The phrase mental health doesn’t always sit well with me. It suggests that some of us have it and some of us don’t.
I see it more as a continuum.
We all have deep struggles. We can all lose touch with reality. We are all challenged with ourselves and the world we interact with to a greater or lesser extent.
It is a question of degree rather than a split between “us and them”.
This becomes particularly apparent near the end of therapy.
I’ll be with a client who was initially deeply distressed. They are now doing so well that I’ve been known to jokingly suggest that we should probably swap seats.
The idea of the well therapist and the sick client are labels that don’t ring true to me.
We’re all in the same human river.
Worse still is when mental health professionals group people together based on categorisations that don’t seem useful.
They’ll get out their book of disorders, pseudo science to its core, and hand them out like confetti.
Go to a different professional, and you’ll likely get a different disorder.
It’s funny how that doesn’t happen with a broken leg. Every competent health professional will agree it’s a broken leg.
Yet in the mental health world, the diagnostic labels keep on coming depending on who you see.
And usually, you don’t just get the one. They hand out a few at a time.
But is that useful?
Certainly, some people feel a relief at having an explanation for the way things are. Likewise, many feel limited by it.
Either way, when trying to create change, what good does it do?
Many professionals argue that it is heplful to group people together who are showing up in the same way. I’m not so sure. I’ll explain why in a moment.
There are other professionals, more radical in their approach, who take a different view.
The question, they say, is not “what’s wrong with you?”
But “what happened to you?”
They’d rather group people based on a shared experience than scientifically dodgy labels.
So this battle rages between each wing of the mental health world. Those who want to group people based on what they think and do. And those who want to group people based on their history.
Which side am I on? Neither.
Both miss the point. Neither view is helpful when it comes to creating change. Let me explain why.
Personal change is a journey. So let’s imagine that you are at a busy railway station. It’s your job to help direct the travellers onto the right trains.
How would you decide what train to put each person on?
Perhaps you would group people based on what they think or do.
“Everyone with a red suitcase, get on this train”, you might shout.
Perhaps you would group people based on their history.
“Everyone who has ever been to France, get on that train.”
Each is a silly strategy. Hardly anyone would end up at the right destination. Neither approach has a focus on where the person wants to go.
Just because people do or think the same way doesn’t mean they all want the same future. Does everyone with a red suitcase really want to go to the same place?
Just because people share a similar past doesn’t mean they all want the same thing either.
With all good intentions, both approaches are dehumanising because they place the categorisation before the person.
Each person has their own unique preferred future.
Each person wants something different from therapy – no matter what other characteristics they may share.
So the best way to get everyone on the right train is to ask a simpler question. “Where is it that you want to go?”
It’s a powerful question for two reasons.
First, it’s impossible to get somewhere if we don’t know what that place is?
Second, knowing where we want to be provides a benchmark for the decisions we make.
Want to go to London? Then let that train go, it’s headed elsewhere. But this other train? Yep, get on board.
Knowing what we want gives us a way of deciding which thoughts and impulses to get on board with too.
It gives us a criteria to decide which are helpful and which are not. Do they get me nearer to where I want to go, or do they take me further away?
Like trains at a busy railway station, thoughts and impulses will keep on coming. But now we know our destination, we can decide whether to hop on board.
You can notice that the train has arrived, check it out with curiosity, and decide to let it go or climb aboard.
The thought arrives and we can look at it the same way. Is it helpful or is it not helpful? Like with trains, helpful is something that gets you to your preferred destination.
We don’t need to attach to these thoughts anymore. We can assess them instead and gently note which category it belongs in.
“You’re shit at everything.” (Unhelpful – discard.)
“People think you’re stupid.” (Unhelpful – discard.)
“Oooh, that job is made for you. Apply for it.” (Helpful – get on board!)
In my therapy room, I’m interested in your story, and I’m interested in your struggle. But I won’t classify you based on it.
I’ll help you get clear about how you want your life to be. I’ll help you describe the differences you’d notice if life was better. I’ll help you spot the milestones along the way that tell you that change is happening for you.
You’ll know with clarity where you want to go. That alone gives you the power to hold every thought and decision to that standard.
Does it take you away from the life you truly want, or does it bring you towards it?Alun Parry is Director of The Liverpool Psychotherapy Practice