TRAVMA DEDEKTÖRÜ ‘EMDR’

TRAVMA DEDEKTÖRÜ ‘EMDR’

Dünyayı nasıl gördüğümüz, çevremizdeki insanlarla kurduğumuz ilişkiler büyük ölçüde bellek ağlarımızda saklı olan yaşam deneyimlerimizle şekillenmektedir. Anılarımızın oluşturduğu ağlar algılarımızın, tutumlarımızın ve davranışlarımızın yani kişiliğimizin temelidir. Verdiğimiz tepkiler, şimdiki zamanda yapılan ya da söylenen şeyler kadar geçmiş deneyimlerle de ilişkilidir. İnsanı zorlayan ve anlamlandıramadığı bir çok durum, duygu ya da düşüncenin temelinde geçmişi bugünde yaşamak vardır.
Bir yerimiz kırıldığında canımız çok acır, bedenimiz ise o bölgeye iyileşme için hemen bir sıvı pompalar. Kırık, hiçbir şey yapılmasa da kendiliğinden iyileşir. Beynimizde de tıpkı bedenimizde olduğu gibi iyileşmeye yönelik bir bilgi işleme sistemi mevcut. Bu sistem rahatsız edici herhangi bir deneyimi öğrenmeyi sağlar. REM uykusu dediğimiz anda düşünce ve bilgi diğer anılarla birleşip öğrenme meydana gelir. REM uykusunda anı işlenir ve daha uyumlu ve kullanılabilir bir hale gelir.

Travmalar ya da üzücü deneyimler bilgi işleme sistemini baskı altına alabilir ve olayı çözüme ulaştıracak içsel bağlantıların yapılması engellenmiş olur. Bunun sonucunda bu anılar zihnimizde görüntü, duygu, beden duyumsamaları ve düşüncelerle orijinal halleriyle aynı tazelikte muhafaza edilir. İşte geçmişin bugün içinde aynı şekliyle yaşanmasının, zamanın bütün yaraları iyileştirememesinin nedeni budur.

Ancak yıllar önce yaşansa da aynı tazelikte hissedilen acılar en temelde geçmiş deneyimlerin yani anılarımızın beynimizde muhafaza edilme şekliyle ile ilgili olmakla birlikte etkisi değiştirilebilmekte nötr hale getirilebilmektedir.

EMDR Terapisi

“Eye Movement Desensitization and Reprocessing”-EMDR, “Göz Hareketleri ile Duyarsızlaştırma ve Yeniden İşleme” anlamına gelmektedir.
EMDR, Francine Shapiro’nun 1987 yılında parkta yürüdüğü sırada onu rahatsız edici düşüncelerin kaybolmasıyla yani tamamen tesadüfi olarak göz hareketlerinin olumsuz düşüncelerin şiddetini azalttığını fark etmesiyle keşfedilmiş oldu. Ardından yaptığı bir çok çalışma ve araştırma sonucunda çift yönlü uyarımların beynin iki tarafında, mantık ve duygu arasında bağlantı kurup iyileştirme sağladığını ortaya çıkardı.

Dünyada milyonlarca insan EMDR terapisi ile tedavi edilmiş olup özellikle son yıllarda bir çok uzman tarafından sıklıkla tercih edilen bir terapi yöntemidir. EMDR terapisinde amaç olumsuz yaşantıları, travmaları silmek değil bu anıları nötr hale getirmektir.
Beynimizin sağ lobunda anılarımız ve duygularımız kaydedilirken sol lobunda olaylar anlam kazanır. Beynimiz önemli gördüğü anıları hatırlar. Limbik sistem içindeki amigdala’nın amacı da hayatta kalma sistemine hizmet etmek olduğu için gün içerisinde sürekli olarak ‘an’ları taramaktadır. Olumsuz her şey bir sonraki benzer durumdan korunabilmek adına bu nedenle kaydedilir. Yaşadığımız olaylar sağ ve sol beynimiz arasında kurulan temasla olumlu ya da olumsuz anı havuzuna sindirilmiş olarak aktarılır. Travmatik anılar ise bu şekilde işlenmemiş yani sindirilmemişlerdir ve en ufak tetikleyiciyle karşımıza çıkmaktadır. Beyin, travmatik anıyı parçalar halinde kaydeder. İşlenmeden depolanmış olan bu deneyimler aradan ne kadar zaman geçerse geçsin aynı tazelikte yani sıcak kalır. Bu anıların bileşenlerini duyusal girdiler, düşünceler-inançlar, duygular, bedensel duyumlar oluşturmaktadır. Sadece olumsuz çocukluk ya da ergenlik dönemi deneyimleri değil yetişkinlik döneminde yaşanan travmalar da TSSB ya da daha başka bir çok bozukluğun semptomlarını yaratabilir. EMDR terapisi ile bu anılar belirlenir ve işlenir.

EMDR Terapisinde en temel amaç danışanı bugüne taşıdığı geçmişinden kurtarıp sağlıklı ve istediği şimdiye ulaştırmaktır. EMDR terapisi ile danışan geçmişinden ders çıkarır, stres oluşturan uyaranlara karşı duyarsızlaşır ve tüm bunların yanında gelecekte de kullanacağı baş etme becerileri kazanır.

Bilgi işleme sistemini aktifleştirmek için göz hareketlerinden başka ses ve çift yönlü dokunsal uyaranlar – diz, kol, göğüs-kullanılmaktadır. Çift yönlü uyaranlar ile beynin iki tarafında rahatsız edici duyguları, düşünceleri ya da duyumları barındıran anılar işlenerek kendimizi koruyabileceğimiz, olduğumuz halimizle iyi olduğumuz, güvende ve yeterli olduğumuz gibi olumlu yeni bilgilerin oluşturulması sağlanmaktadır.

EMDR, bir çok psikolojik bozuklukta kullanılabilen bir terapi yaklaşımıdır. En sık uygulandığı durumlar:

• Kişilik Bozuklukları
• Aile Çatışmaları
• Boşanma
• Öfke Problemleri
• Panik Bozukluk
• Anksiyete
• Depresyon
• Yas
• Fobiler
• Migren, Fibromiyalji gibi ağrı rahatsızlıkları
• Yeme ve Uyku Bozuklukları
• Bağımlılıklar
• Taciz
• Beden Algısı Bozuklukları
• Cinsel İşlev Bozuklukları
• TSSB
• OKB
• Kompleks Travma

*EMDR Terapisi süresince danışan uyanık ve bilinçlidir, hipnoz karıştırılmamalıdır.

EMDR Terapi Süreci Basamakları

İlk olarak danışanın ayrıntılı geçmişi alınır ve terapi hedefi belirlenir..
Ardından danışanı rahatsız eden sorunların kaynağı olan anılar bulunur.
EMDR terapisinin ne olduğu ve nasıl uygulandığı ile ilgili danışana ayrıntılı olarak anlatılır.
8 aşamadan oluşan terapi sürecinde seçilen anı danışanın kendisini en rahat hissettiği çift yönlü uyaranla işlenmeye başlanır.

