Not many people think they need psychotherapy. This includes almost everyone having psychotherapy. Once, as part of my training, I shadowed a psychiatrist on her ward rounds, seeing patients sectioned under the Mental Health Act. Most of them disputed their need for treatment, despite being delusional, incapacitated by their illness and pretty obviously constituting a danger to themselves and others. Often they seemed to have got a friend or parent on side, someone who would sit in the room and argue wildly that this was all a horrible misunderstanding. It wasn’t. At least in the cases I saw.
Of course, it’s not hard to see how someone who is so ill that they need to be sectioned might believe themselves to be well. A huge number of them actually said to the forbearing psychiatrist: “I think it’s you who needs to be sectioned, you who is mad,” and so on. Still, what is much more intriguing is that people who actually come and ask for treatment still don’t really think they need psychotherapy.
Naturally, we all know loads of other people who need desperately urgent attention. “He really needs some therapy,” “She ought to double the number of sessions.” We are all very clear on that. But ourselves? Never! I must have been lying on the couch every day for about two years when my analyst finally said: “I think it must be very hard for you to see yourself as someone who really needs this analysis.” I bristled. Me? In need? Puh!
I have a patient who is in constant conflict with his overbearing father. “I want to know if he is right. Maybe it is all my fault,” he told me. Essentially, he had decided to have therapy because only a therapist could be an impartial judge, and could tell him by whose rules life should be run: his or his father’s. “He says I’m autistic. Do you think I could be autistic?” Some want to come off anti-depressants without a crash, some feel depressed and want to feel happy, or anxious and want to feel calm. Problems that need a solution, not psychological disturbance that needs examination. That is far harder an idea to bear.
The coping mechanisms we employ can be so convincing we believe them ourselves. I have spent most of my life thinking I am a bright, confident person. Perhaps a bit over-confident. Perhaps rather forbidding. I am so keen to ignore the night person, the terrified, nightmare-plagued me who gasps for breath and sees menace in the shadows that I actually do ignore her during the day. Resolutely. Every day.
I had been seeing one patient for over a year when she said: “I have always thought of my depression as a series of episodes, but I’m starting to realise that I have felt like this all the time for as long as I can remember.” She had coped by allowing herself to know about her depression only at certain times, the rest of the time packing it away under a frenzy of distractions. As the therapy came to an end she began to realise that she might need some therapy.
Having spent a lifetime trying to skate over the despair on increasingly thin ice, even patients seeking help are hoping that the ice might be made thicker. None of us wants to face the fear, injury, hypothermia and slow recovery that will be necessary if we stop skating.
(My own skates are on a hook near the door at the moment, but they always look tempting.)
Anna Blundy is a writer in training to be a psychotherapist. The situations described here are composite and patient confidentiality has not been breached