24 October 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 do short, medium and long term therapeutic and supportive work.

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.



Click here for Contact and Cost Details

PLEASE NOTE : No evening sessions are available for the foreseeable future. I continue to be exceptionally busy. I no longer operate a waiting list but please feel free to make contact and see if a space has become available. 


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.

Regulation 


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  




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. 

Google Plus 

On therapists and retiring


by Amanda Williamson Reg MBACP(Accred)

I recently heard that a prominent local therapist, Bronwyn Carson, is due to retire at the end of the year. My first response was to feel surprised and saddened, quickly followed by a “Good for her”. Selfishly I worried that this was one less therapist for me to refer clients to.

I wrote to Bronwyn to congratulate her and ask about whether she was taking on any short-term work in the meantime. I received a lovely message back which was truly heart-warming. It was clear that Bron loves her work and also loves life and is embracing what is to come.

This news about Bron coincided with me finishing reading IrvinYalom’s Becoming Myself. Without going into too much of a book review here it is very interesting reading about his childhood and development as a person and as a therapist. I find it intriguing that he is still practising at 85. He writes in the book:

“Since I have helped so many people deal with aging, I thought I was well prepared for the losses looming ahead, but I find it far more daunting than I imagined. The aching knees, the loss of balance, the early-morning back stiffness, the fatigue, the fading vision and hearing, all these catch my attention but are minor compared to the fading of memory.”

Yalom discusses issues around ageing and dementia. He writes about witnessing other therapists in his therapist group, having to be removed from the profession due to no longer being fit to practice with issues around cognitive decline. Uncomfortable but an important consideration.

Anne Power explores such issues around retirement, planned and unplanned, in this article published by the BACP. She draws from the research published in her book Forced Endings in Psychotherapy and Psychoanalysis: Attachment and loss in retirement. In the BACP article she states:

“There is no single blueprint for retirement, but one principle is very clear: the responsibility to retire at an appropriate time lies with the therapist. We can’t wait for a signal from an insightful colleague, or for referrals to dry up or clients to leave us.”

Death and decline is a taboo subject and we don’t talk about it openly. My colleague Roslyn Byfield campaigned for the inclusion of the requirement of Clinical Wills in the BACP Ethical Framework. Roslyn has long been interested in the impact on clients of sudden endings in therapy. She wrote in a letter submitted to the BACP publication Therapy Today:

“…practitioners, especially those in private practice, must face the fact of their own demise and plan for it as part of a responsible and ethical stance on work. What gets in the way are the sense of omnipotence, phantasies of immortality and loss of identity if no longer working…we cannot assume we will know when to stop. Anne Power’s research found a good number continuing into their 70s, 80s and beyond, exacerbating the risk of ‘dying in harness’ (some with no clinical will in place). This can lead to collusion between client and therapist regarding the latter’s decline, the former effectively adopting a carer role.”

When I have wondered about my own retirement (partially down to suddenly panicking about lack of pension provision and how I’ve left it rather late at 46…) I assume that I would probably work until around 70, health permitting. Maybe longer. I like what I do, a lot. It seems to be helpful. Being honest, it gives my life some sort of meaning. But what if I’m not very good as I age? What if my brain is not sharp enough to be a safe and effective therapist? But then I did see Yalom when he was age 80 and he was super sharp.  Bronwyn is retiring at 65, and has plans for how to spend her time, checking off her bucket list.

I first heard about Bronwyn’s presence on the Exeter therapy scene before I trained as a therapist, so well over 10 years ago. I heard through a friend, then another, then another, about this brilliant therapist. She’s down to earth, she’s challenging, she’s warm, she’s real, etc. As I was considering being a therapist at the time; I decided that if I did I’d very much like to earn a reputation like that.

During my training I was aware that a couple of peers saw Bron for their compulsory therapy as trainees. Some of us talked about our experiences of our therapists and compared notes. I was aware that she had tighter boundaries than some other therapists e.g. charging for missed sessions…expecting regular attendance. I wasn’t so sure about that 10 years ago when I was in training…things do change and I have learned that good boundaries provide a better holding for the work I do with my clients.

Our paths didn’t cross professionally until I requested to meet with her in 2015. I needed another female therapist to refer potential clients to. As it turns out, unsurprisingly, Bronwyn was/is also very busy but at least it was someone else I could trust who might have the odd space.