Tıpkı diğer terapi yaklaşımları gibi EMDR terapisinin süresi de danışanın geçmiş yaşam deneyimlerine, tolerans penceresine, travmaların boyutuna, sayısına ve danışanın güncel yaşam koşullarına bağlı olarak farklılık gösterebilmektedir.

To read more about EMDR in English, visit Eye Movement Desensitization and Reprocessing – EMDR in West London.

What is cognitive behavioural hypnotherapy and how can it help?

You may have heard of cognitive behavioural therapy (CBT); a foundation of modern psychological therapy which empowers you to tackle unhelpful thinking and improve your wellbeing, and you’ve probably heard of hypnotherapy too. But what about cognitive behavioural hypnotherapy (CBH). CBH combines CBT with hypnosis; bringing these powerful disciplines together to equip you with the tools you need to tackle a wide variety of challenges in your life. This twin approach helps you to achieve change at the very deepest levels and can equip you with skills that will help you to manage challenges throughout your life.

How does cognitive behavioural hypnotherapy work?

Cognitive behavioural hypnotherapy is the main evidence-based approach to hypnosis. Rather than focusing on the notion of hypnotic trance, CBH places the emphasis on psychological factors like imagination, suggestion and expectation. Your brain is an incredibly powerful tool and can be your greatest attribute or your biggest enemy. Sometimes your mind shapes your thoughts and behaviours in ways which can be unhelpful, and the reinforcement of these loops can be damaging and cause ongoing psychological issues such as stress, anxiety, depression, phobias, and low self-esteem. CBH uses the power of your mind for positive change and empowers you to find the solutions to the challenges you face by enabling you to be fully aware of the link between your thoughts, feelings and behaviours. It works on the conscious and subconscious and helps you make positive decisions at a deep, unconscious level. This means you can make sustainable changes to the way you think, feel and behave by converting unhelpful, negative beliefs and thoughts into positive and empowering ones. Hypnotherapy works by allowing you to be focused for periods of time on the thoughts and experiences you’d like to be having. It brings your conscious mind and subconscious mind more closely in sync so that you can make truly meaningful change. By placing you into a deep state of relaxation, we will work together to help your mind absorb new information so that you can develop the tools you need to make positive changes. By relaxing, thinking positively and picturing your goals, hypnosis can help you to progressively adjust habitual feelings and behaviours. Studies have shown that using hypnotherapy alongside CBT can increase the success of treatment by as much as 70%.

What does a CBH session look like?

Effective CBH relies on close collaborative working between the therapist and client and gaining a clear understanding of your unique challenges is a crucial first step. The key to the success of hypnotherapy lies in your ability to understand the interaction between your thoughts, feelings and behaviours and this makes it hugely important that you share as much information as possible. We’ll talk about any specific challenges you face and how your life is affected by these. This will help us to establish your goals and design a treatment plan together so that we can measure your progress against this as we move forward. We’ll then set about embracing this extremely powerful tool to help you take control and make real and sustained changes in your life. Through CBH, you will become more aware of your emotions and behaviours so that we can tackle the ones you feel are most unhelpful to you or are holding you back in your personal life. The number of sessions you need will depend on you and your situation. Some people get what they need after just a couple of sessions, while others need more. In between sessions you may need to complete tasks at home. This may include self-hypnosis techniques to help you to continue to benefit from the treatment.

How can cognitive behavioural hypnotherapy help me?

This powerful technique can be used to great effect for:
  • Treating anxiety and depression
  • Improving self esteem
  • Become more assertive
  • Managing stress
  • Stopping smoking
  • Tackling fears and phobias
  • Changing habits
Though CBH is extremely effective in targeting the specific challenges listed above, many people find that the awareness they are able to develop during this treatment gives them skills they go on to use for the rest of their life; helping them to build their resilience and bolster their mental wellbeing.

If you want to explore CBH to make a change for the better, book a free 20 minute consultation with Chris here

Eye Movement Desensitization and Reprocessing – EMDR in West London

Our psychotherapists offer EMDR in West London, a treatment that was proven by research and welcomed by clients suffering from post-traumatic stress disorder. This page introduces EMDR and offers a list of psychotherapists trained and equipped to offer it.

What is EMDR?

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapeutic treatment discovered in 1989 by the American psychologist Francine Shapiro used to relieve the stress associated to traumatic memories. Over the year it has received enormous clinical support from psychotherapists, mental health researchers, neurophysiologists, and today it is considered the evidence-based treatment for PTSD (Post Traumatic Stress Disorder), validated by more researches and publications than any other psychotherapy in the field of trauma.

It is approved, among others, by the American Psychological Association (1998-2002), by the American Psychiatric Association (2004), by the International Society for Traumatic Stress Studies (2010) and by the World Health Organization (2013).

Out therapists offer EMDR in West London due to its speed of intervention, its effectiveness and the possibility of application to people of any age, including children

Traumas

We are exposed daily to the possibility of experiencing psychological trauma. There are Traumas that can be defined "with a capital T": they are important wounds that threaten our integrity, such as natural disasters, road accidents, assaults, rapes, murders or suicides of loved ones, inauspicious diagnoses.

But there are also traumas "with a lowercase t”, experiences that seem objectively less relevant, but which can take on a weight of their own especially if repeated over time or suffered at times of particular vulnerability or in childhood. In these phases of life, humiliations, abandonments, neglect and fears can leave their mark by changing our attitudes, emotions and relationships with others throughout life, and also impressing themselves on specific areas of our brain.

Psychological consequences

Thanks to their resources and the help of others, the majority of traumatised people manage to recover a new balance, but there are wounds that continue to bleed even after years. In the case of trauma with capital T, people can react with "fear, sense of vulnerability and horror", according to the definition provided by the Statistical Diagnostic Manual of Mental Disorders DSM-5 drawn up by the American Psychiatric Association when describing PTSD. The trauma in these cases is always present, the sensations are alive, and it feels like that the event just happened even if it dates back to months or years ago. The psychological suffering of trauma with a lowercase t can be less impactful but equally disabling. Sensations of insecurity, lack of self-esteem, self-blame, panic attacks and anxieties are the most frequent aftermath.

Effectiveness and therapeutic results

EMDR is a patient-centred approach that allows the therapist to facilitate the mobilisation of his self-healing mechanism by stimulating an innate information processing system in one’s brain. In fact, the eye stimulation used in the EMDR treatment favours better communication between the cerebral hemispheres, relying on a natural neurophysiological process, similar to that which occurs in REM sleep, the phase of sleep in which dreams are dreamed and memories reorganised. The EMDR methodology recognises the physiological component of emotional difficulties and directly addresses these physical sensations, along with negative beliefs, negative emotional states and other disturbing symptoms.

The EMDR session - the model used for EMDR in West London

Initially, a psychotherapist collects the person's history, identifying together the events that helped develop the problem: panic attacks, anxieties, phobias. Using a structured protocol, the psychotherapist guides the person in the description of the event or dysfunctional aspect, helping one to choose the important disturbing elements.

The psychotherapist helps the processing through guided eye movements, or other bilateral stimulation of the cerebral hemispheres, and helps the person relive those memories and important elements.

EMDR is a powerful tool that the psychotherapist and the person being helped decide together to apply inside a therapeutic path. Our West London psychotherapists apply the validated "triple approach" of EMDR, which addresses:

  1. past experiences,
  2. the current causes of stress,
  3. the thoughts and actions desired for the future.

