Helping with Distress

Talk given at the annual conference of the Central England Region of Cruse, July 2000

In an ideal world, I suppose, social and family life would be such that they would be able to cope with any psychological difficulties arising in their members. However, one cannot imagine that such a world has ever or could ever have existed, not least because it is very largely families which are the immediate cause of most of our psychological difficulties! In view of this, it does seem that some form of help should be available to people which is not left simply to the sufferer’s luck in having good relatives, friends or neighbours.

Where once people would have turned at times of emotional and spiritual trouble to the religious institutions within their communities, they now cast around for alternatives which seem to them more satisfying. For the majority of people, religious practice is not part of their experience, belief in God not self-evident, and the rituals of the church barely relevant. Though some weddings may still take place in church, the true solemnity of the ritual goes into the preparations for the reception. Consumerism, these days, has a far more compelling influence than the now powerless precepts of a conventional morality which is widely flouted, if not held in open contempt.

When it comes to death, the traditional formulae of the funeral service have nothing on the improvised shrine at the side of the road, the individualized amalgam of pop music and personal reminiscence which embellish the otherwise bare procedures of the sanitized crematorium.

It is in this general setting that therapists and counsellors are becoming – perhaps have become – a social institution – a formal element of the social structure of modern Western society. Though not yet generally recognized as having such a formal role (in the way that the Church still has) counselling is on the wax while religion is on the wane. In contrast to the Church’s ossified structure, cracking apart under its own rigidity and empty formalism, counselling is in a more fluid, shapeless, formative phase.

That fluidity is something for which we should be thankful, for it gives us an opportunity to think hard about the influences that are at work in the rise and rise of counselling before we find ourselves stuck with a set of rules, whether spoken or unspoken, statutory or merely observed by common consent, that make it hard for us to intervene in the course of its development. Already there seems to be a widespread acceptance of the validity of the whole counselling/therapy enterprise, reflected for example in the treatment it receives from the media, and while that may be music to the ears of the growing army of counsellors and therapists who are hoping to earn their living through their practice, it may also serve to solidify social trends which are far less desirable than they may seem.

For example, one very obvious difference between the counselling ethos and the religious ministration which, I argue, it substantially replaces, is the commercial/consumerist element. Given the times we live in, this is scarcely surprising, but we do need to see that what we are doing is seeking to replace a fixed, familiar resource which existed stably within communities (in the shape, for example, of a priest, vicar or minister) with an essentially purchasable commodity which can be made available when and wherever crisis might occur, by professionals who, rather than being part of a community, are trained in techniques of intervention supposedly tailored to the particular crisis involved (for example some kind of trauma thought to carry a risk of on-going ‘stress’). The traditional model involves a relationship between people whose role depended on personal knowledge and continuity; its replacement on a business transaction between a skilled technician and a consumer.

Please note at this point that I’m not trying to engage here in an exercise in nostalgia and advocate a return to social structures which, however desirable and effective they may once have been, are absolutely no longer possible. The caring vicar whose personal knowledge of and relations with his parishioners constituted a force for spiritual well-being in the local community is no more a significant possibility for present-day urban society than is the general practitioner whose birth-to-death knowledge of his or her patients made him or her a trusty secular support. What I do want to draw attention to is a change in the kind of ideals which lie behind these stereotypes. On the one hand we have, at least in part, what one might call the ideal of personal relationship, on the other the ideal of business transaction. It is not self-evident that the one is better or worse than the other. But it is something we should think about.

If ever demonstration were needed that Reason is not a significant determinant of the way things pan out in the world, the success of the counselling industry over the past couple of decades would do very well. For psychotherapy and counselling have flourished beyond all the expectations that one might have had, say, towards the end of the seventies, and in the face of mountains of evidence that the kind of help that they deliver is for the most part not really very effective – that is to say, neither profound nor permanent. But Reason, it seems to me, is something human beings by and large only pretend to be moved by; far more important in the construction of our motivation is the factor of interest, and in the case of therapy and counselling one can see clearly enough, I think, that it is a confluence of interests that has made their rapid growth virtually irresistible.

