An animated TV documentary broadcast by the BBC illustrates some useful ideas in counselling and psychotherapy. It’s a bit creepy, too.
The term counselling covers such a wide range of things that it can be very confusing. At one end of the range, it is fairly close to advice. At the other, it is indistinguishable from psychotherapy.
The documentary film, The Trouble with Love and Sex, uses the voices of real clients and counsellors in an animated film that weaves together three stories. The animation is well done, but we do not know how much of what we see is based on reality, nor indeed whether some of what we hear was recorded specially for the film.
Guidance counselling is an old-fashioned but useful term for counselling-as-advice. You go to a guidance counsellor to benefit from their knowledge about good solutions to the problems of ordinary everyday life. This is the kind of counselling shown in the documentary.
The advice you get from a guidance counsellor is somewhat personalized, in the sense that the counsellor has to understand your situation a little in order to choose from a selection of prefabricated solutions. However, the counsellor’s role is mainly to elicit information from you, categorize it, and inform you about the solution they think fits your situation best.
In the film, people sought guidance about relationships at the charity Relate. Counsellors interviewed them, advised them about the kind of things that are known to work in relationships, and encouraged them to adopt those solutions.
Facing problems can make people emotional. Guidance counsellors know to expect some shouting, and some tears. On a couple of occasions the film focussed on the box of tissues on the counselling room’s coffee table.
But in guidance counselling emotion is not central to the plot. Guidance counsellors, like other advisors, keep their distance from it. In the film this was portrayed as physical distance between the chairs in the counselling rooms, which faced each other directly — confrontationally.
When emotion is central to the plot, it changes the nature of the counselling. This is the kind of counselling that you can expect (well, OK, not expect, but you might get it if you are lucky) from the NHS, and from many private counselling practices.
Counselling of this kind deals with normal emotions. That is, the emotions relate to something that you can identify, but the emotions themselves disrupt your life to some extent.
To engage with an emotional problem, you and the counsellor have to get close. The chairs are probably not that far apart, they are probably on the same side of the coffee table, and they are probably angled instead of confronting each other.
Emotional counselling mostly relies on activating your own ability to recover. Having a counsellor who is close to you makes it easier and quicker. The counsellor might throw in a little guidance for good measure — advice on good ways to solve life’s everyday problems.
When you have emotions that disrupt your life severely, when this goes on for a long time, and when you cannot identify any good reason for the emotions, that’s an illness — an emotional disorder. Treating an emotional disorder goes beyond counselling into psychotherapy.
A psychotherapist also has to get close to you, just like a counsellor dealing with normal emotions. Psychotherapy introduces you to ways that you can recover that go beyond your own abilities and strengths, and beyond prefabricated solutions.
For example, if the psychotherapy is CBT you and your therapist might explore how certain of your thoughts interact too strongly with your emotions. It’s hard work for the therapist, who has to understand you as an individual well enough to help you work out what’s going on.
Ian and Mandy
One of the cases in the film illustrates guidance counselling very well. Mandy feels that she and her husband, Ian, have drifted far apart emotionally.
Their guidance counsellor suggests that they don’t talk to each other very much. So they talk to each other more and the difficulties go away. Toward the end of the film we see them in the bath together drinking champagne cocktails, and then telling each other that they love each other.
“Talk to each other more” is a prefabricated solution often used in relationship counselling. The fact that a counsellor is telling you to do it probably makes it easier to do. There’s an element of parenting about it, an element of coercion, an element of consulting tribal elders who tell you how life should be lived.
In another case, Dave, a single man, feels strongly attracted to a woman he knows at work, but he finds it difficult to approach her. When he talks to a guidance counsellor, he soon finds himself describing the way his father often beat him and even tried to kill him on one occasion when he was a boy, his subsequent thoughts of suicide, his tendency to drink too much, and the large collection of pills he has saved up.
The counsellor in this case is an odd bloke, considerably odder than the client. The film makers portray the counsellor as a stock Hollywood psychoanalyst type, dressed over-precisely, with a pointed beard that he sometimes strokes, peering over rimless glasses. He says “Hmmmmmm” a lot. One feels that if they had not had to use the original voice they would surely have given him a creepy Austrian accent (14:18):
Dave: I actually thought about finishing myself off, actually.
Whenever the counsellor finds himself at the edge of his comfort zone, he stops dead. Some of his behaviour suggests he might have Asperger Syndrome, although we do not know how much of what we see in the film was invented by the animators — we can only rely on what we hear.
