Dorothy Rowe

OpenMind - Journal of the mental health association MIND

January 2003

ARE YOU SUITABLE FOR THERAPY?

Dorothy Rowe

Jonathan, who'd read one of my books, wrote to me to tell me what had happened to him when he'd asked his GP to refer him to an NHS psychology department for therapy. He was sent an appointment, but when he went along he was told that this was an assessment, not the start of psychotherapy. A week later he was sent a letter which stated that he was 'not suitable for psychotherapy'. He was very distressed by this and wrote to me to ask, 'Does this mean I can never get any psychotherapy?'

This happened about four years ago, and I hope that by now all psychology departments have worked out much kinder ways of letting some of the people referred to them know that they will not be offered an appointment because they, the psychologists, don't have anything to offer them. However, there is a long tradition in the psychiatric system of blaming the patient for the failures of the professionals.

Nowadays psychiatrists call those patients who fail to respond to the psychiatrists' treatment 'treatment-resistant patients'. In the olden days, before psychiatrists learned management-speak, they were quite straightforward in their prejudices about certain patients. I worked with psychiatrists who believed that therapy only made those that they called 'schizophrenics' worse. However, these psychiatrists were quite frightened of university students who may have become psychotic after taking illegal drugs. (It wasn't the effect of the drugs the psychiatrists feared so much as the possibility that the students were brighter than they were.) So they gave the students the diagnosis of 'drug-induced psychosis' and sent them to us psychologists. Unhappily married, middle-aged women who refused to respond to the standard treatment for endogenous depression (pills and ECT) were shunted off to us. Sometimes a psychiatrist would take against a particular patient, and say to me, 'Look, I can't stand this chap. Will you take him off my hands?' One of the nicest men I've ever met was referred to me in this way.

This was back in the days when we psychologists didn't have managers looking over our shoulders, telling us how many patients we should be seeing, irrespective of the depth of distress each patient suffered. Today psychologists are well aware of the managers' need that waiting lists be kept short and large numbers of patients be seen, even though this 'seeing' may make not an iota of difference to the patient's individual predicament. Psychologists know that they have excellent skills to help people who have relatively new and clearly defined problems, but that they are no better than most therapists and counsellors in helping those people whose distress is rooted in childhood and permeates every aspect of their life, and that they are no better than the rest of society in dealing with the effects of social and economic conditions over which we have no control.

Psychologists, like therapists and counsellors, want to be able to think of themselves being good at their job. Unless they are completely honest with themselves they can easily allow themselves to use the jargon of management and of therapy to condemn the people who fail to get better.

It is obvious that if someone is sent along to therapy against their will that person is unlikely to benefit from therapy. Recently I was at a conference where a particular therapeutic method for adolescents who were not fitting in to school was discussed. The therapist using this method remarked that he wouldn't accept anyone who hadn't chosen to attend, but later in the discussion he referred to such teenagers as being 'in denial'. They wouldn't admit that they had a problem. Such language ruled out the possibility that these teenagers didn't have a problem intrinsic to them but that they were responding in socially unacceptable ways to the pressures and expectations put on them by their family, their school and society. Indeed, this possibility had already been ruled out. Psychiatrists had already diagnosed such teenagers as 'suffering from Oppositional Defiant Disorder', a diagnosis which absolves all adults from responsibility for a teenager's reaction to a situation created and forced on to the teenager by adults.

When we suffer from mental distress we are more than inclined to take to heart every negative comment someone may make about us. So please remember that no one is unsuitable for therapy. It is just a matter of finding the therapist who can offer you the help that you need.