FREQUENTLY ASKED QUESTIONS

This is a question I get asked really frequently. Basically, if you are looking for talking therapy, you need someone who has officially recognised specific training in providing psychotherapy. While all of the above mental health professions can have this training, you cannot assume that they do, and you should always look for evidence of training. ​ Psychiatrists are medical doctors who have specialised training in mental health conditions which they can treat with medication and refer for talking therapy. Some but not all psychiatrists have additional training as psychotherapists and so can provide talking therapy.

Psychotherapists who are registeredhave completed a minimum of five years of post-graduate clinical and academic training in talking therapy, human development and pathology. Psychotherapists are experts in talking therapy and aim to tackle problems at a very deep level, to help bring about personality change. It is important to note, that unlike psychiatrists and psychologists, psychotherapist is not a protected title, basically anyone can call themselves a psychotherapist! For this reason, it is essential to make sure that your therapist is professionally registeredwith one of the main professional bodies such as UKCP, BPS or BACP.

Psychologists have academic degrees in the science of human behaviour. Clinical and Counselling Psychologists will have additional post-graduate training in talking therapies. The focus of their training includes greater focus on conducting research and the concept of measurability of human behaviour.  Clinical Psychologists tend to be specifically trained in more severe mental health difficulties than Counselling Psychologists.

Counsellors in general tend to have less clinical and academic training than psychotherapists, and tend to work shorter term with a more problem/ solution focus rather than personality change focus. I use the word 'tend' as this is the norm but not the rule. Some counselling psychologists for example will refer to themselves as counsellors, and some psychotherapists will include it in their title as they are aware that potential clients often conflate the two terms (as I do here). Add an answer to this item.

There is perhaps some truth in the statement that everyone can get some benefit from psychotherapy; simply having the space to talk openly about yourself to someone who will not judge you can bring the clarity you need. However it is important to bear in mind that to embark on psychotherapy is an investment of energy, time and of course money. Good psychotherapists will always be very open with potential clients about their suitability for psychotherapy, for example if I find a potential client is not quite ready to do the work I will refer them to their GP to consider medication, or will direct them to  CBT practitioner or a very good book that may help them.

However, if you are somewhat stuck trying to decide if you really do need to talk about your problems, it might be worth thinking about what is lying beneath your doubt. Often we can find that we are living with certain beliefs around asking for help such as ' I don't deserve help - there are so many people worse off than me', or  'If I ask for help, it proves I can't cope alone, and I will feel weak or deficient', or perhaps even 'I have been hurt so many times by people I trusted, how can I trust a stranger to really care'. These sort of ideas are built around an idea of self-reliance and strength, but they can ultimately weaken us by preventing us from reaching out for what we need in life in order to move forward. It may well be that these beliefs actually underlie or come from the problems that you are considering bringing to therapy.

When I was training, research was indicating that the answer to this question is that it does not matter what type of psychotherapy you have providing you have a good relationship with a well trained psychotherapist. While this is still basically the case, there is now some evidence that certain types of therapy can work particularly well for certain types of symptoms, for example symptoms of PTSD (Post traumatic stress disorder) are seen to respond well to EMDR, Sensorimotor Psychotherapy and other body therapies, borderline personality pisorder responds well to MBT, DBT and CAT and psychosis can be managed with CBT.

It is perhaps worth researching the different forms of therapy and asking prospective psychotherapists to tell you a little bit about how they work to help you form a feeling about whether that specific approach is the right fit for you. Mind also offer a helpful breakdown here.

Although different therapies may have slightly different emphases or ways of looking at things, with the exception of perhaps CBT, EMDR and more classical forms of Psychoanalysis, the experience of different types of psychotherapy will feel broadly similar; providing you with the space to talk and reflect, to help you explore and understand your feelings, thoughts and behaviors, so that you can make better choices in life. It will involve you speaking to your psychotherapist about your current and past problems and your psychotherapist listening in a particularly empathic and skilled way. They will be looking for and carefully highlighting previously uncovered patterns, meanings, emotions, defences and beliefs, the understanding of which will help you see yourself more clearly and thus clear the pathway to change. As the therapy progresses you will gain a better understanding of and compassion for why you live as you do, and you will observe when and where your problematic patterns are being enacted. Over time as your feelings and confidence start to change through the process of psychotherapy, you will begin to feel secure enough to start co-formulating and experimenting with new and more satisfying ways to be; reducing your symptoms and improving your relationships.

Most good modern psychotherapies can be described as 'relational'. This means that your psychotherapist will also have an eye on what is happening between you both in the room, based on the understanding that you will react to your therapist in a similar manner to the way in which you react to the other people in your life. Bringing this to light and exploring it together in the moment is understood to be one of the more influential transformative techniques in psychotherapy.

