That famous stiff upper lip, it turns out, may well get you through the after-effects of shock much better than spilling your guts to a therapist.
The popular assumption is that talking about a terrifying experience, such as a terrorist attack or natural disaster, can be therapeutic and helpful.
But new evidence suggests “getting it off your chest” may not be the right thing to do.
Psychologists in the US used an online survey to test people’s responses to the September 11 2001 terrorist attacks on New York and Washington.
Those who chose to express their thoughts and feelings were compared with those who did not over a two-year period.
To their surprise, individuals who bottled up their feelings ended up better off. They suffered fewer negative mental and physical health symptoms than people who were willing to talk.
I’m always pleased to see another nail hammered into the therapy industry’s coffin.
Can I raise the possibility of a selection bias here?
The thought occurs that at least some of those who chose not to talk about what happened may have been simply those who were less traumatised in the first place – and therefore felt no need to talk about it. Likewise, those who were more traumatised may have therefore felt more need to discuss it.
Or simply looking for a shot at appearing on Oprah?
“It’s important to remember that not everyone copes with events in the same way, and in the immediate aftermath of a collective trauma, it is perfectly healthy to not want to express one’s thoughts and feelings,” he said.
Equally expressing one’s thoughts and emotions may be the healthy thing for an individual to do. As Z says those who didn’t need to talk about their experiences were presumably less traumatised by their experiences in the first place. And those that did receive counselling may have been in a worse state had they not had the opportunity to talk about their experiences.
So far at least 255 veterans of the Falklands conflict are believed to have killed themselves since the conflict ended in 1982 over twice the number that died in the fighting itself. I hope the Army have learnt their lesson and are offering some kind of trauma counselling to the service men and women returning from Iraq and Afghanistan. If they have it will be interesting to compare the suicide statistics from this and other wars. If are have not then society will have a demographic time bomb given the numbers who have seen active service out there and given that most symptoms of PTSD emerge sone 10 to 15 years after the event.
But I agree with Beakie in as far as if someone does not want or need counselling following a trauma it should not be forced on them.
My thoughts, for what they’re worth: some people will want to talk about it, some won’t. For those people who want to talk about it, by far the best option would be a nice cup of tea and a long chat with someone who is a good friend or a caring relative. I’ve pretty much lost all faith in therapists to provide anything better.
“Can I raise the possibility of a selection bias here? ”
Gah, well yes, what my other half said
Two other points :
1) It’s a sort of self-help therapy. Like drugs, ECT, surgery and other therapy, there are risks and benefits. Just because it’s talking and doesn’t involve gadgets, gizmos and overt science (like funny two-coloured capsules to swallow with bobbles inside) doesn’t mean it’s placebo. You meddle with your mind, you intervene, and for some folk there are treatment emergent adverse events. Surely none of us surprised by this?
2) We do know that “counselling” given promptly after events correlates with worse outcomes. This is reflected in NICE Guidance for PTSD. You don’t give therapy straight away. Letting yourself have space and letting your mind process stuff without focussing and interfering and pathologising it is known to be associated with better outcomes.
Law 13 tells us, “THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.”
So true
@beakie
some people will want to talk about it, some won’t. For those people who want to talk about it, by far the best option would be a nice cup of tea and a long chat with someone who is a good friend or a caring relative. I’ve pretty much lost all faith in therapists to provide anything better.
Well, yes. A lot of people will want to talk to someone about things, and will be able to get that from a friend or relative.
So…what are therapists good for?
Well, they’re for people who can’t talk about it to their family or friends – perhaps because they’ve become totally alienated or isolated from their peers, or their family and friends aren’t likely to want to listen (this kid is a good example of that), or because it involves deeply personal stuff that they might not want to share with their peers (“Fancy a pint, lads? While we’re down the pub, let’s have a chat about when my uncle used to touch me up.”)
Other things therapy is useful for:
- building up trust and a personal relationship, particularly for people who’ve forgotten how to do this, or never learned in the first place.
- challenging negative thought patterns/behaviours and reinforcing positive ones. This is where your CBT techniques like “evidence-based thinking” come in.
- problem-solving
- getting people to communicate when they’re not communicating, particularly in systemic or family therapy. Basically banging heads together that need banging together
- teaching new skills: anger/anxiety management, assertiveness, social skills
None of the above are rocket science, and it certainly doesn’t justify some of the exorbitant fees therapists in the private sector charge for it, and I certainly agree that a lot of people will be able to do this without going to see a therapy. But for those who for whatever reason CAN’T do this elsewhere – that’s where the therapist comes in handy.
Also there’s the other stuff that you can get done while simultaneously doing the therapy – assessing mental state, monitoring medication concordance and side effects, psychoeducation etc.
You mount a defence of the therapy industry that I’ve heard before, Z and I’m afraid I don’t buy it. Therapies share a lot in common with homeopathy and acupuncture: they are largely based on untested assumptions, and are mostly placebo in their effect in that what makes the difference is the relationship, not the therapy per se.
I think people are much better served by self-help or by support groups, wherein they can build up trusting relationships, challenge negative thinking, solve problems for themselves and learn new skills without having to fork out huge amounts of money to some self-appointed expert. I think claims made for talking therapies are hugely overinflated and they also serve to privilege the professional voice over the patient’s.
Not entirely a defence, Beakie. For one thing, I’ve conceded that it’s overpriced (in the private sector, anyway – NHS therapists just get a regular NHS salary).
