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! 

New beginnings...

Spring is definitely in the air, and I am feeling a sense of anticipation and excitement as spring flowers begin to bloom and nature begins to wake up after a winter sleep. But I have other another reason to feel anticipation and excitement - I am about to start a new phase of my work as a psychotherapist. 

I am increasing the hours available for psychotherapy work, enabling me to work with more clients.  As a result, I have been looking for new rooms to work from, visiting different psychotherapy rooms in and around the centre of London, hoping to find the one that feels 'just right' for me and my work.  It struck me that there are several similarities between this process and the process of starting therapy - and I would like to share them with you.

Excitement mixed with anxiety (or is it dread?) - when we start something new such as therapy (either working as a therapist, or embarking on our own therapy), there is often a mixture of excitement and anxiety.  We can see a successful image of ourselves in our mind's eye, but at the same time we might have a nagging anxiety - "will it work out as I want it to?"  Of course, none of us have a crystal ball, so we can never be 100% sure new ventures will be a success.  But our past can act as a form of crystal ball in reverse -  our previous experiences can give us clues about what new ventures will be like.  Will they be exciting, coupled with a sense of 'can do' about our ability and chance of success, or will they be squashed by negative self-talk:  "It's bound not to work, after all, what have I ever done that is any good?"  Therapy is a wonderful opportunity to get to understand what has held us back in the past, whilst at the same time, building a new relationship - a relationship that can enable us to create new possibilities. 


Can I afford it? - In this day and age, with the financial insecurities life can throw at us, it is vital to carefully think about whether the financial outlay a commitment such as weekly (or more frequent) psychotherapy (or room hire) is affordable, manageable and a good investment.  Some people view psychotherapy as an "expensive luxury", with the money being better spent on a holiday or nice clothes.  But unlike a holiday or nice clothes, psychotherapy can enable us to make permanent changes in our outlook, relationships with others, and perhaps most importantly, our relationship with ourselves. Put it like that, can you afford NOT to begin psychotherapy?

How will I be greeted? - Finding a new venue to work from has meant a lot of travelling around London, as well as meeting the person due to show me the venue.  Since most of these people are new to me,  I want to make a good impression, especially if the person showing me around is the room's owner.  But given a not-so-hot sense of direction, in combination with the need to visit unfamiliar parts of London, I often find myself a little bit lost (as well as hot and bothered!) and end up arriving later than I hoped.  At such times I wonder how I will be greeted - with warmth and understanding, or with carefully concealed irritation and frustration.  

Starting therapy can bring up similar feelings of anxiety about how the therapist will greet us. Such anxieties can be compounded if, like me, you have struggled to find the venue. As a therapist and past therapy client myself, I understand how anxiety provoking that first step of making an initial appointment can feel, and how that anxiety might make anyone flounder - even people with a fantastic sense of direction! As a true believer of 'treat others as you would like to be treated yourself', I aim to offer warmth and understanding to every person who has the courage to ask for help via psychotherapy.   

First impressions really count! - As I visit different places I have become aware of the importance of first impressions. What does the environment feel like as I  walk through the door and move round the building? Does it feel comfortable? Do I feel at ease? There is plenty of research to show that we have a gut sense of whether something works for us or not, but we might struggle to listen to these feelings, tending to be swayed by logic, rationale and our own expectations or desires: for example, "I want this place/job to work, so I am going to try it, even though my heart is saying no".  Therapy is no different.  

We tend to know pretty much straight away if someone feels like a person we feel comfortable with, and want to get to know, and the same is true for psychotherapists.  So even if the photo looks like someone we feel we could really get on with, and it all seems to have gone well when we speak on the phone, if, when we meet, it doesn't feel right, then it's important to listen to this feeling.  However, being in the heat of the moment, I sometimes found myself agreeing to something, even when a big part of me is saying "NO!" This is one reason why I do an assessment over two (or more) sessions, so that both the prospective client and I can have some time to reflect on what it felt like to be in the room together, rather than rush into a commitment that perhaps, in hindsight, doesn't feel right.

Is there a shared ethos/belief system? - I have come to realise that choosing a venue from which to practice involves gaining a sense of the ethos of the place I am viewing.  Does it feel like a place where I can say hi to someone over the metaphorical/literal water-cooler and feel confident that there might be common ground about how we feel about the world (for instance), even if we work in completely different fields of work? 

At first sight, this might not feel that relevant to the world of therapy.  However, as I made my way through my own therapy journey, and then on into training to become a psychotherapist, I realised that there are as many different modalities of therapy as there are countries in the world (now I come to think of it, there are probably far less countries in the world than therapy modalities!).  When I first made my tentative steps into starting therapy I had no idea that there were different schools of therapy (such as CBT, psychodynamic, person-centred, and so on), let alone that there were different forms of psychoanalytic psychotherapy.  Although every therapy I have had has made a positive difference to me, some have made more difference than others.  And some have only been positive because they have made me realise what type of therapy I do not want to have, and what type of therapist I do not want to be!

As someone who really wants to change, you might not feel that bothered about how your therapist works, so long as the therapy itself works. But having a basic sense of the theory behind it can be a very helpful and help us avoid wasting time and money engaging in a treatment that just doesn't match our sense of how problems arise.   Worse, if we tend to 'hoover up' responsibility for something that doesn't work, we might get stuck in a therapy that isn't right for us, thinking that it is our fault it is not working. We might also then be put off trying a different type of therapy that better suits our situation.   

Sad child.JPG

In brief, attachment theory places our earliest relationships at the heart of any predisposition to develop emotional (and some related physical) difficulties in later life.  The relationships between us and our carers in the first few years of a child's life help shape our brain as it develops - for good or ill.  As an attachment-based psychotherapist I see the relationship between client and therapist as the scene for the repair to the damage that happened so long ago.  Because this often happens before the child has a good vocabulary to describe their distress, putting words to the hurt can be difficult.  In therapy, the therapist and client carefully piece together the roots of the client's distress, via words, shared feelings or understanding relationship patterns that seem to repeat across the client's life.  If you would like to read more on this, take at look at my website, or the Bowlby Centre website (where I trained).   


And the outcome to my quest?  Well, after all my work to find a new from which to work, I have now decided to use rooms at Counselling King's Cross, and I will be working there on a Wednesday lunchtime from 4th March 2015.  If you fancy joining me for your own journey into attachment-based psychoanalytic psychotherapy with me, why not get in touch? I would love to hear from you!