Tag / Counselling

by Therapy place uk

On beginning to change your life: the first session

blogfirstsession‘Signing up’ for counselling/psychotherapy can be a big move? It may even turn your life around in ways you hadn’t thought of. So it’s wise to consider a few things before, during and after your initial session.

Many people looking for a therapist do an initial search online. Others look through a directory. And yet others may be given recommendations by friends or a GP. However you ‘find’ a therapist, you may still wish to run the following checks.

First, your new therapist should, at minimum, be registered – if not also accredited – with a respected professional organisation such as the BACP or UKCP. (Psychologists should be graduate or chartered members of the BPS.) You should also read their website carefully to check they have the experience of, and feel comfortable working with, your general/specific issues. (This is particularly important in areas like sexual difficulties, as few general psychotherapy/counselling trainings offer enough input in this area.)

You shouldn’t be persuaded that someone is a good therapist because they have a lot of letters after their name. Studies suggest that once core requirements of education and training have been met, the effectiveness of the therapist is not dictated by their qualifications; indeed, research indicates it is the quality of the relationship between you and your therapist that can have a huge positive influence on the outcome of your work together.*

Remember also that, with personal recommendations, what works for one person may not always work for someone else. There is still a ‘goodness of fit’ to consider.

And so, having selected a therapist who you believe will be a good fit for you, the next step is to chat to them – through Skype, email, text or telephone call – and, if it still feels like a good fit – book an initial session.

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So what can you expect at your first session. If your therapist works for an organisation, your initial session might be quite prescribed. You may have to fill in the organisation’s routine forms and even complete questionnaires or diagnostic tools. However, in a private practice situation, where the therapist works for themselves rather than an organisation, things might be a little more personal and relaxed.

In my own practice, for example, I like people to spend a moment or two getting comfortable on the sofa. It helps me to know how difficult it is for the person to be in the room with me at the start of it all. I often ask people how anxious they feel about coming along for this session – something simple like: ‘On a scale of 1 to 10, where 1 is low and 10 is high, how anxious do you feel right now?’ Perhaps people don’t always tell the truth – a little in the manner that doctors can’t always trust patients to be honest about the number of units of alcohol they drink in a week – but it gets us started. (By the way, the usual ‘anxiety score’ is around 8. Also, people who have had some counselling or psychotherapy before often find it easier to be in the first session with a new therapist.)

Quite often, we might then go on to talk about how odd it is for two strangers to meet in a room, knowing little about each other but being there with the intention of talking about some of the most challenging areas in one of those two people’s lives. I make no secret of the fact there was a time when I, too, needed the help of therapy. I might use that at some point in an initial session if it helps to build a bridge. After all, most of us understand things best when we know something about it – and sometimes going through a process is the best way to find out.

When you’ve said a few things about your issues and discovered that the therapist is a human being, just like you, your anxiety can fall a point or two.

As the session goes on, people begin to sit back on the sofa. They pick up a bottle of water, which I always have available. They might even check out the tissues. In short, they begin to dial into the character of my room, my therapy space. Their breathing deepens and they discover that therapy is just a special kind of conversation. It’s a confidential place where: the therapist won’t have expectations of what you want to do; the phone won’t ring; no one else will ‘break in’. It’s a special conversation because it’s focused on you. That doesn’t mean the therapist has to be silent or a tabular rasa (blank slate) like you see in the movies (although if that’s what you need, then that sort of therapist can still be found).

I see the therapist as someone who: joins you on your journey, facilitating you to find your answers to fulfil your needs; won’t get their story in the way of yours; can help you, from a detached position, to look at things. I also think that therapy is a distinctively creative process that, through working together, forms the unique therapy you need.

The first session normally races by. People often comment they were worried they wouldn’t know how to say things, or even what to say. Yet, somehow, in the end, there wasn’t enough time to cover all the things they wanted to mention.

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Your first session is over. You are walking away from the place of therapy and are going about you real life again. What can you expect now? You may realise you feel pretty tired, perhaps even exhausted. This is the time to start looking after yourself. Between now and your next session you may spend time thinking about the process. You may even dream some answers or questions. An awful lot of the therapy happens between sessions. Your process has begun … Bon voyage.

