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On the couch

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The chicken is lying on the psychiatrist's couch. 'So,' says the doctor, 'why do you think you cross the road?'

What happens in the psychotherapist's office is mysterious and somewhat scary. Who are these people who know us better than we know ourselves? How can we trust them not to lock us up in a straitjacket, feed us drugs that turn us into zombies, or subject us to potentially dangerous electric shocks?

Yes, there are better drugs now, and a new understanding of the application of mild electroconvulsive therapy, but it's still not surprising that the mental health profession has a long way to go before it shakes off the stigma it acquired in the early 19th century. In the Western world, care for the mentally ill at that time consisted mostly of locking them up where they couldn't hurt other people, hence the reputation of 'loony bins' as places you wanted to avoid going to at all costs.

The now commonplace style of talking therapy only really began to take root at the beginning of the last century, when doctors such as Jean Charcot and his more famous student Sigmund Freud popularised their theories of psychoanalysis. This and other theories have spawned literally hundreds of possible forms of therapy, which are often used in combination with each other. The standing joke on the sitcom Frasier is that the main character is a Freudian and his brother Niles is a Jungian and they're always at odds, but in reality it's unlikely any modern therapist would align themselves so unbendingly with one way of thinking.

Authors Nigel C Benson and Borin van Loon, writing in their idiot-proof guide Introducing Psychotherapy(Icon Books, R145,95), describe seven main forms of psychotherapy. These are: medical therapy (Prozac and friends), behavioural therapy, cognitive therapy, humanistic therapy, group therapy and com-plementary therapies. That is not the only possible breakdown, though. The Mental Health Information Centre describes a different classification under the two headings of individual and group therapies. Individuals may expect to encounter person-centred therapy (same as humanistic), psychoanalysis (come back Freud, all is forgiven), hypnotherapy (you are feeling sleepy), transactional analysis, crisis intervention or cognitive behavioural therapy (see below for definitions of the trickier ones). Group therapies include family, marital or group psychotherapy. Other sources list postmodern therapy, gestalt therapy, play therapy and art therapy as main categories.

Probably the best way to find a form of therapy that suits your needs is to talk to friends, find out who does what and shop around a bit. Don't be shy to ask your doctor to recommend someone, and don't stick with someone if it's not working for you. You wouldn't stay with a dentist that gets on your nerves, so why should you hang around with a therapist that makes you grit your teeth? But while you're out shopping, here are some of the terms you might encounter, so that you can assess if this is something you want to explore.

Cognitive behavioural therapy – A very dynamic form of therapy, probably the direct opposite of the therapy stereo type of lolling about on a couch moaning about your mother. Not aimed at delving into all the sad things that hap- pened in your past, cognitive behavioural therapy rather aims to change current patterns of thinking and behaviour by ac- knowledging unrealistic beliefs or expectations. The person is given tasks to help them find new ways to cope, for example, one might be asked to keep a journal of thoughts or to practise positive actions.

Person-centred therapy (PCT) – this modern form of human- istic therapy is aimed at helping people remove blocks that prevent them from reaching their true potential. By talking about their feelings, ideas and behaviour, the person experiences personal growth, explain Gerber and Middle- ton. The therapist may ask the person to role-play talking to someone they're having a problem with, or may ask them to exaggerate their feelings to get to the bottom of them. Gestalt is a more challenging version of person-centred therapy.

Transactional analysis – Used to understand patterns of relating to other people, transactional analysis is based on an understanding that there are three main ego states: parent, child and adult. Depending on our life experiences, we may react to stressful situations mostly from our child ego state, or from a parent position. The ideal is to mostly react as an adult, although, of course, there are times when seeing things from child-like or parental point of view is an advantage.

Crisis intervention – Most often used as a short-term way to help a person through a life change or loss such as divorce, illness and bankruptcy. The idea is that the crisis can be used as a catalyst for learning a new coping skill.

Hypnotherapy – Before psychoanalysis took off, hypno- therapy was all the rage. The technique was to dangle some- thing in front of somone's eyes and talk in a quiet, soothing voice, until the person slipped into an alpha state of conscious relaxation. The theory was that in this super-relaxed state, one could access all the thoughts and feelings that usually wouldn't emerge. While it's still used as a tool by some therapists, it's most commonly combined with other types of psychotherapy.

Art therapy – This doesn't consist of just a bit of dabbling with paints and hoping you feel better soon. It's usually com- bined with analytic tools to help the person understand what their art is saying about their mental state. It's a particularly useful tool when dealing with children or others who may have difficulty expressing exactly what they're feeling. Music therapy, play therapy or dance therapy may be used in similar ways, to get in touch with the emotions through non-verbal means.

'HI, I'M AN OBSESSIVE- COMPULSIVE PERFECTIONIST'
Group therapy has spawned jokes in millions of movies, television series… even a dandruff shampoo ad in which the people at the social phobia group can cope with one another's foibles but not with the new guy's dandruff. There's a group for pretty much whatever ails you, from alcohol dependency and eating disorders to bipolar depression and schizophrenia.

Jokes aside, these kinds of groups, which usually run under the guidance of trained counsellors, who may or may not be psychologists, serve a vital function in providing sufferers with a crucial support network as they try to fit into a world that has scanty understanding of their condition. One of the largest and most widespread such networks in South Africa is the Depression and Anxiety Support Group, which not only holds group sessions but also provides ongoing information to the public and media.

  • Call them on (011) 783-1474 to find out where your nearest group meets.

    Loads of useful support and information on the promotion of mental health can also be supplied by:

  • SA Federation for Mental Health: (011) 242-9600
  • Mental Health Information Centre: (021) 938-9229
  • Cape Mental Health Society on: (021) 447-9040

    Image: Jean Leprini/ True Love magazine

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