Feeling tired, undermined, lacking in self-confidence? Americans are finding friendships might be to blame. Tim Shipman reports from Washington
Rhona Rogers had been friends with Sally Thompson for more than 20 years. They grew up together in a small town in California state. They played together, went to school together, swore they would be friends forever. Then one day, earlier this year, Rhona realised that she couldn't stand Sally.
Sally constantly put her down; she was rude about Rhona's mother and her other friends. For two decades, Rhona had made excuses for Sally, but now just being around her made Rhona feel anxious.
Realising that one of the most important relationships in her life had gone bad, Rhona -- a 32-year-old estate agent -- did what any self-respecting American with issues would do: she went to relationship therapy. But this was a different kind of therapy.
For years, the American self-help industry has told romantic couples how to repair their rifts. But now, counsellors are being called in by troubled patients who want to know how to ditch those "friends'' who are ruining their lives.
More than 10,000 registered psychologists and counsellors are offering sessions on relationships with friends in America. Someone needing their advice can expect to pay anywhere between $75 and $200 for an hour-long session.
"Sally was always making snide comments,'' says Rhona. "For years, I felt she couldn't mean what she said -- and then I realised she did. I saw someone and she helped me realise that Sally was a toxic friend. I cut her out.''
The phrase "toxic friends'' is becoming commonplace and has been recognised by the American Psychological Association.
The phenomenon has even received the ultimate popular endorsement -- becoming the subject of a recent edition of Oprah Winfrey's talk show.
The self-help industry has also not been slow to get in on the act. A succession of books with such titles as Toxic Friends/True Friends and A Smart Girl's Guide to Friendshiphave hit the American bestseller lists.
Among those writers whose books compete for space on the self-help shelves is Mike Albo, a performance artist from New York. He had been troubled by a friend whose back-handed compliments were destroying his confidence. So he set about writing his manual, The Underminer, with his flatmate.
"In this culture, people are competitive but polite at the same time, so they undermine you with a smile on their face,'' Mr Albo said. "In other ages, people would have hit each other with clubs, we just have someone saying to us: 'Oh, you look tired. Are you OK?'
"People say: 'Oh, I just saw your ex-girlfriend, she looks beautiful,' or 'Oh, you're drinking. I realised it was making me feel bad but it's so great that you can still do that.' Underminers latch onto your weaknesses. My favourite is: 'Do you still like your new haircut?'
"In a romantic relationship, when it reaches that stage, you have an argument and split up.''
"All relationships are like marriages in a sense, and some people can be bullies while others can lack self-esteem as a result," says Beth Fitzpatrick of Access relationship counselling on Dublin's Greenhills Road.
'Often we find that if a friend is being toxic it is their own inadequacies that are coming through, and directly tackling the person can sometimes stop them in their tracks.
"Asking them 'And why do you think that?' or 'Did I really need that from you?' can be enough to make them think."
The realisation that friends can be the cause of unhappiness is fuelling a rapid rise in the number of people consulting therapists. Dr Judith Orloff, a psychiatrist at the University of California in Los Angeles, who also runs a private practice, says: "Probably 90pc of the people I see have issues with their friends. ''
Dr Orloff, the author of a self-help book, Positive Energy, said: "Energy drain comes from all our relationships. There is now a much greater appreciation of the effect that friends can have, as well as spouses and bosses.''
It is a point on which her colleagues on this side of the Atlantic agree. Christine Northam, a relationship counsellor and therapist for Relate, says that to maintain our emotional health, friendships need to be frequently re-assessed. "Analysing friendships is increasingly important in all types of relationship counselling,'' she says.
Beth Fitzpatrick points to a common phenomenon of friends literally growing apart, and says that sometimes we have to just realise that the friendship is over and move on.
"People will have been neighbours or gone to school together, and they feel the need to keep things going afterwards as they take different directions in life," she says.
"They 'put up with' things rather than say directly that they feel the relationship is all one-sided and that they are doing all the work."
And if confrontation suddenly leads to the collapse of a friendship, Beth feels that the relationship was destined to failure and both parties should move on. "Great friendships will survive, and a bit of open honesty will not put it in jeopardy in the long run," she explains.
Beth also places credence in the theory that men and women handle relationships differently.
