Therapy: Everything you wanted to know but were too afraid to ask

More and more people are seeking help for mental illness - but what happens after the first trip to the GP?

(selimaksan/iStock)

James* first sought therapy when he came home to find his flatmate dead. He had taken his own life.

Despite this deeply traumatic experience, he was reluctant to get help. He was worried he wouldn't respond well to therapy, and his view had been skewed by how therapists - who poke and prod at your life - are represented in the movies.

“I was nervous,” the 29-year-old living in London tells The Independent. “I thought the therapist would try to ‘go back’ and unpick previous trauma from my family life, something that I think I picked up from popular culture representations of therapy.”

From those struggling with the weight of depression or attempting to cope with the near-constant tension of anxiety, more and more people are seeking help for mental health issues. James is among them. Over a quarter of people in the UK have visited a therapist, compared with one in five in 2010, and depression is the fastest growing condition that GPs must deal with.

Many therapists use cognitive behavioural therapy to treat patients with anxiety, depression, OCD, post-traumatic stress disorder, phobias, eating disorders, sleep problems, and addiction. The sessions work by helping the patient to tackle negative thoughts that are debilitating their life.

But after plucking up the courage to tell a medic that your mental health is waning, what happens next can feel unclear, says London-based psychotherapist William Pullen, and the author of self-help book Run for Your Life.

​“I try to normalise the fear, explaining that such a reaction is understandable while also suggesting they view it as a practical solution - like a service on a car,” he explains.

One of the biggest misconceptions people have is that therapists have all the answers, he adds.

“Many people have no idea what kind of approach their therapist follows,” he says. “Their research tends to centre around the problem at hand, post-codes and cost.”

James, who admits he was worried his sarcasm would block his progress with a therapist, said the experience wasn’t what he assumed it would be. “It was more talking through the guilt I felt in not being able to stop the events. This, as well as talking through the anger I felt, which stopped it coming out in other areas of my life."

"I wear my heart on my sleeve a little more now, which can be tough at times," he says, adding: "But I like the person it has made me."

Claire, a 25-year-old from Brighton, meanwhile didn’t have the space in her mind to feel nervous about trying to ease her mental ill-health three years ago. “I sought therapy after a general sh*t storm in my life,” she tells The Independent. She stopped being able to cope with her anxiety when she was studying for a masters degree, had recently come out of a long-term relationship, and her mother was struggling with depression. This was compounded by heavy partying. “My family was at the point of collapse,” she says. By the time she reached out for help she says she was “too tired to feel anything.”

“I just remember getting to uni one day, and uncontrollably crying. In that moment I just knew that it wasn’t right to be so emotionally fragile that I couldn’t get myself to uni without a breakdown, so I just walked straight to the counselling office, tears still going strong, and asked to talk to someone.”

“I didn’t want therapy or counselling but I just didn’t see what else to do. While I’m very open about my life with those close to me, the thought of speaker to a stranger about the darkest moments of my life was utterly terrifying.”

Uncertain of what to expect she soon realised therapists can’t offer a magic bullet. And after her first therapist left for maternity, leave she struggled to gel with her replacement. She suggested Claire should take anti-depressants, even-though she had stressed she wanted to avoid this.

“As the sessions went on she actually made me feel more frustrated and I felt that she was putting word into my mouth.

“She said that I should go to the doctor and tell them that I was thinking of ending my life. This she got from the fact that in one of our sessions I said to her that I couldn’t see the point to life and I didn’t know what I was working towards anymore. But that was a philosophical pondering, not a suicidal admission." She was so upset that she cancelled all other appointments with the therapist that day.

Pullen explains that the patient-therapist relationship is the most important factor of the process. “Never settle for someone who doesn't feel right just because you think that's how it should be," he stresses. "Bring your doubts into the room with your therapist and explore them together.”

“With therapists I’ve seen since I would say naturally you get more comfortable over time, and it’s more of a friendship," adds Claire. "I got more comfortable with silence as the time went on, and more comfortable thinking in front of someone. It’s hard to structure your thoughts when someone’s watching. Sometimes it’s harder to say nothing at all."

Her advice for those who are nervous about seeking therapy is: “Don’t be. Who are you trying to impress, after all? There’s no shame in needing someone and actively trying to make your life better. Enjoy the rush of letting go of everything that’s been holding you down. It’s OK to be sad, and it’s OK to talk about being sad."

“Going in, know what you want," she adds. "I went and I just wanted to feel better, which ultimately only made me feel worse because I couldn’t answer any of the questions about how I was going to get to this happier place. They can’t do it for you."

Jane, who is 36 and lives in London, had bad experiences with a therapist in her twenties, revisited CBT to help her cope with her husband’s severe depression and suicidal thoughts.

“The downside to therapy is feeling exhausted after the sessions,” she says. The stigma around therapy has also been an issue.

“I have been open and honest with my friends and work colleagues that I have had therapy, it does open you up to criticism from people who do not understand but from my experience it is much healthier to get help when you need it than to deny a problem and become so entrenched in negative thoughts and behaviours that the struggle to get better is harder.”

James, Claire and Jane all chime that despite being stressful in itself at times, they are glad they sought help.

“The Japanese have a word Ma - the space between things,” says Pullen. “Find that space, because this fast paced world we live in can be exhausting and unsatisfying.

If you are having suicidal thoughts, you can call Samaritans on 116 123.