* See for example: Lambert and Barley (2001) in Psychotherapy: Theory, Research, Practice, Training, Vol 38(4).

Why not visit my therapy website – therapy-space – where you can contact me or find further information about the therapies I provide for women, men and couples.

by Therapy place uk

A mood forecast for the autumn

octoberblogAs the temperature and light levels drop at this time of year, so each day rapidly shortens. Falling leaves unequivocally announce autumn and the inescapable ‘decline’ towards winter. It’s difficult not to be aware of the lack of vitality in nature and the echoes of endings: the end of summer; the end of long days; the end of warmth; and, deeper down, the counterpart that yet another year has slipped through our fingers – and, for many people, an uncomfortable connection with death.

Like the change in leaf colour, the calls to my therapy practice also alter during this season. Certain types of depression become prominent, and relationships seem to suffer even more as couples and families are thrown into closer proximity by the shorter, colder days … not to mention Christmas already becoming a pressure point for many. I note, too, that the two times when existential issues flurry most prominently into my practice are spring (the counterpart to birth) and once autumn beckons (reminding people of the ‘what should have been’ moments of the year).

But it isn’t just a myth that lower light levels bring about a time of increased depression for many millions of people. The ‘winter blues’ (which start in the autumn) has scientific evidence in its support. Seasonal Affective Disorder (often just referred to by its highly appropriate acronym SAD) is thought to occur because of the way our bodies respond to the lack of light available in the short daylight months. Theory around SAD suggests that the light entering our eyes causes changes in hormone production levels in our body, lowering the ‘feel-good’ hormone serotonin and also interfering with our melatonin levels – a hormone that helps determine sleep patterns. And, overall, the low light levels disrupt our circadian cycle – our naturally recurring body rhythms during a 24-hour period. For many people, these changes add up to considerable lethargy and the experience of other connected symptoms of depression.

So far, I’m not really offering much positive about the final part of 2016 stretching into 2017 – especially as I mentioned death earlier (the one unavoidable issue we must all come to grapple with at some point). And while August has the fewest deaths in the UK, January looms at the top of the chart, which equates to an unwelcoming month with more anniversaries of people’s passing – another great trigger for dialogue in the consulting room.

While we can’t avoid death, we can take a leaf (or perhaps an acorn) from a squirrel’s book and prepare for those light-depleted winter days by taking action and planning a few things before the dark takes hold.

For example, think about good, clean eating rather than succumbing to sugary carbohydrates that will add to a feeling of sluggishness, not to mention a few pounds.

Get active before your New Year’s resolutions. According to Dr Andrew McCulloch, the former chief executive of the Mental Health Foundation, ‘There’s convincing evidence that 30 minutes of vigorous exercise three times a week is effective against depression and anecdotal evidence that lighter exercise will have a beneficial effect, too.’* Of course, it follows that exercising outdoors (e.g. brisk walking**) during this period will be useful in helping to expose you to higher levels of light than you would get indoors.

When it comes to that increase in relationship stress, it might be time to book in a relationship MOT session with a therapist, where you can talk in a safe, comfortable, non-confrontational space about any issues troubling you in your life together.

*NHS website

**Walking for health website

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Why not visit my therapy website – therapy-place – where you can contact me or find further information about the therapies I provide for women, men and couples.

by Therapy place uk

Suffering from creative constipation …?

Blog awaiting imageI’m not quite certain if I first heard, read or spontaneously thought of the phrase ‘creative constipation’, but over the years I’ve made it my own. Often, when I first use it as a possible explanation for a feeling people are trying to express, it is greeted with a smile or chuckle before, on reflection, it begins to reveal its more serious nature in the therapy space.

The UK government reports that the creative industries are worth £84.1 billion a year to the UK economy, generating nearly £9.6 million an hour. Indeed, these have been a growth area of the UK economy as a whole: in 2014, they grew at almost double the rate of the rest of the economy.

While creative activity can be profitable, most people, at some point in time, decide they aren’t actually creative. Sometimes that moment of ‘discovery’ is quite clearly remembered. ‘My music teacher communicated to me that I was welcome to sing in the choir, just not on performance night’; ‘Our art teacher was a sarcastic man; he suggested to me that while the naive style was practised by many artists, first they had to learn to make it look like the thing they were drawing and then unlearn the rules. I never tried to draw again.’

