“Writing is such an exhausting enterprise ! All that work for one slim volume. I think I am much better at just living.”

           Lytton Strachey, author of Eminent Victorians,                                          quoted from the film Carrington

                

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Frequently (and Not so Frequently) Asked Questions


We have used the term ‘therapy’ here to cover ‘counselling’ and ‘psychotherapy’. We also use the words 'client' and 'patient' interchangeably.

PLEASE NOTE 

Some answers are generalisations about therapy; some refer specifically to our own practices. Different therapists would answer these questions differently; we do not claim to be speaking for them. This FAQ is intended to stimulate your curiosity and thoughts about therapy, without compromising truth or facts. 

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What particular problems do creative professionals have?

Creative professionals are human beings like everyone else. However, they have talents and capacities that bring particular stresses and challenges. 


The kind of occupation-specific problems that creative professionals bring to a therapist, or which have been a part of other difficulties presented in counselling and psychotherapy, can include:

  • blocks and inhibitions in work
  • inability to start or complete projects
  • excessive negative self-criticism
  • perfectionism that gives rise to procrastination or self-criticism
  • a collapse of grandiose self-evaluation
  • envy in relation to the creativity of others
  • confusion over one’s own wishes, ambitions, plans, desires
  • fear of failure
  • fear of success
  • loss issues
  • grievance in relation to the success of others
  • grievance with latent associated conflicts
  • over-sensitivity to others’ comments, opinions, judgements
  • boredom
  • burnout
  • depression
  • obsessional thinking
  • compulsive behaviours
  • anxieties arising from creative work
  • anxieties impacting on creative work
  • childhood abuse survival symptoms 
  • traumatic stress
  • work- or employment-based conflicts
  • issues related to authority
  • self-harming and self-neglect issues
  • relationship and intimacy issues
  • loneliness and isolation
  • peer group conflicts
  • attachment and separation issues
  • health-related and disability issues
  • concentration difficulties
  • cognitive impairments
  • learning difficulties and inhibitions

How can I be confident that a therapist is the right therapist for me?

By checking if you feel confident after you have spent some time with them. You cannot be one hundred per cent certain, but then you do not need a perfect therapist (where on earth are you going to find one of those?). You need one that is 'good enough'.  Some people 'try out' a few therapists before embarking on treatment. This is a great deal better than a random selection. If you are 'checking out' therapists, and you are entitled to do as much of this as you like, of course, it is not a bad idea to let each one know this. You will see how they respond to your communication. Their reactions may make a difference to your estimation of their suitability for you.


Where (geographically) the therapist is based matters. Who wants a three-hour journey each way to see a therapist ? Actually, some people do not mind at all, and find that a journey becomes part of the work. It can be a time to reflect on the coming session and to think about it afterwards. You definitely do not need a therapist who lives next door, or around the corner. Seeing your therapist in Tescos is not the end of world (actually it could yield some interesting material in a subsequent therapy session) but it can complicate things for therapist and client, and the therapeutic relationship is complicated enough.


Some clients feel it is important to choose a therapist with a preferred sex, gender identity, social background, ideological stance or whatever. This is entirely down to the choice of the client, but you may at some point find yourself wondering what these preferences were about. There is nothing stopping you from asking your therapist what his or her opinion, stance or world view consists of 


How can ‘just talking’ help?

Language is fabulously useful for making sense of things. It is also terribly prone to giving us problems, since it can trap us in ways of thinking and feeling that can cause us a great deal of confusion and distress. Paradoxically, it is a blessing and a curse. Language, speech, talking   -  these are different conceptually and practically. Therapists are trained to listen in ways that most people do not ordinarily do. 


One outcome of a therapy is that the patient learns how to listen to him or herself. This is not an easy thing to do and for those in a great deal of distress, or with troublesome backgrounds, it may be impossible without getting the right kind of help to do so. Also

  • Talking can release feelings that are 'trapped' the body and in repetitive behaviour.
  • Talking connects people. Many people present for counselling suffering from feelings of isolation and loneliness. It is also one of the ways we can keep other people at a healthy distance, so to speak, since the speaker, (creator of the 'I' that speaks), becomes the subject in relation to the ‘other’ to whom we speak.
  • Another point to consider here is that not everything that happens in a talking therapy relies on the talking. The client's experience of the setting, the consistency and reliability of the therapist's presence, the healing effect of silence in the context of the therapeutic relationship, and a whole host of other experiences that do not rely on talking, are part of what is therapeutic.

Why are so many people turning to counselling for help?

