What is psychotherapy for?
I was recently at a party when a sceptical neighbour (a lawyer) challenged me about my profession.
“Why do people need therapy?” he asked.
My challenger pointed out that, in the UK at least, less than 5% of the population will receive therapy at any one time. What, he asked, are the other 95% doing? Are they all going slowly mad? Or are they making their own way without the help of a therapist?
In this connection, he reminded me that psychotherapy is a fairly recent invention (the first use of the word in print was in 1896). What were all those people doing about their mental health for three thousand years before therapists came along?
Good questions, I thought, and I gave him some answers which I will share with my readers.
Therapy before psychotherapy
It is not in fact true that there were no psychotherapists before the twentieth century; it is just that people didn’t call them that. We know that the ancient Greeks practiced a form of talking therapy and, in fact the word ‘psychotherapy’ comes from the Greek therapeia psyche, or ‘care of the mind’. We know of a philosopher in Athens 2500 years ago called Antiphon who, for a fee would banish personal misery by arguing his clients out of their thoughts. Rather like a Cognitive-Behaviour therapist today.
In the same way the Stoic philosophers in Rome held tutorials in mental health which survive today in the journals of Marcus Aurelius. In India, China, Persia, the Arabic world, and in the West there existed wise men and women, learned in philosophy or the healing arts who offered their wisdom, with or without a fee.
Therapy without psychotherapists
Our ancestors were familiar with multiple ways to heal. Their methods included medicinal herbs (they knew, for example that St. John’s Wort was a remedy for depression, and Valerian for anxiety). Robert Burton, writing in the 1620s recommended exercise, communion with Nature, horse-riding, gardening, music, study (to focus the mind), and artistic pursuits.
Now, as in the past, the first thing people did if they were stressed, depressed or upset was talk to their friends and family. Our ancestors may also have chosen to talk to the wise old woman in the village or some other person known to give good advice. This person may, or may not, have been a priest, a shaman, a healer, or a guru.
Alternatives to personal psychotherapy
We are fortunate to live in an age in which awareness of mental health problems and their solutions are widespread. People can turn to talk-shows, books, podcasts, YouTube videos and newspaper articles for information on how to address their problems. There are also internet-based therapy programs and apps.
For example Moodfit is an app that people can use to improve their moods, while Mindshift offers help with anxiety. Both these programs provide information, worksheets, mental health exercises, and daily feedback scores on progress. They are definitely the best option for those who cannot afford face-to-face therapy, or if the free services such as the NHS Talking Therapies have too long a waiting list.
Perhaps the first self-help therapy books ever written were the Pali scriptures on the teachings of the Buddha. two thousand years ago. Numerous other books on the care of the mind and the soul have been written by philosophers, spiritual masters and psychologists over the centuries. My own personal favourite, which I have read off and on throughout my life, are the Essays of Montaigne.
I have written before on ten recommended self-help books, while also pointing to research that suggests that these books can be more effective when used alongside face-to-face therapy. However, it is also true that many people profit from them without the aid of a therapist, as I have myself. A lot depends on how good a reader you are, and whether you can stick to the advice offered.
What is psychotherapy?
Clearly, personal therapy should be your choice if all the other avenues: advice from friends, healing methods, medication, and self-help haven’t worked. However, there are more compelling reasons why therapy should be your first choice, assuming you can afford it. I list them below:
A holding relationship. You may find it easier to talk about your distress with a neutral professional who will normalise your fears, and offer you support on your healing journey. A good therapist will provide a supportive environment in which personal change can take place, and offer a fresh perspective.
New perspectives. At the heart of therapy is the reframing process, in which you are invited to reconsider your problem from another angle which offers fresh possibilities. For example, if you have developed the idea that problems are due to ‘failure’ on your part, your therapist may invite you to consider how problems are often due to external factors over which you have little control. Thus enabling you to move towards adaptation rather than self-blame.
Insight. An experienced therapist will help you identify the deeper source of your distress more quickly than you or your friends might be able to. From there it will be easier for you to understand what you must do next.
Focus and direction. Your therapist will provide you with a plan for recovery, with clear-cut directions which activate changes in thought, feeling and action on your part.
Motivation. Working with a professional who inspires confidence can give you the impetus needed to make the necessary changes in your life. Also helping you through your doubts and setbacks along the way.
Faster recovery. Although it is true that many people recover from mental health problems over time (or else they learn to manage them), a good therapist will help you to achieve this more quickly. If, having tried every other means to overcome your issue then personal therapy could be your best option.