We met at her office and it was lovely to chat with her about ethics and integrity. She spoke about her work in a way that was respectful, warm and confidential such that I have felt very happy to refer clients to her. Hence feeling saddened and aware that her retirement is a genuine loss to the therapeutic community.

It prompted me to have a little exploration around therapists and retirement, hence this post. If I am fortunate enough to choose when to retire I would like to do it with grace and with a quiet celebration of my work; as an honouring of the intimacy and trust of all the therapeutic interactions; all those therapy hours listening to people’s truths.

Bron very kindly agreed to me interviewing her about her impending retirement so that others might reflect on their own:

Please tell me how you came to be a therapist.

I came to be a therapist, as I needed to get back into full time work after having my family. I believed if I had to work for the next 25 years, then it would be sensible to find something I really enjoyed. I had worked in the Samaritans voluntarily for about 6 years prior to this time and loved it. I felt so engaged in this work and it seemed to come naturally from within.
Retrospectively I realized this was my apprenticeship into the world of therapy.

How has your practice changed since starting out?

In the first 8 years I worked in a G.P. surgery and also held a job as a lead Counsellor in Occupational Health. Working in the NHS gave confidence and credibility to me as a professional. Alongside this I had a growing private practice. There was a definite point in time when I had to choose between NHS and private work, as my reputation grew, and the number of client hours increased alongside this.

I chose private practice for 3 reasons:

• I was now getting known in the field and had enough referrals from clients who had enjoyed good outcomes working with me.
• I liked the concept of working for myself, in a room that was of my choosing, professional, but not clinical and in the convenience of my own home. (I was fortunate to have the facility for this, yet a private room rented would have been an equally good option)
• I would earn double the hourly rate privately than that in the NHS and I was now for the first time starting to really think about the concept of pension planning and saving for my older years. I was now in my mid to late 40’s.

What aspects of the work have you most enjoyed?

The aspects I have enjoyed the most have definitely been working with people of all walks of life. I have loved the diversity of the job and the challenges we are presented within this style of work. No one day is the same, no one person is the same, no one problem is the same, everyone experiences life from their own unique perspectives.

When did you decide your retirement age?

I always thought I would work until I was into my mid to late 60’s. I have always known I would not work beyond that time as I have great pride in my work and it has been my intention to retire when I am still operating from my best level of competence. Every decade that I have lived in my adult life I have been aware of my changing self. I know I cannot do the same things at 65 that I could do at 35. I believe it is the same with our competence as
therapists. Our wisdom and knowledge grow throughout our career, but time is also running alongside that and our mental agility does slow down and change too. My observations of older therapists over the years, has gained me great insight into preparing for retirement both in service of self and my clients.  My experience of life in this field of practice is that sometimes people are not aware of declining competency and cognitive decline, hence my decision to retire now whilst I still am!

What advice would you give a trainee therapist and a therapist such as myself who are perhaps midway along the journey between starting out and retiring?

My advice to all therapists is we must all keep in sight the reason for doing the work that we do and also when to stop doing it. Our work is about being selfless in the service of others, offering a service that is safe, has integrity, and can be trusted. When I hear supervisees saying – I can’t afford to retire, or I have no other interests I will be bored if I retire - I ask - how is this in service of your clients? Our clients are not here to fill our short fall of financial planning for older age. Nor are they here to fill our lack of social interaction outside of the therapeutic room. So my advice to all therapists is to always work towards the wanted outcome of the client. Find out from the client what they want from therapy. Help them to achieve this outcome and lead them onto autonomy. Encourage them to move on, let go.

What learning has there been for you since declaring your intention to retire? Has this led to anything unexpected?

Since declaring my retirement I have had a number of interesting “learns”. Firstly I have been through an unexpected gamut of emotions! Am I doing the right thing? Will retirement suit me as I have been so engaged with my work for so long? When clients ring up will I see the odd one for old times’ sake? I realized in order for me to retire I needed to close the door behind me with no hidden codicils (modifications). So I set myself a clear date. December 19th 2018. I cancelled my insurance from that date on. (I know I would never practice without it) I have given due notice of intent to clients, supervisees and professional bodies. And then just like I have done in other areas of life I started to research, to find out what a good retirement should look like. I now have an ever-growing bucket list of things to do in this new phase of my life, starting with a celebration holiday in January to kick off the year. By doing this, I have become surprisingly excited about retirement. I have started to look forward to it. I have given it momentum by counting down the weeks of work left to do. All of this process was modeling the underpinning of my work with my clients, the process of taking responsibility for life choices, making them work for you and looking forwards not backwards. Celebrating successes to raise self -esteem. I made a decision to
make my retirement as successful as my working life and I know I can do this, as I am the architect, designing its success.