For what it’s worth, I also agree that the relationship is what makes the difference rather than necessarily the techniques themselves (some of them can be useful tools, but it’s the relationship that counts). The only difference between you and me is that I don’t have a problem with that.
I`m agreeing with Beakie, which is far more likely to give me psychological trauma than any of my operational military service.
Looking at the bigger picture, the medical model is simply awful. Yet it`s dominance is barely challenged. If psychotherapy were, in any way, cutting the mustard would there really be millions of people on psychiatric medication ?.
Beakie`s spot on about self help and support groups too. Nothing terrifies psychiatry and psychotherapy more than simple solutions. No one wants to consider a burger flipping future.
I meet a lot of patients who are not a member of patient organisation and are not interested in meeting other patients or going to support groups. And a lot of my patients have tried the neighbour, selfhelp books and they come to the psychiatrist because it didn’t work for them. I personally like simple solutions, but sometimes life is not simple.
“No one wants to consider a burger flipping future”
Depends on how good your relationship is with the burger and not the flipping, per se.
OSB – you agree with me more than you disagree with me, did you know that?
*evil cackle*
In my experience, patients don’t need a cognitive behavioural perspective on their symptoms or a psychodynamic exploration of their own navel button, they need money, a bunch of friends, a decent place to live, a job or something meaningful to do during the day plus or minus a regular girlfriend/boyfriend or, at the very least, someone who actually gives a shit about them. It’s my belief that services should be helping them get those things (while doling out a bit of judiciously used medication to control the symptoms) instead of noodling about with therapies of dubious worth. I suspect that very soon, even the great and powerful CBT will turn out to be a crock for most people.
And Z, you’re right that I have a problem with the relationship being more important than the therapy used, because it’s dishonest therefore to claim any kind of efficacy for any therapy and thus attract funding and government backing. If it doesn’t matter whether it’s CBT or Rogerian counselling, then the CBT people really shouldn’t be having their pockets stuffed with gold to provide therapy for the NHS, training for NHS staff and what have you.
I can’t think of any other (medical) discipline that agonises so frequently about the value of its day to day tools (be it one brand of therapy vs another, the value of psychiatric drugs, or ECT, etc, etc).
If the professionals are so divided/unsure (about prospective benefits) how can anyone confidently advocate the use of one intervention over another ?
Of course as a rather gauche staff nurse on an acute psychiatric ward I realised very quickly that I had more questions than answers.
One of my main gripes back then was the lack of any meaningful framework to involve/engage families once patients had been admitted to the ward.
I was a keen proponent of systemic ideas back then, but I had no idea if this approach would have made a difference.
A fairly standard question (popular amongst the family lot) was, are you ‘depressed’ or are you ‘oppressed’ – god, we must have sounded like right wankers ?
Beakie
Beneath the shouting, I think your views and mine are actually quite close together. I’m inclined to agree that CBT is simply the latest fashion rather than a cure-all. Some of the techniques involved can be useful in a “just another tool in the tool box” kind of way, but not really any more than that.
I personally would love the NICE guidelines to stop looking for the latest CBT model to plug and start emphasising the importance of the therapeutic relationship. Sadly, I don’t see that happening any time soon. It should though.
I also certainly agree that talking therapies are not any sort of cure-all, and for plenty of people with mental health problems it may not be high up on their order of priorities. Within a CAMHS setting, since it’s my field, I think psychotherapy should be targeted mainly at eating disorders, mood disorders and teenagers who are developing or at risk of developing borderline personality disorders, plus to a lesser extent some problem-solving and social skills work for kids on the autistic spectrum.
Unfortunately in CAMHS there seems to be a lot of pressure for the talking therapies to be focusing on kids with conduct problems and ADHD, who are precisely the kids for whom psychotherapy is usually a complete waste of time.
You won`t think of another discipline Charge Nurse, that`s because there isn`t one. No one likes to have their professional competence questioned, however, if an alien or a truly impartial observer were to look at the mental health world and conclude we`ve no idea what we`re doing – they would have a point.
My latest Blog is linked to your blog on Be British. Trauma and Human Resilience is of course the title of the last chapter of my book, The Cockroach Catcher.
The Cockroach Catcher
Interesting post, Cockroachcatcher. I particularly agree with this bit:
A good therapist is hard to come by, and should be like a wise aunt or uncle to whom one turns to for advice that one may or may not accept or act on. A good therapist needs to be intelligent and broad-minded, and mature with rich life experience. A bad therapist, on the other hand, takes over and does not allow for any leeway on how one should continue with life.
Until you can find one it is best to BE BRITISH.
Thanks.
The Cockroach Catcher
Oo gosh Z, sorry if you thought I was shouting at you!
In my experience, patients don’t need a cognitive behavioural perspective on their symptoms or a psychodynamic exploration of their own navel button, they need money, a bunch of friends, a decent place to live, a job or something meaningful to do during the day plus or minus a regular girlfriend/boyfriend or, at the very least, someone who actually gives a shit about them. It’s my belief that services should be helping them get those things (while doling out a bit of judiciously used medication to control the symptoms) instead of noodling about with therapies of dubious worth. I suspect that very soon, even the great and powerful CBT will turn out to be a crock for most people.
Beakie, you might be right, but if you are not able to keep friends, or are always making stupid decisions so you don’t have money, or are not able to find a decent job because you don’t know what you want, then maybe, therapy might help to be able to keep friends and have a better live. Therapy is really helpful for some people.