The duration of treatment with EMDR is linked to the type of problem, the circumstances of life and the extent of past trauma. The programmes of EMDR in West London offer an average of 3-6 sessions per EMDR cycle. Early-in-life traumas or multiple traumas usually require repeated EMDR cycles.

The effects of EMDR

In the words of Dr. Shapiro, EMDR treatment is linked to a reduction in symptoms, a change in the person's negative beliefs towards new positive ones, and the prospect of optimal functionality.

After EMDR, we still remember the event, but we feel that all this is part of the past, intrusive thoughts fade or disappear, emotions and physical sensations are reduced in intensity.

Following an EMDR psychotherapy, the person strengthens the aspects of one self-esteem, is more focused on the here and now and on the sense of self, has more confidence in one’s abilities and one’s value as a person. The traumatic events thus lose the initial emotional impact to be transformed into a positive resource.

Below is the list of psychotherapists offering EMDR in West London

Emily Cavendish

UKCP Accredited Psychotherapist

Working on Mondays, Tuesdays, Fridays
Phone: 07766140325
Email: info@emilycavendish.com

Jodie Mainstone

BACP Accredited Counsellor & Psychotherapist

Working on Thursdays
Phone: 07903619191
Email: Jodie@mainstonecounselling.com

Are counselling and psychotherapy practices safe for face to face work after the pandemic?

The current pandemic has impacted various areas of our lives including how and where we access counselling. Although initially, the majority of sessions moved to the online domain, clients and therapists are more often considering restarting face to face sessions. This guide is an outcome of a study that Kensington Counselling Rooms along with Pimlico Counsellors and Psychotherapists did to ensure our practices offer the highest standard of virus control.

In preparation, we have reviewed the governmental requirements, Counselling and Psychotherapy Union guidelines, undertaken the coronavirus risk assessment, and spoken to our colleagues in Italy and Poland that are already working face to face.

Is it safe to see a counsellor face to face?

We are confident that following these guidelines, the risk of passing the coronavirus in the counselling practices will be low. However, there are specific steps that each private practice needs to take to enable working in the same physical space. Please check with the practice management if there is a coronavirus risk assessment in place. Even though the infection may be minimised within the counselling practice, a higher risk may appear on the way to get there. Clients and counsellors should consider their own safety before deciding to work face to face.

When to start working face to face?

The government has not explicitly prohibited offering face to face therapy, and in fact, some of the most emotionally vulnerable clients were seen face to face during the lockdown. Even though most of the shops and hair salons are now operational, each therapist and client will need to make an individual decision based on the risk. Therapists and clients who are in more vulnerable groups or who cannot easily access the practice may carry on working online for longer.

To make sure that a private practice is ready for working offline, it needs to have rigorous procedures in place including a specific cleaning schedule.

How to increase the safety of a counselling practice during the coronavirus epidemic?

Each counselling practice will have to go through a rigorous assessment of what needs to be changed to enable safer working during the epidemic.

Below are the most frequent considerations:

  1. Waiting areas may need to be closed. Waiting areas used to be meditative for some clients while for others offered nothing more than a rain shelter, now they may need to remain closed and clients may be requested to come on time of their appointment.
  2. If working in a larger practice, therapists may be requested to change the time of their appointments to make sure that clients arrive at different times.
  3. If possible, a one-way system should be developed to enable clients to stay away from each other and use different doors for accessing and leaving the practice.
  4. Hand sanitisers should be available at the entrances and exits, and clients and staff should be encouraged to use them.
  5. Reception and other areas where staff work on a regular basis may need to be protected by screens or temporary walls.
  6. Therapists should have discussions with their clients about what to do if either of them is diagnosed. The government was not able to deliver the application that could have made the tracing clearer for our clients. Since contact application cannot be used, we need to discuss if, how and when can we disclose the client’s names and contact details to the infection contact tracers or our will executor. I think that calling our clients when having high fever and covid anxiety should be out of the question, so I suggest you get in touch with you will executor to make sure you have a procedure for when this happens.
  7. Clients and therapists must have procedures in place to quickly move sessions online if any of them develops symptoms. I would suggest that each therapist carries with them a charged device ready for online work even though they scheduled a face to face meeting. E.g. our coronavirus poster encourages clients to check their temperature before leaving for the appointment (see poster below).
  8. Cleaning rotas and schedules. Therapists may be requested to ventilate the space and use an antiviral wipe or spray to clean surfaces after each client. Furthermore, each private practice needs a cleaning rota for common areas that include door handles, bathrooms, etc. How often the practice is cleaned should be determined by the number of clients and therapists using the practice.
  9. If a therapy room does not offer a comfortable two-meter distance or appropriate ventilation, it may not be suitable for face to face counselling and should be dedicated to teleconferencing only.
  10. Each practice should identify the procedure for appointing a professional antiviral cleaning company if required.
  11. Rubbish should be removed more frequently during the crisis.
  12. Some facilities, e.g. water cooler may not be available.
  13. Practices need a good stock of single used gloves, aprons, antiviral sprays, wipes, and paper towels.
  14. Soft furnishing would need either to be protected (we used cat scratch plastic covers on the arms) or regularly disinfected using a spray that can be applied to soft furnishing, e.g. Dettol All-in-one.
  15. Communication with clients and therapists will be crucial during this time. Practices may use posters, stickers, emails and telephone to prepare both therapists and clients for the new normal. We have designed our own floor stickers showing 2-meter distance and a poster with info for clients (see below). Feel free to download the poster and send it to your clients.

COVID-19 poster for clients

Implementing the above steps require consultations and training. Each counsellor and staff working at the practice must be aware and have agreed to these changes. With the influx of counselling clients that are expected after the coronavirus pandemic, counselling and psychotherapy practices must have procedures in place to minimise the possibility of infections.

If you are looking for a counselling room to rent that is coronavirus ready, please find more info here.

How to survive the coronavirus isolation when living alone?

Self-care is important in every day-to-day life, but especially when we find ourselves in isolation. With the Coronavirus spreading, isolation is becoming the norm for the elderly and vulnerable. You can also feel isolated if you have had a recent bereavement of a partner or parent. A person who has been a big part of your life suddenly not being there can trigger feelings of being alone. Or, if you are feeling depressed and you cannot face the outside world physically or mentally, you can shut down and avoid connection as it can feel too overwhelming.

We have been asked to self-isolate and most of us, more or less reluctantly complied. Most of us went through a phase of disbelief or even denial of the severity of the problem. It is hard to accept the need for isolation if we are in good health or young age, yet the virus reminds us that nobody is immune. We may also pass it on other people, so why it’s so difficult to accept it? It’s hard to recognise and accept our vulnerability in a society that on day to day basis teaches us to ignore it, we may also resist desperately the isolation that is against most of our human, social instincts. Isolation is difficult.

