Therapy takes a long time
TRUE and FALSE
First, “therapy” isn’t one thing; the British Association for Counselling and Psychotherapy lists 33 approaches. “It’s so broad that it would be like saying ‘engineering’ – there’s chemical engineering, civil engineering, AI engineering,” says Susie Orbach, the author of In Therapy: The Unfolding Story, who comes from a psychoanalytic background. “I’m ancient now, so I don’t take anybody on for long-term therapy any more – but you can make fundamental changes in a short timeframe.”
Dr Jessamy Hibberd, a clinical psychologist and author of How to Overcome Trauma and Find Yourself Again, says that for a phobia, one session may be enough, while for a straightforward problem “the evidence base shows that 12, 16 or 20 weeks is a common timeframe”. Simone Bose, who provides couples therapy at Relate, says on average she sees couples for about six months, while Health & Care Professions Council-registered practitioner psychologist Dr Tara Quinn-Cirillo says, “Good therapy should be time-limited, and should have agreed goals and outcomes – it shouldn’t just be this open-ended chat.” Someone tell Hollywood!
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Everyone needs therapy
FALSE
Celebrities may give the impression we should all be “in therapy” but not all experts agree. Orbach believes that, as a society, we need “to have more emotional literacy, ways of thinking about how we connect and disconnect, and manage difficulties, sorrows or pleasure. But I don’t think everybody needs therapy.” Coaching and counselling psychologist Prof Stephen Joseph, author of Think Like a Therapist, remarks that everybody benefits from personal growth, “but you can find that in various ways, from reading books to watching the sun set – therapy is just one”.
Hibberd says research backs up the fact that “your friends and family can be really key to going through difficult times, but so can doing your own thing – self-help, writing things down, putting strategies in place”. Quinn-Cirillo advocates self-help methods but has concerns around the buzzword “resilience”: “It suggests that if you’re not coping, you’re not resilient, but it’s about coming back to you – do you feel you need help?” Finally, Jodie Cariss, a drama therapist and founder and CEO of Self Space, points out the unique merit of therapy: “There’s a magic in having a conversation with somebody who’s absolutely focused on you. I don’t think that everyone needs it, but I don’t think there’s anyone who wouldn’t benefit from it.”
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It’s all your mother’s fault!
FALSE
This characterisation has (arguably mangled) Freudian roots. It’s the concept that your early mother-child relationship is the prototype for all future relationships – but it raises a wry laugh from virtually every therapist. “Even we joke that our parents messed us up,” Bose says. “You do tend to look back on your family script but it’s never about blaming parents.”
Orbach describes this deep-seated stereotype as “inelegant” and explains that “therapy is useless unless it puts the parent in their own social and psychological context. Blame doesn’t help – understanding helps, about limited capacity or notions of what it meant to be a child in that moment in history.” She looks at family history to understand someone today: “What emotions were prohibited, couldn’t be voiced, and therefore there’s an impoverishment for the person in terms of their own development of emotional capacity or literacy,” she says. Hibberd echoes this: “Reviewing your history is a key part of getting to know yourself better. What you learned as a child provides clues for why you act and think as you do now, but it’s not about blame.”
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Therapy is expensive
TRUE and FALSE
It’s available free on the NHS, and you can self-refer, but there are long waiting lists. So does private therapy come with a hefty price tag? “Yes, and it’s a terrible thing,” Orbach says. “Therapy on the NHS has been cut back and cut back, and people have to be paid for the work they do, the office they rent, the insurance they pay and the training they’ve gone through, so it’s expensive.” Cost will vary by the type of therapy and location, but a session will probably cost between £40 and £100.
Local Mind organisations offer therapy from as little as £12.50, and Bose says, “There are, luckily, places like Relate, where you can pay a lower rate.” She adds that online therapy has cut costs, as therapists don’t need to rent a space. Joseph says universities sometimes offer free therapy as part of studies. Cariss raises the value of therapy versus other spends: “I see people buying a £100 round at the bar, talking about how unhappy they are,” she says, pointing out that good therapy – for those who can afford it – “maybe stops us chucking money at these other defensive mechanisms”. Quinn-Cirillo recommends discussing money with your therapist: “Ask what you can achieve with the funds you’ve got. We’re trained to assess, formulate, create a plan and revise that plan if needed.”
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Therapy is hard work
TRUE
Therapy isn’t passive, it’s effortful. People think it’s like “seeing a doctor, and they have a treatment to make you better, but therapy is about learning to be ourselves and we do that in our own way, at our own pace, so it’s as much work as we put into it”, Joseph notes. Hibberd says unearthing challenging feelings can feel daunting: “People worry that it will swallow them up, but I see the reverse: you can arrive feeling heavy with all you’re carrying and leave feeling lighter.” She discusses the importance of work outside the therapy room: “I give people tasks or things to think about because it’s important to not just learn the theory but implement it in your life.” For Quinn-Cirillo, “it should be an adjunct to your normal life, it should never be overwhelming”. She compares therapy to physio – if we do the exercises, we make a good recovery. “To create change, you need to do the work with your therapist and maintain that in the long term,” she says.
