Counselling and clichés

We GPs have known it for years, of course, but it is still nice to have it confirmed. The Bullshit Quotient of counselling must be way higher than anything else, with the possible exceptions of golf, wine, and Reiki, and now its uselessness has been even further underlined.

A recent paper in the British Journal of Psychiatry (like the Journal of General Practice, which is mandatory reading for any serious GP: only joking;  alternatively it can be scavenged from Minerva in the BMJ) reported on a randomised controlled trial of ‘emotional ventilation debriefing’ and educational debriefing versus no debriefing of people after a traumatic event. 

It found that individual debriefing was not useful and that after six weeks people in the emotional debriefing group actually showed more symptoms of post-traumatic stress disorder than controls. With some luck, the trend to pour counsellors on to scenes of devastation to help mop up the tears and distress of people caught up in traumatic events may be on the way out. 

This is not to say that counselling is totally without its uses; spouting the whole gamut of incomprehensible psychological clichés can be strangely satisfying, and I frequently employ this technique to annoy patients whom I reckon deserve it, particularly when I’m a bit down myself and need a bit of cheering up. I goad and needle them till they are ranting and raving and ready to spit, then I lean back, assume a relaxed posture and say: ‘That’s good, that’s very good, you’re ventilating now, let it all out, go with your feelings.’

‘Whaddaya mean. I’m ventilating?’

‘You’re getting in touch with your emotions. I think we are making some substantial progress.’

‘I’m not angry!’

‘Why so hostile? You’re okay, I’m okay, where does it come from?’

‘Aaaaaaargh’ (this is a loose translation, expletives have been deleted).

‘That’s better, a great big scream, don’t it feel good? Dig deep, let it fly, go with the moment, live in the now, don’t project. And there’s nothing wrong with a  few tears. Does it remind you of your mommy?’

He held his head in his hands and rocked to and fro in the traditional manner of those manifesting a nervous breakdown.

‘I feel awful doctor,’ he said.

‘There, there,’ I said, patting his knee. ‘If it’s any consolation to you, I’m certainly feeling better.’ 

- Dr Farrell is a GP from County Armagh.  You can write to him at GPcolumnists@

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