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Fitting Therapy Into Your Life – Frequently Asked Questions

The decision to seek counselling or psychotherapy is not necessarily an easy one to make. Following are some of the frequently asked questions about finding a therapist and the right kind of therapy to meet your needs and wishes. More information can be found on the UKCP website here. If you would like to discuss, in confidence, any aspect of starting therapy, please get in touch – by phone, text, email, or through the contact form. I aim to reply to all messages within 24 hours.

How do I choose the right therapy for my needs?

In general, there may be several different types of therapy that would be equally appropriate for addressing your concerns. Research shows that finding a therapist that you feel comfortable working with is just as important as the therapy they practise. Broad categories of therapies, however, might include the following:

Where there are long-standing emotional and/or behavioural patterns that are causing distress, a depth therapy might be helpful. This includes exploring the unconscious substructure of what is happening in the client’s conscious life, as current issues are often predicated on events in childhood and/or unrecognised trauma. Alternatively, some people prefer not to delve into the past but to work on symptoms in the here-and-now by analysing and changing the thought patterns believed to underpin them. In this case, CBT-related therapies may be a preferred option.

Another very broad categorisation might be along the lines of how relational a therapy is. Traditional psychoanalysis employed the idea of the “blank screen,” where the analyst says very little. Most other therapies are more relational than this, and there is even a relational version of psychoanalysis now. Some therapies are clearly collaborative, where therapy is a joint venture between therapist and client.

If you are concerned that you may be suffering the after-effects of psychological trauma, it may be appropriate to consult your GP. However if this is not desired or not possible, an initial discussion with a therapist trained in trauma work may be helpful. There are several therapies with a good evidence base of efficacy with trauma, the most well-known being EMDR and trauma-focused CBT. However, establishing a therapeutic relationship with a professional that you trust and have confidence in is also important.

So when you have found a therapist you think may be able to help you, make contact and talk with them on the telephone. If all goes well, they will invite you to meet them for an assessment session to ascertain what the therapy is about and how to proceed.

How do I find the right therapist to work with?

Research has demonstrated many times over the importance to the therapeutic process of the client-therapist relationship. It is often the single most important factor in good therapeutic outcomes. Any therapist who has completed a recognised training and is a member of a professional association should be able to advise you about the suitability of their type and style of practice for addressing your concerns. Some therapists specialise in working with certain types of issues or clients, and some can also offer a second language for those whose first language is not English. You may also like to consider whether you prefer a male or female therapist, and whether they are open to any spiritual or other views that are important to you. These kinds of things can generally be learned from their website or literature. Most therapists will offer you a client agreement, either written or verbally, which describes how the sessions operate in terms of confidentiality, missed sessions, fees, and so on. A qualified and experienced professional that you feel welcomed by and safe with is likely to be a good choice.

What is psychological trauma?

When a person’s psychological homeostatic mechanisms are overwhelmed, their ability to cope with a situation may be exceeded. They are then no longer able to help themselves through the fight or flight mechanism and they go into a freeze response. Many people will recover from this naturally, without professional help, but some people may develop ongoing symptoms which become chronic. These symptoms include, but are not limited to:

  • Intrusions, e.g. flashbacks and/or nightmares. Dissociative symptoms may also be present.
  • Avoidance of people, places and things which are associated with the trauma as they may trigger reactions.
  • Hypervigilance, e.g. anxiety and nervousness, feelings of lack of safety, paranoia, insomnia.

What is challenging but manageable for one person may prove traumatic for another. Trauma may go unrecognised for years, sometimes only being picked up when the sufferer seeks help for something else, such as anger management, addictions, suicidal ideation, or relationship issues.

Single event trauma might result from, for example, a car accident, a mugging, rape, or natural disaster. When a person has been subjected to ongoing trauma, as in child abuse or domestic violence, that could give rise to complex trauma. Abuse or neglect in childhood that has significantly affected normal psychological, emotional and social development may be referred to as developmental trauma. Post-traumatic stress disorder (PTSD) may be diagnosed after certain kinds of traumatic events when symptoms have been ongoing for longer than one month. Delayed onset PTSD is also possible.

Complex PTSD (CPTSD) may develop from the accumulation over time of a number of smaller incidents, or from an ongoing situation of abuse and/or neglect. This is often associated with events in childhood but may also be linked with domestic violence in adulthood. The symptoms of CPTSD are the same as for PTSD but with three additional symptom clusters. These are affect dysregulation, negative self-concept, and disturbances in relationships.

What is it like being in counselling or psychotherapy?