So where are you now weeks off your date of retirement?

Many people have been surprised at my decision to retire, as, in a way I have been. I began the process at the beginning of the year. A dear friend died unexpectedly causing me to review my life and retirement goals. All the background planning to support my retirement led me to be able to take up the option of retiring now. As the news of my retirement has drifted out into the universe, I have been greatly surprised by the wonderful response. Some
clients have asked to come in and say goodbye and to tell me of the progress they have made since our therapy ended. Some have asked to come in and do a short piece of work before I go. Some just wanted to say thank you. I have loved my work and I feel this greatly as I say goodbye to a profession that I have been proud to serve and enrich and which in return has enriched my life.

~

This looks like good modelling for how we as therapists should handle retirement. I value Bron’s commitment to clients and the fact that their needs should be at the heart of our service. I am sadly seeing an emerging sense of entitlement within a pocket of the profession and wonder about the integrity of practitioners who emphasise their own needs above our service users and the profession as a whole. We would do well to listen to and take heed of Bron’s words.

I went onto Twitter to ask about other people’s experience of their therapists retiring and received the following: 

“It came a bit as a shock to me. My therapist and I had said goodbye after 8+ years working together. Three years later I had a bit of a life event and I contacted her for some more support, more for time limited focussed work than long term exploration and resolving some old issues. When we met she said she was winding down and retiring in a few months. In that session I didn’t register much but afterwards I felt quite scared and lost. My secure and safe go-to was no longer going to be there. Like I was suddenly on a high wire without safety net. When we spoke about this later I realised that actually she was more or less retired already and only had taken me on to support my process of really saying goodbye to her and learning again that she wasn’t my only safety net and that actually the biggest safety net I had was my own. All in all it was a good experience because she was so attuned and gave me the time and UPR*”.

*unconditional positive regard

When I was researching for an article on working with trauma I learned how abandonment in therapy can be traumatising. That sense of abandonment can be perceived rather than intended but can still provoke a strong emotional response and a therapist retiring can be perceived, by our vulnerable part, as an abandonment. It might also trigger old pain around the loss of grandparents or parents.


Colleague Hazel Hill, a BACP Accredited therapist and supervisor shared the following about her Supervisor retiring:

“It was wrenching news to hear that my supervisor was retiring due to ill health. I felt sad. She supported me through my accreditation and through my early days of private practice. We had many laughs too. I loved her eccentric ways and our thinking (and cynicism) was perfectly matched. I was totally understanding to her retiring but if I’m really honest I was slightly cross at her for leaving me in the lurch.

She gave me plenty of notice and a list of supervisors to contact but I buried my head in the sand and told myself it was ages away and did not start looking for a new one early enough. In hindsight this was not helpful. I ended up having a year moving around different supervisors. I think I was trying to replace her and did not give any new supervisors a chance. I focused on my old supervisor’s personality rather than thinking what I wanted from a supervisor. In some ways, although I still miss her, it has been good for me to focus on what I actually want from a supervisor and to make the most of my sessions now.”

I was also contacted by a practising therapist who shared her thoughts around her personal therapist:

“When I decided to train as a psychotherapist, I asked my own, older therapist if she was considering retirement, as I knew I was making a long-term commitment to my own therapy. She said no, and we had worked together for about 8 years altogether before she suggested that perhaps we should stop because of my "chronic resistance" . I wanted to stay in therapy until qualification, and didn't want to start work with a new therapist at that point, so we negotiated a continuation.

When I gained my qualification, we worked through closure and ended with the agreement that she would come to my award ceremony some months later. In the meantime, she contacted me more than once, which I found invasive, to tell me that she was unwell and she repeatedly made mistakes about the details of the ceremony. At the ceremony she told me that she was now semi-retired, giving up membership of her professional organisation and working only on a part time voluntary basis. I later discovered that she was in fact almost 80 at this point. I wonder if she had in fact wanted 
or needed to retire at the time she suggested stopping work with me, but 
had not been able to acknowledge that.”

This vignette highlights the possibility of doubts around fitness to practice in old age and whether all therapists are self-aware enough to ensure that their ongoing practice in later years is truly with the best interest of the clients at heart.

