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.


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