of help: psychiatric medication, CBT and psychotherapy. Each has its own advantages

and drawbacks. Medication can be exemplary in a crisis, at points when the mind is so

under siege from fear, anxiety or despair that thinking things through cannot be an

option. Correctly administered, without requiring any conscious cooperation from us, pills play

around with our brain chemistry in a way that helps us get through to the next day – and

the one after. We may get very sleepy, a bit nauseous or rather foggy in the process, but

at least we're still around – and functioning, more or less. Then there is Cognitive Behavioural

Therapy (CBT), normally administered by psychologists and psychiatrists in six to ten hour-long

sessions which teach us techniques for arguing rationally with, and with any luck at points

controlling, the ghoulish certainties thrown up by our internal persecutors: paranoia,

low self-esteem, shame and panic. Lastly there is psychotherapy, which from a distance looks

like it has only drawbacks. Psychotherapy has a very hard time showing its efficacy in scientific

trials – and has to plead that its results are too singular neatly to fit the models

offered by statisticians. Also, It takes up a large amount of time, demanding perhaps two sessions

a week for a couple of years – and is therefore by far the most expensive option on the menu.

Finally, psychotherapy requires active engagement from its patients and sustained emotional effort;

one can't simply allow chemistry to do the work. And yet, psychotherapy is, in certain

cases, a hugely effective choice, which properly alleviates pain not by magic or chance , but

for three solidly-founded reasons: – Firstly, our unconscious feelings become conscious. A founding

idea of psychotherapy is that we get mentally unwell, have a breakdown or develop phobias

because we are not sufficiently aware of the difficulties we have been through. Somewhere

in the past, we have endured certain situations that were so troubling or sad, they outstripped

our rational faculties and had to be pushed out of day-to-day awareness. For example,

we can't remember the real dynamics of our relationship with a parent; we can't see

what we do every time someone tries to get close to us, nor trace the origins of our

self-sabotage or panic around sex. Victims of our unconscious, we can't grasp what

we long for or are terrified by. In such cases, we can't not be healed simply through rational

discussion, as proponents of CBT implicitly propose, because we can't fathom what is

powering our distress in the first place. Psychotherapy is a tool for correcting our self-ignorance

in the most profound ways. It provides us with a space in which we can, in safety, say

whatever comes into our heads. The therapist won't be disgusted or surprised or bored.

They have seen everything already. In their company, we can feel acceptable and our secrets

sympathetically unpacked. As a result, crucial ideas and feelings bubble up from the unconscious

and are healed through exposure, interpretation and contextualisation.

We cry about incidents we didn't even know, before the session started that we'd been through or felt so strongly

about. The ghosts of the past are seen in daylight and are laid to rest. There is a

second reason why psychotherapy can work so well: Transference: Transference is a technical

term that describes the way, once therapy develops, a patient will start to behave towards

the therapist in ways that echo aspects of their most important and most traumatic past

relationships. A patient with a punitive parent might – for example – develop a strong

feeling that the therapist must find them revolting, or boring. Or a patient who needed

to keep a depressed parent cheerful when they were small might feel compelled to put up

a jokey facade whenever dangerously sad topics come into view. We transfer like this outside

therapy all the time, but there, what we're doing doesn't get noticed or properly dealt

with. However, psychotherapy is a controlled experiment that can teach us to observe what we're

up to, understand where our impulses come from – and then adjust our behaviour in

less unfortunate directions. The therapist might gently ask the patient why they're

so convinced they must be disgusting. Or they might lead them to see how their use of jokey

sarcasm is covering up underlining sadness and terror. The patient thereby starts to spot the distortions

in their expectations set up by their history – and develops less self-defeating ways

of interacting with people in their lives going forward. Then the third reason why psychotherapy works. It is the first good relationship

We are, many of us, critically damaged by the legacy of past bad relationships. When

we were defenceless and small, we did not have the luxury of experiencing people who

were reliable, who listened to us, who set the right boundaries and helped us to feel

legitimate and worthy. However, when things go well, the therapist

is experienced as the first truly supportive and reliable person we've yet encountered.

They become the good parent we so needed and maybe never had. In their company, we can regress

to stages of development that went wrong and relive them with a better ending. Now we can

express need, we can be properly angry and entirely devastated and they will take it

– thereby making good years of pain. One good relationship becomes the model for

relationships outside the therapy room. The therapist's moderate, intelligent voice

becomes part of our own inner dialogue. We are cured through continuous, repeated exposure

to sanity and kindness. Psychotherapy won't work for everyone; one has to be in

the right place in one's mind, one has to stumble on a good therapist and be in a position

to give the process due time and care. But all that said, with a fair wind, psychotherapy

also has the chance to be the best thing we ever get around to doing.

If you are interested in trying psychotherapy, The School of Life offers a service in person in London,

or by Skype around the world. Click on the link for further details.