Dr Jonathan Leach looks at the role friends play within the recovery state of a person mental health problems. How friendship and support, even from a stranger can be therapeutic.
‘Quite often talking is the best form of therapy and having someone who knows you, who you can confide in and can talk back to you on a personal level based on the fact they know you, can sometimes be very comforting.’
(Service user quoted in Leach, 2015)
BBC Radio 4’s All in the Mind Awards invites listeners who have experienced mental health problems to nominate individuals or groups who have played a special role in their recovery.
One category for nominations is friends and family members, whilst other categories include those in paid and professional roles.
So what is the difference between the support that a friend or a professional can give?
This article looks at some the differences that exist between the roles of someone providing talking therapies, such as might be accessed through IAPT (Improving Access to Psychological Treatment), and the informal support provided by friends and relations.
The Collins Dictionary definition of ‘therapy’ is typical of many:
‘the treatment of physical, mental, or social disorders or disease’.
More specifically the British Association for Counselling and Psychotherapy (BACP) explains that: 'Counselling and psychotherapy are umbrella terms that cover a range of talking therapies.
They are delivered by trained practitioners who work with people over a short or long term to help them bring about effective change or enhance their wellbeing.’
So a therapeutic relationship is concerned with working towards change and dealing with problems, but what about friendships?
Sociologist Graham Allen (2008) has studied the nature of friendship and suggests that there are at least three key features in maintaining a friendly relationship: shared interests, equality and reciprocity.
We form friendships with other people because we like them.
However, those friendships are only likely to persist if both parties share enough of a common outlook, are roughly equal in terms of their social and economic status, and are able to give and take in providing mutual support.
People may be changed by their friendships, but this is not usually the main reason for engaging in them. Friendships are about having fun and for some people part of preserving a friendship may consist of taking their problems to a professional instead:
‘It is much easier to talk to a stranger than to sit down and talk about certain personal issues with someone who knows you.
Part of your self-respect is to promote a healthy picture of yourself to friends, not to show all the eyesores that only you can see on the inside.’
(Student quoted in Leach, 2015)
In contrast to friendships, the relationship between therapist and client does not rely on shared interests (other than a successful outcome of the therapy), and is not based on equality of status or reciprocity.
In therapy there are clearly stated time limits and boundaries to the relationship, whereas in friendships the boundaries are less clear and are often up for negotiation. What is said in the consulting room is classed as private and confidential and so may encourage discussion of topics that it would be too embarrassing to mention to friends.
The therapist will have a structured approach to their interaction with their client which is based on psychological theories, training and supervised practice. Friends interact with each other in an intuitive manner and are unlikely to apply a structured and theory-based approach to their relationships.
When a friend is experiencing mental distress people tend to rely on their own experiences and understanding to provide help, some of which may work better than others.
Although friends may not be officially ‘qualified’ to support someone in distress, there is no doubt that their help can be greatly valued. Just being listened to can be very supportive, as can be the provision of companionship and distractions from worry:
‘My friends who were there to talk, to make me cups of tea, to share their experiences or just take my mind off things with a silly movie and lots of cake!’
(Service user quoted in Leach, 2015)
Friends can help out in other ways too, such as providing practical support and advice and helping the distressed person to access other forms of support when the need arises.
They can give hugs and suggest fun things to do as well as providing a sympathetic ear.
Research on informal support indicates the value of being alongside the person in distress, taking their situation seriously, but without making it seem too catastrophic, and reminding the person of the small but positive steps they can take towards greater wellbeing through doing everyday activities such as going for a walk or watching a light-hearted film (Borg and Davidson, 2008).
There are things that trained therapists are better equipped and supported to do than friends, these include: opening up difficult emotional issues, identifying new ways of thinking about problems and challenging self-defeating beliefs and behaviours.
Taking everything into account it would seem that you don’t have to be your friend’s ‘therapist’ in order to help them and, in fact, you can be more helpful by being a good friend to them in a number of ways that a therapist can’t.
Allan, G. (2008) ‘Flexibility, friendship, and family.’ Personal Relationships 15, 1-16.
Borg, M., and Davidson, L. (2008) ‘The nature of recovery as lived in everyday experience.’ Journal of Mental Health 17, 2, 129-140.
Collins Dictionary //www.collinsdictionary.com/dictionary/english/therapy
Leach, J. (2015) Improving Mental Health through Social Support: Building Positive and Empowering Relationships. London: Jessica Kingsley.