4 April 2018

Professional, confidential, friendly counselling in central Exeter

Serious about making changes in your life?

If you are looking for a therapist you have taken a courageous first step. Life can be hard for us all at times.  I love the work I do; helping people to explore what's troubling them in order to live more fulfilling lives.

I work privately from beautiful premises on Southernhay, right in
the centre of Exeter, Devon, with a wide spectrum of people with many differing presenting issues. Professional, approachable, open-minded and non-judgmental, I have the utmost respect for your individuality and life circumstances. 

I draw from several reputable theories of practice enabling me to work effectively, progressively and collaboratively with individuals and couples.

Offering a fully professional service I am fortunate enough to be able to work full-time at my dedicated Exeter practice, seeing clients five days a week. 

I am committed to facilitating the exploration of the issues you bring. If you are serious about committing the time and energy required I invite you to make contact to arrange an initial appointment.

This site is where you can find out information about counselling and how it can help you, my personal approach and services offered, and some details about my background, by clicking on the information tabs above. 

This is also a blogsite which I use to make regular posts about my work and continuing professional development as a counsellor. Click here for my Articles.

I would be very happy to discuss your requirements should you be interested in coming along for counselling. Embarking on a course of counselling can be daunting and I aim to help you feel relaxed and confident that you make the choice that is right for you.


Please, whoever you decide to have counselling with,  whether individual or agency, ensure that they are registered with an adequate professional body. The BACP is the largest professional body and have a robust complaints procedure which is why I choose to be registered with them. BACP Accredited status is an established, recognised and accepted assurance of experience and maturity as a practitioner. Without membership of a self-regulating professional body then clients have no recourse should they feel that they are being treated unethically. At the moment, there is nothing to stop people practising as counsellors without this protection for their clients. Following the dreadful scandal involving the Exeter based Palace Gate Counselling Service I researched and wrote about this topic on this post about the regulation of counselling and psychotherapy

I spent several years campaiging for the regulation of counselling and psychotherapy along with Phil Dore via the website Unsafe Spaces. I have taken a step back from this to focus on my practice (March 2018).

Check my BACP Registration entry here  

Counselling in Exeter with BACP Registered and Accredited Counsellor
Look for the logo

Registered with WPA Health Insurance 

Imitation is the sincerest form of flattery but in the case of therapists lifting content directly from other therapists' websites I reckon that this is not good for our clients and does not reflect well on either ourselves as practitioners with integrity nor the profession as a whole. We all take inspiration from other professionals but please at least change some of the words and sentences around. I am proud of the content of my website which has been carefully constructed over many years of practice and have been concerned to see some of my site lifted almost word for word on other therapist sites. 

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1 January 2018

What to expect from Counselling and Psychotherapy

by Amanda Williamson Reg MBACP (Accred) - A guide to my therapy sessions

The first session

You might be feeling very anxious...

It is completely normal to feel anxious at first, particularly if this is your first experience of therapy. It can take a while to get used to the situation but almost all clients report feeling significantly more at ease as the session goes along. It can be quite a relief to talk about difficult issues with someone who is understanding, who clearly withholds judgment and with whom you do not have an emotional attachment.  

You might be surprised at how tearful you are...

It is also quite common to feel tearful and cry much sooner than anticipated. You might feel surprised by the intensity of feelings but it is completely normal especially after having to hold so much, usually for quite some time. The tears might be as much about relief as about expressing sadness. I have lots of boxes of tissues and am very used to witnessing tears in the therapy room.

We aren't very good at dealing with tears in this society. Because of this we can tend to be very self-conscious about crying in front of others and it's at that stage that I wish I had footage of me in therapy when I was a trainee therapist. It's one of the reasons why therapists who train with reputable and ethical training providers have personal therapy as part of our training. If you could see me having a good, hearty blub with my therapist, complete with blotchy eyes and runny nose, you might not feel so self-consious about your own tears. 

Most therapists understand what it's like to feel self-conscious, vulnerable, anxious and tearful and I most certainly do. It's also okay and normal to feel no anxiety or sadness.

