Some degree of distress just proves the process is working

‘Get help and get happy!” runs a tagline for one of the new generation of e-counselling services, offering psychotherapy by text, phone and video chat. Except it turns out that getting happy is by no means guaranteed to be therapy’s only outcome. One recent paper (which I found via the excellent Research Digest blog) estimates that, when it comes to cognitive behavioural therapy, 43% of clients will experience unwanted side-effects like distress, a deterioration in their symptoms, or strained family relations. “Psychotherapy is not harmless,” the paper’s authors conclude. It’s useful research. But that conclusion highlights a widespread belief about therapy that gets stranger the longer you dwell on it: why on earth would anyone assume it was harmless in the first place?

There are echoes, here, of the surprise that greets media revelations that mindfulness meditation – another seemingly guaranteed path to happiness – has its perils. Beginners, especially if they’ve experienced trauma, sometimes report emotional “flooding”: once they turn their attention inwards, and follow the instructions to notice their emotions without...

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Mental health is a level of psychological well-being, or an absence of a mental disorder; it is the "psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment".

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26 March 2019