About Counselling & Psychotherapy

Frequently Asked Questions About Therapy

What's the difference between counselling and psychotherapy?

Whilst there are no universally agreed definitions for counselling and psychotherapy, I think of them in the following ways:-

I believe that individuals have the potential to solve their own problems. I offer a supportive, confidential, safe environment, of acceptance, empathy and genuine warmth, in which you can explore and determine your own solutions. Whilst this applies to both counselling and psychotherapy, counselling tends to be more oriented towards addressing specific issues affecting your life. By improving your awareness in depth of how and why you think and feel as you do, you are more able to take fuller ownership of your life.

My psychotherapeutic work pays more attention to the person's patterns of relating particularly those emerging in the therapy sessions. Through the therapeutic experience, new patterns of relating can emerge. As an integrative psychotherapist, my way of working draws on various schools of thought, primarily humanistic and psychodynamic.

Counselling and psychotherapy may help in addressing issues of anxiety, stress, depression, bereavement, relationships and any aspect of your life about which you are concerned or wish to improve.

Some Concerns about Therapy

Many clients have concerns about whether therapy (counselling or psychotherapy) is right for them. Here are some of the more common concerns: -

If I go for therapy, is this an admission of weakness?
Will I lose control of my life or my sense of self?
Once I've opened pandora's box, will I ever ever be able to close it again?
If I start crying, will I be able to stop?
Will I become dependent on the therapist or the therapy?
Will I be stigmatised?
Do you have to be mad to need therapy?
If I go for therapy does that indicate that I am somehow mentally ill?
If I disclose my darkest thoughts will I be judged as deviant, mental or be put away?
Will social services be contacted if I disclose my worries about my children?
Can I afford it?
Am I being self indulgent?

Therapy is different from going to a GP with a physical problem where the GP is the expert and you put yourself in their hands, trusting they will fix the problem. With therapy, you are the expert in your experience, the therapist will not be trying to tell you how to live your life or come up with solutions to your problems. The therapist's job is to provide you with a safe space in which you can explore your thoughts, feelings & beliefs in a non-judgemental environment so you can figure out your own solutions. If I were to give you a solution then that would merely be how I would deal with the situation and that may well not be appropriate for you, and you probably wouldn't feel more confident in your own ability to deal with the next problem that arises for yourself. Thus, the whole focus of therapy is to empower you to trust yourself to figure out your own way forward and in doing so to enhance your own sense of yourself.

Some of the things that clients want to talk about are coupled with a profound sense of shame ("I know this sounds silly but...", or "I've never dared tell anyone this before but..."), which is often the reason they haven't been able to talk fully about it. This is why trust is such an important element in the effectiveness of therapy, and in this your most powerful ally is your "gut instinct". When choosing a therapist, the best way to judge whether you have the right therapist for you is to trust your "gut instinct" so shop around until you find someone you feel you can open your heart to. Over 50 years of research have solidly affirmed that the most important factors in determining the effectiveness of therapy are: the relationship between the client and their therapist and the motivation of the client. Thus, if you are coming to therapy with a belief that it doesn't work, or that you don't trust your therapist or because you have been told by someone else that you need therapy but you don't feel that, then the chances are much less likely that it will be useful for you. However, therapists will check out just these sorts of questions with you before proceeding. Trust is something that is earnt and developed over time. For matters of profound shame, clients may choose (consciously or otherwise) not to disclose such details until they feel that their therapist is offering a safe, non-judgemental space in which to do so. Thus, it is in the clients' power to decide how they keep themselves safe.

The idea that it is a sign of weakness to seek therapy seems to stem from the history of our culture and beliefs in "the stiff upper lip" and the virtue of being able to "grin & bear it". If that works for you, fine. However, I have yet to meet a client for whom this approach works in the long run. Humans are social beings and as such need some level of support at certain times. When an individual feels that they are struggling to cope and are unhappy in that struggle then the healthy approach would be to seek support. This support does not have to come from therapists, it depends on your situation and what suits you. Partners, friends, relatives, work colleagues, GPs & the clergy may between them offer what you need. However, some clients are wary of burdening their loved ones, or feel that they are judged by their friends, or do not feel able to share their vulnerabilities with someone they know. Thats when therapy may prove beneficial. This does not indicate some failure in you or your relationships. Seeking therapy is a positive step towards addressing a problem. This issue is linked to the question of stigma. Prejudice remains in our society over many aspects of difference (e.g. race, sexuality, gender, disability, mental health), despite major improvements in our society's awareness of these issues. Similarly with therapy. Some stigma remains but this is dwindling fast. I think this is happening much faster than for the other aspects listed. Increasingly, people are advising their friends who are experiencing difficulties of the benefits they experienced in therapy.

