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Therapies

The A, B & C of Working with a new Counsellor.

When you have the opportunity to begin therapy with a counsellor, the initial meeting will bring up anxieties for many therapy-newbies.  Even experienced patients can get the heeby-jeebies before the assessment, and whilst this is probably the same social anxieties as you might experience when meeting with anyone new, the counselling assessment may be just that little more distressing.

It’s untrue that counsellors, psychotherapist and psychiatrist can read into your very soul!  At the same time, it’s particularly true that many experienced counsellors do gain the experience of being able to understand where a new client is coming from during the client’s story.  Counsellors call it empathy, and the more ethical ones of us counsellors use it to try and help you understand yourself. But, this isn’t going to be an article on how kind and amazingly helpful we, as therapists, are! 

Because of recent reports of counsellor/client imbalance (who knows – maybe it’s always been so) I’d like to give you three tips that may help you face your new therapist for the first time.  I’d like you to feel a little more empowered than you may normally do.  Introducing my A, B, C of working with a new Counsellor.

 

A is for Authenticity

[dropcap style=”font-size:52pt;color:black”]A[/dropcap] is for Authenticity.

During the first meeting with a counsellor, you’ll probably be asked a series of questions.  This isn’t always true, though.  Some therapists pride themselves in being able to work therapeutically without asking any questions at all. Amazing (even frustrating) as thatm ight be, we’ll save that discussion for another time.

So – “A” is for authenticity – meaning: be true as yourself to yourself as you can be in any of your replies to the counsellor.  The counsellor isn’t trying to trap you or catch you out.  The therapist is trying to learn about you and your story, primarily so that the therapist can judge if they are the right person to be working with you.  If you don’t know an answer, say so.  If you’d rather not answer a question, you can say you’d prefer not to answer that.  The counsellor may be curious (and hopefully respectful of your reply too) and may ask you to say a little more.  Again, if you’d prefer not to go into a subject area you can decline to do so.

An assessment should be a mutual one – you’re assessing the therapist too. Being authentic means that you will get a better experience from a counsellor who is, too, trying to be as authentic with you as possible.

 

B is for Behaviour

[dropcap style=”font-size:52pt;color:black”]B[/dropcap] is for Behaviour.

Don’t change your usual behaviour.  Or, if for reasons of social niceties you feel you do have to change your behaviour, share with the counsellor your change in behaviour and try to describe how you might normally behave.

Socially, we humans can have a whole series of different behaviours that we bring out depending on what situation we’re in.  Sometimes we’re the life of the party.  Sometimes we’re the businessman that invites new business orders.  Sometimes we’re the dad picking up his kid from school surrounded by female-conversation we feel awkward to join in with. But meeting with a counsellor is about you, the inner person, and behaving just as your true, authentic self is best.

If your behaviour is effecting your life, and it’s something you want to change as part of the therapy, then it’s useful to discuss this with your counsellor too – your counsellor may need to learn about those behaviours … and you’re the tutor

 

C is for Challenging the Counsellor

[dropcap style=”font-size:52pt;color:black”]C[/dropcap] is for Challenging the Counsellor.

You’re meeting with a counsellor, presumably, to find to help.  If the counsellor is asking questions that make you uncomfortable, or the counsellor says something that disturbs you, challenge the counsellor.  You don’t have to feel that you must comply with the counsellor because you’re feeling forced to do so.  If you’re not receiving help, you have the right to point this out.

Challenging doesn’t have to be confrontational or impolite.  It can be a simple way to show that you don’t agree with the counsellor, or that you would like the counsellor to be somewhat more clear about what he or she has just said.  if we remember that counselling is a partnership there are a vast number of studies that it is the relationship between counsellor and client that makes the difference – not what the counsellor does to you. 

So, if you feel uncomfortable about what’s been said to you, challenge the counsellor to explain more.

Addressing Client/Counsellor Imbalance.

This article has had a hidden agenda – it’s been about addressing a reported-increase in the imbalanced between the some counsellor/client relationships.

At the present time, Increased Access to Psychological Therapies (IAPT) at the NHS has introduced an increase of newly trained CBT counsellors.  Whilst this is a good thing, unfortunately the practice of IAPT low-level CBT intervention offered by newly-qualified IAPT therapists has, somehow, embraced the medical approach to therapy.  Doctors practice the role:  “there’s something wrong with you, and I have to cure you.”  This is leading to an unfortunate counselling-practice of “I am the counsellor, so I have to cure you.”

Studies show that counselling and psychological therapies are effective because of the relationship between the therapist and client.  The effectiveness is not because of being given instructions-to-follow in order to be cured by the counsellor.

This is not an attack on CBT.  This therapist incorporates CBT in his private practice.  I incorporate CBT from a position of collaboration and empathy between myself and my client – we’re in this shit together.  In my professional opinion, the client experiencing a newly qualified therapist’s sometimes-dominant instruction is counter-productive.  You cannot be cured of anything by being told what to do (except, perhaps, allowing for a sadistic/masochistic relationship being played out between the counsellor and client – a discussion for another articl).

This article offers you, the client, the very legitimate and very real approach that you’re a fellow in the therapy. You are not a subordinate, and I hope you won’t feel like you are when you next go to meet with a new counsellor.

A, B, C and meet your counsellor with the expectation of equality & collaboration.

Enjoy your first meeting with your new counsellor!

