Counselling & Psychotherapy FAQ – by Jack Sheehan

When is it time to go to therapy?

You can read more about this in my previous blog post ‘Do I need therapy?’, but basically there are no rules around this. You might go to therapy because you are in a crisis and feel like you really need some support, or perhaps you will go to therapy because you simply feel like you want someone objective to talk to. It doesn’t matter how big or how small the issue seems, therapy is a safe space for you to discuss anything. If it feels important to you, then it is important, and it will be important to your therapist too!

What are some examples of the reasons people attend therapy?

As I said, there are no rules, and on any given day there will be a wide variety of issues that present themselves in the therapy room, some complex and challenging, and others more straightforward. All are important! In the first session I always ask clients what brought them to therapy. Sometimes they know, but sometimes they aren’t sure, and that’s okay too! We work together to figure it out. Some common reasons that people attend therapy is for support with; anxiety, depression, anger, grief, family dynamics, identity issues, sexuality, relationship issues, low self-esteem, complex trauma, physical illness, stress, life goals, work issues, difficulty with friendships, addictions, feelings of worthlessness. Often people tell me they just want to learn more about themselves! Therapy is a non-judgemental place for all of that and more!

How do I find the right therapist?

The most fundamental part of therapy is the relationship between the client and therapist. It is so important that you feel connected to your therapist, and that you trust them.

To begin you will need to ensure that your therapist has the right qualifications and training. At the moment there is a lack of regulation within the profession which will hopefully be changing soon. However presently people can advertise themselves as a Counsellor or Psychotherapist without having the sufficient training. I have seen people with less than one year of training doing this. I have also seen individuals from other professions take on roles as Counsellors. While these professions are very important in their own right and do very challenging work that may involve some similar skills, it is important for you to know that they are not properly trained in Counselling & Psychotherapy unless they have specifically completed this qualification.

Adequate training in Counselling & Psychotherapy includes between 3-4 years of university, hundreds of hours of clinical placement & supervision, and requires the therapist to engage in their own process of personal therapy. For example my training;

  • 4 years of university (Honours Degree).
  • 80 hours of weekly personal therapy.
  • 100 hours of clinical placement during university, followed by an additional 450 hours of client work in order to be fully accredited in Ireland.
  • Ongoing supervision.
  • Ongoing CPD (continued professional development).

Before you book your appointment, research the therapist! They may have their credentials listed on their website. If not, call them and ask! I know this might feel difficult especially if you are already nervous, but a good therapist won’t mind at all, and in fact they will welcome it. Things to ask;

  • How long was your training?
  • What qualification do you have? This should be at least degree level, unless they have extensive experience.
  • Who is your accrediting body?  In the South of Ireland this should be IACP or IAHIP and in the North of Ireland this should be BACP or NCPS. Being accredited with one of these bodies is THE MOST important factor in ensuring that your therapist is suitably qualified. These organisations will only accredit therapists with the right training so if you find a therapist on one of their website you will know they are qualified.

You can select the ‘find a therapist’ function on any of their websites and scroll through the profiles of various therapists. Psychology Today is a repudiable platform for finding suitably qualified therapists. I will add the links to these sites at the end of the blog post.  You can also use another search engine like Google to find a therapist in your area. Word of mouth or recommendations from other people is always a really good place to start too, or else asking your GP who may have a list of recommendations. Whichever way you find them, ask the questions!

When you get to your session, remember what I said – the relationship is the most important thing! If after one or two sessions you really feel that this is not the right therapist for you, please tell them. Again, a good therapist won’t be insulted, they will understand this, and will support you in finding someone more suitable for your needs! Don’t give up based on one or two failed experiences, the right therapist for you is out there!

Being a Counsellor & Psychotherapist is very different from being a Mental Health Advocate, a Life Coach, or Resilience Coach. While these are also valuable roles within the mental health sector, they do not have the same level of training. Our training was long, intense, and involved deep exploration of our own lives. In order to be able to sit with someone else through their pain, a therapist needs to be aware of their own. We spent many years learning very specific counselling skills, and understanding how to work safely with clients who have experienced the most challenging traumas in life. We have learned about family systems, relationships, the body, trauma, addiction, psycho-pathology, the unconscious, but to name a few. Please don’t accept mental health treatment from someone who hasn’t put in the time and effort to support you in the way you deserve. Remember this when you select a practitioner.

How much does therapy cost?