There are many explanations for this. Not that long ago, counselling was little known about. It was barely mentioned in the media and many people had no idea how to get psychological help and would steer clear of it for fear of being labelled ‘mad’. We are more enlightened now and more people have the time, motivation and disposable income to invest in this form of treatment.


Of course, it is also true that some people are not accessing counselling. There are cultural, socio-economic, demographic, political, educational (and a hell of a lot more besides) factors here that restrict people’s access to psychological treatments. The NHS has developed certain facilities for giving people increased access to therapy (IAPT services) through their GPs and this has played a part in giving therapy a higher profile.


The media, when news scoops are not to be had, go through phases of near- obsession with mental health. This, too, has played a part in drawing people’s attention to counselling. Chat shows, reality TV programmes and soaps frequently focus on, or allude to, counselling in some form or other, and while this does not always represent the talking therapies in an accurate or helpful way, it nonetheless brings them to people’s attention.


The development and availability of counselling goes hand in hand with an improvement in standards of living and wellbeing and we are all much more aware now of the cost of 'grinning and bearing' one's suffering, as opposed to naming it, working on it and turning it when a appropriate to good use.


Is it possible to not have therapy, and just get on with life?

Definitely. Some people live full, satisfying, exciting, purposeful lives right to the end without once needing the services of a trained therapist. These people are what Donald Winnicott calls “candidates for the enjoyment of life” and they became like that through constitutional factors (positivity and optimism is in their genes) and through having had a thoroughly good enough, stable, loving, fun-filled early life with devoted parents who were consistent role models. Such people are not likely to need therapy at all. They are resilient to the ups and downs of life, have a solid sense of self, high levels of achievement motivation, consistent self-esteem and can make use of their relationships to prop them up, sustain hope and give them the drive to succeed.


If you have not been so lucky, you can still get through life without therapy. Family and friends can help us cope in the present with deficits we suffered in the past. Some people land on their feet by getting into relationships with healthy people. They find work that is fulfilling and self-affirming. They participate and contribute to the cultural realm in a way that gives their lives  purpose and meaning.

 

These 'normal', non-clinical resources, let's call them, function as buffers and anti-depressants. Without them, we may be prone to self-doubt and the defensive postures of self-holding that turn us into closed systems, unable to let new things in, and making us fearful of letting certain things (feelings, impulses) out. This may 'pin us together' and keep us going - in some instances for a life-time. However, the psychological price paid for some of these props may be high. 


How can I be sure that a therapist is properly trained?

Make sure they are registered with one of the professional bodies that oversees and maintains standards for professional practice (BACP, UKCP, BPC and others). Scrutinise the self-descriptions of therapists in their profiles. Check out their qualifications and experience. Ask them to tell you how they work.  


How do I decide which kind of therapy to have? 

Find out as much as you can about the different kinds of therapy available. Talk to some people who have had therapy to get a sense of what they got out of it. Speak to some therapists to see what they have to say about the suitability of their way of working for the kind of problems you think you have. Make a decision as to whether you feel you want to get relief from some current symptoms and want to do so in a short space of time, or whether you want to work at depth on the underlying causes of your problems. Of course, these comments will not guarantee that you find yourself in the right kind of therapy, but they reduce the likelihood of finding yourself in the wrong one.


What should I do if I find that therapy is not helping?

Tell your therapist. It is essential to explore this in the sessions and the sooner the better. Your therapist will help you to think about your concerns, will take your ‘complaint’ seriously, will try to work out with you what the issues are. If, after this, you still feel that the therapy is not helping - and discussing it didn’t help either -  it probably means that the work needs to stop. This is a tricky situation in some ways and a simple one in others. The simple one is ‘get another therapist’; the complexity is to do with the following possibilities:

  • You may be expecting help with something that your therapy can’t help you with (e.g. you want advice, but therapists don’t give advice)
  • You may be expecting quick results that therapy cannot deliver and you may need to be 'patient' (it is not a coincidence that clients in therapy are 'patients' !
  • You may be dissatisfied with something about your therapy or therapist that you cannot put your finger on, so you put it on ‘not feeling helped’ (this is called displacement, and your therapist can help you to think about this)
  • You may be trying to find out if your therapist is really trying to help you or looks, from your point of view, like s/he is just having a chat, trusting to luck that somehow you’ll feel better. All these things are relevant stuff for discussion with you therapist - the best person with whom to clarify these possibilities in the first instance
  • You may be unconsciously replaying something not to do with you and your therapist, but something between you and another person from your past. This is called transference and some therapists are specially trained in understanding it, working with it and resolving it. Other therapists will disregard it because it is not a part of their technique and that may not be helpful to you - in which case you really are not being helped and it could be time to look elsewhere.

How long does therapy take? 

