Some Frequently Asked Questions

What kind of therapy do you use?

My approach is sometimes called “Family Therapy”. This can be confusing because I don’t only see whole families. An alternative name is Systems or Systemic Therapy, which is better in some ways but sounds too much like weed-killer to me! My preference is “Relational Therapy” in that we live our lives in relational contexts, so what goes on inside our heads is very much influenced by what goes on - and has gone on in the past – in our interactions with others. Those “others” become to a degree internalised, not always accurate representations incidentally, and these shadows can spill over into other aspects of our lives.

 

A relational approach also respects those other real people you are connected with. They mostly want to help and can be a tremendous resource in the process of therapy.

One other thing to say about my approach is that I have been taught to meet the person, not their symptoms, and to find a unique way of working that fits that person rather than trying to fit them to psychological theories. Each person has their own repertoire of abilities and resources, and a major part of therapy is tapping into these strengths and encouraging the rebuilding of competence and self-esteem.

 

Why are there so many types of therapy out there?

It can be very bewildering to see so many types of psychotherapy on offer. The assumptions underlying the different models can be equally baffling. Some, for example, assume early relationship (attachment) damage and therefore the need for long-term intensive work to correct this. The relationship with the therapist is central in this thinking, on the basis that you will act out primary relationships and eventually restructure things through a reliable new model in the therapist. I accept that attachment history is important and often underlies current problems in relating. I agree also that a strong rapport with your therapist matters – indeed it is known to be a factor in most successful therapy. While taking these factors into account my approach is systemic rather than analytic, and therefore tends to be involve far fewer sessions.

Does talking about a problem help?

Sometimes, but not always. OK it’s better than bottling it all up, but sometimes people share their concerns and get a variety of conflicting opinions and advice. Often friends and family feel obliged to advise because they are worried and want the best for you, but you need someone who is not so close to the problem and who is trained to listen accurately and empathically. It helps too that the talking and listening happens in a safe and comfortable setting.

Are there advantages and disadvantages to using a private service?

First some advantages.

• Mostly you do your own research and make your own choice of therapist. If it doesn’t feel like a good fit there is no obligation to continue after the first session. In the public services you will generally be seen, following a period on the waiting list, by whoever you are allocated to. This is likely to be for an initial assessment and then you will probably go back on a waiting list, which can sometimes be long, particularly for a speciality that is in short supply. You might find yourself being seen by someone from a different profession, and again those sessions might be rationed, eight to ten being increasingly typical in an overburdened healthcare system. You are likely to get seen more quickly and the number of sessions will be by agreement rather than by rationing to meet service demands. You can often be seen at times that are convenient to you, taking account of work and school commitments.

 

…and the disadvantages?

• Obviously, you have to pay for private therapy. Sometimes you can offset this against the expense and inconvenience of inflexible office-hours appointments in the public services. If you all have to attend daytime appointments, or you are expected to get your school-age child to sessions at 10 a.m. obviously this has all sorts of implications, especially if this is over a lengthy period.
• In the public services you will have access to a team of specialists, and this can be a valuable resource. I will often advise my clients to make use of public services alongside our own work. Sometimes there may be particular things that need checking out by professionals within the system and with the required expertise e.g. medical, psychiatric or educational (learning) concerns. It might be difficult to access the right kinds of public sector services otherwise.

 

…and the common ground?

• Whether the service is public or private certain standards of ethical practice apply. These include
• Working respectfully and using one’s best endeavours to help.
• Ensuring appropriate confidentiality is maintained.
• Protecting the vulnerable from exploitation and harm.
• Maintaining one’s own effectiveness through ongoing training and supervision. In my own case this is monitored by the Association for Family Therapy.

 

How effective is your approach?

• There is increasing evidence supporting the effectiveness of systemic therapy across a range of problems and mental health conditions. For example adult depression, which is often viewed as an individual problem and treated as such is strongly related to distress in the couple relationship, and therefore working with both partners (together and separately) tends to be helpful. See Peter Stratton and colleagues’ paper, Review of family, couples and systemic therapy outcome research 2000-2009.
• Part of my approach involves helping you to set achievable goals and the means of achieving them, and I take a strong interest in feedback during and after therapy is completed as to tangible signs of progress.

 

How long is therapy likely to take?

• Inevitably this varies according to the issues and what you are looking for. However my approach tends to lead to relatively short periods in therapy, typically 1 to 15 sessions over a period of 4 to 6 months. What do you expect from me? Therapy is very much a joint venture. Therefore I look to you to be as frank as possible in sharing the information needed. I recognise that this may not happen instantaneously as you check out how sessions feel for you and your trust in the encounter. You may have questions about how much you ought to say and whether anyone else will get to know and this can all be discussed so that you are as comfortable as possible in therapy. I sometimes suggest “homework” tasks, simply things to do or think about in between sessions. It is important to try to complete these tasks and bring your comments and feedback to the next session. A great deal of the work happens in between the sessions.

 

What records do you keep, and are they confidential?

• I usually make some notes during sessions to remind myself of important issues raised. I may also construct a family (and others) tree as you mentioned key people connected to or affected by the issues you raise. Records are strictly confidential. On very rare occasions therapists’ records have been ordered to be released by a court. Otherwise any issue of sharing records would be discussed with you, and indeed might be suggested by you, e.g. for liaison purposes with a doctor or other professional with a key involvement with you or your child.

 

Why might you want to see other people in connection with my concern?

• Others who are close to you might be caught up in some ways with the concerns you are trying to deal with, or they might have information or resources to assist in the process. All of this would be a matter for discussion and negotiation.

 

How do you/we decide it’s time to stop?

• There may come a time when you want to stop –or take a break from therapy. Together we will have been reviewing what has been changing and how this impacts on your ability to live a more satisfactory life in your own terms. You might acknowledge that some level of distress occurs but that you feel less threatened and more able to manage it. You might decide that’s enough for now, but might consider returning at another time.
• Of course you might judge that little or no progress is being made for one or more reasons: that you yourself were not ready to fully commit; that your partner declined invitations to attend; or that the process itself was not helpful – and I would always want to understand more about that.

 

What if things don’t get better?

• We would need to explore this in terms of your goals and expectations. I would be interested in what is blocking change, and even what there is in your current situation that while being problematic, is nevertheless familiar and in some ways comfortable. I will not attempt to keep you in therapy if it’s not working for you and together we cannot find a way through. If I think someone else or a different kind of therapist might be more appropriate I will see if I can make a recommendation or even a direct referral.

 

What is your payment and cancellation policy?

You can pay on the day in cash or in advance by Bank Transfer. Sessions cancelled with less than 24 hours notice are normally chargeable unless there are exceptional circumstances. However I don’t charge the full session fee, but 50% of the rate you are paying. Please bear in mind that in these situations I still have to pay for room rental. If you need sessions but you are struggling to afford them or your financial circumstances change during the course of therapy please let me know and I will try to be helpful with reduced fees.