While psychotherapy can and does help, lasting change generally tends not to happen quickly. While a limited number of psychotherapy sessions will benefit you by bringing you some insight into your feelings and life, or by teaching you techniques to help you manage your symptoms; you are unlikely to get to grips with your underlying anxiety or catalyse much change in a short period of time. I generally advocate that clients commit to an initial six months (roughly 24 sessions) of weekly psychotherapy, during which we will agree to review progress periodically (for example every 10 weeks). This can understandably feel like quite a commitment at first, however do be aware that time passes very quickly indeed (it might be worth asking friends who have had psychotherapy about their experience in this regard). Good psychotherapy lasts until you and your psychotherapist agree together that you are ready to leave. I often offer completing clients follow up sessions one and then three months later which can help them manage the ending with more confidence. You can of course elect to end therapy at any time during your treatment, however it is strongly advised that you do not end suddenly and without first discussing it with your psychotherapist. This is for a number of reasons explained below, but includes the likelihood that a sudden ending to your treatment can lead to a deterioration in your mood.

While psychotherapy should ultimately bring about an improved sense of well-being, at times it can and will feel difficult. Exploring troubling events and relationships and opening up uncomfortable feelings so that you can ultimately better manage them, can feel challenging. Looking ourselves in the eye, although invaluable can often also feel initially tricky. However, any good well-trained psychotherapist will be very mindful of the need to pace the work so that you do not feel overwhelmed. If the work does begin to feel too hard, make sure that you speak up, your psychotherapist will really want to know. While psychotherapy may at times feel difficult, it should never be punishing. Your psychotherapist should and most likely will be supportive, non-judgmental, accepting and empathic at all times. They will be interested in and receptive to your feedback about how you are experiencing the psychotherapy.

A frequent criticism of psychotherapy is that there is no evidence that it works. This is absolutely unwarranted. There is ample evidence that psychotherapy can be very effective in treating mental health conditions. In support of this, in order for any treatment, physical or psychological to be offered by the NHS it must first be approved by the body NICE, which demands that treatments are supported by a robust evidence base. In addition, contemporary research findings in neuroscience and developmental psychology are further validating the theories and techniques of psychotherapy, and in particular those theories from the psychodynamic/ psychoanalytic schools.

The aim of psychotherapy is ultimately to enable you to better and to more authentically navigate your life, making more positive and considered relationships and choices. This means coming to rely confidently on your own judgement. Feeling more able to do this, comes about not by your psychotherapist telling you what they would do in your circumstances; but by working with you to help reveal how and why you form the judgments and make decisions you do, and how you might improve these processes so they both feel right more often and get more satisfactory results for you. Although it can be frustrating when you feel anxious and your therapist refuses to tell you what to do, withholding advice in favour of helping you look at your situation from different and/or deeper perspectives actually helps you get better in a much more sustainable way.

Initially for some people this can feel like a very strange part of psychotherapy. Understanding why your therapist is deliberately evasive about themselves can sometimes be difficult. However, this is actually a very important aspect of psychotherapy for a number of reasons. It might seem that knowing more details about your psychotherapist may make you feel more comfortable sharing your private thoughts and feelings with them; however, more often than not it can work in the opposite way. Knowing personal details about your psychotherapist might actually make you less comfortable talking about certain issues; for example, knowing they are married might make you think that they couldn't understand what it is like to be single in London. Similarly it may seem that knowing that you share certain experiences with your psychotherapist, for example childhood bereavement, would be helpful, however it could actually mean that rather than engaging in the very important process of  fully and deeply exploring your experience, you may bypass this by assuming that your therapist already understands it. Additionally, and more importantly for psychodynamic and other relational psychotherapies, a significant part of psychotherapy is about learning to notice the assumptions that you make about people and in particular your therapist. These assumptions which tend to be habitual and to emanate from past experiences, influence how we see and feel about ourselves and how we behave with other people, which can on occasion cause us problems leaving us and other feeling misunderstood and even frustrated. Skilfully noticing, exploring and challenging these assumptions is an essential component of psychotherapy. To reveal these assumptions, it is thought that the less you know about your therapist, the more you will assume about them and therefore reveal about your unique way of seeing the world and how, if at all, it is contributing to your difficult circumstances and feelings.

If your psychotherapist/ counsellor/ psychologist/ psychiatrist is a qualified psychotherapist they will be registered or accredited or a member of one of the main professional bodies such as UKCP, BPC, BPS or BACP. This will be noted on their marketing material (websites, directory listings, business cards etc). If it is not detailed, it is always worth asking them which body they are a member of. Being a registered psychotherapist means that they have been trained on an approved and monitored post-graduate clinical and academic program. It also means that they are insured, adhere to professional and ethical standards and are committed to continued professional training.