Clients may be offered short-term, time-limited, open-ended or long-term contracts. Roughly speaking short-term means 6 - 12 meetings; time-limited means something like 12 sessions to one year; long-term therapy can only be called long-term once it is finished. More precisely, it is open-ended since an end date has yet to be agreed and it may become long-term or not-so-long-term in the event of it being terminated for some reason. If you have some concerns about how long you will need to be in therapy, talk to your therapist about. It is worth bearing in mind, too, that relevant factors are

  • your choice (no one can make you stay in therapy
  • the nature of the problems for which you are seeking help
  • the model of therapy being offered (some types of therapy work very usefully on a long or open-ended basis (e.g. psychoanalysis and psycho-analytic therapy) while others offer time-limited work


Is therapy suitable for all people?

It depends on what you mean by therapy and when or who is seeking it and for what reasons. The idea of a one-fit for all notion of therapy is a mistake and it is one that the NHS is prone to implement out of budgetary constraints and inequality of access to psychological help. Herein lies the vagaries of the NHS vision for Improving Access to Psychological Therapies (IAPT). There will always be room for improving access, but what kinds of therapy are easily accessed by whom is a different matter.  People are different and it would be ridiculous to recommend the same form of treatment for everybody. In the private sector, there is a myriad of models of therapy for the general public to choose from, so perhaps one could conclude that there is something out there for all of us. Having said that, the word 'therapy' is used here to cover counselling and psychotherapy  and it is not true to say that counselling and psychotherapy are "suitable" for all people. Relevant issues are therapy availability, affordability and the general matter of choice. It is not much use if something is suitable, but people do not want it.

 

Another (tangential) point is that all talking therapies share certain features or techniques and these are suitable for all people. Empathy, for example, is in the toolbox of every therapist on planet earth and I cannot imagine a client for who it was not suitable. But then empathy is not a therapy, although it is intrinsically therapeutic.    


What happens in therapy?

Lots of things. Here are the basics, though some do not apply to all patients:

  • The therapist listens with total concentration and attention to a wide range of communications hidden (and not so hidden) in what the client says
  • The client talks about whatever comes into his mind, no matter how odd, strange, horrible, crazy, nasty or whatever
  • The therapist tries to make sense of what the client is conveying to him, putting this into words to check out understanding and to bring out hidden feelings
  • The client opens up in a way not possible with anyone else, trusting that the therapist is accepting, non-judgemental and utterly there to help, support and following everything said and as much as is possible of what is not said
  • The therapist provides a secure, safe, consistent, reliable space for the building up of trust and a solid working alliance so that the two people in the room can work together on a project (the patient, the problems)
  • The client has an experience that s/he has had before, but has forgotten it, or has not had before and can have it now: of being totally attended to and valued, supported and held (in mind) and this creates further attachment and a form of dependence on the therapist
  • The therapist helps the client to understand this dependence and to come through it to a position of independence and renewed self-reliance and self-esteem
  • The client ‘gets in touch’ with feelings that have been pushed down sometimes for many many years. Freeing up these feelings makes them available for expression, use, communication, knowing who we are, knowing what we need, knowing what we want
  • The therapist becomes a model of how to think by making use of the ‘raw stuff’ that the client gives him to turn into thinking
  • The client gets the experience of thinking in the presence of another person and thinking with another person and learns how to use this experience independently - without the actual presence of the therapist. This is the independence that is the aim of all therapies.
  • Etc, etc, etc……..


Will I have to talk about my childhood?

“Have to” are the key words here. No therapist will ever put a pressure on you to talk about things you do not want to talk about. Therapy is an invitation to talk and to explore, not a command. Childhood experiences lay the foundations for so much later development and structuralise so much of our personality and defences, so it is not surprising that therapists may want you to think about your childhood and will very likely try to open up this area in an assessment session and in the therapy itself, but always respecting your readiness and your capacity to think about painful events from the past. 


Can therapy cure a person?

It depends on what you mean by ‘cure’. Actually, if we go by the definition of cure, then no it can’t, since 'cure' means to structurally, irreversibly change something without the possibility of a reversal. Once this happens its material state is not the same. Freud spoke of therapy as working on neurosis as in the dredging of flood-prone rivers to form dry land. There may be no sign of water after this process, but a torrential downpour will follow the original riverbeds and the old waterways (neurosis) will manifest again. Extreme stresses and traumas can always reactivate symptoms that have not been around for years. However, therapy provides the means of anticipating difficult times ahead, thereby preventing symptomatic distress, equips us with the means of recovering quickly from such ‘attacks’ and puts in place the means for more and deeper self-understanding each time the prospect or reality of pain returns.  The ‘means’ referred to here are essentially the capacity to be self-reflective or self-aware which are common to all talking therapies.


