“Everything depends on inner change; when this has taken place, then, and only then does the world change.”
Here are some brief facts about Psychotherapy and Counselling:
- You don’t need to have anything ‘wrong’ with you to benefit from psychotherapy
- A psychiatric diagnosis is not required to overcome psychological, relationship, emotional or ‘psychiatric’ problems
- Psychotherapy and counselling are processes, not one-off events. As such they take time and regular attendance to develop and to effect change
- Success in therapy relies heavily on a mindset of effort, commitment, goodwill, honesty, openness to new experiences and openness to being challenged in your existing views and ways of acting in the world. Without these qualities to your mindset you risk wasting your time in therapy.
- Change is natural. It takes more time and energy to resist change (and so maintain old habits and problems) than it does to fully engage in the change process
- The psychotherapist’s skills and experience, and the patient’s motivation and mindset are more important than the type of psychotherapy
- You can talk about everything and explore anything in psychotherapy
- It is best to seek help sooner rather than later
- Individuals, couples, groups and families can do therapy
Where to start
Psychotherapy, counselling, psychology, psychiatry and other services can be very confusing if you are unfamiliar with how it all works and have no experience of seeking such help and don’t know where to start. The first step is to learn the differences between the different forms of helping:
Many people wait until they are in or near crisis point, when their decision-making may be compromised. The following page has information and links to help you navigate your way to the type of help that is best for you and covers both private and public sector help. Use the information when you are calm and able to make informed choices about the type of help that is best for you:
“A good psychotherapy relationship is one in which both therapist and patient respect, care about and value one another enough to invest energy in the relationship.”
Your Mindset: Are you ready for change?
Engaging in the therapy process is about your investment in your personal development and having a genuine openness to new experiences that allow change to happen. Change involves talking openly and truthfully about yourself and being prepared to persevere in doing the therapeutic work offered by the therapist. A good psychotherapy relationship is one in which both therapist and patient respect, care about and value one another enough to invest energy in the relationship. This forms a trusting space between you where you can tell your truth – truths that may be uncomfortable to reveal, discuss and work with in other kinds of relationship. You are responsible for how you use the sessions, what you focus on and what you take away from them. Your therapist responds to and works with whatever you bring, developing a deeper and fuller understanding of you over time. The proper starting mindset, then, is that you the patient are ultimately responsible for any changes that you make in your life (or don’t make). Your therapist is there to help facilitate that change, not do the work for you.
If you feel ambivalent about starting therapy, or feel a bit stuck or scared to look at difficult things this can also be a source of uncertainty when considering the therapeutic change process, and in these cases only you can decide whether you are ready and what you are willing to tackle. Now may not be the right time. Ask yourself how you will do if you just carry on as you are without help.
What mindset do you have for facing, talking about and doing the work needed to overcome your current difficulties?
- Resistant: Not at all motivated
- Reluctant/Indifferent: I’m not bothered one way or the other
- Very Ambivalent: I need to make changes but wish I could just take a pill to fix me
- Moderately Ambivalent: I know I can’t go on like this but am uncertain about change
- Mildly Ambivalent: I want to make changes and see how I feel
- Resolved: I’m ready to address my issues and am willing to do what it takes
- Committed: I’m keen to learn more about myself and to persist with the work in order to make the necessary changes to my life
The stronger and clearer your mindset is for embracing change, acting with goodwill, and channelling your energies into the work, the more chance you have of benefitting from psychotherapy. Strong commitment to engage, to being open to new ideas, to motivating yourself to facing some discomfort in the service of personal growth (stepping outside your comfort zone), and to making a real effort to attend sessions weekly and apply new learning each week are essential requirements if your work with any psychotherapist is to have any chance of success. If in doubt, an informal chat with a prospective therapist can often allay any fears, answer any queries, and help you be clear on your level of motivation without spending very much money. I offer a reduced fee introductory meeting for this purpose. After that, if you want to have a detailed picture of your problems, needs and what therapy might entail you can take the next step and attend an assessment.
- If you have mixed feelings about therapy read this: Ambivalence in Psychotherapy
Once you are clear that you are suitably motivated, decide whether you want public sector help such as the NHS, or private sector help.
Once you decide, start looking around at fees and get an idea of what costs might be involved.
- It’s useful to check around your area and compare fees, which can vary widely. However, high or low fees should not be considered an indicator of quality or competence. You’re paying for the therapist’s depth and quality of experience, qualifications, insight, skills, sensitivity and perception of your difficulties and needs. Some practitioners/ private clinics, for example, will charge you £160 or more for a standard 50 minute session for little more than simple CBT, and £350 per hour for assessment of your needs.