While being creative is rightly connected with the arts, I tend to see it as a much wider human activity. Indeed, I’d boldly state that to be human is to be creative. While artists, musicians and actors are the creatives we think of most readily, teachers, builders and engineers, for example, can be hugely creative in all their various forms.

Creativity is an experimental activity. Small children do it naturally, acting out roles and bringing life to inanimate objects. But the socialisation processes of modern society, in the home, in educational settings, rarely stop to focus on the development and enhancement of the creative process. (I’m reminded of the lyrics of Harry Chapin’s ‘Flowers are Red‘.) And there begins the long constipating process. Life, vitality, energy, spontaneity can all begin to sludge up in our system when we abandon or refuse to see the creative spirit in human activity. When it gets really bad, even sex itself, the ultimate creative expression of human beings, can suffer.

Rather than a neat conclusion to this blog I thought I’d end this post with a challenge. How have you been creative this week?

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Why not visit my therapy website – therapy-place – where you can contact me or find further information about the therapies I provide for women, men and couples.

by Therapy place uk

Just call me …

Blogfind200

“Yes you’re right,” says Jessica, as we begin to talk for the first time about the process of therapy. “The only clues I’ve got,” she says, “are from TV sit coms and films.” We laugh together for a moment and then I begin a fairly routine explanation of what my work role as a therapist is.

First, what I am not. I’m not a psychiatrist. The Royal College of Psychiatrists* describes Psychiatry as a “medical speciality, like general practice, surgery, general medicine or paediatrics. You have to train for 5 years as a doctor and in the UK – like every other medical specialty – do 2 further years of ‘Foundation’ jobs in hospitals before you can start to specialise in psychiatry. It usually takes another 4 years to pass the two professional exams of the Royal College of Psychiatrists, after which you can specialise further.”

Although I studied some developmental psychology during my initial degree, I am also not a psychologist. A Clinical Psychologist (the type of psychologist you are most likely to encounter within an NHS setting) will have gained an undergraduate degree in psychology. Again, according to the Royal College of Psychiatrists, psychologists will have gained “further experience working in relevant healthcare settings[;] clinical psychologists then do 3 years Doctorate clinical training in an approved training scheme at university. During this time they work with patients under supervision from experienced psychologists and study for an academic doctorate as well as their first degree. They complete training placements with adults, children, older adults and people with learning difficulties.”

Historically, psychology has applied experimental approaches to exploring sates of the human mind. My shorthand for people is that psychiatrists are doctors of the mind and psychologists are scientists of the mind.

So back to what a psychotherapist is and isn’t …

“I’m not an analyst.”

“So I’m not going to be lying on a couch answering your questions,” says Jessica. “It’s not a Woody Allen film, then?“

Indeed, in my own twice-weekly analysis that lasted nearly 6 years I never laid down on a couch because even analysts don’t all do that.

“I am a therapist who deals with people’s internal mental and emotional issues and difficulties,” I continue. “Sometimes people are comfortable with me as their counsellor – a word that is derived from one who walks alongside. Other people I work with refer to me as their psychotherapist, from the Greek for ‘soul and healer’. Some think of me as their coach, and others come to me for hypnotherapy.**

“What I will actually do is sit in a chair opposite you and listen, talk and engage with you in a relational manner. In short we will have conversations about you, what course of action you might need to take, often what you have done or experienced in the past, how you see the world and your interactions with it, and where it is you are trying to get to. I work with all the issues a human can have problems with – including things that are really difficult to talk about such as sex, addiction, relationships, anxiety and bereavement. But I’m not a doctor of the mind and I’m not a scientist of the mind. I’m more an interpreter or an artist, helping you to construct your own canvas by pulling things from one place and sitting them somewhere else.”

“I call myself a therapist, but my professional registration*** says I am a counsellor/psychotherapist. You can just call me Duncan.”

* http://www.rcpsych.ac.uk/

** I am fully qualified hypnotherapist and is registered with the General Hypnotherapy Register.

*** I am a fully qualified, registered and accredited BACP (British Association for Counselling and psychotherapy) counsellor/psychotherapist.

