Suzanne Harrington: Do you need your head examined?
Published 22/10/2011 | 05:00
Here are some reasons why people don’t go to therapy: It’s too expensive. I’m not telling some stranger my innermost stuff. It’s self-indulgent to sit talking about yourself for an hour. People would think there’s something wrong with me. I can solve my own problems. It pathologises normal life. I’d rather talk to my friends. I can’t see what good it would do. It’s a load of whiny, middle-class rubbish ...
... All perfectly valid, of course, but personally, I'm a believer. Not in any particular type of therapy per se, but in the Better Out Than In principle. I find this works more effectively than its evil twin and unhelpful counterpart, the Keeping It All Bottled Up syndrome, which can lead to all sorts of short-circuitry -- mental and physical.
Which is why I love therapy. The whole idea of taking time out to check in with yourself and process things seems eminently sensible. I love the anticipation of an hour off from the busy-ness of the day.
I love the stillness of the room, the familiarity of sitting in the same comfortable space facing the same neutral face every week. The tissues on the table, in case you get weepy.
I love being able to say what I really feel without any concern about its impact on the other person; we are not friends, yet I can feel assured of non-judgmentalism, confidentiality and what Jung called unconditional positive regard.
I love the feeling when I leave -- lighter, clearer, calmer, or just more relaxed. I love that it is my time, devoted to me alone, which I make for myself so that I remain healthy and well.
Substitute the word 'therapy' for 'the gym' and 'therapist' for 'trainer', and you have what many people do to take care of themselves.
We go to great lengths to look after our physical selves -- exercise, yoga, Pilates, massage, personal trainers, good nutrition -- but tend to ignore our mental health until it goes wrong.
Until there is some kind of crisis, and somebody says, "Have you thought about counselling?"
Hence the tendency to associate therapy with crisis management, rather than emotional maintenance. We wait until we have hit the wall -- or the bottle, or our best friend -- before we take action.
In his book 'Happiness', scientist-turned-Buddhist-monk Matthieu Ricard points out quite reasonably that we spend years at school and university training our brains, we expend a lot of energy enhancing our outer lives -- comfort, wealth, status -- "yet we do so little to improve the inner condition that determines the very quality of our lives".
He's got a point.
Ruby Wax says that if she could open her skull and show you the inside of her brain, you would be able to see her depression. But that's the thing with mental health -- you can't see it. It doesn't show.
There's no tumour, no bandages, nothing on the outside. I'm going to see her show next week, with three friends -- we somewhat burst the one-in-four statistic (which is, that a quarter of the population suffers some kind of mental health problem in any given year), in that only one of us is technically sane.
The other three of us are, respectively, a recovering addict, a recovering alcoholic and a bi-polar. Two of us also have depression, which tends to come and go in biannual bouts. The technically sane one works in mental health.
After a lifetime of low-level fruit-loopery, I now look after my mental health really, really well. I look after it as though it were a slightly flighty thing that at any moment could escape and start flapping and flailing away from me.
In the past it has, quite a few times, so I kind of have the hang of what I need to do now to keep my brain chemistry from short-circuiting and blowing a fuse.
Until a few years ago, it never dawned on me that your mental health was something that you actively took care of; I only ever did something about it when it had already spun out of control.
To look after my addiction stuff, I go to 12-step meetings. To look after my depression, I take pills prescribed by a shrink -- unlike Ruby Wax, I have never been hospitalised for it. (Well, I have, briefly, more of which later).
And to look after my emotional well-being, I do three things: spend time outdoors in nature, practise mindfulness and see a therapist.
Unlike the meetings and medication, the therapy is neither cheap nor essential. I do it because these days I believe in prevention; in keeping in good shape between my ears.
I used to be a bit nuts. My thinking used to resemble a load of hopelessly tangled cable, and there was never any distance between my feelings and my actions. Angry? Punch! Sad? Howl! Bored? Off my head!