Counselling profited greatly in the eighties from the general market deregulation which overtook pretty well all sectors of economic activity, and permitted large numbers of people to, so to speak, get their feet in the door who had been held back from training and practice in therapy and counselling by the stuffy and restrictive codes of established professions (in particular medicine). At the same time, of course, there was and is a vast, virtually limitless supply of people who find their lives, either partly or wholly, distressing enough to seek help beyond the confines of their own families and friends. (Many, of course, suffering such distress precisely because of the absence of friends and supportive relatives.) The promises of therapy and counselling to such people, whether implicit or explicit, are very understandably greatly appealing.

A third element in this confluence of interests is the convenience of what one might call counselling philosophy to a social system which inevitably damages people psychologically. If that damage can plausibly be represented as temporary and fairly easily curable through a brief encounter with a therapist of some kind, it obviously makes it much easier for social institutions which cause the damage in the first place to carry on regardless. The most obvious everyday example of this kind of thing I can think of is where employers generously provide counselling for people they’ve just made redundant.

Ever since I’ve come to see the workings of interest as absolutely fundamental to what we think of broadly as ‘motivation’, I’ve found it very difficult to talk and write about it without being quite badly misunderstood, and increasingly difficult to make friends and influence people! Because of this, I do want to make it absolutely clear that I do not see being swayed by our interests as anything we choose to do with conscious duplicity. It is not that the proper and normal course for human beings is nobly to disregard their interests and act in accordance with some abstract principle of Right and Reason, nor that departure from that course is somehow deeply reprehensible. But I think it is because we are haunted by some such notion of moral rectitude as the norm of human conduct that we come actually to repress the consideration of interest in the way that Freud accused the Victorians of repressing sex. And just as sex is not only normal and healthy, but absolutely essential to the future of the human race, so is acting in accordance with our interests. And again just like sex, whatever we think or say about it, we do it anyway.

The trouble with repression, though, is that it puts our conduct beyond rational guidance. If we do not perceive that we are acting in accordance with certain interests, we are helpless to decide whether they are good or bad, just or unjust, valid or invalid. And we dress them up in rationalizations in which we believe unquestioningly (and not dishonestly: it is not that we lie about our interests, just that we disregard them).

This, I believe, is precisely what has happened with therapy and counselling. The rationalizations which have cloaked our interests in them have come to be seen as self-evident truths despite there being plenty of objective evidence that they are really not as effective as we crack them up to be. And inevitably, supply creates demand. People’s feeling that there is something available which will assuage their distress soon enough leads them to demand it as a right. Almost any ‘trauma’ comes to be seen as something whose effects can be more or less eradicated by ‘counselling’: a belief certainly fostered uncritically by the media, and one which counsellors themselves can hardly be expected to be among the first to deny.

And there is no denying the attractiveness of what Thomas Szasz called the ‘myth of psychotherapy’. The basic assumption of much therapy and counselling – that psychological distress can be eradicated through a relatively brief association with a professional expert - introduces an element of magic into our lives. Injuries that we have acquired through having to live in a harsh social environment can, it seems, be soothed away by repairing the interior spaces in which they appear to reside, and for this we need do no more than consult an expert in, say, unconscious mental processes, ‘cognitive restructuring’, etc., etc. In this respect therapists and counsellors line up with the soothsayers, ‘cunning men’ and astrologers who in former times offered similar shortcuts to a happier life.

Most approaches to therapy have a surface plausibility which appeals strongly to a ‘common sense’ formed out of deeply entrenched cultural assumptions our society holds about psychological functioning. According to these assumptions, we see ourselves, for example, as to a great extent self-creating individuals who choose our actions through exercising processes of decision and responsibility. Our mental life appears to take place in interior space, forming an ‘inner world’ which is the source of our strengths and satisfactions – as well, of course, as of our weaknesses and ‘dysfunctions’.