"Men will run from a conflict whereas women feel they have to deal with it in some way," she says.
"So men are less likely to have toxic friends, they simply move away from them. But women will persist, and while that can mean exposing them to the risk of toxic friends it also means that if they do confront them and the friendships survive -- they are deep and worthwhile relationships," she adds.
This view is also held by psychologist and author Ann Marie McMahon, who says men take life at face value, but women will try and shape it.
"Guys will move on from a complex relationship if it is proving draining, but women will magnify difficulties and spend time trying to analyse and change things when maybe the best course of action would be to move away from the friendship of put some distance in it," she says.
"Most don't confront it, we try to be non-confrontational and are afraid of ending things," Ann Marie adds.
The consequences of not dealing with toxic' friends can be dangerous. A recent study, published in the Annals of Behavioural Medicine, found that when participants merely saw a person who was an "ambivalent friend'' -- one who upsets you as often as they please you -- their heart rates and blood pressure increased.
According to counsellors, these toxic friends come in several forms. In addition to the passive aggressive underminer, who delivers barbs dressed up as friendly inquiries, there is the naysayer, who undermines you more obviously, the plan-breaker, who ditches you at the last minute, and peer pressurers who won't let you go home when you want to.
They all agree it's tougher for women. Jan Yager, the author of When Friendship Hurts: How to Deal with Friends Who Betray, Abandon, or Wound You, says: "Males, having a much lower threshold for complications in friendships, will disengage themselves from a negative friendship more easily, and faster, than women.''
Dr Orloff said that women friends can become "energy vampires'' like the "sob sister who keeps you on the phone for two hours with problems but no solutions and who leaves you exhausted''.
Dr Orloff advises those with toxic friends to "recognise it -- don't blame yourself or think you're neurotic -- honour your own intuition. With friends, you can tell someone what's bothering you. If they don't listen, it's OK to stop returning their calls.''
Not everyone is convinced that therapy is the answer. Mike Albo says that the self-help industry has provided underminers with a subtle language for convincing friends that they have a psychological problem.
"One thing that worries me about friendship counselling is that underminers prevail in the self-help society,'' he said.
"Without therapy, people wouldn't say: 'I'm worried about you. Are you making the right choices?''' Debbie Mandel has another warning for those confronting toxic friends: "Listen to their side of it because perhaps it's you who is toxic.''
'We only bonded through pain"
Jennifer, a 33-year-old nursery school teacher, turned to her friend Patricia when she found her marriage collapsing after the birth of her son. Patricia also had a bad-tempered husband and the two women discussed whether to leave home.
"We would talk on the phone every day, moaning about how horrible our husbands were and what we had done to deserve this," said Jennifer.
Jennifer divorced and went into therapy, Patricia did not. Now they barely speak. Jennifer's therapist convinced her she was attracted to abusive relationships -- both romantic and friendly -- and should put an end to both.
"It's like we only bonded through the pain," she says. "It doesn't seem like she wants to hear my good news now that things are better. Our relationship was at its best when we were at our worst."
Types of toxic
Passive Aggressive Underminer
The friend who uses their knowledge of you to subtly undermine you, often making barbed comments about your appearance or habits cloaked in a veil of concern.
Example: Edie Britt, Desperate Housewives
The friend who dismisses your hopes and dreams as unrealistic and is generally negative about your plans. The classic "glass half-empty" individual.
Example: Blanche Hunt in Coronation Street
The Peer Pressurer
The friend who imposes their need for fun and attention over your best interest, who knows that you have a job interview tomorrow morning but pressures you to drink until midnight.
Example: DCI Gene Hunt from Life on Mars
The Plan Breaker
The unreliable friend who agrees to go out for dinner but then ditches you at the last minute because they got a better offer.
Example: Frasier Crane from Frasier
The SOB sister
The friend who saps your energy by whining all the time, who would rather complain than fix things, dragging you into victimhood and using you as a therapist.
Example: Ian Beale from EastEnders
The constant talker
The friend who hogs every conversation and wants to be the centre of attention, with you in their orbit and shadow.
Example: David Brent, The Office
The Drama Queen
The friend who elevates every minor setback into a major crisis, who is convinced that she's going to be fired because the boss didn't smile at her.
Example: Ally McBeal from Ally McBeal