Deposited in a psychiatric hospital while in my teens by a doctor who thought I might top myself, I was self-harming before I had ever come across the term 'self-harming' (or before there were entire emo chatrooms devoted to it).
I didn't know it then, but I had the twin classics of alcoholism and depression.
I saw my first psychiatrist when I was 19, as well as my first therapist. This was Ireland in the 1980s, and, let me tell you, being in therapy was NOT considered normal, or intelligent, or a good idea.
People wouldn't know what to say or where to look. Drinking yourself senseless was fine, but being in therapy absolutely wasn't, which always struck me as a bit counterintuitive. A bit, you know, mental.
Being in therapy as an Irish teenager wasn't much fun at the time, but what I took away was a life-long belief that therapy is essentially a good idea.
It is not a magic wand, but as one of my kids put it, "It keeps your brains healthy". (Both of them have done therapeutic work with other bereaved kids after their dad died, which I believe helped them to process the loss. Not diminish it, just process it.)
We get all muddled up around mental health. We take medication when really we need a talking therapy, or we do the opposite and think we can get cure clinical depression with counselling.
We listen to well-meaning people around us telling us that as our lives are so clearly very nice, what is wrong with us? What can the matter be?
Come on, they say. Perk up, take some vitamins, go for a walk. Stop obsessing. Lose the self-absorption and neuroses.
So your mum didn't give you a KitKat when you were six -- build a bridge and get over it. Move on. Count your blessings. Pull yourself together. And why on earth would anybody be in therapy if there wasn't a giant problem in their life, such as bereavement or divorce or some other external catastrophe?
I've been in therapy on and off for 25 years. I have most recently started seeing an addiction specialist I can't afford, but whose input is already proving invaluable -- the older I get, the more I realise that asking for help is more than just a good idea, it's vital.
You can ignore stuff as much as you like, but it won't go away by itself -- it will always need processing. For me, it's about priorities. I would rather spend my disposable on the inside of my head than, say, the inside of my house.
There's not much point sitting on your pleasurable new sofa if you're too unhappy to enjoy it -- yet we still confuse happiness with pleasure all the time. The thing is, pleasure wears off. Rapidly.
My latest therapy stint started recently. It was not as a result of something terrible happening, but more about wanting to shine a light on my inner workings so that I don't act out like a raging four-year-old when things do go wrong.
My friend Sarah thinks therapy is daft, and says that your friends are who you talk to when you have a problem.
This is true, of course, but the thing with friends is that they cannot appraise stuff with total objectivity, because, well, they're your friends.
Also, how much do they want to hear? And do they really want to hear it over and over and over? Plus, how much is Too Much Information?
There is something rhythmic and solid and cumulative, turning up for your weekly hour and talking about whatever it is you need to talk about. It is not the same conversation you have with friends.
For me, it is not crisis management (this is where the friends come in, the 4am friends on whom you can depend with your life), but about an ongoing uncovering of the layers and patterns of feelings and behaviours that have built up over decades like layers and layers of old paint sealing yourself tight shut.
You don't go in expecting to leave a month later with the secret to eternal happiness -- if you do, you need locking up in a secure unit, not a therapy session.
It's a process, and if you want it to, it can last a lifetime. There is no end point. Obviously, there can be if you need one. A short course of Cognitive Behavioural Therapy is considered more effective for an immediate problem than 10 years of rehashing your childhood.
If you are an addict about to lose your job/home/spouse/marbles, you'll want something that has immediate results -- such as a treatment centre, or a 12-step programme -- rather than meandering through your past, or having someone ask, "And how does that make you feel?"
Lots of people hate the idea of baring their souls, of stopping all the headless-chicken stuff and having a deep look inside.
Others find religion does the trick.
And occasionally, there are even some people who are genuinely happy souls, untroubled by wonky brain chemistry or defective thinking, who skip through life's chaos unscathed, such as Mike Leigh's 'Happy Go Lucky' character.
They are rare, I think. Most people fall under the Mustn't Grumble category.
