What Kind of Psychotherapy?
The Wikipedia entry for psychotherapy notes that ‘there are hundreds of psychotherapeutic approaches or schools of thought’ – a confusing situation for a person seeking psychotherapy for the first time. In recent years, rather than adopting a label, I have taken to describing myself simply as a psychologist and psychotherapist. For those who are interested, details of the theoretical influences that have shaped my practice can be found in the biography section of the website. My aim here is to present a picture of the kind of psychotherapy I offer.
As a psychologist, the evidence base for what works in psychotherapy is important to me. Research has shown that, regardless of therapeutic approach, the relationship between the practitioner and the patient is key to therapeutic change. My aim is not to be a neutral observer or ‘blank screen’ but to involve myself in the patient’s efforts to find coherence and meaning in the thoughts, feelings or actions that are troubling him or her, while also allowing quiet space for thought and reflection. The insights and understandings that emerge from our conversations are co-constructions – the result of our joint efforts to find meaning and connection in the face of distress and confusion.
Research has also pointed to the role of coherent self-narrative – a story, or set stories about oneself that is without significant gaps and has the ring of authenticity – in mental well-being. Our personal histories are always being re-written as the present unfolds and events appear in a different light. In psychotherapy, the objective fact of ‘what happened’ is less important than the personal and emotional truth of our memories and the stories of self. Where self-narratives are lacking in detail, or where there are significant gaps, I see part of the therapeutic task as ‘narrative repair’. To help with this aspect of the work, I sometimes invite patients to draw and annotate time lines in the session or bring in childhood photographs.
If, after meeting me once or twice, you decide to come and see me regularly, we can discuss whether you prefer a time-limited or open-ended period of psychotherapy. Generally speaking, time-limited psychotherapy works well for those who find themselves struggling at a particular time, for example in the wake of a trauma, bereavement or other distressing event. It also works well for people who have had undergone an analysis in the past and are seeking a period of short, focussed therapeutic work. I offer a six-month time-limited course of psychotherapy closely modeled on cognitive analytic approach, which is well researched and has a strong evidence base.
Longer term psychotherapy is recommended for people who have experienced difficulties over a considerable period of time or recurrently find themselves in difficulties. The problems addressed may be well defined, for example heightened anxiety or chronic depression, or more elusive, for example paralysing indecision or prolonged unhappiness without any obvious symptom or cause.
In the event, the majority of my patients come to see me once a week for between six months and two years. Some increase their sessions to twice or three times weekly at times of particular stress or distress. A few – most often those whose childhood circumstances have been exceptionally difficult – continue to see me for many years. I offer all patients the possibility of returning for a short series of sessions from time to time after the main period of psychotherapy has come to an end.