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Why not visit my therapy website – therapy-place – where you can contact me or find further information about the therapies I provide for women, men and couples.

by Therapy place uk

The transient existence of meaning and belonging

Connection200

The transient existence of meaning and belonging

29 June 2016

The midsummer light has finally faded around the edges of the blinds and I am sat within 3 metres of two of the most beautiful voices imaginable. As the climax of the final piece fades and the last statement of the main theme rolls from the trumpet bell, it is possible to anticipate what is about to happen within the venue. Almost in slow motion an eruption of connectedness pushes forth as cheers, shouts and bellows for an encore assault the very oxygen of St George’s concert hall, Bristol. The Unthank sisters, singers of extraordinary presence and warmth, are clearly moved by the reception, and for a few minutes I know I am truly alive – in the moment with every one of the 500 humans emoting in the space.

It is several hours before I can settle, but as I drift off to sleep I am already beginning to think about The Unthanks experience in terms of the wider psychology of human beings. I realise that the gig, and my weekend visit to my home city of Bristol, was about meaning and belonging. Viktor Frankl, psychiatrist and Holocaust survivor, put forward the idea that humans are driven to find meaning in life.

While many men and women naturally discover meaning, our perception of how much of it we have and/or need appears rather variable and subjective. From the therapist’s chair I witness that believing one’s life lacks meaning is correlated tightly with a number of negative mental health issues including stress, anxiety, depression and thoughts of suicide. Conversely, through therapy I see that people often find their pathway to meaning, which brings with it positive inner feelings and good mental health.

Research frequently focuses on meaning and belonging in connected ways. Social bonds and attachments are clearly tied to this research and are undoubtedly important for humans – so much so that, at certain points, our very survival is predicated upon it. Men and women commonly associate their social relationships as something that creates meaningfulness in their lives, and this is reported in several pieces of research. However, this view of meaning and belonging invariably leads us too often to understanding these issues in relational terms only.

It seems to me that there are other important ways of finding and internally holding our connections of meaning and belonging as a human being. It might be no surprise that I put forward the idea that the arts are one way in which we might build such a sense of belonging and meaning in life; that said, there is also the need for being part of ‘tribes’ whether they are found in sport through supporting a team or the simple acknowledgement of where one comes from … And here I am back with the Unthanks’ songs, deeply rooted and evocative of a culture and geography.

Fast forward to a wet Monday morning. The weekend has ebbed but the music, art and culture of my home city has filled me with a sense of meaning and belonging. Although I must return to Cambridge, it is my connection with my tribe in the West that helps me fully to understand exactly who I am. Beyond the more normal way of viewing meaning and belonging within relationships, I recognise that I have both these things dynamically alive within an internal map of connections built across time, culture and geography, and however present but transient artistic and cultural experiences of meaning and belonging might be, I realise the richness, depth and importance of its touch on people’s lives.

Why not read: Crying has an upside – for men and women alike

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Why not visit my therapy website – therapy-space – where you can contact me or find further information about the therapies I provide for women, men and couples.

 

by Therapy place uk

Living life by numbers … and the midlife crisis

Numbers_edited-1Living life by numbers … and the midlife crisis

May 7 2016

Conveniently, for lovers of statistics, the Canadian-born psychologist and social analyst Elliot Jaques – who coined the term “midlife crisis”* – died at the age of 86. I say ‘conveniently’ because his lifespan correlates so well with modern statistical expressions about the mid-point of life. As examples of this, the World Health Organization revealed in 2013 (the most recent figures available) that life expectancy for the average UK citizen is 83 years, and a 2015 report from the Economic Journal revealed that life satisfaction gradually declines throughout the early part of adulthood, reaching a low between the ages of 40 and 42 – so close to Dr Jaques’ midlife point.

The difficulty with reporting averages and statistics about human life is that it can obscure life-lived experience and meaning. If we expect a ‘midlife crisis’ to occur at a certain age, then we will be likely to attribute all negative experiences and challenges to that age rather than to the actual experience triggers and events we are living through at that point in time.

Our later 30s and 40s can be especially difficult times, not particularly because of our age, but because of the responsibility life tends to have assumed. In contrast to childhood – a time when the vast majority of people will have been nurtured, protected and cared for by other people – 35 to 50 year-olds generally have to work hard to support themselves and other family members. And with these struggles come other issues – including depression, anxiety and the realisation that time is passing quickly.

