In the Great Depression of the thirties, wealthy bankers and traders had a long way to fall, and some threw themselves from their office towers. On the 25th of September last year Kirk Stephenson, operating officer of Olivant hedge fund threw himself in front of a rush-hour train; one of a number of people in the financial sector who have recently chosen suicide rather than the disgrace of bankruptcy. In America even some of the mega-rich are getting together in support groups to share their anxiety and no doubt their guilt. Hard times throw up strange ironies. When the economy plunges, those in the big cities are likely to suffer first.

Then And Now
What about all those people in the middle who are neither mega-rich nor Calcutta poor; those with jobs in the City, a hefty mortgage and kids at school? They’ve managed in boom times to make ends meet, and with two incomes even afford a holiday abroad once a year. Now it’s not just the holiday that’s under threat. If only one partner loses income, it could spell privation or even disaster. Singles are no different. The bottom line for everyone is the possibility of losing one’s home, whether it be a semi-detached in a leafy suburb, or a one-bedroom pad in an inner-city area. For thousands in the banking world it’s also the knowledge that they will never again find another job in that field, even when the economy picks up.

Not Just The Men
Paradoxically, the anxiety of not knowing whether you will have a job is almost worse than being out of work. When the worst has happened you can at least start to plan. The recession may have been caused by men in suits playing fast and loose with our money, but Professor Marilyn Davidson of Manchester Business School observes: “This impact on women is a very new phenomenon that we haven’t faced in this country before. We have far more women in work, far more one-parent families and far more female breadwinners. There certainly is a risk that the progress women have made could be thrown into reverse.” The government funded Employment and Skills Commission on job prospects through to 2017 foresees that “the majority of the additional jobs (created) are expected to be taken by males”, and men “are also expected to take a greater share of the jobs in many parts of the economy dominated previously by females”. For any post-feminist young women, or university graduates, that’s a profoundly depressing prospect, never mind for those women already in work.

The Threat To Relationships

Partners on modest incomes living together and sharing expenses are no less threatened by the economic shrinkage than the so-called ‘ chequebook marriages’, where only the spending power of two high incomes held an unhappy couple together. If only one of those partners is fired or made redundant and their lifestyle threatened, the sham of the relationship is rudely exposed. If they’re married the legal expense of divorce may be so crippling that they cannot afford to separate. Family solicitors say they have received a dramatic rise in instructions from high-earning partners. Of course the credit crunch does give them some leverage in down-grading the settlement. Even so the fall-out can be traumatic. Pauline Fowler, a divorce lawyer at Hughes, Fowler Caruthers, is reported as saying that she watches the markets daily to calculate what her clients are worth.

A Safe Place To Talk
In a crisis like this everyone feels desperately alone. Even those in a relationship. Other people have their own problems, how can we possibly burden them with ours? Yet the need to talk, not just to off-load, but to share and compare, feels inwardly urgent. Human Resources managers report a big rise in the number of staff asking for help or advice - often in tears. H.R. are also responsible for the unhappy job delivering the bad news. Fortunately there is now a venue where you can meet with others in the same boat. WPF, one of the biggest and most reputable counselling and psychotherapy training centres in the U.K., has just moved its London headquarters to London Bridge in the heart of the financial centre. They are offering to run a support group, with a maximum of 12 members. It will be run on support rather than therapy lines, but members will be able to talk freely. It will be conducted by an experienced group analyst. Contact: www.wpf.org.uk .

The common sense answer is an obvious no! A therapist can do nothing to stop the avalanche of the economy. If you need to see a counsellor, best wait until the thaw sets in and incomes are more secure. Meanwhile, fall back on that old British standby, the stiff upper lip. Well yes. And no. A deeply unstable society leaves our defences hugely exposed. Everything we could safely ignore in boom times is suddenly hurled into sharp relief, and it can be quite terrifying - especially in the small hours. Several big financial players have already committed suicide. Without money they felt they were worthless. They defined themselves purely as breadwinners. They were not alone. Money can hide a lot of personal problems.