As Bronwyn alludes to above, we practitioners need to take responsibility for our own old age, particularly if we are self-employed, to ensure that we do not leave clients or supervisees in the lurch nor practice beyond a level of competency in order to fill a short-fall in our planning. What are we modelling to clients if do not face up to our inevitable old age and decline?

I’ll leave you with some food for thought:

Anne Power’s words from the article linked to above:

“Talking to colleagues is usually a great way to work through our difficulties, but sadly retirement is often still a taboo subject. This may be because of the association of retirement with aging and dying, the fear of being seen as a ‘has been’, as well as the risk that referrals might dry up before we are ready to stop.”

And Roslyn Byfield:

“If we cannot face our own endings how are we entitled to work with others in their dark places?”

So, let’s talk…







15 October 2018

Short/Medium/Longterm Work


Reflecting upon my typical caseload there tends to be natural balance between a mixture of short, medium and long term work. Here is a little summary of some of the differences in timespan of therapy:


Short term work

Sometimes my clients come for a few sessions in order to talk over a pressing issue in a neutral space. This can be useful for example for people in a position of power in their career, who are unable to chat things over with colleagues who may be employees who they feel a level of responsibility for. Short term work can also be useful for checking out important one-off life decisions that are not fuelled by childhood wounds, such as for example deciding to leave a relationship, whether to have children or not or discussing aspects of one's career.


Medium term work

The larger part of my caseload consists of people looking for work which would equate to a couple, and possibly several months long. This might be appropriate where there are habits that have formed which aren't useful but are impacting on quality of life. Examples of this might be where one's confidence has been affected by the end of a relationship, being affected by workplace bullying, the impact of having children, difficult family dynamics, health issues and exploring sexuality.


Long term work

Some of us require long term ongoing work and this is especially true for people with deep-seated childhood wounds which might arise from all types of abuse or neglect in childhood. Being the child of a parent with mental health issues, particularly personality disorders (Narcissistic, Histrionic and Borderline Personality Disorders), schizophrenia/schizotypal illnesses, PTSD amongst others, can have a deep and lasting negative impact on one's sense of self. Chronic emotional neglect (often due to the way our parents were parented) can affect our self-esteem/self-worth as pervasively as more obvious forms of abuse, much to the surprise of some clients.


People with PTSD and in particular Complex PTSD due to abuse at the hands of others can understandably find it incredibly difficult to trust so creating a place where the entirety of a client can truly feel safe will often take a long time. If this work is rushed then there is a risk of retraumatization so it needs to be handled competently and with due diligence.

This work typically takes longer because the now unwanted habits and thought processes are associated with a sense of survival; we adapted this way of being because it helped us to survive. Making changes at this deeper level requires a lot of effort, a lot of soul-searching and I find that the relational aspect of what I do (looking at what goes on in the relationship between myself and a client) is an important tool in this type of work. This is sometimes referred to as psychodynamic work. For this reason I have had extensive personally therapy myself (I need to know where my wounds are to do this work safely and effectively) and I have fortnightly clinical supervision with a very experienced therapist/supervisor. I will reengage with personal therapy where necessary to work my stuff out in a separate space. Therapists are often wounded healers and without deep self-reflection and honesty, their stuff can get played out in the therapy room and is probably behind many therapist misconduct hearings.

Therapy for maintenance

Some clients want ongoing long term work because they see at as "maintenance" in much the same way as some people have regular massage or chiropractor appointments. Certain careers might mean that someone benefits from ongoing support, in much the same way that I have my fortnightly clinical supervision. This might be true for people in very high powered positions or careers that require an element of therapeutic input such as headteachers, family law solicitors, personal trainers; any job where you are regularly supporting others' emotional needs.


Regardless of time span of therapy, I value the uniqueness that each client brings. Work is reviewed regularly to ensure that we are working with a client's best interests at heart.


14 October 2018

Why I oppose the movement to automatically make all Registered BACP Members Accredited

[UPDATE: the resolution did not receive enough support to go forward, thankfully]

A resolution has been put forward to the entire membership of the BACP as follows:

"We are asking members to vote that the title of 'BACP registered' is changed to 'BACP Accredited' for all counsellors in recognition of their qualified status, commitment to professional and ethical standards and in line with other PSA accredited registers."

The closing date has been extended to lunchtime Monday 15th October.  If there is enough support for this resolution then it will go to a vote at the BACP AGM on 16th November 2018.

I oppose this movement as I believe it has been done with inadequate consultation with service users and other members.

