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.

***

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.

***

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.

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.

When someone strays

Blog200Couple29 February 2016

Most people – whether through experience or empathy – can understand the range of feelings that go through someone’s mind and body when they discover their partner has, or is currently having, an affair. The event more often than not is experienced as a catastrophe by at least the wronged partner and it is common for all blame for the situation to be heaped on the straying partner.

From the therapist’s chair, affairs often look rather different. An affair, almost without exception, is actually a specific form of communication. In supposed monogamous relationships the fact that an affair has arisen suggests there might be evidence to support the idea that this is a relationship that has issues – and the underlying issues have probably developed over time. While it is very difficult to look beyond the pain of the immediate situation, couples who find their way to the consulting room tend to be providing themselves with an opportunity to really deal with their immediate and more longstanding problems.

One of the difficulties couples have to overcome when starting work, if an affair is the presenting issue, is avoidance. Avoidance is a strategy that rarely works in relationships and, while I don’t have space to go into any detail about it in this blog, it might be obvious to most people that avoiding an issue doesn’t mean it goes away. Indeed, a wide range of strategies of avoidance gets used between couples. One thing to bear in mind is that avoidance restricts resolution.

If you have discovered that your partner is having an affair, then I suggest you move more slowly with things than you might immediately feel driven to do. If you leave the relationship straight away you limit your opportunity for understanding what has happened and ultimately for your own repair.

Find yourself space. You are unlikely to want to go on sleeping in the same space as your partner for a while, but if you move too far away this is likely to fuel your anger and indignation. Try to reach a civil agreement that can work for a short time about how to use the space in your home.

Seek out some help, but be careful of other people’s moral judgements or advice. Therapists can be useful at a time like this because we don’t have to take sides. We tend to try to open up the picture so that understanding of the situation can be brought to bear, and the non-judgemental position can help make sense of the anger and rage that is commonplace at a time like this.

The process of working things through is actually just as likely to make you a stronger and closer couple than it is to split you up, providing you both want to work on the issues and are happy to look at not just your partner’s actions but also your own. Sadly, not every relationship can be brought back from the brink, but in thinking and talking together it is likely that even the decision to split will bring some positive benefits.

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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.

When the sex goes bad, make the talking good

Blog200Couple1 July 2015

Sadly, lots of people don’t feel very satisfied with what happens in their sex lives, and there are many reasons why it can go wrong. Sexual difficulties for men such as premature or delayed ejaculation (when they orgasm too quickly or, conversely, take too long to get there for the couple’s satisfaction) or issues for women like vaginismus (where they might not be able to let their partner enter, or find penetration painful) are common experiences for couples. When a couple suffers the issues rather than talking about them to try to work out the root of the difficulty, things can tend to get worse. Many common sexual issues can have organic, health-based origins or can be related to the use of some types of prescription drugs. Other difficulties can be psychological at their roots. Age and general health also often contribute to an individual or couple experiencing difficulties.

Additionally, sex can break down because relationships become stale or are challenged by life events. Over time, negative issues in sex lives build up because talking about your sex life often seems too difficult and challenging. Talking about your own intimate and personal experience, especially with the partner you share your life with, is a different type of talk for most people. No one really teaches us how to discuss a part of our lives that can make us, and our partner, feel unusually vulnerable. Add to this difficulties around intimacy for one partner due to, for example, a loss of trust based on infidelity, cheating, flirting or perhaps use or overuse of pornography, and you might begin to see why sexual activities fall into a rut or ‘just cool off’; rejection and blame are often quick to follow, and the sex cools further. No one dares to talk about the root issues – be they physical, emotional, psychological, cultural or even spiritual – that can affect what is or isn’t going on in the bedroom. And yet, that is where therapy can begin.

While you might perceive that talking to a therapist (a total stranger) about your sexual issues will be anxiety provoking (quite normal), or could be even worse than suffering in silence or living with the proverbial elephant in the room, the majority of people who talk to me as a couple or as individuals generally find it easier than they thought. I’ll always do my best to make clients feel comfortable: there are no ‘off-limits’ topics of discussion; you’ll always be treated with professional respect; and I’ll do my very best to facilitate the least stressful way of working with you. Therapy really can become ‘good talk’.