YOU’D imagine – wouldn’t you? – that we Irish are pretty good at talking. Telly chat shows. Radio talk-ins. Texting; e-mails; Tweeting. Talk seems to be inescapable these days. But one kind of talk has gone strangely quiet, and that’s the kind where people lie on the therapist’s couch and talk themselves better.
Psychoanalysis – once the therapy of choice for everybody who was anybody – has been eclipsed by treatments such as cognitive behaviour therapy, which appear to offer quicker, cheaper results. “People have a kind of Woody Allen idea that psychoanalytic psychotherapy is self-indulgent,” says Ann Murphy. “That it’s about lying on a couch and blaming other people for your problems.”
A clinical psychologist who trained in Canada, Murphy begs to disagree with this view – which is why, on her return to Ireland as a practitioner, she set up a low-cost clinic which offers long-term therapy at rock-bottom rates to people who wouldn’t otherwise have access to it. She’s convinced that in these days of financial uncertainty, when unemployment can throw lives into sudden and catastrophic disorder, psychoanalysis is more useful than ever. “This kind of therapy is about developing the capacity to face the truth,” she says.
It’s not, she hastens to add, suitable for everybody. Psychotherapy is helpful in situations which involve anxiety, relationship difficulties, or mild to moderate depression: it’s definitely not for anyone who has a serious diagnosed psychiatric illness or an active addiction. “It’s important for people to understand what the process is, as it can take a long time and it’s a big commitment,” Murphy says.
“It can be painful. The treatment itself is designed to bring up feelings and emotions which can be very disturbing. People sometimes think, ‘Well, I’ll have three sessions and all my problems will be solved’. That’s not how it works. It’s not directive. The therapist doesn’t give advice. What psychotherapy offers, instead, is the opportunity to work through problems in real time.”
The low-cost clinic operates in conjunction with the master’s degree course in psychotherapy run by the Irish Institute of Psychoanalytic Psychotherapists and accredited by Trinity College, Dublin. Graduates and senior trainees accept clients at greatly reduced costs: €40 for those who have an income, €20 for anyone who is unemployed. Potential clients get in touch with the Irish Psychoanalytic Clinic (IIPP), have an initial consultation and are then referred to a participating therapist. Most of these are in Dublin, although there are some in Galway, Carlow, Kilkenny and the Midlands as well. The arrangement is of benefit to both sides; and if it sounds like Murphy is letting a bunch of untrained students loose in the real psychological world, that’s not how it works. “Not every graduate student is suited to this work – and even when they’re given the OK, they’re closely supervised,” she says.
Not surprisingly, she is critical of the way in which the health services in Ireland have – to all intents and purposes – written psychotherapy out of the therapeutic script.
“Short-term therapies, such as cognitive behaviour therapy (CBT), tend to be sold to the health services as the best – indeed, the only – option,” she says. “But if someone is supposed to be ‘fixed’ after 10 sessions of CBT, who’s going to follow up on that? Who’s going to check it out – and how can you prove it?” CBT aims to jolt people into behavioural change by “prescribing” new ways to think about problems, or new ways to organise problematic areas of life. Murphy insists that a slower, less dramatic process can be much more beneficial in the long term.
“People develop mechanisms to cope with emotional pain. The coping mechanisms are themselves painful – but they’re used to that pain, because it has been developed very slowly and gradually,” she says. “That’s why this form of therapy is gradual as well. It creates a space where people can develop new ways of dealing with their difficulties. It’s not about shock or control or forcing some kind of solution on the client.”
If the therapy is open-ended, how do you decide when someone is “fixed”? “How we work is that both therapist and client come to an agreement,” Murphy says. “The client may feel that their anxieties have diminished, or that areas of life which felt blocked feel freer, or they may have faced things they couldn’t face before.”
These days, she says, we all carry the illusion of “perfection” in our personal lives. One outcome of psychotherapy is a more realistic approach.
“The human condition is often painful and traumatic. Psychotherapy is about having the resources to cope with those kinds of challenges. It’s not saying you won’t suffer loss and pain – but you’ll be better placed to deal with them if you do.” Not even Woody Allen could quibble with that.