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 compete 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, pleas 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.














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