with a simple set of instructions at the end that will change your life (naa, just kidding!).

The upsetting thing about these positive, superficial, teachings - 19.95 for a DVD on Enlightenment or Realizing Your True Self - is that they are facile; they don't work the way they make out. They do not deliver what they appear to promise. Most of the time, most of us see straight through them. But just once in a desperate while, we try them. We fail miserably, and then we get disappointed. That’s not a big deal. But more importantly, we become cynical, which means we stop trying stuff like that. Which is a shame, because there is, of course, a kernel of truth in all of it, which is why we tried it in the first place.
But how do you access that kernel of truth?
If I could tell you that, then the people who want to sell you their clever stuff in the first place would be able to tell you; and then we wouldn’t be having this problem.

The uncomfortable truth is: whatever the clever practice, typically the teacher or instructor cannot even quite get you into the starting blocks. Or they cannot get you through the initial eye of the needle.
Because there is no generally applicable procedure or trick for that crucial first step; no ‘one-size-fits-all’ instruction that can be mass distributed - it’s an individual thing.

So the best I can do here is try and give you a general handle on: why general instructions don’t work, and cannot work (at least not on their own, and in and of themselves).
So rather than telling you how to make the instructions work (whatever the instructions are that you are attracted to), we need to also focus on: how you cannot help but sabotage them. So we need to somehow find a way of accessing and becoming aware what your individual way of ‘sabotaging’ the general instructions may be.

Because this is one reason why we mistrust most of those goody-goody sets of instructions: because they are focused on positive intentions.  And they imply that if only you focus properly on the positive intention, results will follow. And if the results don’t follow, then it’s your fault for not bloody doing it right. It’s never the fault of the instructions (apparently, these have worked for millions of people all over the world, as you can see from all the grateful testimonials), so you are the one single dumbass who didn’t do it right. Or maybe you are just too messed up. And it was such a simple thing to follow and they made it all so plain and simple; so if - in spite of that - you did not succeed, you must be a real dork.

That is upsetting. If it did not work for you, it is because the instructions were a) flawed, b) incomplete or c) they just cannot be mass produced.

So let’s say, to begin with, they were flawed. One regular and typical flaw is to only focus on the positive intention. Who are you kidding? If it was just a question of a positive intention, I would have figured it out by now. I want a beer, I go to the fridge - I make a decision. Please don’t tell me I’m dumb because I haven’t decided properly or determinedly enough to make myself happy.

Most of us know that there is an internal devil somewhere, interfering with our best intentions. Some little saboteur is structured into the fabric of our decision-making. Some fiend is eroding our discipline. Please don’t tell me I just have to have better intentions. That’s insulting my intelligence (or whatever shred of it I have left, after failing your wonderful instruction).

So instructions that are mainly focussed on positive intentions (and the determination and discipline to stick to them), we wisely mistrust. We think they are facile. And right we are.

Most of us know that to get liberated even from some minor psychological hiccup normally takes some work; not necessarily huge effort, but some kind of attentiveness, some determination and mainly: some discomfort.
Not all change works by “no pain - no gain” (development can occur gracefully and through pleasure, not to say: love, which most of us to find much more threatening than pain!), but generally speaking things don't drop away easily once they have become ingrained. 
More than 30 years of being a psychotherapist seem to confirm that (but maybe I am pre-selecting a non-representative subsection of the population).
But generally speaking, when people have good intentions, they don’t just get put off by external circumstances. There is an internal mechanism that sabotages them. We need to factor that in when we give instructions towards a happier life.

Unless whatever instructions you are attracted to include that little detail, they have a fundamental flaw right there – so let’s not put ourselves off with facile simplistic bullshit.

For example, it is no good going on about how precious and unique your individuality is, and how important it is to get in touch with that. The thing about individuality is that it is not just your talents and gifts and virtues that make you you (as you will have noticed); the amazing thing about individuality is that also your fuck-up is uniquely, extraordinarily YOU. Yes, you are idiosyncratic and unusual, specifically in your creativity. But creativity works both ways: your inner saboteur is also creative and makes use of your one-in a-million qualities, to sabotage you in an entirely unique way.

Which is precisely why general positive guidelines about thinking positively, or doing little practices here and there, ain't going to work (at least not in terms of the hype that gets promised around it).

So let's put something substantial in place: there is a character.
‘Character’ is something that psychotherapists - in their weird, contrary way - have come to define in just the opposite way that the rest of the population does.  But in their weird way, they have a point, as we will see.

Normal people define ‘character’ as something positive, we think of strength of character; as something that  traditional education was supposed to foster and hone; as something that other people can rely on in times of crisis. Character is all the good stuff that makes you you.

Well, not so psychotherapists:  for about 80 years now, there is a well established definition of ‘character’ as a defensive armour that we put on,  or more precisely: that gets put onto you via conditioning and  socialisation. It is all the  outer stuff you have acquired, the trappings, the front, the masks we wear, everything that is precisely not you.  Think of Pink Floyd and ‘The Wall’ -  that wall is ‘character’.

‘Character’, in the psychotherapists’ definition, is a set of well-worn, partly defensive, partly creative adaptations whose main purpose in life is to shield you, to protect you, to restrict the realm of possibilities (in terms of hurting yourself further than you already are).
Now, whatever practice you are being taught to do (to take yourself closer to salvation), the thing is most of us, most of the time, cannot help but …
a)   hear it via our character,
b)  misunderstand via our character, and
c)   apply it via our character
By the end of that, nothing much helpful is left.

To Be Continued ...