Is medication a good alternative to therapy?

For some people it is the essential alternative, given the nature of their psychological difficulties, the impact these difficulties have on themselves and others, the risk to their survival without medication, and the reality of the ineffectiveness or limitations of non-pharmacological interventions for them.

What is definitely not good is the reliance on medication in instances where other treatments have never, and will never, be offered or considered and where this condemns the patient to a lifetime of dependency on drugs when other forms of help may have worked.


Can you be in therapy and on medication?

Many patients are. Some patients need to be, want to be and choose to be. No patient should ever be encouraged to stop their medication without recommending that they talk to the medical practitioner who prescribed it.

Some patients are only able to make use of therapy by being on medication. This is sometimes the case where a patient is in treatment in a psychiatric or mental healthcare system, in which case their treatment regime takes account of the combined interventions of drugs and talking therapy in the context of multidisciplinary care.


With regard those patients in the private sector, therapists will always want to know what other treatments a client is receiving.  They will know or will seek to find out, what the implications for the therapy may be, and will continue to be thoughtful about the side-effects of medication and how this may confound the progress and outcome of the therapy provided.

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Can I see two or more therapists at the same time?

Not a good idea, even if they are very different in their backgrounds, training, model of treatment or whatever. I have come across patients who have ‘overlapped’ the ending of one therapy with the start of another and this is not to be recommended either. Therapists are unlikely to be critical or judgemental   in these instances, but it will be their responsibility to help you to think about what this situation means  - its meaning in terms of the client's presenting issues and the therapeutic relationship itself.


How will I know if therapy is helping me?

It would not make much sense to conclude that therapy is helping you after one session, although you may certainly know that you came away feeling better. If on the other hand dozens of sessions later you are none the wiser if you are feeling helped, then there is a problem and this needs to be discussed with your therapist.

  • Progression and improvement in therapy does not happen in a steady, linear way. It is not uncommon to feel you are making progress one week and have gone back to square one the next. These are all concerns worth sharing with your therapist. All therapists take issues of progress in the work very seriously indeed. No therapist would want to persist in offering help to someone who felt they were not being helped.
  • You cannot get a grip on your own progress unless you face clearly what your expectations were at the beginning. If you came looking for a quick fix, the problem lies not in the therapy but in your expectations, but your therapist may have picked this up already. Having said that, if you came looking for a quick fix to the fact that nobody really listens to you, then that definitely needs a quick fix - in the form of your therapist listening to you very well indeed. This may not change anything at all in your daily life and it may take some time to understand why people are not attentive to you.
  • It is no coincidence that clients are also called ‘patients’ - patience is necessary for the healing process.
  • It can be useful to distinguish the difference between changes in your daily life, relationships, etc on the one hand, and changes in your therapy itself. The two have a very interesting connection, although at times it may not feel like a connection at all.

Have all therapists had their own therapy?

The majority of counsellors have had their own personal therapy as part of the training requirements. How much therapy (number of sessions and frequency) they are expected to have varies across courses. For psychotherapists the duration and intensity of therapy are substantially greater than for counselling training; psychotherapists will have had at least a year’s personal therapy before starting a course, regular therapy for the full duration of the course (usually 4 or more years) and for the full duration of their preparation for membership/registration after qualifying, however long that takes.

 

Note the difference between a trainee being required to have the "experience of being in therapy”, which is actually how it is worded in some training prospectuses, and a trainee being required to be in therapy in order that they have done an appropriate amount of work on their own neuroses, not merely gained an idea of what it is like to be in therapy.  


What makes a good therapist?

This is by no means a complete answer, but here are a few suggestions that are often not mentioned in the business promotional literature of therapists:

  • has had a substantial amount of personal therapy/analysis for their own issues and problems - well above the number of sessions they offer to clients and equal or above the frequency of sessions offered to them per week
  • has a measure of the maturity that comes from reflection on the kind of life experiences that no person can be expected to have had straight out of university
  • has a rich, full life aside from the therapy they practise
  • rigorously applies the principles and ethics of counselling to themselves in and out of the consulting room
  • has an interest in both the theory and practice of therapy and a commitment to ongoing professional and personal development
  • an understanding and appreciation of paradox
  • a sense of humour
  • total absence of pomposity or self-importance
  • warm, relational, serious, funny, intelligent, patient, creative
  • compassionate, non-sentimental, honest, non-judgemental
  • imaginative, nuanced understanding of irony, lover of poetry
  • open-minded, inclusive, trusting, wise, reflective
  • capable of thinking, and thinking about thinking
  • exploratory, curious

I am quite sure that there are others that could be included, but these may suffice to get you thinking. 


