What makes people decide to have therapy?

Although I trained and then practised for many years as an applied psychologist I have always been aware that my work had a therapeutic potential, in other words, through talking with a person about their issues it was possible, putting aside the psychology or specific psychological approach in use, that a positive difference could be made to that person and the issues that they brought through talking and listening.

Any non-psychologists or non-therapists reading this could be forgiven for wondering about the difference between therapy and psychology. I can write most confidently about the latter although I do have some therapeutic qualifications.  Applied psychologists, otherwise known as practitioner psychologists are regulated by the Health and Care Professionals Council, have undertaken lengthy undergraduate and postgraduate studies and training, operate on a theory-informed basis,   enploy scientific method and work to a professional code of conduct and ethics.  Therapists may also claim some of the above but there is no legal requirement and regulation for a framework for their professional practice and conduct and what is on offer to the general public is very varied.  For this reason when I am asked to suggest a counsellor or therapist I always refer people to the British Association for Behavioural and Cognitive Psychotherapies, which holds a register of appropriately trained and supervised practitioners. It is generally true to say that the focus of therapeutic work is most likely to be upon individuals’ emotional issues whilst psychologists can have a wider focus on couples, groups, organisations or even society as a whole.

Back to therapy though, ofen referred to as ‘the talking cure’, there are many different types employing various techniques and modes of working, for example, Cognitive Behavioural Therapy, Play Therapy, Music Therapy, Art Therapy, Narrative Therapy, Gestalt Therapy, Person-Centred Therapy and Rational Emotive Therapy. According to meta-analyses examining the efficacy of different types of therapy it is suggested that 30% of clients report that they feel worse, 30% consider that they improve due to personal support, i.e. family and friends and 30% attribute their improvement directly to therapy. In addition these large-scale studies have found that the single most important factor is that of the level of rapport established between client and therapist. The awareness of the importance of this aspect of the therapist and client relationship can be attributed to Carl Rogers. creator of person-centred therapy and founding member of the group of individual professionals who devised Humanist Psychology. In my practice I have always held this principle to be hugely important but I was also aware that even before the client sets foot in the therapy room something else had to happen. Somehow the individual must make the decision to do some work on themselves through seeking support from a professional.

I recently attended an interesting talk hosted by the BPS on Self-Responsibility Therapy by Professor Nigel Maclennan.  In his talk Maclennan explored possible influences on people taking responsibility for their own wellbeing and mental health; was it government health education? The words and advice of friends? Social stigma? He had no clear answers other than to say what most people, psychologists or not already know , i.e. that many individual and interacting factors and dynamic, time and context bound aspects all led the individual in their choices. Put very simply, this may just be what we call life. 

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