Our inner worlds are more exposed

A low self-esteem that a good job hid from the world, a recurrent depression that has been painstakingly concealed from friends and colleagues, fears about how we have brought up our children, about the security of our relationships, about never finding love, haunt us as never before. The super rich are not exempt. The so-called ‘cheque-book marriages’, where two high incomes alone kept an unhappy couple together, are on the rocks as soon as one partner is made redundant. Family lawyers are reporting a huge rise in instructions. And now women’s jobs are as much under the axe as men’s. Some think even more. Many employed in finance will never find work in that field again – even when the economy picks up.

Of course I know only too well that psychotherapy is not a form of crisis management. Losing your job or seeing your shares slide is no reason to see a counsellor. Most of us, however, are more aware of our private and long-hidden insecurities and despairs than we were before the recession. Our defences that successfully kept the world out now feel desperately fragile. Many people privately fear some sort of breakdown; and often the last person to know is the one closest to us. We worry that our anxiety may be contagious.

Paradoxically, this might be a good to start when you remember that at the beginning of therapy months can be spent in resisting any exposure of our cherished defences. Those months cost money of course. It’s a curious irony: we go into therapy to change, and then spend much of our time resisting any change whatsoever. Better the devil we know, we think. It’s irrational, but that’s what life has taught us - so far. As for our defences, they were erected in childhood to keep us sane. They were how we survived in our families of origin. Now that we are adults they are sadly redundant. Neurosis is essentially behaviour that is long past its sell-by date. Worse, it is now counter-productive, no longer saving us from disaster but maddeningly inviting it, preventing growth and intimacy. Even so, you may think why not wait until the economy recovers before embarking on a course of counselling? Well yes, but as we all know, when we have no immediate worries, we tend to put things on hold. We tell ourselves we’ll get round to it one of these days – which of course never comes. If that chimes with your own experience, and there are aspects of yourself that have long worried you and are now uppermost in your mind, you can find a counsellor/psychotherapist through the Counselling & Psychotherapy Resources Directory, published by BACP, or of course the Internet.

About the author
Tony Yates is a psychotherapist based in Central London

It had started earlier during the performance - a nagging voice in his head telling him he was ‘a fraud’ and ‘not good enough’ to be there. ‘My bow hand started to tremble. I doubt the person next to me even noticed, but it felt like an earthquake. My hand started to freeze so the vibrato sounded like a nanny goat.’ It was a three-hour performance and it would be a torment to survive. ‘My heart was going 19 to the dozen. I felt sheer terror - claustrophobia. I was playing in a sea of strings and had to swim with everyone else. It was like being in a straitjacket.

I felt cold and tingly, even my vision was affected, I could barely see the music. Stage fright is exhausting. I thought I would collapse.’

The performance was a success and, to prolong the violist’s agony, the audience cried for more. The encore would be just four minutes long and the music was technically unchallenging, but it was still too much. ‘As I rushed out, a brass player was coming on to the stage. I handed him my instrument then slid down the wall on to the floor. The man asked me my name but I couldn’t remember it. I was so relieved to be off stage, but also very ashamed.’ Today, relaxed and happy, the man still refuses to reveal his name. The professional stigma of stage fright in the performing world is too shaming - the taboo too insurmountable.

In the trade, a bad case of the shakes is known as ‘the pearlies’ as in ‘Pearly Gates’, says Julian Maunder, who teaches strings and offers shiatsu to stressed musicians. He says these people would rather suffer in silence than risk their careers. ‘It’s like people calling cancer “the Big C”. They think if they say it they will catch it. Stage fright is the same.’

Strangely, performers are not just hush-hush about stage fright and stress but also illnesses and injuries generally. ‘Within all of the performing arts, the pervading attitude is that the show must go on. Performers are expected to overcome injuries and illness. If you fail to overcome this, there will always be 30 to 50 people wanting to step into your shoes. There is no incentive to put your hand up and say, “I need time out,”‘ explains Eileen Quilter Williams, general administrator of the British Performing Arts Medicine Trust (BPAMT).