What makes a good patient/client?

This is the most difficult question for me to answer and is best left to a client to tackle it for themselves and at different points in their therapy. It is not that therapists never comment on whether a patient is a good one or not. In fact I have heard it said thousands of times by hundreds of therapists. The difficulty is that the term ‘good’ is used to mean whatever the therapist wants it to mean at the moment of using it.


Is there life after therapy?

There are several ways of responding to this question depending on whether one is talking about the client or the therapist, or whether one means after a session or after a full treatment !

Therapy can become a way of life for both therapists and clients and it is a very sad state indeed. With therapists it shows up as never knowing when to switch off; they look lost and redundant out of the consulting room or may find it difficult to have normal conversations with friends and colleagues. This is a form of institutionalisation in which the therapist becomes over-identified with the role of therapist or is identified with a particular version or construction of what they take therapeutic practice to be. All therapists commit to ongoing professional development to guard against this.

It is not unusual for some clients to be so delighted with having found a therapist that they can barely leave off going on about it. This is ordinary and normal in the early stages of a therapy and what are good friends for, if not to put up with our new-found passions and projects?


With regard to life post-counselling: the whole point of a therapy is that it should end, and this could be called the point where the client gets on with life. There is a paradox here, however, and one that applies to both therapists and their clients. Therapy in a certain sense does not end. The therapist’s capacity and inclination to be thoughtful and self-reflective is more or less operative 24/7, settling down, obviously, with the onset of sleep, not withstanding the fact that some therapists dream about their clients.  For the patient, eventually, self-reflection becomes an habitual mode of thinking about oneself. Internalising the therapist/therapy sets one up to be ‘in therapy’ for the rest of one’s days, and in that sense life and therapy become one and the same. 

 

There is a further point to add here, and it is one that can usefully be given some focus in (long-term) therapy as it comes to a close. The point is that there are gains to be had after therapy has ended. The client discovers the joy of independence and the wonderful sadness of the loss of a therapist who may be with you internally for the remainder of your days. This marks a new beginning for the client, facing the future alone with a set of feelings and a knowledge that one need not ever feel, for too long or overwhelmingly, alone again.

 

How can I get my partner to have therapy?

To attempt to “get” anybody to have therapy is highly questionable and very likely doomed to failure. If the attempt is coercive or threatening it is likely to make its recipient resistant to accessing help in the future - not a good outcome. Instances of this kind of situation come in many different forms and with a variety of issues embedded in them, such as interpersonal conflict, confusion over who needs help, misunderstandings of the nature and purpose of therapy, to name a few.


Calm, rational discussion without threats, blame or retaliatory remarks is more likely to be helpful. Except in cases where a person is a danger to themselves or others, interventions are not to forced on anyone, but then the intervention in those cases is not likely to be therapy, but other forms of support or emergency care involving mental health or medical services.


Why does my therapist refuse to answer some of my questions?

The best person to answer this is your therapist. Those who have never had a therapist may be interested to know that indeed you might be responded to with silence when asking a personal question (e.g. Are you married? Do you have children?) Actually more likely that a therapist will respond not with silence, but with an explanation or with their own question which attempts to get you to think about why you are asking the question.

 

These conversations can yield very interesting hidden motives, feelings and anxieties in the client, which means that your therapist is keeping you on track (helping you to understand yourself) rather than going off track (talking about him or herself). There are likely to be thousands of things you would want to know about your therapist, but you may not need to know them. Therapists are trained to know what is in the best interests of their clients and the limits of self-disclosure is included in this.


I tell my clients that they are entitled to ask me absolutely anything they want; I the add that I am entitled to not answer anything I am asked, unless it is necessary as a part of attending to the their needs, rather than their wants or demands. Another point to add is that therapists have different views on these matters and some operate more flexibly than others.

If yo r therapist talks too much about themselves, offering up personal information about themselves regardless of whether you have even asked for it or not, this could be troubling for you and you should, in the first instance, raise the matter with your therapist.

 

Why does therapy cost so much?

In the private sector therapists can charge whatever they like, as in any open market economy.  


Clients have to make decisions about cost-benefits for themselves, but they can do so with the help of friends, family and colleagues who know something about these things. However, just because your friend asserts that she is getting therapy at a knock-down price, does not mean that this has to be your guiding criterion for choosing a therapist.


Here are a few things to hold in mind when thinking about the cost of therapy. 