Making your way to the therapy room

When you find my premises you will ring my doorbell and I will buzz you through to the hall. If it's your first session I will tell you to make your way up the stairs and I will come down and find you to show you the way to the room. It's on the second floor and there's lots of
doors that look the same. So it makes sense for me to show you the way, especially if you are feeling a little anxious or unsettled (or if you have an appalling sense of direction at the best of times, like me).

The environment

I will offer you a drink (tea, coffee, herbal tea) and a seat on the sofa. There is a jug of water by the sofa for you to help yourself to (and boxes of tissues), It's a nice spot with a view of some trees and the sky. As a client, I appreciated being able to look outside sometimes. My room is comfortable and pleasant and certainly the nicest of the premises from which I have worked. The other practitioners on the same floor are also therapists and are very professional and considerate. 

Getting started

The first thing I will do is some data gathering. This includes practical details such as address, date of birth, whether you have read the contract or not. Then I will move onto asking you about any physical or mental health issues and medication. I will ask about your family background (parents, siblings, partners, children etc). I will also ask whether you have had any suicidal thoughts, attempts and/or self harm and also whether you have encountered suicide or self harm in a family member or friend. 

Please note that all notes are taken and stored on paper, in a locked filing cabinet in my room. I do not share the room with anybody else. The only person who has access to the filing cabinet is my colleague with whom I  have a "Clinical Will" arrangement in the event of my sudden illness or death.

CORE 10 form

I may ask you to complete a CORE 10 form which is a short measure of psychological distress. It can help highlight problem areas quickly and be a useful reference tool. It is a tick box form and only takes a couple of minutes. 

Focusing in on the therapy

Then I will ask about any life events that may have impacted on the issues you are bringing to therapy and also ask what your goals are for therapy; what was it that lead to contact being made to set up this session? The aim by the end of the session is to have an agreed focus of work for future sessions. It is usual to have gained some insights, perspective  and food for thought by the end of the first session.

Any questions?

Please do have a think if there is anything you might want to ask me during the session, to help make your mind up whether you want to continue with further sessions.

Payment and rebooking

Towards the end of the hour, the question of booking another session is looked at. It may be appropriate for me to refer you to another therapist and I will explain clearly why, if this is the case. Payment is usually made at the end of the session although some clients elect to pay upfront which is absolutely fine. It is common for people to forget about payment until prompted. If this happens, please don't feel in any way bad. I don't feel bad about asking and that is partially because it happens so frequently but also because I definitely forgot sometimes when I was in therapy.

Subsequent sessions

I will usually refer back to the therapeutic goals regularly and review how we are doing and whether those goals need to be tweaked or added to in any way. 

During sessions I write down notes in a fairly organic "mind mapping" way. Some clients find it helpful for me to email a picture of these notes as it helps remind them of the themes discussed. It's also okay to not want to see the notes.

I will sometimes ask how you feel about the sessions and whether you feel that we are working on the areas we need to be working. I might also ask whether you think we might be avoiding anything.

I will sometimes bring up the topic of ending or reducing the frequency of sessions and this is never because I am trying to get rid of a client. In fact, if that is the feeling that you get then it can precipitate a healthy therapeutic discussion about perceiving rejection. I bring it up as a therapeutic tool, to see if we are working on what we need to work on, as a genuine wondering whether it would be beneficial to look at reducing the frequency, particularly where it seems that very good progress has been made. Sometimes, by asking the question, it precipitates the opening up of something more for us to work on.

Without reviews and talk of endings I believe that therapy can become stagnant for clients with a potentially unhealthy dependency being fostered. That said, sometimes a long term therapeutic relationship is what is required. I don't think that there is a right or wrong but these things should be discussed to keep the therapy fresh and healthy for the client.

As a therapist I strive to foster empowerment and autonomy in my clients but also endeavour to never push away when what someone needs is the experience of being part of a consistent and safe space for a longer period of time. We are all different.

More details about how I work can be found on the My Approach page of my website.

Ending therapy (sometimes prematurely) and resistance

Most often it is by mutual agreement that therapy ends. Goals have been largely met and it feels right for both the client and myself to end. We can review the goals, discuss the changes that have been made and celebrate the work we have done together. It is an important and wonderful part of therapy. Bittersweet in some ways as I do miss working with clients as we build a relationship and I do genuinely care, But it is also quite wonderful to know that my client does not need therapy any longer. 

