Slow and steady wins the race. Or, how psychotherapy doesn’t have to wipe you out for days after a session

I recently tweeted about how feeling wiped out for hours/days after your therapy session isn’t necessarily helpful.  In fact, in my experience it can be very unhelpful, both to the therapy process (as it makes clients understandably anxious and reticent about coming to therapy), but also because it temporarily stops them from living their life and can leave them feeling more, not less vulnerable.  Therapy should be about supporting people to feel more able to live their lives, not less so.  Sure, therapy is often about working through some deeply painful or overwhelming stuff, but it feels like a widely held belief (dare I say, myth) that to do therapy ‘right’ it needs to hurt – really hurt.  I think that’s a belief that needs to be debunked because it’s potentially toxic.

In my tweet I suggested if this is what therapy feels like for you, then it would be a good thing to talk to your therapist about it.  ‘Great advice’ came a response, followed by, ‘but what should a therapist do if a client raises this?’.  That’s such an important question that I decided to write this blog.

I think the ability to name this as an issue is an incredibly crucial step.  Because in my view, if it’s not identified and addressed it rarely, if ever, goes away on its own, and can derail the therapy.  So, the first thing I do is acknowledge that this is an important and brave thing for a client to say.  Clients might feel anxious that any expression of disappointment or struggle with an aspect of the therapy might lead them to be rejected by the therapist (perhaps as their childhood or later experience has borne out).    

Next, I work with the client to help them feel calmer in a session.  I might use a grounding exercise at the start and at various points in the session, enabling the client to feel safe, to connect to the room they are in and to themselves, perhaps via supporting them to slow down and deepen their breathing.  I might think about how the space between us feels – do they need me to move my chair back, or sit at an angle rather than opposite them (so they don’t feel stared at)?  As the session progresses, I encourage clients to tune into how they are feeling moment by moment – for example, what is happening to their breathing, what do they feel in their body, are they finding it hard to think or is their brain feeling ‘foggy’?  If I observe them becoming overwhelmed, I might say something like, “I notice your breathing has become really shallow so let’s pause and take a breath here”.  Sometimes clients feel able to go deeper into the material, but sometimes not.  If not, that’s absolutely fine – it’s vital to feel more in control of the impact of our ‘stuff’, and to go at a pace that is right for us.  Once we can do that, we naturally tend to go further into the material because we know we can control our responses to it.  

I work hard to manage the time in sessions.  I give a time check around 10 minutes before the end, so that clients can begin to manage their transition from the therapy space to the outside world.  It’s important for clients to be grounded when they leave – too often I have heard clients say they felt ‘spacey’ after a session or can’t remember how they got home.  So, I might end a session with another grounding technique, and/or encourage them to take a moment outside of the room before they leave the venue. 

All of this is the ideal, but I know how tempting it is to feel like you must get as much as you can out of a session (especially if your therapy is time limited for whatever reason).  If I recognise a client hasn’t left in a calm state, at our next appointment I would be interested to know how a client felt after the last session.  This can be an opportunity to open a discussion about all the above points.

Finally, I want to think about how attachment can inform this work.  Attachment-based psychotherapy often involves observing for indirect communications of distress or dis-ease with the therapy process.  Often clients come to me because they recognise they have an insecure attachment style and want to change this.  Insecure attachment develops because childhood caregivers have been unable to offer unconditional acceptance of emotional distress.  As a result, a child learns to either bury their distress (leading to avoidant attachment style) or ramp up their hurt to be seen by a caregiver who is inconsistently emotionally available (resulting in a preoccupied attachment style).  They learn that stating their needs doesn’t work, or perhaps can make things worse, so they innately learn to bury them.  But we rarely give up on communicating our needs – we just do it indirectly.   

A big part of my learning over the decade or so I have been a psychotherapist has been to really listen for these indirect communications.  Missed sessions and clients regularly turning up late might be two such examples.  I might wonder aloud if these are indirect communications that the work feels overwhelming to them in the ways I have described above, adding, “It’s a hunch, and only a hunch, but what do you think?”

If I am beginning to wonder if the therapy feels overwhelming, I listen for indirect communication via the material a client brings.  Listening for this, I might hear stories that suggest life feels out of control, perhaps precariously so.  For instance (and this is a fictional example), a client might report she was rushing to the bus stop, carrying heavy shopping.  She tripped, and the shopping went everywhere, but people only jostled her to get on the bus and no one stopped to help. 

I might wonder if the shopping is a metaphor for her emotional distress (which feels heavy, cumbersome and slows her down), and that our work is ‘rushing’ her along at a pace that makes her unsteady.  Perhaps I am like the people who don’t stop to help, unconcerned and perhaps irritated that her distress (shopping) is uncontained and getting under their feet.  Perhaps that I am only interested in my journey, not hers.  Again, I tentatively put these out as a theory, and I am prepared to be wrong.  But I think the aspects of a client’s week that they choose to share in therapy can be a powerful communicator and that we (the client and I) need to try and understand what is being communicated.