The Trust, a registered charity whose patrons include Richard Baker, Simon Rattle and Cliff Richard, among others, is now in its 16th year. It offers a designated health service to performers, including musicians (popular and classical), actors and dancers. It views these professionals as special cases not dissimilar to sports stars. Here is a group for whom even minor medical problems can impact on their very livelihoods. A sore throat, for example - a mere inconvenience for most of us - could be momentous for an opera singer.

In addition, punishing schedules bring a whole raft of occupational hazards into play. Musicians are at risk of muscular problems and hearing difficulties. Actors and dancers risk injury. Irregular hours and long rehearsals allow little time for healthy living and the competitive nature of showbiz raises stress levels into the stratosphere. It is either ironic or a classic example of self-protective denial that the performing world thrives on a culture of repression. It’s a case of put up or shut up.

Angelina Spurrier, a classical ballerina who works at the BPAMT, remembers one director telling any dancer who complained: ‘I have a top hat full of names of girls who will dance for me for nothing.’ During her career touring in Germany, she says she never dared show any weaknesses. ‘You had to appear to be 100 per cent focused at all times. Any anxiety and even injuries had to be buried. So many of the girls I worked with had eating disorders or drinking problems and everybody smoked.’

But the culture is changing. Increasing numbers of performers are learning of the BPAMT’s existence and turning to it for help, while health and safety legislation means employers can no longer afford to be complacent.

Typically, a performer’s first contact with the BPAMT is made via the charity’s helpline. Around 20 to 30 people call each day and most are invited to attend one of its clinics or are put in touch with an appropriate consultant, doctor or therapist. At the BPAMT’s headquarters in London’s Covent Garden, Louise Miller, a GP working part time in a city practice, is holding her monthly clinic. Like so many of the Trust’s doctors, she has a strong interest in the performing arts, singing in a choir and playing the cello. She gives her time for free, offering each patient a 30-minute consultation - a luxury compared to the seven to 10 minutes most of us get when we visit our doctor.

‘I love coming here. I never know who is going to walk through the door next. I have seen everything: actors with acne, singers who think their voices change when they go on the pill, tumblers with back problems, dancers with eating disorders, keyboard players with neck problems,’ explains Dr Miller. The list goes on. Musicians arrive with their instruments. Dr Miller likes to watch how they play, as their posture or the way they move or hold their instrument can provide diagnostic clues. If an instrument is too big to carry, she will have them simulate the movement by using her desk as, say, a mock keyboard or drum kit.

Simon Hallett, a double-bass player with the Royal Opera House Orchestra, consults Dr Miller with an archetypal musician’s complaint. He has hearing problems. ‘The pit is so enclosed that it is like a resonating box. Over the last 12 to 18 months, I have experienced a loss of high frequency sounds and I also have mild tinnitus,’ he explains. He has already seen a doctor but wants a second opinion from the BPAMT’s empathetic and knowledgeable medical team.

‘An ordinary GP may not recognise that the problem takes on a new importance because you are a musician. They will treat you the same as if you are a bricklayer,’ says Hallett. He is delighted that the Trust also helps raise awareness. When he first joined his orchestra, musicians were not offered hearing tests and nobody wore earplugs. Now this is standard practice. Dr Miller is familiar with the issue - the use of earplugs is one of her hobbyhorses. As well as running clinics at the Trust, she is the medical advisor to the London Philharmonic Orchestra (LPO) and insists that all its musicians wear earplugs.

Placing doctors with orchestras is another service overseen by the Trust. Dr Miller was assigned to the LPO in April last year and remembers being invited to stand on the conductor’s rostrum to introduce herself to the ‘band’. As a perk, she gets to see her patients perform for free. ‘As they come on stage, I wonder how they are feeling. It is very nice going to a concert where you know the performers.’ Dr Miller visits the orchestra every three to four weeks, whenever it is resident in London. Her sessions take the form of an open house. Any LPO performer with a medical issue can consult her.