After making initial contact and agreeing to meet, the first session is usually taken up mostly by an assessment process. This is about finding out the factual information and background of the client and what has brought them to therapy. In the early sessions it may also be appropriate to talk about goals for the therapy and to formulate a plan of how to proceed. This is particularly important when therapy is time-limited. One has to be realistic about what can be achieved in the number of sessions available so the work can be focused appropriately.

Sessions are usually 50 minutes long, although longer sessions may be appropriate for EMDR therapy. Sessions take place weekly, on the same day and at the same time each week. This regularity is important for the therapeutic process to work well, although some flexibility may be possible in some circumstances. When clinically indicated, it is possible to have more than one session a week, either temporarily or on a regular basis. Fortnightly and ad hoc sessions are also possible in some circumstances.

It is good practice to review progress from time to time, just to check that the work is on course, or whether perhaps things might have changed and a new direction is appropriate.

Talk therapy is not only about talking! Transpersonal and integrative work can include creative activities such as drawing, guided visualisations, analysing dreams, keeping a journal, bibliotherapy, working with parts of the psyche, and much more. These kinds of activities allow a degree of access to what’s going on in the unconscious mind, as well as facilitating processing and integration of material.

EMDR therapy follows a specific protocol, described in more detail on the EMDR page of this website. When appropriate, however, EMDR sessions may be supported by sessions of regular therapy. Similarly, regular therapy can include some EMDR work when appropriate and agreed with the client.

Where do you see clients?

After seeing clients at consulting rooms in central London for twelve years, my practice is now fully on-line. I continue to see many London-based clients and now have clients in other parts of the UK and internationally. The online video platforms I use are Zoom and a specialist video platform for EMDR called Bilateral Base. I also offer therapy sessions by telephone, live chat, text messaging and email. Sometime, therapy with an individual client may use several of these modes of communication.

Is online therapy as effective as face-to-face?

There is a good evidence base of research that shows online therapy is just as effective as when meeting in-person in a consulting room. Although there was some research before the Covid pandemic, there is now a lot more recent research on different kinds of therapy, including EMDR. They all work online just as well as in-person.

How long does therapy take?

When a fixed number of sessions has been agreed, this is known in advance, and the work is carefully focused to achieve the best outcomes in the time available. Short-term work could be anything from just a couple of sessions to six, twelve, sixteen or more sessions. Six months would still be considered short-term. In open-ended psychotherapy, however, how long the work may last depends on many things and is an almost impossible question to answer. Therapy is a process, a journey if you will, that happens in its own way and in its own time. It is rarely linear but often spirals around, revisiting different aspects of our life, but each time with greater insight and forward movement.

When the therapist and/or the client feels the work is drawing to an end, this is discussed in sessions and an ending date is agreed so it can be worked towards in an orderly way. Planning the ending of therapy is important because it is not only the work that is ending but also the therapeutic relationship. Although the client may continue their journey long after therapy finishes, the journey that’s been shared is drawing to a close.

Can I book one session?

Yes, you can. If you’d like to book a try-out session, perhaps if you’re not sure about therapy, or doing therapy on-line, you can book a 50 minute session on Zoom to continue the conversation we started on the phone. There’s no obligation attached to this.

Alternatively, single session therapy is available, where you can book therapy for just one session, or perhaps on an occasional, ad hoc basis. More information is available on the Single Session Therapy page.

Do you see clients in-person?

My therapy practice is now fully online and I’m not offering in-person sessions at the moment. You’re welcome to book a try-out session if you’d like to see how you get on with therapy over Zoom.

I'd like to try out EMDR

EMDR therapy starts with an assessment, just like when you start any kind of therapy. That’s followed by about one session of preparation work to get ready for the reprocessing stage of EMDR. Then even if we’re able to resolve a trauma memory in one session, for safety and good ethical practice it would be advisable to have a follow-up session as well.

What are your fees?

Please enquire about fees. I’d be happy to discuss this with you as part of our initial contact. If you have health insurance, it may be possible to arrange for fees to be paid through your insurance.

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Online therapy - more flexibility for busy people

There’s a good evidence base from research to show that psychotherapy and EMDR are just as effective online as they are in-person. Major advantages of working online include increased flexibility to adjust appointments, and being able to do therapy at home and when travelling. Now you can access the specialist trauma therapy you need, even if it’s not available locally.

Karen J Williams
MA, MSc, Dipl Psych, MBACP, UKCP Reg,
EMDR (Accred)
Counsellor, Psychotherapist, EMDR Practitioner
07801 273768

My therapy practice is fully on-line. Sessions can be through Zoom, Bilateral Base, telephone, live chat, text or email. I consult with London-based clients and those in other parts of the UK, and internationally.