Therapy, unfortunately, is primarily a private sector service. In the South of Ireland, only those who have a medical card are entitled to free counselling sessions, and this is usually capped at 6 sessions and there tends to be quite a long waiting list. In Northern Ireland there tends to eb long waiting lists in the public system, so people often turn to private practitioners or charities/non-profit organisations for support. If you are having financial difficulty and are not in a position to pay for counselling you should speak to your GP to see what free services are available in your area. However for the most part it seems that people pay privately to ensure they get the most immediate support with a therapist that feels right for them. While this can seem like an expensive process, it has to be said it is one of the most valuable investments you can make. My understanding of the fees are as follows;

South of Ireland – anywhere between 50 – 80 Euro per session depending on experience and qualification.

North of Ireland – anywhere between 40 – 60 Pounds per session depending on experience and qualification.

Most therapists understand that the situation regarding free mental health services is not adequate, and therefore many of us offer some low cost appointments and are also willing to make payment plans with our clients to ensure they get the right support. At MindSpace we offer low-cost therapy with our Trainee Therapists at a fee of £30.

Is there a cancellation fee if I can’t attend a session?

Each therapist will have their own cancellation policy. Usually a cancellation of less than 48 hours will incur a fee, simply because this is the therapist’s business and livelihood. Most therapists will also be flexible with this in the case of an emergency or ill health.

How often do I need to attend therapy?

In order for therapy to be effective it needs to be weekly or fortnightly, preferably weekly, especially to begin with. You can discuss this with your therapist who will most likely be flexible to your needs but will remind you of the benefits of attending regularly.

What is the length of a session?

Each session usually lasts from 50 minutes to an hour.

How long do I need to attend therapy for?

There are no rigid guidelines around this. Some people decide to come for some short-term intensive therapy, for example 6 sessions. Others embark on a longer process of self discovery and change, for example over a number of years. Some people attend therapy for a period of time, take a break, and then return at a later date. You will know what is best for you and your therapist will support you through that!

Are there different types of therapy and how do I know which one I need?

Most therapists who have had the correct training will be qualified to work with a broad range of issues and will have been trained in various modalities of counselling & psychotherapy, so this is not something you really need to concern yourself with. As I said earlier it is the relationship between therapist and client that is important, and not so much the mode of therapy. A lot of therapists will have had integrative training, meaning they integrate and incorporate different approaches during sessions with clients depending on the needs of that client. My training was integrative and included the following;

  • Person-centred Therapy – Learning how to build an honest, safe and trusting relationship with the client, providing unconditional, empathic, and non-judgemental support. This also involves being aware that the client is the expert of their own life. It is not my job to tell them what to do, but rather to facilitate the space for them to find the answers for themselves. By engaging in the therapeutic relationship people can feel safe to be themselves and understand their own needs.

 

  • Psychodynamic & Psychoanalytical Psychotherapy – Helping the client to develop an understanding of how their past may be impacting their present. How we feel or behave in the current moment is often a presentation of something that occurred in the past. It is about gaining awareness around those unconscious triggers, understanding the importance of our attachment style, and having a deeper sense of our past lived experiences that may have become repressed. By bringing this into our conscious awareness, and making interpretations as to what is occurring and why, we are immediately better equipped to make positive changes.

 

  • Existential Psychotherapy – Providing space for the client to engage with their understanding of their place in the World. What makes them truly fulfilled? What fears do they have? What gives them a sense of purpose and meaning? The facing of our own mortality and contribution to the World can lead to complex and troubling feelings, all of which can be explored in therapy.

 

  • Cognitive Behavioural Therapy – CBT deals with the conscious mind and allows us to use techniques in order to challenge irrational or negative thoughts, beliefs and behaviours. However before implementing such techniques we need to be aware of the unconscious drives and the deep rooted feelings. Thus I will only integrate this modality when appropriate.

A good integrative therapist will organically combine the above modalities without you even noticing! When selecting a therapist, don’t be afraid to ask ‘what type of therapy do you do?’

Another more specialised form of therapy that we provide at MindSpace is EMDR;

  • Eye Movement Desensitization & Reprocessing – EMDR was developed to help people who have experienced traumatic events. It involves a structured eight phase process using bilateral stimulation, such as eye movement to help individuals process distressing memories, and reduce the emotional and physical symptoms associated with trauma. The goal is to help clients reprocess traumatic experiences and develop more adaptive coping mechanisms.

While integrative therapists can work with most issues there are a couple of scenarios where I would recommend seeking a specifically trained therapist. If you are struggling with a serious addiction, you may want to source an addiction therapist. This is likely someone who has the same core training as me which included addiction studies, but then gained a further qualification specifically in the area of addiction. Similarly if you have an eating disorder, there are some very particular ways of working with this issue, and a therapist who engaged in specific training around this will be most beneficial to you.

How is a therapy session structured or what can I expect?