Me, I like a good grumble. Better Out Than In. That is not to say that therapy is sitting there moaning about your life. That would be a monumental waste of money. It's about untangling, illuminating, neutralising.
And just as there are all kinds of clients, equally there are all kinds of therapists.
Several of my therapists have been Nodders. They sit and nod, and say very little. Nodders are helpful if you are getting used to being in therapy, getting the hang of the whole idea of talking from the heart, of overcoming shyness and preconceptions about spilling your guts to a paid stranger.
Nodders are the training bras of therapy. Some people love them -- a friend of mine has been seeing a Nodder for 15 years, because for him the process works; he goes in, talks to a nodding head for an hour, and leaves feeling better.
It's worth remembering that while therapists may be better trained in mental health, cognitive psychology and therapeutic theory, they do not have super-powers.
Our heads are not made of glass, and so they can't read our thoughts. You can therefore manipulate your therapist, just as you can manipulate anyone else.
Addicts are brilliant at this. I once told a therapist -- for a whole year -- that I was a teetotal lesbian rather than a heterosexual drunk. I'd tell you why, but it's a long story.
The point is I lied, repeatedly, in therapy, which is like lying to yourself, except out loud. The recovery community is full of people who have lied to doctors, shrinks and therapists, just as they lied to themselves.
One addict friend was so good at manipulation that she had her therapist believe she was a poor, hard-done-by soul and a victim of terrible friends and family, while in fact she was quite insane from alcohol and cocaine and lied her head off to everyone on a daily basis. The therapist only served as a bolster to her denial.
You can call yourself a therapist very easily -- buy some aromatherapy oils, read a few self-help books, do a weekend course. That's why choosing the right therapist is so important.
Personal recommendations are always better than the Yellow Pages, and generally you get what you pay for.
Also, no matter how amazing a therapist is, no matter how qualified, experienced, respected, you still might hate them on sight.
An ex and I decided to do couples therapy years ago, but only did one session because I took an instant loathing to the therapist. Couldn't bear him. Insufferable. (And yes, we split up.)
The best therapists are the ones who work with what you need. Writing in this month's 'Psychologies' magazine, psychotherapist Phillipa Perry (partner of Turner Prize sculptor Grayson) talks about a case study of a woman who felt controlled by her mother.
Perry, using role play, tried to get the fearful, passive woman to stand up for herself. In doing so, she scared her client away.
"I was too directive," she writes. The point being, some people need extreme gentleness, while others benefit from a more directive approach.
I'm one of the latter. I need direction, action, progress, results. When I turned up a shaking wreck to a therapist's room for my first session a few years ago, she told me instantly that I needed an alcohol recovery programme right away.
"Get to a meeting immediately," she said. So I did -- but if a friend had said the same thing (and they had, many times), I would have ignored them.
A good therapist will see exactly what is going on, and will point you to what you need rather than engaging in protracted discussions about your past.
Or as the therapist I am currently seeing, a former director of addiction services at the Priory, puts it, "If you turn up in A&E with blood spurting from your head, you don't want to spend an hour talking about how it happened. That comes later".
He then proceeded to draw me a diagram of my brain, showing how my addictive behaviour is not because I am weak-willed, but because -- like all addicts -- I have an enlarged ventral tegmental area and need to stop stimulating it.
I learned that sugar and cocaine have the same effect on this part of the brain. But I don't use cocaine, I whimpered, knowing what was coming next.
"Give up sugar," he said. See? Bish bosh. Problem -- reason -- solution.
I am not a poster girl for therapy, any more than I am a poster girl for sanity.
My mental health is precarious -- I'm just very good at managing it.
More importantly, I take responsibility for it -- although this is only a relatively recent thing.
I use words such as nuts, mental and bonkers with a wry grimace, because I doubt the existence of true sanity, unless you are someone like Matthieu Ricard, who has practiced meditation day in day out for decades, and rewired his neural pathways towards detachment and compassion.
Meanwhile, therapy is a great tool, a great place to start.