Typical problems include string players with muscular-skeletal problems, musicians with hearing problems or complaints about stress, exhaustion or performance anxiety. For the latter, she may suggest relaxation techniques or, if a performance is imminent, prescribe beta-blockers. However, if the problem is more severe, she might refer the patient on to one of the BPAMT’s specialists, such as psychotherapist Tony Yates. The frightened viola player (not a member of the LPO) who dashed from the stage found help via the Trust. Tony describes the man’s ‘critical inner voice’ as ‘a severe superego’. It is a phenomenon he sees commonly. He says the problem normally stems from childhood, where the critical voice was that of a pushy parent.

‘This inner voice may be partly aspirational (it tells you how to perform better) but is also partly judgmental,’ says Yates. As part of his therapy, he teaches the patient to ’separate their self-esteem from the performance’. In other words, the person is taught to have an identity outside their work.

‘Interestingly, the minute you take the focus off the performance and look at the person’s whole life, the performance problem starts to diminish,’ he says.

He likens the process to marital therapy, which may bring a couple closer or help them to separate. And so it is with performers. Therapy helped make the viola player ‘psychologically healthier’, but he has stopped performing professionally. ‘Now I just play for the hell of it. I play better now than before because I no longer carry that burden.’

What is the BPAMT?

The British Performing Arts Medicine Trust (BPAMT) is a charity that puts performing artists in touch with a network of doctors, associated professionals and alternative practitioners experienced in performing artists’ problems.

Regular clinics are held at the BPAMT’s headquarters in London and Manchester. Practitioners running these sessions include, among others, GPs, an ear, nose and throat consultant and two hand specialists. Therapists working with the Trust range from psychologists to chiropractors. Most services are offered to performers free of charge, or at reduced rates. If you are a professional performing artist or ’serious’ amateur (such as a member of a colliery band or choir) in need of medical support call the BPAMT’s helpline on: 020 7240 4500 (London) or 0845 602 0235 (outside London).

The BPAMT also runs the Association of Medical Advisors to British Orchestras, which is currently seeking to recruit medical professionals who can donate their time free of charge. Contact the administration department on (020 7240 3331) for more details.

Anyone who would like to support the Trust financially can subscribe to the BPAMT supporters’ organisation, Take a Bow. Annual subscriptions cost £35. More details from the administration department or on the BPAMT website, at www.bpamt.dial.pipex.com.

Shiatsu, aromatherapy, cranial massage, CBT… Alternative therapies for mind, body and spirit have been mushrooming up ever since the 80s and now flourish alongside traditional counselling. Some want to reach your mind through your body; others would introduce you to the universal mysteries; one or two want to re-acquaint you with the wisdom of your tribal ancestors. The choice is bewildering. Where on earth is a mind in need of help to turn?

The sceptic as always has an answer: turn to a good friend and take a bottle. When it comes to life we are all amateurs. Why pay good money to a so-called expert? You can’t go on blaming your parents forever. Besides no one promised us a rose garden. Now I’ve a sneaking admiration for that stoical view, and I speak as a self-confessed therapist. In today’s market-driven society, every whim and whimper it seems is catered for by some consultant or other - for a fee of course. Whatever happened to that proverbial stiff upper lip? On the other hand - and here I put my counsellor’s cap on - many of those sceptics lead lonely and isolated lives; life has taught them to be wary of depending on anyone. If only they knew counselling could help. However, if you’re not a sceptic and the New Age is beginning to look rather old hat, where do you start? Ad what are you letting yourself in for?

