17 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 

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

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.














3 June 2018

Processing Data Policy – A guide to what I do with your details

Data collection

I will collect your name, address, email address, telephone number, date of birth and your GP’s details. I will also collect potentially sensitive data such as physical and mental health issues, medication taken, family details and reasons for counselling.

During sessions I will write down some of the salient points and issues as they arise.

Process and use of this data

All details are restricted to hand-written paper documents which are stored in a locked filing cabinet.

The contact details allow me to contact you during our counselling sessions. I will only share this information with the police or your GP if I believe you to be a significant risk to the lives of others or yourself through stated intent to commit suicide. I am also legally obliged to notify the appropriate authorities regarding terrorist activity or drug money laundering.

The notes regarding sensitive personal details assist me in working appropriately with the issues you bring. I may refer to and discuss the content verbally with my clinical supervisor however your identity will be concealed.
I may share information I hold about you, if requested to by my insurance company, in the event of a complaint made against me.

Disposal of data

I will hold all data in my filing cabinet for a period of 7 years following the end of therapy. All notes will subsequently be destroyed.

Letters to third parties

Where I am requested by a client to write a letter to a third party such as a solicitor, GP or to write an invoice which includes your data, I will delete the files from my computer and keep a hard copy with your client file in my filing cabinet. The laptop I use for writing such letters is for my business use only and is password protected.

Clinical Executor

In the unfortunate event I can no longer work with you due to my sudden sickness or death, I have appointed a clinical executor who will have access to this data to notify you of the situation.

Consent

Please sign below if you consent to your above details being stored in this way:

Name:   ________________________________________
  
Signed: ________________________________________    Date: ______________________________

(Updated 3rd June 2018)


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