For some of us, coronavirus isolation will trigger a sense of abandonment. Even though rationally we know that we have to stay separated, in our feelings, we may be reminded of the times when we lost connection with someone or got rejected. Being in a state of anxiety can also feel hugely isolating, as a person can feel nobody else can understand how they feel. They believe that avoiding connection or any social contact is easier than having to reach out and explain how they are feeling. When in a fight/flight mode it is hard to communicate how we are feeling, as the part of the brain that helps us communicate shuts down - so reaching out can feel particularly hard. Having a self-care plan for these moments of isolation, as well as long term self-care, can be immensely valuable and healing. In times of isolation, it can be a time to ground, be present and set goals for the future and recharge. It can also be a time of feeling alone, overwhelmed and mentally unstable. Having self-care in place can help with this.

The most important thing is that our self-care pattern doesn’t become another burden. Coronavirus isolation and fear can make us overactive too and we can even use this article as a new project for ourselves, rather than a resource and support. Please treat every piece of advice in this article as a possible invitation and start from pausing and sensing what is good for you. For example, healthy food is good for us, but turning ourselves into nutritionists in the next few weeks is a rather challenging task.
Self-care means being kind to yourself and taking responsibility for your emotional and physical wellbeing. There are many types of self-care, I will mention just a few - physical, emotional/mental and social.

Physical self-care during coronavirus isolation

Good Sleep

Getting enough sleep is paramount for mental wellbeing. When we sleep, we produce serotonin which is our happy hormone, so if we are not getting enough sleep on a regular basis, our serotonin will be low.
Tips for good sleep:

  • turn off all electronics a couple of hours before bed,
  • do something to help switch off the thinking mind before trying to sleep (e.g. a hot bath, reading, mediation, yin yoga) - read out article on Mindfulness for more info.
  • If you have had a stressful day and your mind is racing, it can be helpful to write down how you are feeling in a journal or even on a piece of paper
  • Keep a journal of your dreams.

Also, often when we feel tired can be the best time to connect to our emotions as we do not have the energy to suppress them. You often hear people say “I am feeling sad because I am tired”, but the truth is the feelings you have when you’re tired are what need to be connected and expressed. So it can be useful to check in with oneself when tired to see what feelings are there that we might be unaware of.

Moving/Exercise

When we move, it helps move our energy and process our emotions. When feeling isolated, we can get stuck in the thought loop of “I am alone”. Moving can help move through this. Exercise also makes you feel good physically and emotionally.
Some ways to move if stuck at home: put music on and dance round the kitchen (how many times have you done that after a few wines!). This is a great thing to do first thing in the morning. Music is also uplifting or can help you have a good cry/release of anger if you feel you need to express that.
Shaking – literally shaking things off. Our bodies do this naturally when we are in shock or trauma.
Walking in nature – leave your phone at home and be present in the moment, connecting to nature is healing.
Yoga and stretching are amazing for the mind and body. Yoga can help you breathe deeply and tune out of thinking and become present, not lost. Stretches feel great in the body.

Healthy food

Soul food! Food that we enjoy and that is good for us is nurturing. It can also be great to spend time cooking for yourself (an act of self-love).

Expressing

Being able to express emotions is vital for self-care - having a good cry if feeling sad, having a good shout (not at someone) if you need to express anger. Often when we do this, we end up laughing, which is a great physical release too. Own your feelings, though, don’t blame someone else.

Emotional self-care

One of the most important areas of emotional self-care and stress management is our relationship with social media. Designed to cause a sensation, Facebook, Twitter, Instagram, and so on, need to be assessed in connection to your own wellbeing. What news is necessary during coronavirus isolation? How much in a day can you take? Which sources of information nourish you and provide you with an adequate connection with the situation outside of your home and which cause you unnecessary stress?

Connecting to people, you feel safe with to be able to express how you feel is important. Perhaps have a couple of friends on speed dial that know sometimes you are isolated so need to speak to someone or even have a check-in text.

What things can make you feel grounded?

Feeling grounded in a state of relaxation when we feel in touch with the ground underneath or just aware of our breath. You can achieve this through mediation but also deep belly breaths, listening to music, reading listening to a podcast, cooking or gardening. We are all different, so finding our unique way to de-stress is vital. Some of us can benefit from belly breathing. When we feel stressed, our breathing tends to go shallow, fast and into the chest, not the whole body.

Compassion and kindness to self

Watching your inner dialogue with yourself. If you find yourself thinking negative thoughts about yourself, ask yourself: “would I talk to someone else like that?” If you tend to have negative thoughts towards yourself, perhaps you could try starting the day with three things, you are grateful for or like about yourself.

Social self-care

That’s not a surprise, we are inherently social beings, and lack of interactions may be detrimental to our mental health. Many of us started reaching out to friends, either via the telephone, zoom or other apps, and some of us may choose to have additional support seeing a counsellor. Zoom dinners, book clubs or birthdays quickly became a reality, and it’s important that we schedule some of them. However, we may also need to have good boundaries. If you don’t have a strong “No”, your “Yes “means nothing. It’s important to not people-please. Check-in with your needs first don’t do something just to please someone else.
Sometimes someone can feel too overwhelmed or stuck in a place where it’s hard to reach out. However isolated you are feeling, please remember you are not alone; there is always someone you can connect to and support you.

If you’re feeling isolated, depressed, anxious or in a place where you need some support from professionals, please reach out to a counsellor or, if urgent, here are some useful places to call and connect with.

Samaritans call 116 123 or email.
Sane: 0300 304 700
The Mix If you are under 25: 0808 808 494
Calm if you identify yourself as male: 0800 585858
Nightline if you are a student.

For online counselling, if in isolation, please contact our online counsellors.

Marketing for counsellors: How writing counselling profiles may be similar to tinder?

Marketing for counsellors is an underexplored subject within our profession and even less explored when it comes to advertising online. Most of us search for services online, and even though there are more differences than similarities between buying services and using social media, this article is a playful invitation to compare dating apps to writing professional profiles for self-employed professionals. As controversial as this comparison may sound, both professionals and users of dating apps look for a match through building a profile that includes text and photographs. They hope that the algorithm (mechanism working behind the scenes of an app or directory) will link them to people who are looking for similar things.
For this purpose, let’s imagine James, who is going through a break-up and does not feel good about this. He looks for support in various places, but he also wants to boost his self-confidence, so he decided to start dating. He signed up to Tinder and made his profile from carefully selected pictures writing a rather honest description of himself. It turns out he has absolutely no interest in his profile and have not been liked back in any of the apps for a good few weeks. Why?
In Tinder or online marketing for psychotherapists, there are three factors that one needs to consider: algorithm, profile and readiness of the subject (e.g. psychotherapist to see clients or James to date someone new).

How do directories work?

The algorithm is how the application connects you with the other person (be it your love on Tinder or a client on Google). Tinder has an algorithm that is also based on a geographical location. Is James seen by the application in the right areas i.e. was his profile adequate to these areas? Is James more Chelsea or Peckham? This is an important consideration in advertising. Who is a certain application or directory made for? Is the application attracting the right audience? Is this an app for people who are looking for a long-term relationship, one-night stand or anything else? Which one does James want at this stage? By algorithm, I mean all the aspects that are related to the medium that we chose to use for advertising. Similarily in the marketing for counsellors, we need to make sure that a directory we are considering has the best potential to attract the clients we are looking for. An easy way to do it is to google phrases that we hope to be found at and see where that directory appears in the search results.