Sometimes, a client might start to feel resistant or rebellious. This is within the realms of normal behaviour within a therapeutic relationship. I see this as happening for a couple of reasons:

1) Our back brains resist change - by back brain I am referring to the limbic system and brainstem which learn from previous experiences (particularly childhood) how best to be. These ways of being become subconscious habits and are linked to our very survival as children. These adaptations were probably ideal for the situation we were in as kids but less so now as adults - they have become maladaptive. However, whilst our sensible front brain knows rationally that we need to change these old ways, the back brain begs to differ, and sometimes quite robustly. We might suddenly feel resistant to change and to the therapy.

2) Ideally we are able to go through a healthy teenage phase where we are loved and accepted unconditionally. Even when we are breaking boundaries and forging our independence in perhaps quite unhealthy ways, we need the experience of parents/caregivers who have robust enough egos to allow us to leave and come back, leave and come back. If we haven't had that experience before then being able to disengage from therapy and then choose to reengage again at a future time can be incredibly healing; Phase 2 therapy I call it. The early child stuff is kind of easier for clients and therapists. It's easier to appeal to a younger child so that part of us responds well to therapy. If we are working with our teenage hurt then it gets a bit more challenging, as any parents of teenagers might tell you.

The message is, it's okay to come back. Whether it was a planned ending or a sudden retreat, it is worth exploring the option of working together again.

If you have any questions at all about any elements of this guide then please do not hesitate to contact me. This guide is intended for new clients of my service, to be read in conjunction with my therapeutic contract.

30 August 2017

Therapists and holidays

I write this a week after returning from two weeks annual leave. I have been wondering whether it might be an idea to give newer clients a hand-out to read prior to planned breaks so that they have a idea of how a therapist having a break might impact on a client. Most clients do not appear to be adversely affected by my having time off and I always do my absolute best to give as much notice as possible. Some clients value having a bit of a breather. However, during any holiday I take, some clients might be impacted negatively and although it might seem clear that clients with attachment issues and complex trauma would have more chance of being impacted, it is not always obvious to me who might be affected and in what way. It might not even be clear to a client that they are being impacted by their therapist's absence so open and honest dialogue is important and, on the part of the therapist, an awareness of this being a possibility.

Occasionally, a client might be so impacted that they withdraw from therapy completely without giving themselves the chance to learn and grow from the experience. I would venture to say that of the few clients that have disengaged from therapy without prior discussion this is more likely to happen following my absence. Of course this might be that time out from therapy has given the client enough space to decide that it doesn't seen to working for them but I strongly suspect that this is not always the case.

The importance of self-care for therapists

I very much value and enjoy the work I do but it can sometimes be emotionally depleting, especially if one is a busy, full time therapist and/or if dealing with serious trauma work. Taking time out from being a therapist is paramount for many reasons:

Avoiding burn-out - a therapist with burn-out who then has to take time off with stress might result in unplanned breaks which for clients are almost always much harder to deal with than planned breaks.

To regain a healthy perspective - this is particularly true when dealing with issues such as childhood sexual abuse and complex trauma. These are areas where even the most positive thinking therapist might start to view the world with a somewhat negative outlook, finding ourselves immersed in the darker side of what human beings are capable of. This can be one of the warning signs of burn-out and a reason why self-aware therapists will cap the amount of trauma work they take on as well as taking adequate breaks.

To spend quality time with friends/partners/children/family - important for almost all people, no matter what their job or lifestyle.

To have some alone time - also important for most people, perhaps particularly for the more introverted therapist *holds hand up*.

Modelling self-care - how can we expect clients to learn to value themselves and honour their personal requirements for self-care if we don't do the same by not taking adequate breaks?

Taking time out for other work related tasks - as a self-emplyed therapist I run my own business, update my own website and social media accounts, do my accounts and like all therapists, regularly engage in Continuing Professional Development such as workshops, reading, research and occasionally writing articles such as this. Due to my working full-time and having family commitments, I do not have much spare time to catch up on the admin side of the role.

I asked for therapists and people who are/have been in therapy to share any comments they had about the topic.

