Cause and effect aren't much of a mystery if you break your leg. In fact it's usually immediately obvious.

Emotional injuries aren't quite so straightforward.

Many people come into therapy expecting, or even fearing, an exercise in talking about the past in detail; conversations focused on childhood memories and past struggles. Yet, in contrast to this most people actually come to therapy because something is going wrong in their life right now.

Perhaps one of the most readily accepted of all Freud's ideas is that of the unconscious: that we can be upset and distressed in ways we don't fully understand, and that certain behaviours may happen without us being clear about why we're acting in such a manner.


Take anger, for example. We're all pretty used to the idea we can be just "taking it out" on others when we're actually upset about something completely different, such as how you get angry when your partner has stacked the dishwasher wrong AGAIN and they look at you and ask, "What's really going on?"

Psychotherapy recognises there is often a difference between the "symptom" and the underlying struggle, conflict, past grief or trauma: that pain and suffering of the past finds echoes of itself in the present. Our emotional life is really just a collection of moments and experiences that can easily be awakened by similar events, even if we're not consciously aware of being reminded.

Of course, if it was that straightforward, we wouldn't need psychotherapy. As it happens, however, we all need a helping hand to see these patterns, these repetitions, that are beyond just needing to change our automatic thoughts, or simply learning to meditate.

In fact, for some people in overwhelming situations - stress, grief or trauma - these tools can be very useful, in fact they may be enough on their own. The distress isn't a symptom, it's just the present that is causing the problems.

But when we run headlong into a deeper pain - the echoes of the past - then symptoms that are harder to understand show up, overwhelming anxiety, obsessions, compulsions, addiction, the unrelenting bleakness of depression.

One of the objections I've always had to the "take these pills, and come back in two weeks" approach, is that it provides no meaning. Don't get me wrong medication has it's place, and I happily recommend it, but when it is the first - or only - treatment offered, it helps us understand nothing about why.

Because ultimately we're all writing a story, every day of our life, with ourselves at the centre. Therapy helps us re-write that story, beginning, middle and to be left more in charge of the ending.

And just like any story, we don't start a novel in the middle, nothing would make sense. We start at the beginning.



If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.


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