It is easy from this kind of perspective to assume that, potentially at least, individuals are in control of their fate, and that if they stray from the correct path they can quickly be re-orientated through consultation with someone able to assess their situation objectively and provide them with ‘insight’ on how to proceed. ‘Insight’, in fact, is absolutely crucial to our Western way of thinking, and pretty well all forms of therapy and counselling are heavily dependent on it. It relies utterly on the notion that if the individual can see what’s wrong, he or she is free to put it right. A necessary, but often unspoken, companion of insight is ‘will power’, which supposedly provides a person with the necessary dynamism to act upon insights gained through therapy, etc. ‘Will power’ is similarly essential to our idea of responsibility.

For me, one of the central paradoxes arising from the experience of therapy – possibly the central paradox – is that there is no such thing as the will power we implicitly call upon our clients to apply. The most painful discovery for many people in the grip of emotional distress is that they are powerless to do anything about it, no matter how much they want to. No amount of insight makes any difference.

It might seem strange in the light of this that therapy and counselling should continue to be so well thought of and so widely sought after. For all the lack of evidence of their effectiveness, they have barely faltered in their development. I don’t think this is so strange when we bear in mind that, as I’ve already suggested, our beliefs – conditioned by our interests – are more important to us than our actual experience. In many ways we are quite used to living in a ‘virtual’ world where the magic that can be spun from words has a more powerful influence upon us than the evidence of our senses. In this way there is, I think, a kind of ‘virtuality’ about the help that we assume can be delivered by therapy which is much more potent than the reality of its actual limitations.

At this point you could be forgiven for concluding that my view of therapy and counselling is that they are worthless as means of providing help to people in distress. This, however, if far from what I mean to say. I do think that therapy and counselling as ‘professionalized’ undertakings with elaborate training courses and systems of accreditation, etc., rely for their plausibility on cultural assumptions and expectations which in fact have very little validity and are driven by interests which practitioners are reluctant to confront, if not largely unaware of. But this is not to say that the endeavour of one human being to help another in distress is a vain undertaking. There is virtual help and there is real help, and what we need to do is distinguish between them.

There are people who in my view articulate a view of psychotherapy based in what I would call the reality of its practice and who, consequently, are able to illuminate the ways in which it can be helpful. Two British writers who spring to mind in this respect are Peter Lomas and Paul Gordon. Such voices as these, however, tend to be drowned out in a deafening, if discordant, chorus of, on the one hand, pseudo-scientific and self-interested professionals and, on the other sentimental, ‘postmodern’ and ‘New Age’ enthusiasts who appeal to our longing for magical solutions.

I would like now to balance what has so far been a mainly critical account with an outline of what seems to me to be the ‘real’ helpfulness which is often to be had from therapy and counselling.

We are social animals. At times of trouble we draw comfort from being associated with others. There is a lot of truth in hackneyed sayings such as ‘a trouble shared is a trouble halved’. But only while it is shared. There is a kind of solidarity in the relation between therapist and patient, counsellor and client, which strengthens the person’s ability to deal with his or her difficulties. Having someone to talk to, someone to listen, is in and of itself ‘therapeutic’, that is to say, comforting and reassuring. It doesn’t take a genius to establish this – it’s part of everyday human experience. Of course, some people are more comforting and reassuring to talk to at such times than others, and much of the more interesting and enduring research in the therapy field has been in investigating what kinds of personal qualities, what features of the personal relationship, are most conducive to the easing of distress.

However, the craving to technicize therapy, to turn it into a packaged commodity, inevitably means that, in true Fordist manner, any insights gained about it will quickly become part of a production-line process from which all the truly personal elements have been drained. Therapists will be trained in ‘listening skills’, in evincing ‘warmth, empathy and genuineness’, etc., etc., until they conform to a kind of stereotype of professional therapy, their character as individuals all but obliterated. Furthermore, commercial pressures mean that the nature of the association between client and counsellor will be changed from a relationship into a time-limited contract.