Comments from other therapists via my Twitter post

A therapy client's point of view (sent via my Facebook page)

I was kindly sent the following by somebody in therapy in response to my question about the impact of holidays:

I've seen many therapists and a flash point for me is always when they have long breaks e.g. the summer holidays etc. Although I am completely aware that all good therapists need to have breaks and look after themselves I find it so hard to reconnect with them after a break and this is often the time I chose to bail on them and not return to sessions. I find it very hard to bond with people, especially professionals, and find that a long break just makes me shut down and then I don't want to go back. Want is probably not the best choice of word.

The first time my current therapist, who is by far the best I've seen, was going to have a month off for summer she said 'While I'm on holiday can I ask you...' and I finished her sentence 'Can you ask me not to contact you as you need family time, you are a professional with boundaries etc' and I had that sinking feeling that it was all about to go wrong for me. But to my surprise she said 'Nope, can I ask you that if shit and fan collide please get in touch and we can have some communication?'.  Because she had said that I didn't freak out, feel trapped,  or indeed contact her, I think because I knew I could and I didn't feel rejected.

During the Christmas break I miscarried my IVF baby and I emailed her and we did meet up, her suggestion not mine, and that was so helpful. I know if we hadn't been able to I wouldn't have been ok about continuing sessions after Christmas.

I do completely understand therapists need holidays and breaks and probably need more than most! Clients, me included, can be very selfish and see long breaks as rejection or as a wobble in therapy and previous to my current therapist I couldn't then reconnect with them as they had laid down tight professional boundaries which were inflexible and made me feel 'controlled'.

Therapy is so intense , I see mine twice a week, and a break of a month is eight sessions and that seems insurmountable when you're in a mess!

Somebody else commented:

I really appreciate and value that my counsellor takes around a month off in the summer. Showing her commitment to self care and always well prepared for.

So as therapists it is important that we:

  • Take adequate breaks from the work
  • Give as much notice as possible to clients about breaks
  • Be aware of the potential impact of our breaks and introduce a discussion with our clients around the topic before and after

And for clients:

  •  Be aware that it is normal to be impacted by breaks so don't judge yourself negatively
  •  Bring any uncomfortable feelings about breaks to your therapist. If you don't feel able to talk about this with your therapist then maybe this isn't the right therapist for you
  • A good therapist will welcome discussion around any impact on you. It can be a valuable part of your process, particularly if you have struggles around trust, attachment or abandonment.

Please leave your thoughts in a comment below. I value feedback and we can all learn from each other.

12 March 2017

Recently published article on trauma work on counselling and psychotherapy

I used to blog so much more regularly however since working full-time as a private therapist (I went to 5 days a week in January 2015) I have had very little time for writing. Along with a busy life outside of work and campaigning for regulation of counselling and psychotherapy I often have topics I would like to write about...if I had the time...but, well...

Last year saw the important publishing of the Unsafe Spaces report which I co-authored along with Phil Dore* my fellow campaigner. Finding the time to focus on this was difficult but it is very important to me to contribute to discussion within the profession.

Then a few months ago I was invited by the online magazine The Counsellors Cafe to write an article. Having spent several months prior to that thinking about writing something about the difficulties of working with trauma I decided to use this opportunity to focus on producing something to get some of my concerns out there. So I finally got my act together and started to work on a piece which was published on 10th March entitled Care When Working With Trauma (click to take you directly to the article).

I had a few factors that had motivated me to write such a piece:

  1. Working directly with clients who have been abruptly dropped by a therapist and hearing accounts from service users in general about feeling abandoned when therapy is suddenly terminated with no warning or ending.
  2. My own journey of learning more about trauma from reading books by Babette Rothschild and Bessel Van Der Kolk and attending specialist trauma workshops such as those run by Positive Outcomes for Dissociative Disorders. I realised that there were gaps in my core training. 
  3. The realisation that a few years ago, when my therapist had to end sessions with me it was emotionally difficult, even though there were very good, ethical reasons for doing so.
  4. Hearing and reading various comments on counsellors forums which quite frankly have greatly concerned me about the competence of some practising therapists. 

Like anything I write, I reflected and immediately wished I had included more. I see this piece as work in progress and I have further work to do. I do believe that there is insufficient training in a lot of basic counsellor training and that there is a danger that therapists can unwittingly retraumatise their clients.