It seems that headline statistics as reported in the media tell us very little about the real nature of a person’s issues – although they do appear to make people feel unhappy when they don’t live up to the ideal average. And how do we, as individuals, ever know when midlife will be? For some, 50 will be the figure they never reached; for a few – take, for instance, therapist Hedda Bolgar** who, aged 102, still worked four days a week – that midpoint would not yet have been reached.

I remember sitting on the sofa with my mother listening to the radio on the eve of my 10th birthday, feeling sad that it didn’t matter how long I would go on to live “I could never count my life in single digits again”. While I didn’t realize it at the time, I was actually making an observation that the middle of life can only be seen on reflection, since the truth of it all is that we are actually continually positioned at the extreme end of our lives. This is as true today at the start of my 51st year as it was at the conclusion of my ninth.

Crises can happen at any time of life and it’s important to see each crisis for what it is – and act accordingly. Then, perhaps we can aim for 45 joyous, rather than a total of 90 miserable, years.

* Elliot Jaques (1965) Death and the Midlife Crisis

** http://www.today.com/id/45287411/ns/today-today_people/t/age-therapist-still-psyched/

by Therapy place uk

What are you living for now

JamWhat are you living for now

5 April 2016

It is a gloriously sunny spring afternoon and all I can see, as I walk away from the city centre of Cambridge, is an unending line of traffic queuing to make its way to an impossibly small number of parking spaces. I am aware that I feel very free, liberated, uplifted by the sunlight. But as my passage contraflows the stationary victims – would-be shoppers – I can’t help picking up on the silent messages of those stranded in their overheating metal boxes. Hands flex and contract as they grasp and ungrasp leather clad steering wheels. Passenger seats wriggle with adults and children, each stretched to breaking point by the seemingly endless wait to reach the junction of this road in order to join the main queue on the next one. Further along, the frustration has already erupted in road rage as a woman in a 4×4 mounts the pavement in a very unwise manoeuver. For a while my joyful mood is attenuated. I have stopped enjoying my journey (on foot) and begun to focus on getting to my goal, far away from this line of traffic. Without conscious passage, my head is cluttered with thoughts about the anxiety of modern life – something I’ve been meaning to write about for some while – and then my working mindset is to the fore.

From the communication style they’ve adopted, the male/female pair in the silver Merc look ready for a couples session. Come on! Shouting rarely gets listened to. The family in the people carrier could do with an anger management workshop. And will someone please hand the sports car driver a paper bag to breath into before he passes out!

For a few more metres I’m left wondering what this line of suffering stretching out in front of me is all about before the words of British philosopher and Zen exponent Alan Watts come to mind. In one of his engaging talks* he states: “You can’t live at all unless you can live fully now.” The point he is making is that it’s not the end goal that forms the major reward and provides the greatest pleasure, but the journey itself. And having engaged with this thought, I felt once more liberated, uplifted and grateful that I wasn’t sat in the traffic looking for anticipated reward in my shopping basket.

*If you can spare 2 minutes 22 seconds, you can listen to the rather inspirational way Alan Watts talks about life fully in the now.

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Why not visit my therapy website – therapy-space – where you can contact me or find further information about the therapies I provide for women, men and couples.

by Therapy place uk

On being ignored, forgotten or abandoned

AttachmentblogOn being ignored, forgotten or abandoned

1 December 2015

From my window seat, I was enjoying watching the early Saturday coffee addicts flock into the café for their various flat whites, cappuccinos and espressos – or at least I was for the first ten minutes. But, during the next five, it was becoming increasingly clear to me that my friend had forgotten we were supposed to be meeting for a long overdue catch-up. At times like this, there is often a choice of internal conversations to follow, and by the time I’d sat for twenty minutes on my own I began to indulge a few childhood voices. Some remembered being ignored, others the embarrassment of being forgotten; and then came the memory most often worked on in my own twice-weekly analysis: the sorrow of abandonment. So, what are these often strong feelings based on?