Whilst it is true that what has been said cannot be unsaid, that does not mean that you need be left vulnerable for the remainder of your life. This has many layers to it. It is important that enough time is allowed to enable the material that surfaces in the course of the sessions to be properly processed. This is one reason we emphasise the need for an appropriate period to work through the ending of the work, ie. to avoid a client running from difficult material but leaving themselves unsupported.

Some fear that if they open themselves up to their emotions they won't be able to stop and they need to be able to stop to carry on with their busy lives. I would suggest you trust your "gut instinct" as to when, whether & with whom you decide to open up to. Clients' defences are there for a good reason. It is not appropriate for us to crowbar through these. I aim to offer an environment that your defences recognise poses no threat so they become redundant and you are free to express whatever it is that is difficult to express.

Some fear that they will become dependent on the therapist. Interestingly, the type of person who is likely to fear dependency is one of the least likely to allow that to happen. As stated before, therapists are actively seeking to empower the client to take more responsibility for themselves so dependency is unlikely. Further, good therapists will be actively challenging clients if they feel that clients are attending for a long time but are not in some way progressing and finding benefit in the work. As a further safeguard, accredited therapists are required to attend regular supervision of their work, and the supervisor would challenge any therapist with a long standing client relationship for which no discernible benefit is being gained.

Early on, clients often express some concern that they may be "mad", "mental", or heading that way. This is rarely the case. It may be fairer to describe many clients' experience of the world as "maddening" when their thoughts wont stop racing or when they cant stop behaving in ways that they dont want to e.g. "I get so angry sometimes I find myself yelling at the kids which is not fair to them". None of this relates to the fragmented sense of self & distorted reality (psychosis) of the insane, e.g. hearing messages from the TV that are personal to them. When clients are given space to explore their experience they most often begin to understand why they feel as they do, and as they express these feelings then the thoughts no longer need to race to try to keep control of them. For psychotic clients it is questionable whether once weekly psychotherapy is sufficiently therapeutic to address their needs. In such cases, I would tend to suggest that they seek a referral from their GP for psychiatric evaluation. This is quite rare.

Some clients fear that if they disclose their darkest fears they will be judged as inadequate or bad or mad. None of these judgements would be helpful to anyone. Nor are they appropriate. I believe that we are all being the best that we can be. We have each learnt ways of dealing with our world based upon our experiences, most often heavily influenced by our experiences when young. Sometimes these adaptations, whilst they were vital for survival in the originating environment, have become maladapted to the new situation in which they find themselves. By providing a non-judgemental environment in the therapy room, clients can gain a sense of freedom in which to learn new ways of being that are more appropriate and enable the client to live more fully.

Other questions about therapy:-
How long will it take? - This will very much depend on the nature of the issue to be addressed, how long the issue has been around, and the readiness of the client to engage in the work. An issue which has arisen for the first time in recent weeks or months, does not form part of a more historic pattern of relating for a client who is clear about what might reasonably be achieved within short term work and is highly motivated towards change may well be addressible in just a few sessions. Addressing patterns that have been ingrained over many years are hardly likely to be addressed meaningfully at the flick of a switch. Similarly if a client is not clear what the focus of the work should be and says "I just want to be happy" or "I want to stop feeling like this", then it may take some time before we identify a clearer focus for the work.

What is Integrative Psychotherapy? There are over 400 schools of thought about therapy with new ideas and ways of working being developed all the time. Some training courses for therapists focus on only one of these, e.g. psychodynamic, humanistic, cognitive behavioural therapy. Integrative psychotherapy is a process whereby each individual therapist finds their own coherent combination of the various schools of thought that they have been trained in. Different schools of thought have sometimes opposing beliefs about what is useful in supporting a client. An integrative psychotherapist would consolidate ways of working that are consistent within an overarching theoretical model. An eclectic psychotherapist would not necessarily need that consistency, nor necessarily have an overarching model, but would be free to choose any way of working that feels appropriate to that client.

A therapist is a generic term covering practitioners of all talking therapies.

A psychologist studies the science of the mind and behaviour. Treatment via private medical insurance is done by psychologists. Often used to make evaluations e.g. fitness to work.

A psychiatrist is also trained in medicine and is the only type of therapist who is able to prescribe drugs. So these are used where an evaluation of the drugs prescribed is required along with a psychological evaluation. Typically, these are used for the more severe mental health issues. However, they are also used in evaluating the needs of clients claiming support through their private medical insurance.

How might I prepare for therapy to get the most out of it? Allow yourself some time (more than one day) to reflect on the following questions:- What will I be saying to the therapist? What will be the focus of the work? What will be different as I leave the final session? You do not have to have perfect answers to these questions. What is important is that you have given yourself space to think about how you would use therapy and are taking some responsibility yourself for addressing the issue. If you come along thinking that the limit of your responsibility is to get yourself to the session and to pay for it, and that it is my responsibility to solve your problem for you, then it is unlikely that it will work. On the other hand, if you are willing to work together with me, then it is very likely we can address your issues.

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