Counselling - is it good to talk?
Counselling is increasingly being offered to anyone who has suffered some kind of emotional distress. But does it really work or is it little more than a modern form of cure-all snake oil?
Modern society now takes counselling so seriously that therapy has worked its way into the legal system. When actress Winona Ryder was found guilty of shoplifting, her lawyers argued that, rather than face a jail term, she should be given counselling. Violent husbands in the UK, until recently, were given a "sentence" of counselling in a bid to tackle the root cause.
Then there are high-profile counselling cases: relatives of Harold Shipman's victims, and the pupils at the Soham school attended by Holly Wells and Jessica Chapman. There are also the seemingly absurd cases: pet insurance offering grief counselling as part of the package. And there is even counselling offered to people before something happens.
Two recent studies, however, have questioned, not only whether counselling is beneficial, but also whether it may actually be damaging.
One US study reviewed the effectiveness of counselling sessions given to survivors of the World Trade Center attacks soon after the event - known as "debriefings". The researchers concluded that, far from helping people come to terms with the incident, the therapy "may have even put some survivors at an increased risk of later developing mental health problems" - by making them relive the event.
A second Dutch study, published in The Lancet, analysed similar debriefings, and found there was little difference in the long-term health benefits between people who had undergone counselling and those who had not, or those who had simply spoken to family and friends.
Many experts have been dubious about the benefits of counselling for some time. UK consultant, psychiatrist Martin Deahl reported in 1998 that those routinely exposed to traumatic situations, such as people in the emergency services, aid workers and journalists, were better served by "stress-inoculation" techniques before an event, rather than counselling afterwards.
And back in 2000, Dr Jo Rick - a researcher for the Institute of Employment Studies at the University of Sussex - warned the British Psychological Association that a joint study found no evidence that debriefing helped victims in the long term, but there was evidence it had harmed them. "At best its efficacy is neutral and at worst it can be damaging," she said.
Listening and thinking
But this view is strongly contested by some. Phillip Hodson, a fellow of the British Association for Counselling and Psychotherapy, says that, not only are these assertions wrong, but they also misunderstand the nature of counselling.
"These studies are over-reported and flawed," he says, pointing to other studies by the Department of Health that support counselling. "Let's be clear: bad counselling is bad, and bad psychotherapy is bad. The problem is that the industry remains unregulated by government despite our demands for it to be so."
Mr Hodson draws a clear line between counselling, debriefing and trauma support. "Counselling isn't offered in an emergency or crisis. It is a reflective process and you do have to be in possession of all your faculties."
Not that "debriefing" is not important. "If there is a train crash, you'd have to be a pretty heartless beast not to ask someone if they are all right," he says. "But sometimes intervention made at that point may be inappropriate and do more hurt that good. Some people may not be ready."
He says there is a the major difference between counselling and what is increasingly becoming a money-spinner for at best do-gooders, at worst, quacks. "If you call me and say your wife needs to see a counsellor, I'd say, 'Okay, get her to call me'. It's not a matter of, 'Great, I've got another one'. Not everybody needs help. You can't counsel people against their will."
Helping you help yourself
So is counselling damaging? There is certainly increasing evidence that our obsession with talking about our feelings, combined with a lack of regulation, may be inadvertently damaging those not yet ready to talk about traumatic experiences.
Ironically, some people actually shun counselling, fearful that it means they have somehow failed or that it is only for major traumas. But most people, at some time in their life, will find themselves having difficulty coping.
We all need people to talk to, and often our friends or family will provide enough support. However, increasingly in our society, where we are less likely to live close to the people who are important to us, or when we feel uncomfortable discussing certain topics with friends, a counsellor can form a vital function and help us get back on our feet.
From depression to bereavement, counsellors are trained to help people work through their problems without judgement. Put simply, if you do feel the need to talk to someone who'll be able to help you, advocates say you probably should.
British Association for Counselling and Psychotherapy