Conversations with a care provider
One million people seek help for their psychological problems every year. Older people often don’t do this out of shame. Or because they doubt the effect of psychotherapy. Right or wrong? Psychologist Pim Cuijpers answers.
1. What is Psychotherapy?
“Psychotherapy is a treatment method for psychological complaints, which revolves around conversations with an expert counselor. A psychotherapist does not solve problems for you, but helps to see bad things differently, to process painful feelings or to approach difficult situations differently.
This can be done in many ways: individually, together with the family or partner, or in a group. There are more than 250 forms of psychotherapy. There are big differences between them. In addition, one therapist has a completely different view of how psychological problems arise and should be treated than others.”
2. Is every psychotherapist equally good?
“It is important that the therapist has followed training to apply psychological techniques. In the Netherlands, psychotherapist is a protected profession: only care providers who have completed a recognized psychotherapy training may call themselves psychotherapists. You can recognize them by their BIG number.
BIG is a register where psychotherapists must register to be allowed to use the title psychotherapist. Anyone can enter the BIG register (www.bigregister.nl) to find out if his medical assistant is in it. Unfortunately, it regularly happens that non-psychotherapists use the title. For example, by calling himself a ‘therapist with a psychotherapy practice’. And in addition to the recognized therapies, there are alternative therapies that pretend to remedy psychological complaints, but for which there is no substantiation.”
3. For whom is psychotherapy intended?
“For people with specific psychological complaints. It can be sadness, fear, problems in contacts with others, unprocessed traumatic events, addiction, etc. Last year more than one million Dutch people received help from a psychotherapist. That number is still growing.
It is striking that people over the age of 65 ask for the help of a therapist much less often than young people. This is not because the elderly have fewer psychological problems: between 10 and 30 percent of the elderly have such complaints. That percentage is even higher for older people with physical disorders.”
4. Why do so few elderly people follow psychotherapy?
“Unfortunately, there are many people who are ashamed of their problems. You also see that they often ‘package’ them in physical complaints: fatigue, backache, stomach ache. And GPs tend to focus primarily on those physical complaints. GPs who are aware of psychological problems are more likely to prescribe pills for the elderly. That is partly a legacy of the time when it was thought that psychotherapy in the elderly would not be possible. A lot of research has been done into the effect of psychotherapy on the elderly. If you put all those studies together, it turns out that it doesn’t matter how old you are.”
5. There are about 250 types of psychotherapy. How do you know if a therapy is working?
“Every new therapy is said to work even better than what we already have. That can rarely be proven. You would think that everyone gets a treatment that has already been scientifically proven to work, but unfortunately that is not always the case “Therapists sometimes have a preference for a new therapy because they want to do something different. Moreover, general practitioners do not always know what is available, so always ask the practitioner whether there is scientific evidence that the proposed treatment is effective.”
6. Are there any psychotherapies that have been proven not to work?
“One therapy that has been researched and found to be ineffective, or rather counterproductive, is debriefing: a method of quickly providing psychological help to people who have experienced a distressing event through a conversation about what they have experienced. There are also alternative therapies. that have a negative effect on some people, such as rebirth therapies, even causing some fatalities.”
7. What about popular therapies like mindfulness?
“Mindfulness or attention training has been developed to prevent relapse in depression. That works well, that has been sufficiently proven. However, mindfulness is now widely used for all sorts of other psychological problems: in the treatment of depression itself and with anxiety symptoms. While we do not yet know whether it works just as well as with the therapies whose effect has been shown in scientific research.”
8. What if there is no effective treatment for my problem yet?
“Psychotherapy is one of the most important tools we have for alleviating psychological distress. But it is also clear that there is not a proven effective treatment for every psychological problem. In that case, the therapist will have to decide in consultation with the client what the is the best treatment. Then it’s a matter of trying it out. Fortunately, there are many good therapists who know how to achieve results with complex problems.”
Pim Cuijpers is professor of clinical psychology at the VU University in Amsterdam. He specializes in research into the effectiveness of psychotherapy for common mental illnesses. This year appeared from his hand ‘Psychotherapy. A handbook‘. In this book he examines the question to what extent psychotherapy works.