In fact, there is no one way, no proven way to be helpful, any more than there is any one, proven way to be, say, a good parent or a good spouse. I have known many good therapists in my time, and the most obvious thing about them has been their differences as people. What a good therapist brings to his or her work is a set of personally learned resources which s/he is able to place at the disposal of his or her clients. No doubt there are some things in common which differentiate good from bad therapists: a kind of honesty, perhaps; an awareness of and readiness to distinguish between one’s own interests and those of one’s clients; a willingness and ability to face without flinching the bleaker sides of life; a tolerance of and affection for ‘otherness’ (Rogers put it well when he spoke of ‘non-possessive warmth’; another way of putting it would be to stress the importance of good will). But when it comes to what we tend to think of as ‘personality’ there seems to be a great deal of room for variation. Extraverts can be as good as introverts, people who lead with their emotions as good as people who lead with their intellect. Active interveners can be as good as quiet wait-and-seers. And so on, right across the full range of human character.

As I have suggested, for the comfort that comes from solidarity to be effective, it has to be available for as long as the client needs it. Essentially business concerns about time limits and ‘cost effectiveness’, etc., have in my view little constructive place in therapy and counselling, and strictures against creating ‘client-dependency’ and so on tend also to be over-stated, though of course it is possible for therapists to abuse their position by attempting to make themselves indispensable to their patients when they're not. In other words, an essential element of what can be healing in psychotherapy is the relationship between therapist and patient itself, and not some technical magic which the therapist works to ‘cure’ the patient.

However, comfort and reassurance, important though they are, are by no means all there is to the process of therapy and counselling. There are also the important factors of, first, understanding the nature of the client’s predicament, and, subsequently, establishing whether there is anything that can be done about it (which, in view of the limited powers usually available within the therapeutic setting, tends to mean whether there is anything the client can do about it).

Understanding is traditionally what therapy is best at. Many well-intentioned approaches to helping people in distress – whether religious, medical, or just plain ‘common sense’ – are found unhelpful because they frequently wade in with a ready-made set of assumptions about what the trouble is and what the sufferer should do about it. The perfectly understandable instinct of many such helpers is to give advice and prescribe solutions – even though personal experience teaches most of us that emotional distress rarely responds to this kind of approach.

Psychotherapists and counsellors, on the other hand, have learned that , however things may seem at face value, the best way to discover what is troubling someone is to listen, alertly and sensitively, to the story they have to tell, to maintain a kind of non-intrusive curiosity and inquisitiveness which aim at making sense with clients of what they have to say. Essentially this is an attitude of respect towards people, one which takes their experience seriously and accords them a kind of moral equality which is often lacking in other professional expert/lay person relationships.

The idea, then, is to clarify with the client the meaning of his or her experience. Bereavement – especially unusually intense or prolonged bereavement reactions - provides a very good example of the way in which popular conceptions and assumptions (about the impact of death on those left behind) can entirely miss the point. To respond too readily with sympathy, with condolence for the person’s loss, for example, though perfectly proper as a formal social response, would as a counselling response cut the person off from all kinds of possibilities for the expression of emotions not normally regarded as appropriate for the bereaved. I don’t need to tell people here that death rarely occurs at a convenient time; it can catch people out in the middle of complex and difficult relationships where frustration, anger, even hatred, are suddenly frozen, as it were, into historical permanence through the death of their object. In these circumstances grief may become fused with guilt in a way which can only be disentangled through the kind of patient, attentive, non-judgemental enquiry which is characteristic of counselling at its best.

One factor which helps in my view to give counselling its ‘credibility’ is precisely its success in this kind of process of clarification. Careful listening; gentle, attentive, respectful enquiry, can reveal with utterly persuasive clarity the circumstances, past and present, which have created the individual’s predicament and thus led to his or her distress.

In the case of circumstances such as those underlying unusual bereavement reactions, this may be all that’s needed. The solidarity of the counsellor’s support combined with the process of clarification may enable the client to face, acknowledge and assimilate feelings which would otherwise remain unexamined and painfully troubling. In other kinds of situation where great claims are made for therapy and counselling, however, success at clarifying the nature and history of the problem can only lead to improvement if the person has available the powers and resources to make a difference. Reliance on insight alone either overlooks the need for such powers and resources or simply assumes their availability.

