What is psychotherapy or counselling?
Psychotherapy (or counselling; I make no difference between the two) aims at improving your well-being through person-to-person contact, connection and conversation between two (or more) people.
You contract a psychotherapist to use their skills, theoretical background, personality, and life experience, to work with you on improving or alleviating whatever you come to therapy to work on.
Goals for psychotherapy and goals for life
Psychotherapy is a big commitment, so I think it is essential that it delivers something significant, and that you know it will. I am thinking here specifically about goals which make a difference outside psychotherapy hours, for your relationships, how you feel about yourself, and your life goals, including work.
What you do inside therapy hours may include reviewing difficult parts of your life, but equally well be about gently exploring what's happened in your day-to-day life or relationship(s), or your feelings and experiences as they occur, in a safe and affirmative setting. I believe it is important when doing psychotherapy to have some sense of goals or direction; they can be anything, from quite specific to very broad experiential and relational desires.
More important than agreement on and satisfaction with what you do inside psychotherapy, is that being in psychotherapy should make a difference outside, in your life and relationships. This is essential for my idea of psychotherapy.
What do you work on in psychotherapy?
These are some of the issues that I have worked on with people in psychotherapy:
- relationship issues or problems
- anxiety, fear, phobias
- problems in living
- problems with or about sexuality, gender, self-definition, identity; or sexual behaviours, including problems with the reaction that others have to what you like doing
- “disorders” (this may rightly be thought to sound negative or stigmatising. But sometimes it can be helpful to tentatively identify a specific diagnostic "disorder" as the name for or at the root of a set of problems)
- out-of-control feelings, experiences, or behaviour; emotional problems
- moods that are not bearable and overwhelm you
- problems with anger or aggression; issues of violence that you have suffered or are suffering, or that you are inflicting on others
- problems with compulsive behaviour; lack of control over certain impulses
- problems with dissociation or full-scale dissociative disorders
- the effects of long-standing wounds or traumas going back into your adult or childhood past, including sexual, emotional or physical abuse, or absence of appropriate care
- somatic symptoms or issues - illnesses or just pains or experiences that appear to be in your body, but might have to do with our human living being bodily as much as mentally. I work at the medical end, but often a sharp separation cannot be made
The psychotherapy I do is highly individualised – no two therapies are the same. Every client is unique, every set of issues, goals or problems is unique, and every therapy develops in its own customised unique way. This is unlike practitioners who would use the same method regardless of the person and their issues, or who would follow a therapy manual or blueprint regardless of its impact and relevance.
Relating and relationships
I believe that relationships, and how people are relating with each other, often are important and are an integral part of many people's problems or issues. If this is the case, it may be effective to work out these connections and bring out the interpersonal aspects of the problem - what relationships with which people your problems touch, or have been influenced by.
The relationship between psychotherapist and client is at the heart of psychotherapy. Often relational issues from a person's past or present appear in the therapy room through influencing or being mirrored in the relationship with the therapist. When this happens, feelings are likely to come up that correspond to the original non-therapeutic relationship or interaction. They may seem to have little to do with how the therapist now is or behaves, and it may feel unusual to pay attention to them. It is an important part of therapy to analyse and understand the example of the problem repeating itself in the therapy session, and to talk about and work through the feelings and their origins in a safe and boundaried environment.
People are fundamentally relational; the personal and the relational cannot be separated.
Some factors that play a role in psychotherapy
Psychotherapy can be an alternative to using prescription drugs; you can also work in psychotherapy whilst continuing to use the drugs you were already using. If, while you are in therapy, you are also in contact with a doctor or psychiatrist who is prescribing drugs, it is most effective if you tell me what you are taking. Sometimes it works well to allow us to make contact and work as a team.
Although psychotherapy only uses words, it is known through the advances in neuroscience that working in psychotherapy leads to changes in the brain. For people who understand the unity of the mindbody, this should come as no surprise.
Research has demonstrated that the different schools and methods of psychotherapy make less of a difference than how the psychotherapy is organised, the motivation and circumstances of the client, the person of the therapist, and the development of their (therapeutic) relationship during the psychotherapy. The therapist needs to have and use a theoretical framework, or an integrated range of approaches, to be effective, but most problems can be approached equally successfully with different methods.
My standard "full fee" is £95 per hour for seeing one person once a week; I vary it for different numbers of people, frequency and time period, and I pass on the cost of my office near Bond Street tube. I am reluctant about not taking on people because they cannot afford this, so I see a (limited) number of people on a concessionary basis for lower fees, depending on their financial circumstances.
I always make a request to have a follow-up meeting between one and two years after the ending of therapy to see how you and your circumstances have developed. This follow-up session is free, and only costs you your time. It is important for me to obtain feedback as to how well the results we have achieved have been sustained.