There is some confusion in the profession as the National Counselling Society, a much smaller and more recently formed professional body, automatically grant their registered members Accredited status without the experience and criteria that the BACP require of their Accredited members. The UKCP,  another professional body for therapists who have a PSA Accredited Register, has a completely different membership system. I believe that it is only the NCS who award "Accredited member" status to newly qualified therapists. This NCS anomaly has been very useful for therapists who wish to call themselves Accredited without going through the procedures and criteria required by the BACP who have had a system in place for many years to allow qualified therapists to demonstrate and provide proof of their extensive experience and self-reflection.  I have questioned this confusion for several years. I do not see that this resolution is the answer and I believe that the main factor for people behind this proposal is to be able to attain BACP Accredited status without going through the Accreditation process. 

If the resolution goes through it will be in part due to many Registered members enjoying this leg-up where all they have to do is click a button.

I know of some Registered Members who oppose this because they value the BACP Accreditaiton scheme and would like to apply as and when they feel ready to do so. I know many Registered members who are very experienced and skilled at their job. In fact, I regularly refer clients to three excellent therapists I know who are BACP Registered but not BACP Accred. This is because I know them personally and am familiar with how they work. They are consistently busy and have no commercial need to attain Accredited status. Outside of this familiarity I would advise clients to select an Accredited member because there will have been a proven level of experience and self-reflection. Although I had a consistently busy private practice I personally went for Accreditation for professional development and found it an extremely valuable process. I wrote about that here.

There is a need for some kind of evolution however this movement seems to be focused solely on a goal of helping newly qualified counsellors get jobs rather than looking at the needs of service users. The issues of jobs for therapists needs to be approached from a completely different angle. That is about government policy and looking at the culture within counselling organisations.

It is claimed by the movement that is discriminatory that those that have undergone the Accreditation process might be more likely to find work than newly qualified. It also continually asserted that only privileged therapists can afford to apply for BACP Accreditation. It is not from a position of privilege that I gained my Accreditation. I had a cleaning job and worked at weekends to supplement my low income when starting out. If you can do a decent counselling qualification you can do BACP Accreditation.

Many Accredited counsellors are understandably concerned that their hard-earned status will be devalued. Moreover, if the BACP are being pressurised to make huge adjustments to be more like the NCS, some are concerned that they will be devalued as an organisation.

Fundamentally, I am all for a wider discussion on the confusion caused by the NCS and Professional Standards Agency now being important participants in the profession. However, I am fundamentally opposed to this particular movement which I believe to be ill-conceived and bullish. The therapists behind this resolution would do well not to be posting in public spaces such disparaging things about other BACP members. I find it highly unsavoury, disrespectful and unprofessional to openly refer to people opposing this resolution in such terms as “losing their shit”, and having “hot flushes” and “clearly needing therapy” (a rather inappropriate insult) and that they are “passing round the popcorn”, in relation to reading the forum, and describing therapists as “willy waving their accreditation”. Further, accusations of people respectfully opposing the resolution as “gaslighting”  and“abhorrent” are undermining of the work we do with people who are genuinely abused.

What many of us are wondering is, if the BACP Accreditation system is unfair, and the NCS is a supportive and according to some, such better organisation, perhaps the answer is for those who are angry with the BACP membership tiers system to resign their BACP membership and join the NCS. I do not see it as problematic if the membership of the BACP is reduced and it continues to represent therapists with similar intrinsic values and principles. 

One of the worst things about this debate has been the way in which it has been argued. I am deeply concerned about how this reflects on the entire profession. The BACP Ethical Framework for Good Practice is not some flimsy document that pays lip service to integrity. It should be the underpinning for how we represent the profession, inside and out of the therapy room, as members of the BACP.

I do not believe the BACP to be a perfect organisation. It would make me rather weird if I did. There are flaws and I believe that it is appropriate to challenge and try and change things for the better, but with respect, integrity and dignity. My colleague Roslyn Byfield campaigned for the inclusion of the necessity for therapists to have Clinical Wills in the Ethical Framework. She did this respectfully and appropriately. It worked.

If/when this has all gone away perhaps we can have an adult debate about the many issues that this resolution is attempting to address.

8 June 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-conscious 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.

Ending therapy against my client's wishes

I may have cause to end sessions if it is clear that therapy is not helping or possibly harming my client or if there is a threat to my wellbeing. It may be appropriate for some clients to be referred to psychiatric services. I will always endeavour to treat such cases ethically and sensitively and am aways informed by the BACP Ethical Framework for the Counselling Professions.

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 and Data Policy.














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