  • The vast majority of therapists are honest, caring, compassionate and ‘nice’ people. They are all signed up to codes of practice that require them to be ethical practitioners and upright members of the community.
  • If you can access low cost therapy and feel you need it then it may be silly not to do so, although you will be stopping someone else from sitting in the chair you’ll occupy and there may be a cost to you and your good feelings about yourself if you do so. Please understand that I am not trying to make you feel guilty, just offering you something to think about.
  • If you can access free counselling and psychotherapy through the NHS or other agencies and the therapy you seek meets your needs, this makes total sense to me. I make no secret of the fact that I was lucky enough to have five years of individual therapy on the NHS in a prestigious psychotherapy department several decades ago. I was a very troubled person and needed it badly. Public sector resources are very different these days and although I have a plethora of additional thoughts to express on will move on swiftly to my next bullet-point
  • Money has its own significance in therapy and there is a wealth of clinical research looking at a multiplicity of meanings that it can have in any one therapy. I have no intention of going into this very much here, but just to stimulate your curiosity I might mention the way in which the patient’s feelings about fees (and money generally) can give expression to related conflicts and traumas around control, authority, neglect, seduction, dependency, deprivation, abuse, anger, resentment, destruction, and so on.
  • If you think your therapist is charging you a little more than he or she should, here's a thought to consider: do you want a greedy therapist or a resentful one? This poses a fallacious dilemma, of course, but it is worth thinking about its implications. 

Why do therapists expect you to pay for missed or cancelled sessions?

Different therapists have different approaches to this issue. Some will take a firm line on it and others will be more flexible. In general, however, most therapists expect their clients to pay for missed sessions, except (of course) when the therapist cancels.


This can seem like a very unfair requirement, particularly where a patient is unwell or has a commitment that prevents attendance through no fault of their own. This expectation on the part of the therapist will be viewed by clients in different ways, some feeling a little resentful, some not at all and some confused. The following points are offered to get you thinking and will not necessarily address all your concerns, if indeed you have any. The best person to explore this with is your own therapist. If your therapist is not bothered about fluctuations in their income this need not bother you, so to speak, but it is likely to have some sort of meaning at unconscious levels (for both therapist and client) and it is the therapist who is best placed to think about this in attending to the needs of the client and in looking after themselves.

The contract you have with your therapist (sometimes written and sometimes not) make it clear what s/he expects. The client should have these ‘household’ practicalities clear from the start.

  • Missed sessions cannot be ‘filled’ so the therapist would be subject to unpredictable payment for work which they have agreed to undertake with you. Comparisons could be made with other professions or trades if this helps, although you will always find exceptions that make this one seem unfair. At the present time in the public sector in the UK patients can miss and cancel at short notice as many appointments as they wish, arguably at great cost to the NHS and maintaining a national mentality that treatment is free and that there is little or no financial impact on the resources of the health service. This situation may possibly change in the future.
  • If arrangements ‘permit’ clients to have control (however unconscious this control may be) over the therapist’s predictable income, then the client is implicated in a system where the therapist has been instrumental in permitting his misuse by the client. Why a therapist would want to set things up so that they were treated badly by their clients is not at all clear. One question that can be posed to highlight the negativity in this situation is ‘who wants a therapist who cannot look after himself?’ All therapists model self-care in its multifarious forms and this is a relevant variable in therapeutic practice
  • Relevant, too, is the issue of what kind of place a client has in the mind of his therapist, between sessions generally and specifically when the client does not turn up for a session. When a client is in therapy, the therapist is in this work too. A client remains the therapist’s client even in his (the client’s) absence. It follows from this that a therapist is still a client’s therapist even when the client is absent, unwell, in hospital or whatever.
  • There is an issue about prolonged absence for certain reasons and this is where a therapist may adjust their arrangement with the client in the acknowledgement that there is a real world out there and it can sometimes prevent clients from getting to their sessions.
  • In my private practice (JE) with creative professionals, I make it clear to clients that I expect them to pay for missed sessions, or ones cancelled at short notice, but that anticipated breaks from therapy due, for instance, to work commitments are a different matter.

Do some patients actually fall in love with their therapist?

Of course. And some therapists fall in love with their clients - although I certainly hope nothing comes of it, that they seek advice and supervision, keep a grip and don’t lose the professional plot.


It may sound strange to you when I put it like this, but clients are entitled to fall in love with their therapist and no regulatory body on planet earth can control the feelings that a therapist may develop for their client. However, there is a big difference between having some feelings for someone in a clinical situation and acting on these feelings. The guiding principle here is that feelings are not the problem - enactment is. Should you start falling in love with your therapist (note: there is a problem here in so far as I have not bothered to offer any definition of what ‘falling in love’ means - how long would that take?) the guiding principle is talk to your therapist about it.