Psychotherapists who are members of the main professional bodies agree to practice in accordance to that body's particular code of ethics. These may vary very slightly depending on the body; however, they all clearly state that psychotherapist's must not engage in 'dual relationships' with clients. This means that they must be psychotherapist and psychotherapist only; they cannot be a friend, a business partner, a romantic or sexual partner, or in any significant way a creditor, meaning they should not allow their clients to run up large amounts of debt with them. In addition, all psychotherapists have a duty of confidentiality towards their clients. This means that information about their clients' identities and session content cannot be shared. This is however subject to important but very narrow legal limitations which should be detailed in their client contract and outlined in the first session. Arguably the most common reason to break confidentiality is when a client is considered to be a significant risk to themselves and/or others, and it is prudent that another professional (most likely your GP or prescribing psychiatrist) be consulted on the best form of combined care in order to keep you safe. Your psychotherapist will normally endeavour to discuss this with you before taking any such action.

As a UK resident you are entitled to free NHS psychological treatments provided by your local trust. These are accessed primarily through your GP. Generally, you will be given an assessment by a psychological clinician who works in your GP surgery and who will then signpost you to the NICE recommended treatment of choice for your symptoms and their severity. Unfortunately, due to funding shortages and high and increasing demand for services, the NHS tends to suffer from quite long waiting lists which may mean that you will not get access to the care you would like immediately. However, if you are prepared to wait, the NHS is home to excellently trained clinicians who will likely provide the most up to date treatments and a similar quality of care as you could expect to receive privately. It is important to bear in mind however that all NHS psychological treatments are 'time-limited', meaning that unlike private care you are unlikely to receive psychotherapy for more than a matter of months. The treatment duration tends to be defined by the type of psychotherapy offered, e.g. CBT tends to be offered for 6-12 weeks, CAT for 24 weeks, MBT, DBT & Psychodynamic Psychotherapy can be offered for up to 18 months. While there are no longer many free charity-based counselling centres in or indeed outside London (thank you funding cuts!) there are still a few available and there are a number of good low cost counselling centres where you can generally expect to pay c.£15-30 a session. The best resource to locate low cost or free psychotherapy services is your local Mind, the excellent national mental health charity. Mind operates counselling services across the country and can also help with information and signposting. Alternatively consider contacting one of the Psychotherapy Training colleges who may offer low-cost sessions with experienced and well supervised trainees.

Confidentiality is one of the cornerstones of a relationship of trust between a client and their psychotherapist. The fact of and content of your psychotherapy sessions are 'legally privileged' i.e., confidential. This privilege is subject to some legal and professional ethical exemptions. Legally there are some idiosyncratic but important exceptions. These include where the client chooses to disclose information about terrorism, the whereabouts of a missing child who is in the care of social services or the courts, or if they disclosed details about a road traffic incident they were involved in and your psychotherapist is approached by the police. Otherwise, your psychotherapist will not be required to reveal any information about your sessions to the legal authorities without them first issuing a formal request. A client may of course waive their right to privilege where they wish information disclosed in their sessions to be shared with an agreed party e.g., with their solicitor, prescribing psychiatrist or social worker, however it is advised that they always think about this very carefully and first discuss the ramifications of the break in confidentiality in detail with their psychotherapist. Ethically there will be times when your psychotherapist will make a professional judgment to set aside confidentiality. This will be when your psychotherapist considers that you represent a serious risk of harm to yourself or others. These occasions rarely arise over the course of treatment, however when they do, most psychotherapists will endeavour to make all reasonable efforts to discuss with you their intention to disclose, to whom they intend to disclose, and the content that they intend to disclose, and why they believe it to be necessary. It is important to discuss this with your psychotherapist in your first session. It is also important to bear in mind that 'serious risk of harm' is interpreted quite strictly by good qualified psychotherapists. Sometimes clients worry that disclosure of 'feeling like they would like to commit suicide' might trigger a break in confidentiality. While you must discuss this with your psychotherapist, most clinicians are able to distinguish between normal or commonly occurring albeit serious and upsetting 'suicidal ideation' and the distinct and less common 'suicidal intention', when the client has made actual plans to commit suicide and vocalises this intention and presents psychologically in a manner which indicates their likelihood to do so. Similarly, so with risk of harm to others. In addition, as a client your data is subject to the legislative rights and obligations of GDPR.

Depression is the experience of persistent low mood. Anyone who suffers from depression will know that this description is a serious understatement. While the symptoms that constitute depression can range in severity from the onset of, recurrence, or constant general low mood to physically debilitating feelings of despair and hopelessness sometimes leading to suicidal thoughts or even plans; regardless of where the sufferer feels they lie on the spectrum, it is at best ruining their quality of life, at worst unlike any other pain. Depression can be a profoundly isolating experience, not just for clients who more obviously display typical symptoms, but for those who do not, who present as successful, outgoing and energetic, but who inside feel utterly broken and alone, a sham. 