In the very early months and years of our lives we build up particular ways of relating to people. This is referred to in the therapeutic world as our attachment pattern. The research into attachment patterns was originally conducted in relation to children and their parents.* These early attachment patterns are referred to as Secure, Avoidant, Ambivalent/Anxious and Disorganised. Later research has suggested equivalent patterns of attachment in adults to their significant intimate partners.** In other words, once attachment patterns are established it then becomes the way we relate in our intimate relationships.

People who had the opportunity to form Secure attachments as children also tend to form Secure attachments as adults. The Secure person has a desire for close connections with others and has a sense of a positive view of her or himself. Not surprisingly the Secure personality holds positive views about partners and their relationships.

The adult Dismissive personality is associated with those who had avoidant attachments as children. People with Dismissive personalities are largely characterised by being more separate, inward and isolated. Relationships and emotional life tend to be viewed as relatively unimportant. The cerebral takes precedence and feelings are suppressed – including distancing themselves from others.

Ambivalent/Anxious children often become Preoccupied personalities in adulthood. Self-critical and insecure, the Preoccupied adult seeks approval and reassurance from those around him/her even though this never provides the sought relief from self-doubt. In relationships, this type of personality imagines they will be further rejected which, in turn, creates more anxiety, over-dependence, lack of trust and emotional desperation.

The Fearful-Avoidant personality has its connections with the childhood Disorganised pattern of attachment: i.e. in childhood there was a detaching of feelings at times of trauma, and this persists into adulthood. There is a desire to be involved in relationships until the point at which the relationship develops emotional closeness. This becomes the trigger for the repressed feelings from early life to become live triggers in the here-and-now, which are then experienced as if they are happening in the present moment. This makes it very difficult to have a coherent sense of (your)self with the corollary that it makes intimate connections with others equally challenging.

By the time I left the café, it transpired I’d had quite a mental workout. Assured that I can still rely on my own Secure attachment, I wandered through the already stressed shoppers pondering whether my friend’s lie-in had been as interesting as my own solo coffee encounter. Perhaps, I thought, I should enjoy my own company more – but that might just have been the edge of some Dismissive personality traits talking.

* See Mary Ainsworth
** See Hazan and Shaver

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Why not visit my therapy website – therapy-space – where you can contact me or find further information about the therapies I provide for women, men and couples.

by Therapy place uk

Finding a good therapist

Blogfind2002 June 2015

I remember reading Canadian educationalist Allen Tough’s pioneering thoughts in the area of self-directed growth in adults and being inspired at the way most adult learning occurred in informal settings and ways. You could say that adults learn on a need-to-know basis. When you need to get a new car you read magazines, check the Internet, ask around your friends and family for their views, and if you are lucky enough to know a professional in the area you are ‘researching’ then you tend to ask them.

I’m tempted to say that the above pretty much all holds true for finding a therapist as well. But if I think back 20 years or so when I needed therapeutic help myself, I can all too easily remember how difficult it was to talk to people about such issues. Back in the early 90s society was still too wary of therapeutic help. It was also the pre-Internet world when counsellors and psychotherapists were more difficult to find. So, should you just rely on the Internet? Is it good enough to simply look someone up on a website and then hand over your emotional wellbeing to them?

If I were looking for a therapist today here’s what would be on my checklist before I started any sessions with them:
Are they registered and accredited by a respected professional organisation such as the BACP, UKCP or BPS?
Will they talk to you on the phone, by Skype or email before you book a session?
Are they experienced in working with the issues you want to work with? (This is particularly important in areas like sexual difficulties, as few general trainings offer enough input in this area.)
Is the therapist used to working with people in short-, medium- and/or long-term encounters? This might be very helpful in matching your needs with the therapist’s skill set.
Has your prospective therapist had their own therapy? (It might seem odd but not all models of therapy require therapists to undertake their own therapy, while some will simply have done the minimum required by a training course. I’d find it odd to have therapy with someone who hadn’t been in the chair themselves.)

Above all, don’t be persuaded that someone is a good therapist because they have a lot of letters after their name. Studies show that once core requirements of education and training have been met, the effectiveness of the therapist is not dictated by their qualifications.

To my mind, all therapists should be looking to make a good match to the people they are going to work with. Again, studies support the view that it is the quality of the relationship that really helps therapy work. So, it follows that I always offer a no-obligation initial session.

Finally, go with your gut feeling and, if it doesn’t feel right in the room, shop around.