What to expect in therapy

How do I know if the kind of therapy you offer is right for me? 

Therapy is a big commitment psychologically, emotionally, and financially, and it is not right for everybody. This being the case, when people contact me to enquire about having therapy, I like to talk to them on the phone initially. This is to get a sense of their difficulties and what they would like to achieve in therapy, and to see if the kind of therapies I offer are likely to be right for them.  If so, I then offer them at least two assessment appointments in order to get a clearer sense of their difficulties and of if there seems to be a good ‘fit’ for them in terms of how I work, and in how we get along. 

If this seems not to be the case, I may suggest an alternative type of therapy.   

What happens in therapy sessions? 

I think of therapy as a joint venture between the therapist and the ‘client’ or ‘patient’.  We meet at least on a weekly basis, in a secure and confidential setting. People talk about their psychological difficulties, and we work together on identifying the causes and nature of them. This includes focusing on how they view themselves and feel about themselves as people, and on the nature and pattern of their relationships with others.  

An example of this would be that someone may have felt that their parents had disapproved of them having certain perfectly normal and healthy needs as a child; and that this had caused them to feel bad about themselves for having these needs, and so to automatically conceal and deny them, even from themselves.  This would have been adaptive at the time, because it would have felt vital to them to protect their attachment to their parents, whom they depended on for their physical and psychological wellbeing.   It may, however, then have caused them to feel unable to be themselves in adult relationships, and to perhaps attract partners who had similar expectations to their parents.  What they experienced in these relationships may then, in turn, have perpetuated their beliefs. Because this process would have taken place at an unconscious level, it would need to be brought into conscious awareness, and understood as a protective or ‘defensive’ pattern. This could enable the person to feel more understanding and accepting of themselves and their needs, and strategies could be identified to alter these ‘stuck’ and unhelpful patterns.

How do the fees work? 

The fee for assessment appointments is payable on the day of the appointment. After that, I invoice people on the day of their last appointment of the month. There is a fee for every appointment when I am available.  This includes sessions which the client or patient misses for any reason, including sickness and holidays.  This may seem difficult to understand at first; but the purpose of this is to secure the appointments, and to protect the work in therapy. Working with unconscious processes is emotionally demanding and difficult at times, and the client or patient needs to know that their appointments are there for them continuously, even when they cannot be there.  This serves to provide an experience of emotional connection, and security, so that people feel as safe as they possibly can to address things at a deep level.   Because of this, I give good notice of any planned holidays, and there is of course no fee for any breaks I take. 

How long does therapy take? 

This is a difficult question to answer because everybody’s difficulties and needs are so different.  If someone is coming for Dynamic Interpersonal Therapy, this is usually a set 16 sessions.  

If they are engaged in Attachment-Based Psychoanalytic Psychotherapy, this would depend on the nature and severity of their difficulties, and to what extent they needed and wished to address them.  This being the case, it could range from several months to several years.  

How do you know when therapy should end?  

One of the main aims of therapy is to help people to become more self-aware, so that they understand, and can reflect on their own thought processes and difficulties, and that they know how to challenge them, and are able to do so; and also that they have been able to grieve over their suffering and losses.  Some people may feel that their issues are largely resolved in therapy. For others, whose difficulties are more severe and complex, this may not be the case, but they may still come to feel that they have addressed them sufficiently so that they are much more manageable, and are no longer having such a negative impact on them.  We would be focusing on how helpful and effective the therapy seems to be proving all the way through, right from the beginning of the process.

Some of the signs that someone is ready to end would be that they are feel more secure in themselves, more self-aware, that they feel better about themselves, that they are more able to meet their needs and to achieve their goals in life; and also that they are more able to make and maintain healthy and satisfying relationships with other people.