As a psychotherapist I tend to approach depression from a dual perspective. Where the client is willing (and only where they are willing- as a professional I am agnostic about antidepressant medication), I will work in partnership with a reputable prescribing psychiatrist who will consider appropriate and managed antidepressant medication. Psychotherapeutically I propose to approach depression with a longer-term emphasis. My initial aim is to help the client break down what feels like an overwhelming blanket experience of 'depression' by making contact with its actual constituent emotions; sometimes grief, anger, loneliness and other difficult feelings, and thoughts and beliefs. This initial step can help break the very common sense of disempowerment experienced in the face of depression, opening up a more nuanced and hopefully manageable condition. With the client, I typically then gently and carefully help them explore the origin and nature of each of those feelings and examine how they manifest in beliefs about themselves and the world. These beliefs and resultant behaviours, in a sad irony usually form a sort of vicious cycle which typically ends up reinforcing or increasing the underlying feelings that constitute the depression. As the treatment progresses and the client can gain strength and confidence, my treatment aim is to begin to more actively challenge these perceptions with the aim of identifying alternative more satisfactory and authentic perspectives which can open the client up to more positive, fulfilling and constructive experiences which can help supplant the original difficult feelings that contribute to the depression.

While this is describes my general approach to this condition, as an Integratively trained psychotherapist, I approach each client as unique in their history, presentation and symptoms and thus seek to build a model that best suits their particular need. While psychotherapy is clinically demonstrated to be efficacious, it is important to note that no treatment can offer absolute guarantees of effectiveness.

Simply put, anxiety is a feeling of unease with a given state of affairs. This can be very healthy; a feeling of discomfort that motivates curiosity, change, creation or safety seeking behaviour. Our non-verbal out-of-conscious processes are alerting our minds to something being not quite right. In these cases the cause of anxiety – the ‘not quite right’, can usually be identified and satisfactorily remedied: re-read the invoice; look at the work in progress from a different angle; visit that possible new house again, don’t pet that dog. Anxiety disorders however, feel very different indeed. Contrary to being a catalyst for change, sufferers of anxiety disorders often feel stuck or paralysed. In this form, our non-verbal out-of-conscious processes feel out of control and are causing troubling disrupted thoughts, overwhelming feelings of fear and/or despondency and severe physical discomfort. Unlike healthy anxiety, the ‘not quite right’ can be difficult to accurately pinpoint and remedy. Instead anxiety disorders can feel like an overwhelming general state of fear, feeling anxious about everything, unable to make simple decisions (General Anxiety Disorder), or in other cases it can manifest as specific anxiety about something concrete like ‘public speaking’ (Phobias).  Anxiety is normally depicted as just the classical feelings of panic, but sufferers will more often than not recognise two discrete states of anxiety: 

Hyper-arousal - a racing heart, breathlessness, muscle tenseness and tremors, dry mouth, clenched jaw, headaches, upset stomach,racing and/or ruminative thoughts, and insomnia; 

Hypo-arousal- extreme lethargy, lack of appetite, numbness and blankness, and a feeling of removal from oneself and the world.

In approaching both forms of problematic anxiety I focus treatment around both short and longer term goals.  The short-term focus is to stabilise and reduce symptoms of hyper and/or hypo-arousal to improve the quality of daily life and to facilitate the longer term deeper exploratory work. After a number of initial sessions to build a trusting and safe therapeutic relationship, I typically focus on helping the client work towards achieving symptom reduction with bespoke manageable lifestyle changes, physical calming techniques and some CBT. Depending on the severity of symptoms, possible medication may be discussed at this point. This work may possibly feel a little challenging at first as it involves doing something different when the anxious instinct is to remain frozen. However, as the psychotherapy progresses and the client begins to feel less burdened and more confident, this becomes manageable and helpful. Once stabilised, the longer-term deeper work explores the root cause of the symptoms; how it is that the client attributes feelings of fear to situations in which many others feel untroubled. This involves gently uncovering the client’s early life experiences and relationships and their impact on the client’s adult meaning-making (fear-assigning) processes. This important work is conducted in an appropriately paced, warm and supportive environment, enabling the important process of putting words to previously unspoken deeper fears, beliefs and anxieties. It is my experience that this working together to understand and question these deeper and older anxieties with a more widely informed adult perspective, and learning how they have contributed to current symptoms brings about the deeper more lasting psychotherapeutic change. 

While this is describes my general approach to this condition, as an Integratively trained psychotherapist, I approach each client as unique in their history, presentation and symptoms and thus seek to build a model that best suits their particular need. While psychotherapy is clinically demonstrated to be efficacious, it is important to note that no treatment can offer absolute guarantees of effectiveness.