This is a huge topic and I feel silly even including it in this FAQ section of my website. However, the erotic nature of therapy has a substantial literature and it is such an interesting topic that I wanted at least to get you thinking about it……

Is it a good idea to end therapy if you are unhappy with it?

It all depends on what you are unhappy with and/or what your unhappiness is about.


Even a very short therapy should not be broken off before the agreed end-date without talking about it to your therapist first. Talking about it may resolve your dissatisfaction, or it may confirm that you do indeed wish, and need, to stop.
Here are a few thoughts, but please bear in mind that these are not exhaustive and other therapists think differently from me; I am not speaking for them:
  • Endings in therapy have a therapeutic significance. Many people who present for counselling have issues with endings and you do not want to find yourself ‘acting out’ these issues or adding more to the ones you already have
  • The principle here is to do with attachment (this happens even in a short therapy) and separation/loss. Therapists are trained to be extremely sensitive to clients’ needs with regard to attachment and endings and will want you to have a good ending to your therapy, just as they were keen that it got off to a good start (yes, that poses another question of what exactly a  good is and what a good ending is). A sudden ending will prevent the therapist from helping you to review the work (evaluate and clarify its impact, achievement and limitations) and this can have a negative effect on the benefits that can be had after the therapy has finished. Put simply, the therapy needs to be ‘internalised’ which will make it accessible, in a way that can be reactivated it for future use and so that each reactivation functions of a further consolidation of it. When this happens, you will know it and a fabulous feeling it is too - bringing a new-found independence, a triumph over the 'lost' and no longer needed therapist, and a new form of gratitude that they can be taken with you wherever you go. None of these things can happen while you are still in therapy, which is one of the reasons it needs to end at some point. 
  • The amount of time spent working on the ending needs to be in proportion to the length of time you have been in therapy. It is not uncommon for clients to have a return of their old symptoms in the months/weeks before ending and along with this there may be some very important unconscious stuff going on in you (feelings of abandonment, anger that the therapist is letting you go so easily, thoughts that they are glad to get rid of you, and feelings that you have exhausted them. These are just a few of the possibilities.
Other issues that can be clarified around the time of ending are
what access you can have to your therapist in the future (are you ‘allowed’ to come back for more?) Are your therapeutic needs now fully attended to (do you need further help?) What should you do if you have a return of your previous difficulties or find you have new ones, and will it be possible for you to go for a pint together now?  (NO it won’t!!)

My therapist takes long holidays. Is this professional?

It would be unprofessional not to take holidays and not to provide clients with the necessary breaks from therapy, during which they learn how to cope on their own. How a client feels about breaks from therapy may very usefully be brought back to therapy following the break. So many useful things can emerge from such discussions under the headings of dependency, abandonment - the problem of how to keep your therapist 'alive' even when they are absent.  

 In short-term therapy, breaks may not feature; in long-term therapy they always do.


Dates and the duration of breaks are usually clarified and agreed at the start of a therapy, so that the client knows what to expect. If your therapist knows six months in advance that they will be across the other side of the planet for six weeks in the summer, then they need to let you know this well ahead. This gives you time to discuss how you feel, what meanings the break may have for you, and so on. Similarly, if you know that you will be taking a long break from therapy, then the sooner you let your therapist know, the better. Some therapists will waive fees if given enough notifice, but this depends on a number of different things, so it cannot be assumed. Talk to your therapist. They want to be transparent about these practicalities, for your sake and their own.


So what is an acceptable length of holiday? In my own (JE) practice I take two weeks off at Christmas, two at Easter and three or four in the summer. Note that two weeks means two missed sessions for a once-weekly therapy, effectively a gap of three weeks from the last session until the next. A holiday that is effectively one session missed is not so much a holiday as one missed session, and therefore more easily rationalised by the client as not a holiday at all. As such, it is likely to have reduced value therapeutically.

 

Clients do not pay for breaks taken by a therapist, although the agreed therapy fee could be seen to include coverage for the drop in the therapist’s income, so there is no need for clients to even give this matter a second thought. The situation can be different when a client takes a break. As for my own practice, I would expect clients to pay for breaks that did not coincide with my own, although I try to arrange a re-sheduled session if I can. If a client gave me substantial notice of a work project or a holiday coming up I would likely not charge them, as I may be able to plan ahead to use the time for alternative remunerated work.


As you can see, some of this sounds complicated and tricky, and there should always be an adherence to regularity and consistency to avoid confusion, to create safety and predictability for the client, and as a form of self-care for the therapist.


Breaks and holidays are not just practical issues. They are an integral part of the therapeutic work, and as indicated above, bring up a huge variety of issues, meanings, anxieties and phantasies for the client on important themes of dependency, separation, control, work-life balance and many more besides - all relevant and useful topics for exploration in therapy.

