Amanda Williamson Coaching and Counselling Service in Exeter, Devon

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

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 for face to face sessions

When you find my premises you will ring my doorbell and I will buzz you through to the hall. It is important that you arrive at the time of the appointment as there is no waiting room and I may still be with a client if you come early.  

The environment

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.  I am now unable to offer drinks so please bring some water or another drink with you.

We will need to establish connection via the chosen format (usually Zoom) prior to the session.

Please ensure that you are in a private space.

If via video, it is better if I am able to see your head and upper body where possible. It might be worth wearing headphones. I have good data connectivity; it might be worth using wi-fi if your telephone data signal is impaired.

Please use a static set-up rather than walking around with a mobile phone as it can be very hard for both of us to focus. I can also feel a little motion sickness when the screen moves around. 

I advise that you give yourself sufficient time and space either side of the session in order to be in the right head space. It can feel a little confusing with no journey to and from the therapy room. I have been doing video and telephone sessions for several years so it is familiar territory for me. I am also suitably insured.
  

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. Notes are destroyed 6 years after therapy has ended.

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.

Rebooking

Towards the end of the hour, the question of booking the next session is looked at. It rare cases it may be appropriate for me to refer you to another therapist and I will explain clearly why, if this is the case. 

 

Subsequent sessions

We will refer back to the therapeutic goals in future sessions 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 is inappropiate to continue working with couples where there are issues around domestic violence. It may be appropriate for some clients to be referred to psychiatric services or other. 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.

Amanda Williamson Reg MBACP (Snr Accred)

A few months ago I was contacted separately by three people asking me to consider chatting to them about a BBC documentary about therapy. I declined on all three counts, then the documentary producer gently persuaded me to have a chat about my interest in the regulation of therapy. He explained that all the messages I had received were in connection with a commissioned documentary that was already being filmed. The producer, Rob Cave, sounded like a decent chap and I agreed to speak to the journalist, Jordan Dunbar. I immediately felt at ease with Jordan and he quickly built trust.

Given my lack of flexibility I found Jordan very accommodating. He came to Exeter to film the interview whilst I was walking the dog. There may yet be a film clip (of Sally dog) on TV at some stage. But for now the interview is part of the File on 4 documentary entitled "The Therapy Business". Inspired by Jordan's experience of unethical therapy, the documentary is pro-therapy and also pro-regulation of counselling and psychotherapy. There are many arguments against regulation but most members of the general public are genuinely perplexed when they find out that there is zero regulation. Instead we have a system of pseudo-regulation run by the quango Professional Standards Authority, called the Accredited Registers. In my opinion this is worse than no regulation as it is extremely confusing and gives an illusion of safety that does not exist. It also implies that a therapist who is newly qualified from a flimsy course with little experience is as competent as an experienced practitioner with more in-depth training and supervised experience.

The documentary includes input from two victims of abusive therapy, Geraint Davies MP who is attempting to put a pro-reg bill through parliament and a BACP representative.

The documentary can be found here.

Related Articles:

Regulation of Counselling and Psychotherapy in the UK - Why we need it

Regulation - a client and therapist friendly way forward?