How to write a profile?

The profile is the main way we communicate. Our pictures and text provide a message on which people need to make an important decision. Nobody likes to waste their time and money either or dates or counselling. Returning to dating, since James is looking for a long term relationship, his profile must show him both as someone confident and approachable. Showing own strong points could be an attractor but may scare people who do not look for perfectionism in their lives. Would a picture of him playing with a child show that he wants to have a family or that he is co-parenting? Is it worth to put an airbrushed photo on the profile, knowing that it may attract people who don’t like him in the real-life and only add to the frustration?

Does a therapist has a capacity for clients?

Having supported about a hundred therapists starting their private practice and miserably failing on Tinder, I have realised that one of the most important and either overstated or understated issues is own readiness. According to the field theory, all of our situations are interconnected. Wheeler (1997) writes that clients do not select us accidentally, so why would people on the dating sites? Is James ready for a relationship or just to build his self-confidence by having some likes and movement in the area love? In my experience of working with counsellors and psychotherapists at the different stages of their career, I believe the readiness or capacity (a term that I prefer) is the most crucial part in attracting clients to our practices. No matter they invest in marketing their counselling practices, their capacity will be the decisive factor.

The self-belief that we can make it

Apart from the algorithm, profile and readiness, although closely linked with readiness is our shame. Am I not handsome enough to have a date? Am I not interesting or do not know how to present myself? Perhaps I am not made for a relationship, or there is something intrinsically wrong with me that will doom me for eternal loneliness? Not only when we start being therapists, but also when we get more experienced, we may be asking similar questions about our ability to do this profession. Although these questions are necessary for self-development and ability to be critical towards the work that we do, I think that the intensity and viciousness with which we may be asking them to ourselves may be related to lack of support, connection or sensitivity to our feelings.
In other posts in this blog, I will share my thoughts and experience of online marketing for counsellors focusing on the algorithm, profiles, capacity (readiness), shame and contracts. I discuss how the algorithm works for Google search engines, directories and other forms of marketing for counsellors including offline, I make some suggestions about how to write own profiles and contain often difficult feelings that arise in this process. I focus on the capacity as our readiness for seeing clients is usually not binary (yes or no), but involves capacity – for example at this time of my life, I have the capacity for five clients. Shame will come in a separate section to describe how we may undermine ourselves in this process after which I will explore various strategies and mistakes beginning counsellor and psychotherapists do when negotiating or not negotiating contracts with clients.
Of course, James had some more work to do. His dating history showed him that he needs to wait and grieve first. His dating app gave very different results a few months later.

What is Psychoanalysis?

Modern misconceptions of psychoanalysis

It’s a shame the father of psychoanalysis Sigmund Freud, has become somewhat of a mockery in popular culture. The Freud cartoons are often very funny, but serve to add ridicule to his ideas; those very ideas that have profoundly influenced and changed our society. Language and concepts that run right through our lives, the unconscious, the meaning of dreams and the idea our behaviour is affected by our past and not just our brains. His thinking and writing were brave, creative and off beam. But perhaps there’s something quite uncomfortable about being reminded we’re not always as in control of our behaviour as we like to think we are. To a certain extent, society survives and operates by denying this fact.

Perhaps similarly, the popular view of psychoanalysis has served to simplify and caricature it as static, an out-dated body of knowledge formulated over a hundred years ago, by a patriarchal figure that believed the root of mental disturbance was unconscious sexual conflict. The reality couldn’t be further from the truth. Psychoanalysis continues to grow and develop organically, being made up of a number of different and related strands of ideas about the human personality, largely generated from and in response to clinical work. It’s neither dogmatic and unchanging, nor possible to define neatly.

What is psychoanalysis?

As a psychological treatment, psychoanalysis is a method of psychotherapy that can be very useful for people who are struggling with longstanding difficulties in the way they think and feel about themselves, the world, and their relationships with others. Shorter-term approaches to therapy may be useful in helping clients find ways to cope with recent manifestations of states like anxiety or depression. It may be easier to identify a trigger in such cases, specific events or life stressors such as a relationship breakdown, or loss of employment. But for challenging psychological and emotional aspects of a person’s life that have been around for longer and may have their beginnings earlier in life, an approach that takes time and endeavours to understand the bigger picture is necessary.

If you were to stop and take a few minutes to reflect on the hour or so leading up to reading this article, noting any thoughts, feelings and sensations, what you’d notice would undoubtedly give a glimpse into the very individual way you have of viewing the world. You’d probably also realise that such an opportunity to stop, reflect and think about how you experience life is extremely rare in our busy modern day society. A psychoanalytic psychotherapist is trained to create a space and a type of engagement that encourages such internal reflection. They carefully observe and listen to you and overtime gradually build up a picture of the way you view yourself, your relationships with others and how your thinking and behaviour influence your experience of the world. They will gradually feed this evolving understanding back to you in ways that are manageable and in which you can talk and think about together. It sounds simple, but it's incredibly important and what many of us may be missing. Having someone to think with us about things can really help us to think about things.

What is the unconscious?

In a recent social situation, I found myself struggling to make a case for perhaps Freud’s most influential concept. Choosing to ignore what we don’t like or feel comfortable with? The retort was yes perhaps, but everyone does that, it doesn’t mean there’s an unconscious. The metaphor of the iceberg is nicely illustrative, what we choose to show on the surface is only the tip, whilst so much remains hidden beneath the surface. Repeating patterns of behaviour even when we don’t want to and they don’t serve us well? Comes close perhaps and something we can all relate to.

The royal road to the unconscious, of course, became the analysis of dreams, but Freud believed there were moments for all of us in which we’re made aware of our unconscious, through what he termed ‘bungled actions’; what’ve become known as Freudian slips. The moment of truth in the conflict between conscious and unconscious, when we trip ourselves up and say what we really mean, without the filter of the conscious mind to censor. We’re probably all able to recall our own often-humorous slips, trips, and bungles. When Radio 4's Today referred recently to the BBC'S "new spanking building" instead of "spanking new building", listeners responded to the unconscious innuendo with gleeful letters.

Moments like this provide us with fleeting glimpses of the thoughts, feelings and desires that have been repressed, relegated and held out of awareness for fear of causing conflict with a part of us deemed more acceptable. The therapeutic setting provides us with conditions for greater unconscious access, the safety and reliability provided by meeting in the same room at the same time for 50 minutes. In traditional analysis, the client lies on a couch, the therapist sitting behind out of view to facilitate the free association that frees the client from censor. Many psychoanalysts still operate this way and require frequent attendance, between 3 – 5 times weekly. Such frequency keeps the link between the unconscious and conscious alive from one day to the next and enables overcoming the resistance that repression creates. Melanie Klein adapted this approach to children, using play as symbolic expression and a kind of pre-verbal free association, giving insight into childhood unconscious conflicts.

Modern developments

Psychoanalysis had always been interested in early child development. Work with children led to the development of new strands, attachment theory, the British school of object relations and inter-subjective and relational approaches. Whilst concepts of the unconscious and repression remain at the core of psychoanalysis, we now know much more about the importance of our earliest relationships. A combination of nature and the nurture we receive from our environment, an interaction between a new-borns temperament, their adjustment to the world and the emotional development and capacity of parents influence our physical and emotional development both early on and into adult life.

