What is Psychotherapy? And is the Film Stutz an Accurate Representation?
At the risk of this blog becoming a review of Stutz, I love it! There. You don't need to read anymore.
What I love is their relationship. It is so respectful, collaborative and trusting. There are points where there is so much vulnerability and so little ego that the roles of therapist and client merge and intertwine.
In the documentary film Stutz, Stutz and his client, the actor Jonah Hill, have worked together for five years. In the States, there is a culture of long-term therapy. This doesn't seem to be the case in the UK.
Stutz uses Person Centred Therapy and Psychotherapy. Neither of these approaches can be rushed. Person Centred approaches are relational, they rely on the relationship between the therapist and client. Relationships require time. Psychoanaytic approaches require trust. In extremely broad terms, psychoanalytic approaches look for patterns. Patterns in behaviours, patterns in relationships, etc... Trust requires time.
Due to the scarcity of time and resource, Cognitive Behaviour Therapy, CBT is widely used in the NHS and elsewhere.
In the UK, therapy is often allotted in chunks of six weeks. Longer term therapy might be considered prohibitively expensive.
CBT is highly effective in many circumstances. However, CBT was not designed to be delivered in six sessions.
There is a risk, in the UK, that time pressures and limited access to therapy misrepresents therapy and does CBT a disservice.
As a result, there are people who believe that therapy isn't for them, or that therapy doesn't work because they had one opportunity to get fixed and it wasn't achieved in six sessions, or they didn't quite connect with the therapist, or it wasn't the right therapy for them.
Therapy is not a one size fits all model.
I often give the following analogy:
A couple of years ago I got an absolute stinker of a chest infection. Not for the first time. It took three lots of antibiotics to find the right one.
When the first lot of antibiotics didn't touch it, I didn't just go, 'Oh well, antibiotics aren't for me. I just have to have a chest infection forever. This is who I am now'.
In exactly the same way, if we 'don't get on with therapy' maybe it isn't the right type of therapy, or maybe it isn't the right therapist for us. This is no one's fault.
It was no one's fault that the first two courses of antibiotics didn't shift my chest infection.
This is where my slightly clumsy analogy starts to fall apart. The stinker of a chest infection to which I refer was pre-Brexit, antibiotics were in plentiful supply. The NHS has been chronically underfunded since 2010, at the time of my stinking chest infection the UK and the NHS had not been ravaged by Covid and the highest death rate in Europe. I digress.
The NHS is free at the point of access provision. It is prepaid for with National Insurance contributions and taxes. That's the theory.
In the States, I suspect therapy costs are covered by health insurance. This means that it is far more accessible for those with financial means than for those without. IE those who can afford comprehensive health insurance.
Similarly, in the UK six sessions of therapy might be accessed via NHS provision, charitable organisation, or workplace employee welfare programme. Otherwise, sessions are funded independently. This means that therapy, mental, psychological, and emotional wellbeing, rely on access to financial means.
For some people a private therapy session is equivalent to the cost of a takeout or a fairly modest night out. Where I live around £40 or £50 pounds seems to be a standard sort of fee. I expect London fees are far higher.
In terms of wellbeing and feeling good about ourselves, £40 or £50 might buy us a manicure or a haircut. Both are legitimate ways of showing care to ourselves.
For some, particularly in the context of the UK's current financial crisis, £40 might as well be £400 - completely out of reach.
Even for clients who do not face financial hardship, there are ethical issues to consider around how long we work with clients and how we manage expectations.
In the UK, working with a client for five years as Jonah Hill and Stutz have, might raise ethical considerations around the risks of nurturing a relationship of dependence, for the client.
In Stutz, there does not appear to be a relationship of dependence. Their relationship is collaborative, respectful, playful, dare I say - loving. There is a lot of affection between them.
Personally, I always feel enormous fondness for clients. I am usually slightly awestruck at their motivation and courage in seeking support and then allowing themselves to be vulnerable in sharing their story with me. It's a tremendous privilege to accompany someone on their healing journey. I often liken it to the client driving while I hold the map.
If I'm not the right therapist for someone, it's okay. There are millions of therapists and millions of clients. I don't imagine that the first two sets of antibiotics I took were upset that they weren't the right ones.
That's a flimsy analogy. Antibiotics don't have feelings.
Okay, so maybe a client doesn't want to work with me because I wear the same perfume as someone from their past who hurt them? Or maybe they don't like my increasingly poor analogies?
For a client to exercise active autonomy in selecting the therapist that feels like the right one for them is incredibly empowering.
And go and watch Stutz. It's quite beautiful.