- Decide what your budget will allow. Psychotherapy and counselling are not quick fix solutions and if you are serious about therapy you can expect to attend weekly for anywhere between ten sessions and any number of sessions, depending on your needs. In terms of how much money you invest in your support and wellbeing, it can be useful to get therapy fees into perspective by, for example, considering the average hourly rates you might pay a local tradesman, mechanic or a dentist, doctor or chiropracter (at the time of writing this ranges from £60 per hour to hundreds of pounds per hour in some cases), or what some people spend socialising each month or on going on holiday. Decide for yourself what value you give to your development as a human being to be realistic about your therapy.
- Compare session length offered: do fees reflect 50 or 60 minute sessions for example? I offer 60 minute sessions on a reducing fee scale, with a 90 minute option. The standard ‘therapeutic hour’ offered by most practitioners is 50 minutes. Ten 60 minute sessions are the equivalent of twelve 50 minute sessions, when comparing fee rates for example.
- My fee rates take into account the work involved, not only during each session, but also:
- the preparation time before sessions
- consideration and analysis of your experiences between sessions
- written work after each session
- time spent emailing you or sending you supportive materials
- additional reading or research required to better understand or support your particular needs
Some private practitioners or private clinics charge £160 or more per 50 minute session for little more than simple CBT, and £350 per hour for assessment of your needs.
Choosing a Service or Practitioner
- Look at the type of therapy offered. Be aware that symptom- or diagnosis-focussed therapies locate a person’s life problems solely in the type of thoughts or behaviours they have e.g. CBT, EMDR. This may suit you. However, other psychotherapies consider social, family, relationship, economic, political and other factors influencing or causing a person’s distress or troubles to be crucial factors in how they are treated. Choose a therapy that is right for you.
- Beware of any marketing hype that suggests one type of therapy or clinic is better than another. There is no reliable evidence that this is the case and you may only be paying for appearance or prestige. Remember, like any other field of endeavour, very often it is the individual practitioner’s talent, experience and skills that count more than anything else. Research evidence suggests it is the therapist’s ability to listen, empathise, understand and accept that are central to change, not the type of therapeutic model, techniques or workplace setting he or she uses.
- Look at the experience, qualifications, length of training and personality of the therapist and how they come across to you on a personal level: genuine, or playing a role? How long was the training? And to what level? Some basic approaches qualify therapists in a few months for example.
- Has the therapist survived and healed from their own trauma, pain and suffering? This can be a difficult one to find out, unless the therapist published his or her account of their journey out of trauma. But seeing a psychotherapist who has received years of psychotherapy to help heal their own wounds as a requirement of their training is, in my view, extremely important. Some models of therapy do not require their practitioners to have had even a single hour of therapy. My training lasted six years, for example, during which time I was in full-time therapy and also working with patients in the NHS. Ask any prospective therapist how much therapy they’ve received.
- Check out my blog post: On Choosing a Psychotherapist
- Look for any additional support a therapist might offer, like between-session support, home or location visits, Skype and face-to-face sessions, or help in urgent circumstances
- Is the therapy process made clear to you before you start? Is there an assessment process and discussion about how therapy might proceed in your case? If not, are you happy to just start, keep going and see what happens without knowing what’s involved?
I offer an initial meeting for a reduced fee where we can meet informally to discuss things and clarify your direction, any uncertainty you might have and your level of motivation, with no obligation to divulge painful or difficult details and no pressure to continue beyond this first meeting. Confidentiality and privacy applies to any meetings we have.
During our first meeting you’re free to ask all the questions you like about the process, services offered and anything else that concerns you or may be helpful to you in getting the right help.
Visit my Blog
You can also get more information on what therapeutic work involves with me by visiting my Blog page, for example:
- Existential Analysis: how I work with you
- Getting the Most Out of Your Sessions
- Psychiatric Diagnosis: a guide
- Inadequacies of Public Service Mental Health Support
- Ambivalence in Psychotherapy
There are other posts covering depression and other topics and I usually add new posts once or twice a month.
I also offer an assessment-only service in which I can make a comprehensive assessment of your needs and offer recommendations to you on what types of therapies or support may be of most help in achieving your aims, with a summary analysis of what your presenting difficulties are and how they appear to work (referred to as a problem formulation) based on the information you have given me. Assessments can take anywhere between one and four sixty-minute sessions*, with two sessions being average.
*or more in some cases with complex histories or circumstances for example
For an additional fee (see Fees page) I offer detailed support plans tailored to your specific needs that outline all of the above plus discreet therapeutic tasks that could enable you to tackle each specific problem step by step.
Please go to the Appointments page if you would like to meet for an initial informal chat to discuss possibilities and options that might be available to you. It could save you a lot of time trying to figure out what to do on your own or finding out by trial and error.
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