Advances in child development research have provided evidence for the importance of our early bonds via neurodevelopmental findings. We’re born with innate capacities to relate, being drawn to eyes, faces, voices and smells and preferring those that are familiar. We imitate our caregiver’s expressions and movements; new-borns stick their tongues out in response to an adult (with quite a lot of effort!). Infants respond physically and physiologically to touch and being held, distress and heartbeats are calmed. From our earliest moments, even in the womb, we respond to the conditions that facilitate our growth and adapt to circumstances when those conditions aren’t present. Foetus’s exposed to chronic stress develop a stress response of their own, perhaps anticipating the world they’ll be born into.

It seems surprising today to think that pre-1950’s, much of the troubles of infancy and childhood, the tantrums, rage and inability to bear frustration had been passed off as unimportant, or simply attributed to physical factors. Psychoanalysis has painted a vivid picture of the primitive anxieties experienced by infants born in a state of total dependency. Even for the immature child, the world can seem completely overwhelming. If we have a parent that’s able to tolerate, think about and in some way make our distress manageable, by 1 year we begin to develop the capacity ourselves. If we’re fortunate enough to have parents that respond to our emotional needs consistently and reliably, we learn its safe to express ourselves and expect to be met; crucial for developing healthy relationships in and outside of the family later on.

When parents aren’t available enough or capable to provide a facilitating environment, perhaps due to anxiety or depression, we know this translates into difficulties in emotional and psychological development and behavioural adjustment during childhood and adolescence. Neural pathways are laid down from our earliest experiences, but continue to be created throughout life. When things haven’t been ideal, the relationship with a psychoanalytic psychotherapist offers a chance to think about these early experiences again, and through thinking and re-experiencing, the opportunity for something reparative and different from before to occur.

Bereavement, loss and grief

Bereavement, loss and grief are universal human experiences

Although grieving is a natural process and a natural response to bereavement, loss and grief still affects everyone differently. Sometimes the anguish and heartache can leave us feeling that we are alone. Finding ways of coping with your grief and reaching out for support when it’s needed can help us feel less alone. As grief is such an intensely personal experience there is no right or wrong way to grieve. You may experience a range of difficult and unexpected emotions, such as anger, shock, disbelief, guilt and profound sadness. The pain of grief can be disruptive for our physical health, interrupting our sleep, affecting regular and healthy eating habits, as well as our ability to concentrate and think clearly. These are normal reactions to a loss, but there are healthy ways to support us during our grieving process.

How you are grieving will be influenced by many things, such as the circumstances of your loss

Death of a loved one
Divorce or relationship ending
Loss of health
Loss of employment or financial security
Death of a loved pet
Loss of home
Loved one’s serious illness

How to live with a loss?

• Acknowledge all your feelings and accept that your bereavement, loss and grief will be unique to you.
• Seek help from people who care for you or from someone professional when needed. At different times during grieving, we may need different things. If you can, be clear with your friends what you need at this stage, whether it is talking it through or having a cup of tea while watching films.
• Taking care of yourself physically will support your emotional well being, but try not to burn out or overwhelm yourself. It is important that you pay attention to how you feel in this difficult time.

How long does grieving last?

There is no timetable for grieving. Sometimes it may feel as if you will not be able to come to terms with the loss you are experiencing. The pain of bereavement, loss and grief can feel overwhelming at times. Living with any loss can be challenging and the first year of a loss can be especially difficult.

Stages of Grief

Although grief may at times feel like intense waves knocking you off your feet, over time these feeling eventually feel less intense and less overwhelming, we can begin to feel we have a firmer footing and although we still experience waves of emotion, they begin to feel less intense over time. Be patient with yourself.
Although we believe that our response to bereavement, loss and grief is unique and may affect you differently, some of our clients find it useful to learn about the five stages of grief described by Elizabeth Kubler-Ross :

  • Denial – Shock and disbelief, it can be hard to accept what has happened. You expect things to be the same even though you know they are not the same.
  • Anger –Experiencing the pain of grief can be difficult. Even if the loss is no one’s fault, you may feel anger and resentment at the injustice, you may also feel guilt associated with your loss.
  • Bargaining – You would make any deal for this not to be real, you are not able or ready to adjust to the loss you feel.
  • Depression – Profound sadness following a loss is natural.
  • Acceptance – Eventually, you may notice that you are putting less emotional energy into your grieving process and that slowly, over time, you are becoming more engaged in your interests and family/social life. This is a time of adjusting and re-adjusting to the situation as it is.

Challenging times

If you can, prepare for those times that you might anticipate as particularly challenging such as anniversaries, birthdays, holidays and first anniversaries can be especially difficult. Putting some support in place around these times may help you, such as asking over a good friend/s, family member or find a bereavement group to share your feelings at this time or talk with a counsellor. You might take a day off or do something to remember and honour your feelings. Don’t be afraid to talk about the person who has died or your own experience of loss; people may not mention it because they don’t want to upset you. Seek out people who value your need to talk about your loss, are able to give you some space and can listen with empathy and compassion.

How to cope with grief?

Grief can feel isolating; sometimes, our own responses to our grief are also confusing and contradictory. One moment we may be laughing and the next moment overwhelmed with tears. You can have a good day and then wake up the next day feeling worse. At times we will want to have some time on our own with our grief, and at other times we will want to draw on support from others around us.

Generally, over time, our memories do fade, the physical details of our loved one become less sharp and for some people this can feel like another loss or even a betrayal of your loved one. It’s important to remember that even though the physical details may become less sharp, the love and affection that we feel about our loved ones, is something that nothing and no one can take away from us and not even time can change what is in our hearts.

When to seek professional help? - Warning signs of depression
It is common for a grieving person to feel sad and depressed, but there is a difference between natural grief and clinical depression. If the feelings don’t fade over time or they get worse it may be time to seek help. If you are continuing to neglect yourself or your family by not eating well or feel unable to perform your usual daily activities, if you are using alcohol or drugs because you are not feeling able to cope, or if you are continuing to find it difficult to get out of bed, your GP or a counsellor can help if you feel you are not coping.
If you are feeling suicidal at any time during your grieving process, seek help immediately.

Samaritans:
Helpline: 116 123 (free of charge from a landline or mobile)
Email jo@samaritans.org
www.samaritans.org
24 hr helpline offering emotional support for people who are experiencing feelings of distress or despair, including those which may lead to suicide

Calm:
0800 585858
www.thecalmzone.net
Campaign Against Living Miserably Help and support for young men aged 15-35 on issues which include depression and suicide.

HopeLine UK
0800 068 4141
www.papyrus-uk.org
For practical advice on suicide prevention for under 35s

Childline
Childline
0800 1111
For children and young people under 19
Nota Bene – this phone number won’t show up on your phone bill.