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You’ll lie on a couch, they’ll be seated
FALSE
It’s the classic depiction, but “most people are sat in a comfortable chair, in a nice neutral space”, Quinn-Cirillo says. “For me, that means there’s no power imbalance – because I think people feel vulnerable lying down.” This, again, has Freudian roots. “Freud was uptight and it became fetishised as a way to let the patient not be distracted by the attention of the analyst, and therefore they could free-associate – just say whatever came into their mind,” Orbach explains. “But I like to look at the person, even if they don’t choose to look at me.” Cariss rejects the dynamic because “there’s something about ‘you’re unwell so you lie down’. I don’t think it fits our lives now.” With the likes of art, music and drama therapy, nobody may be sitting and, as Joseph and Hibberd point out, some therapists walk in nature with clients or have sessions online where you choose your seating arrangement.
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Therapy will fix your problems
FALSE
“Most humans want to do whatever we can to get rid of distress, and therapy gets equated with that,” Quinn-Cirillo says. “But it is actually about helping you understand a problem – where it started, what keeps it going, what makes it better or worse.” Expectations matter. “It’s not about ‘fixing’ but improving,” Bose says. “Any person who is expecting their partner to hold them all the time or to regulate their emotions – that’s not possible; it’s about being more aware, more empathic, listening to one another, knowing one another more deeply – and in that your relationship can really improve.”
Cariss adds that “therapy can equip us with the tools and the buoyancy to navigate choppy waters. It can give us an ally to look at things that are painful, hold the mirror up to things we don’t want to look at, and in that there’s healing.” Therapy doesn’t “fix” things, then, it bolsters us. “Anxiety will always show up,” Quinn-Cirillo says. “It’s not about making it disappear, and when you understand that you get a core shift, because you drop the battle of trying to get rid of stuff.” Hibberd talks about creating new, more helpful responses to challenges. “You’ve always gone the same route so that pathway is well-worn and easy to go down, but in therapy you build new pathways – routes that take you to a better place, and the more you go down them, the easier it becomes.”
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You can become dependent on a therapist
TRUE
“If for the first time in their lives somebody feels listened to and understood, they could put this relationship up on a pedestal,” Joseph says. But rather than this being a problem, he says, “a therapist would see that as something to explore”. Quinn-Cirillo agrees that “it happens, but if you’re noticing people having difficulties and wanting to keep booking sessions, you need to be able to have those conversations and normalise the fact that people find it hard to stop”. Bose says fear is a factor: “People worry everything will fall apart once [the therapist is] not there, so you have to explore that question.” If she thinks clients are ready to wrap up sessions, “I’ll remind them of the tools they have, point out what they’ve done well, talk about how they’ve dealt with things when I’m not there, and discuss how they keep talking.”
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Therapy makes you revisit trauma
FALSE
Worried that therapy is about sifting through your darkest moments? Not so, Joseph says. While he describes how, for many, a traumatic experience is what drives them to seek therapy, “a decent therapist will happily sit with you in relative silence for an hour, rather than make you talk about anything, and many therapies are forward-looking, focused on living in a more flourishing, positive way”. Hibberd agrees that this negative characterisation isn’t accurate, saying, “Therapy is also very much about seeing your strengths, noticing things that are already in your life and building your relationships. It’s about getting people to a better place, or seeing themselves in a better way because when you’re going through a hard time, you can lose that.”
She says that while you might revisit trauma, “it’s about having a chance to tell the story of what happened to you and find meaning, to make sense of it as a way to take control of the future”. For Orbach, “The approach is not to re-traumatise the person but to find enough tenderness and capacity to help them with it.” Cariss agrees that “mostly we’re a product of unresolved stuff from the past, but that doesn’t mean we’ll dwell there. Therapy is not just concerned with the shadowy stuff. It’s also about reaching your potential and feeling more content.”
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You’ll have to talk about embarrassing things
TRUE and FALSE
“People are drawn to explore things to make sense of them, so they will – very slowly – move towards talking about things that are uncomfortable,” Joseph says. “But that happens only because people feel in a safe, supported environment.” Orbach highlights the kindness of the therapy space: “The things that we can be shy about can be really tiny, but it’s so tender for that person, so you do talk about things that you’ll have reluctance to talk about.” Bose makes clear that “as a therapist, you’ve heard everything before – like gynaecologists or urologists who’ve seen everything. In couples therapy, people tell me they’ve never spoken about sex in front of each other, but they get into the flow of talking and it doesn’t seem taboo any more.” Hibberd talks of the lightness that comes with offloading. “This idea that these things are awful or shameful pulls us down, so bringing them out in the open can really help.”
And don’t mistake pauses in the therapy room for judgment. Orbach says, “The therapist may not be responding because they think you may have more to say. In therapy you want to acknowledge what you’ve heard but not close it down, to turn a full stop into a comma.”
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Therapy is a branch of medicine
FALSE
Joseph is keen to unpack this one, saying, “The idea that therapy is a place where people go to get cured of their illness or disorder is a deep-rooted cultural myth. I would say it’s a form of education, a place where people learn to be themselves.” He makes clear that psychiatry, though, is a branch of medicine.
Cariss says the medicalisation of therapy can create stigma: “Culturally, we don’t talk about problems until we literally don’t know what to do and then someone might say, ‘Go to the doctor’, which is where sick people go. Then the doctor refers you to a psychologist, so all the subliminal messaging is when we’re not doing well, there’s something wrong with us, as opposed to this is just what it means to be human.”