Categories
FAQ

Can I ask my Doctor/GP for Counselling?

Counselling can be made available to you on the NHS via your GP.

There is often “stepped” process involved – including a waiting list to begin treatment depending on your presenting issues.

An illustrative example would be:

  • Initially, your doctor may first ask you to come back again in a few weeks time to see if things are better.
  • If things don’t feel better then next you may next be given access to reading material – a form of self-guided self-help therapy.
  • If this doesn’t help you may be offered access to a computerised [tooltip text='Cognitive Behaviour Therapy (CBT) is a form of talking therapy that is focussed on helping a person change the ways they think, how they feel, and their behaviour, in a stepped process. CBT has a reputation for being a manualised treatment (patient is diagnosed and a matching treatment prescribed) which is how computer-based CBT treatments have been created.
    http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy'] CBT [/tooltip] treatment.  This may help you identify and deal with your problems through suggestions the computer may offer based upon your responses to questions.
  • If these “self-guided” therapies remain ineffective, a referral to a low-level  (trained & qualified) therapist may be the next step – involving a waiting list of several weeks or months.
  • If the low-level impact fails to help you, you may be referred to another therapist for further treatment.

Low-level impact treatments are cost effective to the NHS because of their being no need to train highly skilled therapists.

The initially-mild interventions offered to you should be overseen by a therapist who should have an initial qualification, adequate experience & appropriately supervised (i.e. newer (lower-cost) therapists are more commonly used early low-impact intervention stages of a patient’s NHS counselling).

You may later be offered a fixed number of sessions of face-to-face counselling if the previous therapeutic intervention didn’t work for you. You may be offered to meet with a more experienced psychotherapist or psychiatrist if the previous experiences of therapy are ineffective.

Why CBT/Stepped Process?

This NHS stepped process is partially due to costs and partially due to new procedures introduced called IAPT (read more).

CBT is a treatment that GP’s can understand – it principally works on a diagnoses/prescription modality, where several treatments can be normalised (i.e. the CBT therapist follows someone’s recommendations/instructions for treating a particular ailment).  Of course, one would not take a prescription from an unqualified GP, so one would not be prescribed a form of therapeutic treatment from an unqualified CBT therapist – but there are various levels of experience & qualifications.

IAPT originally only offered CBT (cognitive behavioural therapy).  Mild forms of CBT can be offered by minimally trained therapists using a form of manualised therapy (e.g. you may be diagnosed and a therapist may refer to a set of therapeutic interventions that are recommended for your form of diagnosis).

Whilst CBT can be effective for certain issues it is not a fix-everything therapy and not everyone likes to feel like they are responding to a manual-of-therapy.  If you can be helped by the processes then this will be beneficial – albeit that to get to the higher forms of treatment the previous experiences of treatment may have to have failed first.

Private Counselling – Your Choice of Treatment.

Unlike NHS Stepped-Treatment, private counselling with Dean Richardson begins with the FULL service.

There is no tiered/stepped process with Dean. You start immediately with full 50-minute weekly sessions working with Dean face to face.  No computers giving you questionnaires.  No books to read.

You and Dean will begin with an assessment session (meeting to talk about what you need from counselling, and discussing what counselling may and may not be able to help with).

You and Dean will meet weekly (usually the same day, same time, same location – which helps many people manage their commitments elsewhere).

With Dean’s assistance you might decide to discuss choose how many counselling sessions you wish to attend (such as brief/focal counselling) or you may with to work with Dean until the focus of the needs for counselling have been fully addressed.

No waiting lists – no maximum number of sessions.

It’s a very personal counselling service that aims to create a therapy that works for you and your needs.

Categories
FAQ

Do I have to pass (or fail?) an Evaluation to get Counselling?

If you’re thinking of private counselling, then there is no test or evaluation! In private counselling, an assessment for counselling is where you and the counsellor meet to initially discuss what you want from counselling, and what the counsellor can offer you.  This is an ethical approach and informs you about what sort of therapy you are opening yourself up for.

Things can seem somewhat different in NHS counselling.  With newer IAPT services (read more), you may initially be recommended the lowest form of therapeutic intervention to begin with (e.g. go home and come back in a few weeks if things don’t feel better …  or try a computer program that may offer some suggestions on how to cheer up your life).  To the next level of therapy you may feel that you have to be unsuccessful with the previous level of therapy

It might be some time before you meet the most basically trained counsellor – and even more time to meet with an experienced therapist.

This can feel like you have to keep failing stages in therapy before you are allowed to go to the next stage.

I’m not suggesting that this occurs all of the time – each individual will be (or should be) treated on an individual needs basis – but it is not uncommon for people seeking counselling on the NHS to frail levels of treatment until one is found that is successful,

With Dean Richardson you are not offered one level of therapy first, followed by other levels if they are unsuccessful. What you receive from Dean is his full service from the beginning (although, of course, we will always take matters at a pace that works best for you).

At the beginning of counselling, you and Dean will go through an assessment for counselling.  This is where BOTH you and the counsellor will discuss your needs for counselling (i.e. not just you being assessed, you are assessing the counsellor and his methods too).  You and Dean will talk about what can (and cannot) be offered to you. 

The assessment is not a test – Dean is not looking for you to score a high mark (or get a low one).  An assessment is an effective way for you and the counsellor to both assess if working with Dean is, or is not, a good idea.  Other options, such as a referral to a more appropriate therapist, are available too.