Therapeutic psychology tends, as I have already suggested, to be heavily reliant on various forms of word magic: ‘re-framing’ problems, ‘interpreting’ or ‘construing’ them differently is supposed to give clients a different take on reality which, so to speak, airbrushes their difficulties out. However, it is my experience that emotional distress arises from painful struggles with a real world which causes real and often lasting damage. Life isn’t easy and very few of us get through it without being marked by events which, however we look at them and whatever the colour of the light we try to cast on them, leave us worse off than we had hoped to be. The limitations of counselling to have any real impact on the kind of social, economic and health difficulties which may sap a person’s confidence and ability to cope are obvious. What really helps in circumstances such as these is the availability of powers to tackle the problems themselves. This, no doubt, is why as individuals so much of our waking activity is taken up with trying to ensure the acquisition of sufficient material resources to buffer ourselves against the kinds of disasters in family and working life which can so easily lay us low.

Counsellors and therapists are in no position to do much about these kinds of problems. Where they are able to bring material influence to bear on clients’ difficulties, I myself have little doubt that they should do so – an example would be acting as advocate for people whose disability or lack of education hampers their dealings with officialdom. Though I have nothing like your experience of helping with bereavement, I imagine that for many people their grief is complicated and compounded by their being confronted with pressing practical and financial difficulties that they don’t know how to grapple with, let alone solve.

To see ‘counselling’ as a kind of contentless skill that is above sullying itself with practical intervention seems to me absurd in that it rules out of court the potentially most powerful form of help available to it. Where people specialize in helping with a particular form of distress – as in bereavement – they are bound to become familiar with recurrent problems and difficulties, thus allowing the development of a kind of expertise of real potential value to their clients.

For the most part, however, this is not the case with counselling and therapy, and practitioners tend to have no clearer idea than their clients how to resolve the predicaments the latter find themselves in. Indeed, it is important to remember that frequently, having struggled with it perhaps for a lifetime, the client has far more ‘expertise’ in the nature of his or her predicament than does the counsellor, and will long ago have exhausted all the possibilities open to him or her to gain a practical purchase on it.

Even so, an important element of counselling and therapy is the focus on the practical question of what, if anything, the person can do to alleviate his or her distress. For obvious reasons, this question, to be effective at all, can be raised only after the process of clarification which I talked of earlier. If, following that clarification, it does indeed appear that there might be practical procedures open to the person to make a material difference to his or her predicament, then it is likely to be a valuable part of the counsellor’s function to encourage him or her to take them.

The kind of things this might entail usually involve people adopting a different position in the world which constitutes their environment. In other words, this is much more than simply a question of seeing or thinking of things differently, and involves making actual changes to real circumstances. The kinds of changes to be considered might, for example, involve learning to relate differently to people at home or at work; to acquire knowledge or skills which will help with vocational or financial problems; to recognize that physical circumstances, and not just psychological factors, are a real problem, and to act accordingly. Schooled by over a century of magical psychology, people are only too ready to believe that ‘it’s just me’ when in fact it’s things (and people!) happening to them which are causing their distress.

Often, as I’ve said, people will already have tried all the possible avenues open to them and quite possibly found that the powers and resources that could make a difference are not available to them. Where this is the case, exhortations from therapists and counsellors that clients should ‘take responsibility’ for the situation are not only vain, but cruel. There is therefore an important judgement to be made as to whether there are measures which the person could take which are truly within his or her reach. A familiar example would be the intelligent and sensitive middle-aged woman who has been convinced from years of male bullying and exploitation that she is incapable getting a training and/or a job and leading more of an independent life. Therapeutic encouragement in circumstances such as these can be of real assistance – but it does mean staying with the client reliably and possibly over quite long periods of time.

The ability to be helpful to people in distress is not something which should or could be appropriated by a professional elite. What is in consideration here is not a market in the transformation of selves, but the very essence of human being (which for all of us includes the inevitability of suffering) and relatedness (which means solidarity and mutual assistance). This is not to say that one cannot study the processes of helping, distinguish between what is more and less helpful and so on. If one looks at the results of such study dispassionately and in good faith, I think one is pointed more in the direction of inclusiveness than of exclusiveness: that is to say, there are many ways of being helpful from many different kinds of people. There can surely be little dispute as to how much our society needs them.

David Smail
Kettering, July 2000

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