Psychodynamic counselling has its roots in psychoanalysis, t is less intense and less frequent. Psychodynamic therapists seldom see their clients more than twice a week, and usually only once. Both schools, however, believe that we all pass through certain psycho-sexual stages of development in childhood, and how we and our parents negotiate those stages pretty well determines the kind of adults we become. The past, therefore, lies just under the skin of the present; rather like those X-ray photographs of Old Master paintings that reveal the artist’s first attempts lurking beneath the finished surface. With this as its canvas, psychodynamic counselling takes as its subject the dynamic and ever-changing relationship over time between counsellor and client. As you can imagine, that leaves a lot of scope for misunderstanding. For the protection of their clients and themselves, psychodynamic counsellors are therefore bound by a written code of ethics - with serious sanctions if they fail to observe them.

The ‘therapeutic alliance’, as it is called, is like no other relationship. It can and should be deeply intimate, but is held in check within strictly-observed boundaries. Sessions begin and end on time, whether the client is in floods of tears or not, and they take place in the same room at the same hour every week. Inflexible as it may seem, it comes to feel like a safe and dependable container.

Trust is a problem all clients have in common. If the counsellor’s room is a sanctuary, it can also feel uncomfortably like a torture chamber at times. Trusting this intimate stranger with memories and feelings you thought you’d never share with anyone is like giving all your hostages to one fortune. We are all afraid of putting ourselves in another’s power, even someone we have gone to for help. There will be times when you’re convinced that your counsellor is laughing at you, or thinks you are pathetic, or disapproves of you in some way. It is important that you communicate these suspicions. At such times your therapist will feel that he or she has been cast in a role, that a mask has been placed over his or her face; a mask, as it turns out, of someone from your background. Of course you know she’s not your mother, doesn’t look anything like her, but for a while back there, well, in a way she was - and you reacted accordingly. As you and your counsellor become aware of these unconscious misjudgements (the professional word for it is transference) you begin to realise that you have pinned that mask unknowingly on other people in your life - with disastrous results.

Through ‘transference’ - the way we related in the past, usually to parents - subtly distorts the way we relate to others in the present. The distortions are not always negative. Idealisation is also a distortion and inevitably leads to disillusionment. We experience people in part as they are, and in part as we expect them to be, and we expect what early experience has shaped us to expect. Whenever a couple have a flaming row, the ghosts of their original families are often as not the hidden protagonists. They are so much a part of us, so much under our skin, that we are unaware of their existence or their origins. It seems we can never entirely shake them off?

This is what psychodynamic counselling is really about. If you like, it’s a kind of exorcism, a laying to rest of old obsolete ghosts. The defences we erected in childhood will also be there, but don’t expect to dump them overnight. In childhood they helped to keep us from mental breakdown; now they too are obsolete and actually obstructive. Adults have breakdowns when their life-long defences suddenly fail to defend. Counselling, however, is not like peeling an orange: one skin and you’re into the juicy bits. It’s more like peeling an onion; the aim is not to reach the innermost skin (an impossibility anyway), but to peel off the old superfluous skins, or defences, that prevent you from being open and intimate.

Whatever your feelings, you begin to see that this relationship with your counsellor is both the problem and the solution. Unlike others that went wrong and ended badly, this one offers the chance of getting it right, of coming back to it again and again until it feels more secure, more open, even playful. It’s a chance not to rewrite the book, but to rewrite the ending. Of course life can still bring misfortune and misery. As Freud himself said, the purpose of psychoanalysis is to enable people to experience ordinary human unhappiness - as opposed to neurotic unhappiness. Freud was a realist.

Who needs it? It is not for everyone. If you suffer from an addiction, or phobia, or a compulsion, you would be better off seeing a Cognitive Behavioural Psychologist (CBT) first, or joining a support group that specialises in that problem. But if you feel that you yourself are the problem, and it affects the way you relate to others, you will need a therapy that addresses both causes and symptoms in greater depth. Recommendation is probably the best way of finding a good counsellor. Failing that, you could turn to your G.P, or The Counselling & Psychotherapy Resources Directory, published by BACP, or of course the Internet. When you do start don’t be afraid to ask your therapist if you can review the situation after four or five sessions. You should know by then whether you feel compatible or not.

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