Psychological Resilience – why it’s important and ways to build it

I find human beings ability to change and grow fascinating! I became interested in the topic having had my own reserves tested through a particularly challenging time, so I started researching ways in which I could cope better the next time I hit a life roadblock. Inevitability, we all have the odd bad day, but what I am interested in is ones mental attitude to metaphorically dusting ourselves off, getting back up and keeping on going, essentially recognising the incident as a blip, not a constant. This led me to neuro-scientific research on how the wiring in our brains affects our ability to deal with adversity, which is dependent on many variables and impacts on our day to day mental health.
The proof that our brains are capable of repairing (known as neuro-plasticity), enabling us to re-wire our neural pathways or thinking patterns to fortify ourselves in the face of adversity, is such a positive message I am keen to share!”

As corporate life can impose an additional level of stress and pressure on us and in turn, our relationships and day to day living, which can drain our energy and resilience and make life tougher than it should be. Recognising the triggers in advance and learning tips/tools to combat this can be hugely beneficial.

Here we explore more on this important topic, the ways in which our reserves can be challenged and how we can make some lifestyle adjustments to improve our psychological resilience and lead more fulfilling lives.

What is Psychological Resilience?

Psychological Resilience is ones ability to bounce back after a set back or an adverse situation or to put it very simply, to get back up when one stumbles or falls and keep on going. On a word, bouncebackability!
It also links to one’s attitude to life; research has shown that having a positive outlook or disposition can help with building ones psychological resilience.

How might my Resilience be tested?

Modern life places demands on us that can test our reserves - being “always on”, excessive working hours or screen time. Equally, lack of sleep, poor diet and lack of exercise can all contribute to challenging our spirit and energy levels and the knock on affect impacts on our Resilience.

Are there any specific times in life that might impact on our ability to bounce back?

It could be one or any number of things, however times of change or disruption may provide a trigger, e.g. change of career or job, divorce or relationship breakdown, experiencing anxiety and or depression, eating disorders, bereavement, any adverse situation we are struggling with or simply, life!
As we approach Winter, with the limited daylight and decrease in temperature leads to a more sedentary lifestyle where we tend to eat and drink more and typically, exercise less. Whilst there is nothing “wrong” with that per-se, being mindful about having a balanced lifestyle will help to keep energy levels topped up.

What traits do resilient people typically have?

• They have a positive outlook and attitude towards the future
• They do not catastrophise, i.e. they see an adverse incident for what it is, a blip or a one off, not a way of being
• They have solid acheiveable goals and a desire/plan to achieve them
• They celebrate their successes
• They are unafraid of failure, recognising that through failure, we learn (we get back up…)
• They are empathetic and compassionate, however they don’t waste energy worrying about what others think. This is important as is recognising anxious “noise” v what we should be paying attention to
• They maintain healthy, boundaried relationships, they do not bow to peer pressure
• They focus on what they can control and do not see themselves as victims

How can I build my resilience muscle?

The good news is that we all have the ability to develop our Resilience and Reserves! As with tackling any life issue, there is no silver bullet that will “fix”, however adopting a holistic approach will help in abundance. Remembering our mind and body’s are intrinsically connected and therefore looking after one, will in turn, benefit the other.

Some tips for building Psychological Resilience include:

Energy creates energy so think about where you get yours as we are all different. Some tips that have been proven to build our resilience are:

• Move: Do more exercise, if you struggle to do this on your own, find a buddy and commit to certain times to increase motivation. Try different types if you are starting out. In winter, being out in daylight for 40 minutes+ is proven to have positive benefits on our wellbeing. It doesn’t have to be extreme, as long as it gets the endorphins moving and the blood flowing! The ideal would be some cardio mixed with yoga, as long as you feel the benefit.

• Sleep: Getting regular, quality sleep is essential to a healthy outlook. If your sleep is problematic, consider why. Is it the environment, mattress, excessive eating or drinking before bed, or spending too long on screens perhaps - it could be all of the above, by tackling one or all will have pretty instant impact on your sleep. Do not underestimate how lack of sleep impairs our day to day functionality and can make us feel “other”, which is not conducive to a healthy attitude to life.

• Meditation: A personal choice and one I have found useful during particularly stressful periods. There are plenty of app’s to help, many are free. Essentially this encourages a brain reboot and slows down busy minds, temporarily, which can increase energy levels. Research has shown that long term meditation has benefits on a cellular level and combating signs of dementia. However, we recommend you try meditating offline with the help of our Transcendental Meditation teachers.

• Connect: As human beings, we are programmed to connect with others. However in times of stress, we may not feel we have the time or energy to arrange or plan for “fun”. By being around friends and family who appreciate you and just enjoying the connection will have significant benefit on our mental health. Personally, I relate to the old adage of “laughter is the best medicine” - laughter is in addition to a physical release, creates endorphins which lead to a feeling of wellbeing and greater connectivity with those around us.

• Goals: Make plans and goals that reward and give energy, be it physical, educational or something completely different! Consider balance, if your occupation is cerebral, think about something physical or exercise based and if in a more physical job, perhaps an evening class or ways in which to tap into some of the resources you do not use on a day to day basis. This fires up the neural pathways and builds confidence which in turn builds resilience. The important thing is that they should not be arduous or punishing, this is about reinforcing positive and achievable targets.

• Rewards: I cannot stress the importance of recognising your achievements and progress, however small they may seem. By reaching ones goals, and providing a reward structure fires up the neural pathways and builds confidence which builds resilience.

• Supplements: Consider supporting your immune system with acupuncture, supplements, Magnesium Citrate (sleep/mood) Vit D in Winter should the lack of daylight be a thing for you, as it is for me. Everyone needs additional support at different times of life so explore what gives you a boost.

• Therapy: It might be helpful to seek professional support during acutely testing times. This can be particularly helpful in developing your own resilience tool-kit to combat and deal with your own needs.

• Kindness: Simple mantra to live by, be kind to yourself and others! In giving, may we recieve.

If you would like to connect with Katrina to discuss anything in this article, please feel free to do so on kat@welistentherapy.co.uk

How to calculate counselling fees? A guide for counsellors.

Ways of calculating counselling fees

There are various ways businesses decide what the price should be. Some companies check the competition to see how much others charge, some calculate their counselling fees by costs and add a profit margin on the top, some like many big businesses nowadays are prepared to offer services and products for less than it costs to produce them as they want to grow before they start making a profit. The lack of discussion on calculating counselling fees led to a vacuum filled by own attitudes to money, generational gap and a fixed idea that if you have graduated you should charge around £45 per session.

The minimal discussion on the financial matters in psychotherapy may be rooted in our uncertainty and shame of talking about money. Some of us may feel uneasy charging for our services as helping others may feel natural. The generational divide is between generations of therapists who were trained during a more supporting housing situation, they usually own home and often work from it, while the new generation has to pay the high fees for therapeutic room rental and marketing that does not concern most established psychotherapists and supervisors.

This article is an invitation to a more robust discussion on psychotherapeutic financial matters and includes an alternative to calculating the counselling fees psychotherapists may charge. It is an invitation to rethink various aspects of our work that contribute to how we set our prices. All of the questions are based on personal beliefs and decisions; no two therapists should come with the same outcome.

In this article, I will ask you four questions and then propose a calculator with a formula that may be a way to calculate your counselling fees. I suggest you note down an answer to each question on a sheet of paper.

What is a decent salary for the work you do?