I've had some great feedback from other therapists who share similar concerns. I have done some research on whether qualified therapists believe their core training equipped them sufficiently for working with trauma. The findings were as I suspected; many did not feel that their training was enough. I just need to find an idle moment to make contact with some of the professional bodies who accredit training courses and see what their opinions are. Then bring it all together in a compelling article. It will likely take me while!

I don't want to put people off accessing therapy but I do believe that forewarned is forearmed and that as professionals we should be striving to improve our profession and keep it as safe as possible for our service users.

The work I value most is my working directly with my clients but the bigger picture of the profession is also very important to me.

*two days ago I received an official comment from the Professional Standards Authority on our report, requested on our behalf by Ben Bradshaw MP (my local MP and a member of the Health Select Committee). We are still awaiting as response from Jeremy Hunt.

31 December 2016

A framework for New Years Resolutions?

I wonder how many people are setting themselves some resolutions this year? What is the drive behind the choices they make? Are people attempting to make changes because they are critical of themselves? "I'm too (insert word here)", "I'm not (insert word here) enough", "I should/shouldn't be (insert word here)"?

How about a framework for making resolutions?           

How about basing the choices you make on something fundamentally meaningful?

I propose that Bronnie Ware's famous list of "Top 5 Regrets of the Dying" could be a great way of defining resolutions that will ultimately make a difference to the quality of our lives. Bonnie has shared what she discovered as a nurse in palliative care. Her findings, which she has extended into a book on the subject, are as follows:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
This was the most common regret of all. When people realise that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honoured even a half of their dreams and had to die knowing that it was due to choices they had made, or not made.
It is very important to try and honour at least some of your dreams along the way. From the moment that you lose your health, it is too late. Health brings a freedom very few realise, until they no longer have it.
2. I wish I didn’t work so hard.
This came from every male patient that I nursed. They missed their children’s youth and their partner’s companionship. Women also spoke of this regret. But as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.
By simplifying your lifestyle and making conscious choices along the way, it is possible to not need the income that you think you do. And by creating more space in your life, you become happier and more open to new opportunities, ones more suited to your new lifestyle.
3. I wish I’d had the courage to express my feelings.
Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.
We cannot control the reactions of others. However, although people may initially react when you change the way you are by speaking honestly, in the end it raises the relationship to a whole new and healthier level. Either that or it releases the unhealthy relationship from your life. Either way, you win.
4. I wish I had stayed in touch with my friends.
Often they would not truly realise the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying.
5. I wish that I had let myself be happier.
This is a surprisingly common one. Many did not realise until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called ‘comfort’ of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content. When deep within, they longed to laugh properly and have silliness in their life again.
(NB This list is taken from Bronnie Ware's site)
So how might a list of resolutions look using this as a framework?
1) Make a list of things you want to do in life and plan roughly when those things can be achieved. Make one of those things happen this year.
2) Find a better work/life balance. Try a session or two with a counsellor or life coach or read a book on the subject. Watch some Alan Watts lectures. Here's a great one.
3) Find a way to be able to express your feelings. Confide in friends. If you struggle to express yourself then try some sessions with a counsellor to learn how to express your feelings. We all have them. We haven't all had the opportunity to learn how to express them.
4) Dig out your old address book and make contact with people you stopped sending Christmas cards to years ago. Or look at those that you send a quick one-liner to and write an actual letter. Arrange to meet up with at least one old friend this year.
5) Allow yourself to experience happiness. If guilt or shame are getting in the way then find a therapist to work through those feelings. Everyone is entitled to feel joy. Find something joyful that you can do this year. Join a group, buy yourself something silly but fun. This doesn't have to be expensive. I got a lot of joy out of buying an old copy of Ladybird Cinderella which I absolutely loved as a kid. It was a few pounds on eBay. I still drool over the three frocks she got to wear in that edition.
Final note
I do not want to make light of the real struggles that some people face and loss, poverty and ill health as well as discrimination can have a very negative impact on our experience of life. This article is meant to highlight those things that we potentially do have a choice in, although not all of us will be able to make those choices. I remain sensitive to that.

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