Depending on the needs of the client each session will work differently but may include any of the following;

  • Your therapist will listen as you talk. They will allow you the space to express how you feel, and provide you with emotional support.
  • You will learn how to make interpretations about issues that are arising in your life and where they may be originating from.
  • There may be times of silence where you don’t know what to say but take some time to reflect on what is happening for you.
  • You may engage in some writing or journaling exercises that will help you understand your feelings more clearly.
  • Learning stress reduction and relaxation skills through grounding, breathing & meditation may be part of a session if needed.

In general therapy tends to centre around talking, freely associating and allowing yourself to discuss whatever comes up for you in the moment. You lead the session based on what feels important to explore, and then your therapist will interject with questions, perspectives, interpretations and feedback. Whatever shape the session takes, it is first and foremost a safe place for you to be yourself, have your thoughts and feelings, feel supported, gain awareness, and learn new ways of managing your emotions.

Is everything I say in therapy confidential?

For the most part, yes! However there are some exclusions to the rule and your therapist will talk you through these during your first session. It is important that you feel safe to discuss anything you wish, knowing that it will not leave the therapy room. However your therapist also has to keep you and other people safe. If you disclose something that leads your therapist to believe that you, or another person is in immediate danger they will have to inform the relevant authorities. If you disclose something that suggests that a child is experiencing neglect or abuse, your therapist will need to form a child protection report. These circumstances rarely occur and your therapist will help you manage the situation if it arises.

 

Can I ask my therapist questions about their life?

Each therapeutic relationship is different. In the past therapists considered themselves to be seen as the ‘blank slate’, not giving away any insight into their own life or experiences. Today, we know this is not the best approach. For therapy to be dynamic and authentic, we have to accept that there are two people in the room, both bringing a part of themselves, their past experiences, and their unconscious drives into the relationship. When we understand the concept of transference, we know that as therapists we have to allow part of ourselves to be seen and to work with this dynamic during sessions. Of course this has to be subject to boundaries, must have a clear intention, and must not involve any inappropriate disclosures. At the end of the day, this is your session, your time, your money! You aren’t paying to hear about your therapist’s life! But if you have a question, ask! Your therapist will answer if they feel comfortable or may help you understand the boundaries better if it feels inappropriate. Don’t be afraid, whatever you need to say, say it! That’s part of your experience, and it may lead to something very important!

Can I contact my therapist in between sessions?

You can, but be aware that they may not get back to you immediately. Therapy is not a 24 hour support service.  If you have a general query about an appointment or cancellation you can email, call or text your therapist. If you need more immediate support in between sessions, you should use an alternative service or else be prepared to wait for your therapist to get back to you when they are available.

What if I bump into my therapist outside of sessions?

Usually your therapist will agree with you what to do in this instance. You may feel comfortable to wave or say hello, or you may prefer to walk past as if you don’t know one another. Your therapist will follow your lead. Usually it would not be appropriate to have any further interactions than saying hello. It is important that both parties respect each other’s private lives and boundaries.

When should I expect to see results from therapy?

Therapy really shouldn’t be measured in this way. It is a process, and that can look different for everyone. The people who gain the most from therapy are the ones who don’t focus on goals necessarily, but rather engage in the present moment of learning about themselves and increasing their awareness. Thus in turn, slowly and organically they start to see their lives changing over time. For other people, they use therapy as a self-care tool to manage their emotions and feel better in their current lives, without hoping for anything specific to change. Of course there are practical techniques we can learn in therapy to help with a particular work issue, relationship issue, or stress issue, and people can see immediate results from this. However we try not to label these as successes or failures, as it can add additional pressure onto a person’s already challenging circumstances. I tell people to trust the process! Trust that what you learn in a therapy session is enough and will help you in some way in your life! When you walk out the door at the end of a session, don’t try to remember everything that happened. Take a deep breath, let it go! Trust!

‘I want to go to therapy but I’m too nervous’

I meet people like this every day! Don’t worry! Your therapist is experienced in helping you feel at ease and supporting you through these nerves. Tell them about how you are feeling. Take a chance. The worst that will happen is that you won’t like it and you never have to go back. The best that can happen is that you will finally get the emotional support you need and deserve and your life will start to change!

If you are considering going to therapy, I sincerely hope this information has been helpful and supportive in putting your mind at ease and guiding you in the right direction! If you have any other questions, just contact me through the webform and I will add them to this blog post!

Thanks for reading!

Jack

Psychotherapist & Co-Founder of MindSpace

 

https://www.psychologytoday.com/gb/counselling/northern-ireland?gad_source=1&gclid=CjwKCAjwm_SzBhAsEiwAXE2Cv1FLrZH-N15y0YIG_8JIQOnoLrpDhA-o4PP6UxjfbcVObj9Er3UpaxoCMKYQAvD_BwE

https://iacp.ie/page/therapists?co=6&cat=11

https://www.bacp.co.uk/search/Therapists?q=

 

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