Let’s start with a question what a decent salary for the counselling or psychotherapy is? We are looking here for a full-time salary of psychotherapists or counsellor in the NHS or other organisations plus-minus what you believe you should earn? We are coming from different social and economic backgrounds, and at different times of our lives we may value ourselves or the therapy differently, so after you research the salary in the NHS in your area, check if you feel comfortable with this as your salary? Please note down that salary per annum with all taxes as you will need it for the counselling fees formula calculator below.

What are annual expenses in a psychotherapeutic private practice?

Having found the salary, let’s move to consider the annual expenses. If you are a seasoned therapist you can check your last year self-assessment or limited company statement, but please do remember that we are calculating the full-time salary, so for example, if you only work three days make sure that you increase your expenses to a five-day simulation.

For people who need to figure out their counselling fees for the first time, I have prepared a prompt list of some possible expenses people

  • Expenses:
    • Room rental – this is probably the most significant expense if you work in a large city such as London, the final price depends on how many clients you plan to see as a full time professional (see below)
    • Continuous professional development – with a minimum of fifty hours (UKCP standards) and the reality that most of us completes even more hours each year this is usually the second biggest expense. Please add here the cost of travel to the workshops and conferences, hotels and food if permitted by your accountant
    • Clinical supervision including travel to and from the destination of your supervisor
    • Personal therapy including travel (see above) – as most of the guidelines for psychotherapists suggests that we should be in personal therapy, I have included this as a business rather than a personal cost
    • Books and subscriptions
    • Registrations, insurance and other professional costs
    • Advertising (website, directories – e.g. Counselling Directory or Psychology Today, Google Ads, business cards, ads, etc.) – this expense will differ if you work long term or short term as in general short term therapists need to invest more in advertising
    • Accounting and banking
    • Mobile phone, emails, etc. (consider that the percentage of your mobile phone use if you don’t own a separate phone for your business purposes
    • Stationery
    • Equipment, e.g. computer, printer, scanner, shredder (you will not buy them each year, so consider how often you plan to exchange)

How many hours a week is full time for a psychotherapist?

This is a personal question and in order to provide a diversity of opinions. While the United Kingdom Council for Psychotherapists suggests that full time for psychotherapists is anything more than 20 hours, I have asked three senior therapists from our practices in Kensington and Pimlico to share their experience. Please note the number of hours that you think constitute the full time for you. This number may change as depends on our capacity for clients, support and work-life balance.

Cristina Durigon:

That’s an interesting question and of course, this can vary from practitioner to practitioner. In my personal experience, a full-time psychotherapist would be seeing a range between 18 and 22 clients or supervisees per week. This would mean offering more or less 4 to 5 hours of clinical contacts per day. The rest of the day would be dedicated to writing notes, attending supervision or undertaking other administrative tasks. Of course, this varies depending on a number of situations such as time of the year and workload, so, therefore, these are not fixed number. I hope this helps to give you an idea of what a typical week for a full-time psychotherapist would look like.

Gilead Yeffett:

My experience of a full-time practice is working five days a week, my average week includes 26-28 clinical hours.  I predominantly work with couples and parents-children; two- or three-person sessions last an hour and a half so I plan each day to cover no more than six and a half clinical hours.  I find the work highly rewarding and find that with the right weekly supervision I can maintain a solid and viable psychotherapy business.

Emily Cavendish:

What constitutes full-time is not just about clinical hours, it is also about how you manage your resources and the extent to which your work with clients can expand to fit the time and the space you have available. I did not set out to see 30 clients a week and, in truth, I would prefer a slightly smaller caseload. However, as for so many professionals who are self-employed, there can be a ‘feast or famine’ aspect to setting up a business. I am very familiar both with intense anxiety about how I can possibly see everyone and give them the attention they deserve, as well as a gut-churning fear of all my clients abruptly ending therapy and no new referrals coming in. This unpredictably is one of the features of private practice which makes it hardly to regulate the number of clients you take on. Perhaps one answer to the question of ‘what constitutes a full-time clinical practice?’ is that it is the number of hours you can work and simultaneously honour the needs of your clients alongside your own. This is a tricky balance to strike and one that must be subject to ongoing review.

How many weeks will you work on average with a client in a year?

To understand the salary of a psychotherapist over a year, therapists need to be clear how many times in a year they may see a client. Although this can be a simple question based on therapists availability, it includes essential considerations about holiday plans, time saved for sick leave, continuous professional development as well as the therapeutic boundaries. Does your contract with your clients protect you and the therapy from them taking too many holidays? For example, a therapist may plan 4 weeks of holidays, include time for 2 weeks of sick leave, 1 week conference and offer up to 5 cancellations for their clients – this equals to 40 working weeks in a year. Another example would be a therapist who expect to be paid during all of the clients' absences, travelling once for a conference, not working over 4 weeks in August and 2 weeks of Christmas and allowing only one week off due to sickness – their working year is 44 weeks. I am suggesting here only models where therapists charge for missed clients sessions with a short notice such as sickness, train cancellations, etc.

Counselling fees formula:

In the above paragraphs, you were guided through ways of figuring different amounts that now can be put into the calculator below:

 

The counselling fee that you calculated above is an average fee for a session, but you may consider increasing your price to offer some charitable work.

Social responsibility and offering discounts

A lot of my supervisees, especially those who just begun, offer discounts to clients almost automatically. As we (therapist) often had helping roles in our families, the offer of help and work for little money may seem natural to us. Others may feel that they have not qualified enough yet, so their counselling is not worth the full fee anyway. Both of the above reasons are unfortunately related to therapists own lives and have little to do with the reality of the client’s situation; they also may not support therapists in their long term relationship with their clients. A therapeutic relationship lasts for years and it is vital that the therapists prevent a situation when they may feel resentful towards clients, especially if they think they don’t value the work.

If it comes to the requests for discounts, it is important to consider if the client is not devaluing a therapy as they may devalue their own emotions and psychological health. Some of the clients may come from affluent backgrounds where money has always been a point of negotiations; they may bring these skills to the therapy too, expecting that the price we offer is a starting price of negotiations.

Having warned about all ways how it may be wrong, I think that therapy should be and isn’t at the moment accessible, and would encourage therapists to offer part of their time to people who cannot afford it. This can be done on a fixed fee basis where therapists increase their average fee (see above) by the amount they want to reinvest supporting low-cost clients or a sliding scale basis. If you choose to make it on a fixed fee basis, you need to find a discreet way of informing your clients about the low-cost places for example by writing on your website that you offer a small number of concessionary places. The sliding scale system is described below.

Sliding scale

The sliding scale system is a fair and transparent way of offering prices relevant to clients incomes. Therapists prepare the sliding scale considering the average calculated above and link it with the average salary in the area or of the group of clients that they already have in their practice. When clients come to the first session or even in the discussion over the phone, the therapist presents the scale. In most of the cases, clients are asked to self-identify the place on the scale, and we would not usually ask for evidence of their salary.

The problem is that your practice may become an attractive option to the people on low income only and you may need at some point not to accept clients who earn below a certain amount as you will earn below the calculated average.

I hope that the above system and counselling fees calculator will stimulate some discussion on how to calculate fees for psychotherapists and counsellors.