Therapy ain’t no picnic (and it’s not life coaching either)….

It’s a commonly held misconception that people see psychologists for ego massaging, an opportunity to experience catharsis (the idea that letting things out makes you feel better), or some sort of self-fest where the therapist builds up self-confidence in a Tony Robbins-style ‘ra ra’ session. I suppose some of the blame lies with Hollywood, with images of couches (yes still, in the 21st century) and deeply stereotypical representations of psychologists in cardigans. This vague ridiculousness helps us to separate ourselves from those who might seek out help from a psychologist; we’re happy to accept these stereotypes because, deep down, most of us are terrified of the notion of “mental illness”, and are happy to hold very limited ideas of what psychotherapy entails because, in doing so, we can happily protect ourselves from thinking about something that we find disturbing.

So, for most people, assuming we think about it at all (beyond insipid television representations), psychotherapy is either for people who are weak or broken, or a method for narcissists to engage in self-indulgence and ego propping.

For those of you who’ve experienced psychotherapy with a registered psychologist, you’ll (hopefully) realise that it’s none of these things. You’ve probably realised that it’s hard work for both the psychologist and the client, especially for the client – who has to learn a range of entirely new skills in the face of years of embedded ways of thinking and acting. It often involves learning to deal with deeply unpleasant memories, and overcoming what can feel like insurmountable odds. You” understand that most people don’t choose to work with a psychologist for a bit of a jolly. They go because they’re desperate and deeply stuck in their thoughts or feelings. They go because they feel that they don’t have any other options. For most, sadly, they go because it’s the last thing they can think to do.

This last point, that clients seek out the help of psychologists, not as a first step when life becomes overwhelming, but often as a last-ditch option, is worrying. We’re encouraged to see our GP when we feel ill, preferably earlier rather than later, because we know that early intervention is nearly always best in terms of outcome (early intervention is also a lot more effective in psychology). Thankfully, in Australia, many GPs have become a lot better at detecting psychological problems and referring early on (many but certainly not most or all), but elsewhere, the chances of being referred to a psychologist by your treating physician is slim (unless it’s basically too late).

Reluctance to seek help is most likely due to the stigma around asking for help, something that is deeply embedded in most cultures, even more so for men than for women. Although most people wouldn’t dream of attempting to treat a serious medical condition themselves (despite Dr. Google), many people assume that despite all evidence to the contrary, they should be able to manage when things get tough, and that being unable to do so is either a failure, or some sort of character defect. It’s not surprising therefore, that many people feel ashamed to ask for psychological help. So when the common misperception of therapy as a self-indulgence is layered over a person’s discomfort around seeking help, we get a double whammy. Not only is a person who needs help reluctant to seek it, were he or she to admit contemplating the need for help to friends or family, the reaction is often negative. Stigmas prevent us from getting the help we need and, if we’ve been brave enough to actually seek it out, we’re often accused of being self-indulgent!

You’ll probably note that I’ve often used the term psychologist (or better, registered psychologist), rather than “therapist”. This is deliberate, because there’s another destructive stereotype that often makes it very hard for people to get appropriate help: the idea that one therapist is the same as another. Because (for the most part) we’re a lot more comfortable with the idea of medicine than we are of psychology, most people seek out medical professionals with appropriate qualifications. There are also, importantly, regulations around what a medical professional can call him or herself; your GP has to be appropriately qualified and registered. Those who choose “alternative” options (e.g., naturopaths, homoeopaths, chiropractors) often have a poor idea about what it is these “professionals” are actually able to do, and more often than not these hopes are based on wishful thinking (or active misinformation) rather than a strong, empirical evidence base.

It’s exactly the same when it comes to mental health. Like your doctor, a registered psychologist has trained (at university) for a minimum of six years (in the US usually 10 or more), and should have a deep theoretical understanding of both the conditions he or she is working with, as well as the ability to determine whether a treatment modality is actually effective (as opposed to claiming efficacy because of anecdotes and confirmation bias). Because they’re trained to be scientist-practitioners, psychologists should be able to evaluate new research as it appears, and to retrain to reflect the improvements or changes in their field, rather than relying on tradition and appeals to antiquity. In other words, a registered psychologist should actually know what he or she is doing. The same can’t be claimed for the nonregistered “alternatives”: life coaches, counsellors, and therapists of various ilks. Assuming they’ve actually done any training, most of the time it will be ad hoc, unregulated, and certainly not evidence-based. Their professions aren’t registered or scrutinised by an overseeing body, and their claims, like many other “CAM” practitioners, are often misinformed (or even farcical). And they can do harm.

Given the stigma around mental health, and the difficulty most people have in asking for help, it’s extremely important that (if they actually seek it out) they get the right help from someone who actually knows what they’re doing. Just as taking homeopathic medicine for a tumour is going to end badly, seeing a life coach for a serious psychological problem is unlikely to improve things, no matter how well-intentioned the therapist.

Over my years of research, teaching, and practice I’ve come to the conclusion that there are two important things I’d like to be able to change about the way we, as people and as a society, see mental health: reducing stigma and stereotypes; and recognising the importance of early, effective treatment. To my mind, education is the only way forward. Despite the recent crop of Dunning-Krugerism that has led to the rise of anti-vaxxers, and associated anti-medical (anti thought) groups, widespread education around important public health issues (such as smoking, high-fat diets, sedentary behaviour, excessive sugar, etc.), combined with sensible legislation (e.g., public smoking bans), have resulted in large-scale behavioural change and an increase in knowledge about the importance of physical health behaviours. Similar attention to helping the populace to understand mental health risks, and to seek appropriate help early on, might finally catch us up.

And if you know someone who is suffering, help them by attempting to understand. Their issues are unlikely to be their fault, or due to some weakness or failure. Assuming they pluck up the courage to see a psychologist, don’t assume that their visits are self-indulgent, or comfortable, or even easy. Applaud their efforts to overcome difficulties and to learn to be better versions of themselves – they will be working their arses off to do so.

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