There is so much more that can be said on this topic, and I really interested to hear what people think. Perhaps you are a client in therapy, a therapist, or just interested in the subject, but do share your thoughts! 

What the GDPR means for my work as a therapist

Unless you have been living on the moon or down a very deep hole for the last months, you will undoubtedly know that by Friday (25/05/18) the way companies manage your data (names, addresses – email and actual, mobile phone numbers, for example) will have changed rather dramatically (GDPR).  As a psychotherapist working in private practice I work within a ‘small company’, meaning GDPR applies to me and the way I manage data.  So, I have recently been reviewing how I manage your data, so that I comply with GDPR.

In this webpage I want to introduce (in an informal, hopefully engaging way) a little bit about these changes. It’s not meant to be a in depth guide - current clients of mine will receive the detailed ‘official’ version of this in the very near future (I am also very happy to share this with you if it is part of your decision-making process about whether to contact me as a prospective client).  Rather, this webpage aims to give you insight into some of the decisions I have made about data protection, and something of my thought processes around it.

Creating security facilitates good therapy

As a psychotherapist I have always been acutely aware of the need for privacy, confidentiality and the sense of security in the work I do with clients.  GDPR doesn’t change this but adds another layer.  Ultimately GDPR is about security – something that is close to my heart as an attachment-based therapist.  If we don’t feel safe, all our energy goes into maintaining a vigilance of our environment, rather than exploring it (via play in children, and exploration, letting our mind wonder and the freedom to engage with another human being in a new way within therapy).  Exploration facilitates optimal growth, development and, in therapy, healing. 

But feeling safe and secure is as important for me, the therapist, as it is for my clients.  If I don’t feel secure in my work I don’t work optimally.  I am talking as much about feeling supported to manage the (sometimes) challenging work of therapy as much as physical safety.  It is for this reason that I require GP details of prospective clients before I agree to work with them.  I feel strongly that knowing I can contact a GP if the need arises helps me feel secure to fully enter into the work.  In the vast majority of cases I never need to contact a client’s GP, and if I do, it is done with a clients’ knowledge, involvement and consent (there are exceptions – see information on confidentiality on Framework for Therapy page ). 

Requiring GP details is just one example of my rationale behind the data I ask for.  If you want to ask anything else about my rationale behind my data protection policy, please do not hesitate to ask.

Fort Knox at the front door…

GDPR has made me reflect on the ‘front door’ ways I communicate with clients.  Email, text message and video messaging are pretty much the sole way I communicate with clients (outside of sessions), and vice versa.  But the majority (perhaps all) of the standard email providers do not encrypt emails, meaning that they are not secure ways to communicate.  The same is true for text messages.  WhatsApp, while encrypted, is not secure because it’s WhatsApp who do the encrypting, and so could theoretically ‘unencrypt’ data (and let’s be clear, data = your and my messages, video calls and so on).  Plus, it’s owned by Facebook, who don’t have a great track record for data protection!

So, I am moving over to using encrypted forms of communication via a different email provider (ProtonMail), text message service (Signal) and video conferencing service (Zoom).  All of these satisfy my (and my more technically minded/aware colleagues) requirements for transferring data safely over the internet.  All these systems are free and easy to download – but require the message receiver to be using them for the system to be safe.  As a result, I will require clients to adopt these facilities too.  Let’s face it, after the end of this week it’s likely many people will be using these sort of facilities, so they’re unlikely to gather dust on your phone and/or computer.

…but the back door’s wide open!

I have covered the security of the direct ways people communicate, but there are different ‘back door’ ways data is shared, sometimes outside of our conscious awareness.  Think of how your phone might be set up to add engagements (including a session with Helen Cordery – a quick look at Google will tell anyone what I do) to your calendar without you asking it to, as a prime example. GDPR has compelled me to think about as many ways like this that your data is at risk of being compromised, and ways around this.  (By the way, I use an old-fashioned paper diary, listing clients by their initials, not names)

Some are pretty basic, such as not looking at my emails when crammed onto a busy train in the morning.  Other are a little less obvious.  For instance, whilst a passcode and fingerprint recognition make my phone very secure, I realised that notifications override these, showing the first line of a text (for example) as well as the sender, if my phone is at rest.  As a result, I have changed my notifications so that I only know that I have a new message, not its content, and again identify clients on my phone by initials, not by name.

I imagine that GDPR will make us all far more aware of how data ‘leaks’, and that whilst I have tried to be as comprehensive as possible, my data protection policy is more a ‘work in progress’ rather than the finished article. 

And finally…

You might be feeling somewhat frustrated that this GDPR business is getting in the way of therapy.  I completely understand where you are coming from on that one – it’s taken me a while to get my head round it myself! However, I think rather than being a frustrating diversion it could become a valuable way to understand ourselves and the way we relate to the world, especially with the lens of attachment-based psychoanalytic psychotherapy to view it through. And that can’t be a bad thing!