Friends of mine make negative comments about me being in therapy. What should I do?

Make use of your therapy by listening hard to what they are really saying to you. Some people offer their opinions freely without thinking too carefully about what they are communicating. It is just possible that they are trying to find out how you really feel about therapy, whether you are becoming too dependent on it, getting ripped off, or whatever.


Another possibility is that they are wondering if therapy will change you (it does bring about changes) and they are anxious that the change could spell a shift in, or an end to, your friendship with them. They could be unconsciously expressing their envy (they feel that could be missing out on somethig). Therapy might transform you into someone ‘normal’ and boring, and they prefer you being the neurotic or interesting crazy person you were when they met you.


Rather than feeling hurt because your friends do not rate your therapy as highly as you do, why not take opportunities to get them to be explicit about their position. If you cannot prise any sociological or philosophical insights out of them, perhaps they don’t have any. Perhaps there is some kind of spoiling envy or negativity faint on here?


It is a good idea to ask yourself what you sound like when you have talked about your therapy. Some people idealise their their new found relationship, especially when they are new to it. If your therapeutic experience has some substance, it will survive a fair bit of deconstruction and dismantling, even in the presence of others.  Perhaps you talk about your therapy too much? Not everyone wants to hear about another person’s journey through landscapes they may not even believe exist.


One further thought: if you are discovering that your friend has no real interest in your ability to make choices for yourself, and cannot accept or even think about the possibility that you may be in therapy to resolve some real pain and distress, then question marks could start to shift from therapy to the friendship itself. Perhaps you chose a friend who has no interest in your wellbeing?


What problems can arise in a relationship in which one partner is more ‘creatively successful’ than the other?

A relationship in which both persons are professionally successful has the potential for many positive developments and outcomes.  A situation like this can come about by good luck, judicious choice of a partner, and sheer hard work on the relationship itself as a shared creative endeavour.


All relationships have their ups and downs and many people come through the bad times, resolving difficulties with the help of family and friends. Creative professionals are no different to anyone else in this regard.


When there is an imbalance on the success dimension, couples can suffer high levels of distress and conflict. This inequality is not always, in and of itself, the cause of difficulties, though it may be the trigger for other difficulties lurking beneath the surface. Another way of putting this is to say that there were problems in the relationship anyway, and these were going to come out one way or another.


Sometimes, the work itself (the creative work of one or both partners) is the healing agent for the relationship: setting up a benign cycle in which the relationship benefits from the wellbeing and material profits of work, renewing the couple’s hopes for, and commitment to, the relationship. When this situation continues across time it confirms for both that they are in a ‘creative relationship’ - an ideal accompaniment to the creative occupation of one or both. Creativity, positivity, hope, pleasure and all good things abound. We have already acknowledged that luck plays a part in this benign setup, but effort put into making the relationship work cannot be over have won out over the pull into fragmented ways of thinking and behaving. Drivers like conscientiousness, loyalty and mutual respect take the couple onwards and upwards.


There are many many things that can go wrong in relationships. Envy - as one example - can create mayhem. This may arise from resentment about the other’s success as well as distress at what this success brings along with it. Extended periods away from home, celebrity status complications, suspicion and infidelity are just a few examples . Envy of one’s partner’s success can be very difficult to manage and may cause the envious partner a great deal of turmoil. Understanding why these feelings get stirred in us is no mean feat.  The envied partner is likely to have a variety of reactions and defences, ranging from confusion through to rage. Unless one of the pair can do the right kind of thinking about this situation there is the likelihood of a further escalation of anxiety on both sides, and a possible deterioration in the relationship.


Jealousy, often confused with envy, can be equally disturbing. It denotes a strong feeling of exclusion felt by one person in relation to two others, except that in the consulting room I have often seen this as showing up as intense jealousy of a partner’s ‘relationship’ with his or her creative work. The distress this can cause is enormous and likely to be very confusing for all concerned, since it is driven by deeply unconscious conflicts, usually having their origin in early life. Bringing these conflicts to the surface may take a considerable amount of time in the course of an individual therapy.

It is well known - and well confirmed clinically - that many creative people have personality features that can create difficulties for themselves and for anyone who gets into an intimate relationship with them.  Understanding these personality variables can bring enormous benefits, not always through eliminating them, but through learning to tolerate and work with them. Narcissistic personalities - and some creative people are narcissistic - have difficulties connecting with others on a feeling level, and prop themselves up by cutting off from any kind of dependency on the people around them. This can make them unapproachable, cold, uninterested in others, totally absorbed in their own concerns or interests. 

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