Oliver James: Couch potatoes

The exotic menagerie of clients receiving help in Paul Whitehouse's subtly hilarious TV series of the same name are a fine testament to the abnormality of normality and the sloppy loucheness of too many therapists. Whitehouse was inspired to write it because he benefited from help himself, following the break-up of his marriage. Unfortunately, it is largely unknown whether his happy experience is the exception. The matter of whether therapy does more good than harm is still a matter of considerable controversy.

A recent review of the evidence (Psychological Bulletin) concluded that there are severe shortcomings to the studies of its effectiveness. Results are blurred because a high proportion of patients have more than one mental illness and this is not taken into account. The impact of the personality of both patient and therapist is usually ignored. Patients are rarely followed up for nearly long enough after the treatment has ended; while the much-lauded cognitive behavioural (think positive) variants come out well in the short-term, they can emerge largely ineffectual after five years.

The most maligned and least easily tested therapy is that done in the psychoanalytic tradition, invented by Freud. At present, it is best proven to work with personality disorders, like 'me, me, me' narcissism. It's expensive, time-consuming, and if done badly, potentially harmful.

I once sat down with my mother (who was a psychoanalyst) to go through all the people we knew well who had undergone it, about a hundred of them in all. There were some horror stories, like the gay man who was bent back into heterosexuality by his analyst and subsequently committed suicide. Then there was the depressed teenager who, when her father died suddenly in a tragic accident, was told her wish to miss a session in order to attend the funeral was an excuse to avoid the therapy, and then was not allowed to talk about his death in it.

Thankfully, such cases were only a handful. In most of the others, having known them 'before and after' over many years, their experience had equipped them to lead constructive lives. In the best outcomes, their worthwhile careers and impressive performance as parents were inconceivable without that help.

But how do you find a good psychoanalytic therapist. Assuming they have had a truly analytic training (insist they tell you the full name of the organisation which trained them, write it down and call the British Confederation of Psychotherapists, 020 7267 3626), as in any other profession, some are a lot better than others and very few are good for all kinds of problems. My dad, also a psychoanalyst, was better with men than women, for example.

The ideal scenario is if you can check out two or three different therapists recommended by someone who you knew well before they started therapy, with roughly similar problems. Easier said than done.

My strongest tip would be not to stick it out for more than a year if you do not feel the therapist is much cop - and start again.

The mental block

The hormone cortisol prepares us for 'fight or flight' and is triggered by challenges or threats. Having high levels for extended periods damages physical and mental health, weakening the immune system and creating depression and anxiety.

A meta-analysis of 208 experimental studies (Psychological Bulletin) examined which kinds of stressors elevated cortisol. Tasks that did so were ones which induced a loss of control or which caused people to fear they would be judged negatively, for example, by an audience. It also took longer for the level to drop to normal after exposure to these. By contrast, although tasks such as being exposed to loud noises or nasty films led to a depressed mood, because they did not entail fear of being judged or being out of control, cortisol levels did not rise.

Implication: avoid chronic exposure to uncontrollable situations and try not to worry too much about what other people think. Good luck!

A recent review of 14 studies in which adult reports of childhood abuse or neglect were checked by other sources - such as siblings, parents or official records - found that in most cases, the reports are reliable. In one-third of cases where an adult was definitely corroborated as having been maltreated as a child (eg, a social worker was called in), when asked about it in adulthood they denied it ever happened.

Implication: far from False Memory Syndrome being a major problem, there is more likely to be denial and repression of bad childhood experiences.

Thanks to guardian.co.uk who have provided this article. View the original here.