Anyway, a good example is when the first session has ended but Dave wants to say something else. The counsellor is suddenly out of his depth. He becomes agitated and inflexible, ignoring the client’s feelings and using a visual metaphor (the line in the carpet at the door of the room) to communicate the boundary of the session:
Another example is when Dave describes the time his father tried to kill him in his bedroom. His father apparently changed his mind, and Dave ran away down the stairs. The counsellor is completely emotionless, and without the slightest pause he changes the subject to ask about the other children at Dave’s school.
In an early session Dave speaks of a time when he felt there might be “dark forces” in his life (14:48):
Dave: I’m always sort of subconsciously worried about dark forces, or something going to happen, something nasty’s going to happen…
Soon afterwards, the counsellor starts to speak of “voices” even though he understood the word “forces” when it was originally spoken (15:28):
Counsellor: Part of you is saying “Go take the tablets.” Another part of you is saying, “No.”
In a later session, the counsellor refers again to these voices, forgetting that it was he, the counsellor, who introduced them (43:56):
Counsellor: I’ve been very struck by your talking, through our sessions, of these voices.
The guidance that Dave receives is that his father’s violence left him with a dark side. He should say goodbye to his dark side, practice restraint in his drinking, throw away his collection of pills, and forget about approaching the woman at work because he’s better off on his own.
The counsellor writes a goodbye letter to Dave’s dark side. (It’s a standard letter — this is a prefabricated solution.) Dave signs the letter, takes all the other advice and lives happily ever after. Maybe.
The upshot is that when Dave left counselling he was still unable to approach the woman he fancies, but he had solved a different problem he didn’t know he had until the counsellor gave it to him.
Susan and Iain
The third case in the film (but the one the film begins with) is different again. A couple who have been married for a long time feel their relationship is coming to an end. They argue a lot about sex (lack of). Susan has a tendency to be tearful, while Iain has a tendency to retreat within himself.
As the story develops, it turns out that their difficulties go back almost to the start of their relationship, when her parents rejected him as being unsuitable for their daughter. She once had an affair. He is unemployed. The guidance counsellor struggles to find a prefabricated solution to this complex situation.
“Talk to each other more” helps a little. They become more tolerant and more affectionate, but it’s not enough. Although the film ends with them holding hands, we learn later that they continued the counselling.
Both Susan’s tearfulness and Iain’s withdrawal suggest emotional states that there is no apparent explanation for. So this would indicate that they both have mild emotional disorders that could easily be treated with psychotherapy. However, that’s not what happens. The guidance counsellor just struggles on, even though it isn’t working.
After the end of the film we learn that Iain had died suddenly of a heart attack. I won’t write what I’m thinking.
It can be difficult to work out what kind of help to seek when such a wide range of services are all covered by the same word, ‘counselling’.
If an overwhelming feeling is central to the problem, you have had this feeling for a long time, it disrupts your life, and you cannot make sense of why you feel this way, then psychotherapy is indicated. Of the various psychotherapies around, CBT usually works quickest, going to the root cause of the problem and resolving it permanently.
If you do know the reason for the feeling, and you have not suffered from it for very long, or it is not particularly disruptive, then counselling is indicated. Of the various types of counselling around, humanistic counselling makes best use of your own ability to recover.
If the problem is an everyday situation, not a feeling, then guidance counselling or advice is indicated. This applies even when you have strong feelings about the problem, as long as the feelings themselves are not the problem. The type of advice or guidance you seek depends on the nature of the problem.
The film illustrates that people can have all kinds of misery in their lives and yet be mentally well. Even being mistreated as a child and having thoughts of suicide as an adult does not in itself mean you are ill.
Beware, however, psychotherapists and counsellors whose behaviour is not appropriate to the kind of help you need.
For example, if you go along for some advice about your mortgage but the advisor tries to get into an emotional relationship with you, leave immediately. That advisor is trying to mess with your head.
Equally, if you go along for psychotherapy but the therapist sits on the other side of the room facing you directly and cannot engage with you emotionally, leave immediately. All you’ll get from that therapist is prefabricated advice.
Some people choose to become counsellors or psychotherapists because they have problems of their own. That’s not in itself a reason to reject their help. As in the film, if all you need is some sound advice, then someone who knows a lot but has difficulties with personal interaction might do very well.
But if your counsellor’s or psychotherapist’s own problems get in the way of helping you, leave immediately. That could happen, for example, if you need mortgage advice but you end up being asked to invest in the advisor’s own company, or if you need help with your emotions but you end up being asked to deal with your counsellor’s emotions.
Perhaps the worst case is when you go for help with a problem, but the counsellor cannot solve your problem, so the counsellor invents another problem that he can solve (because he invented it).
Or perhaps the worst case is when you go for help with a problem that the counsellor cannot solve, but the counsellor keeps trying anyway, preventing you from getting proper help.