Tag Archives: therapy

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How to find the right counsellor for you

I’m currently training to be a counselling. As someone who’s also experienced “lying on the therapists couch” I thought I’d put some thoughts together for people who might be looking for a counsellor or therapist in these difficult times.

If you were looking for a doctor, you would make sure they were registered with the General Medical Council. Therefore you should make sure that your therapist/counsellor is a member of an organisation such as: BACP, UKCP or NCS* (or equivalent in other countries). The counselling/therapy profession isn’t currently fully regulated (that means anyone can call themselves a counsellor and isn’t breaking the law)…but by making sure that they’re a member of an organisation such as these, you’ll be getting a professional who:

  • Has achieved a substantial level of training (at least diploma level having undertaken 100 hours supervised placement hours etc)
  • Frequently undertakes continuous professional development
  • Adheres to a specific code of ethics (which can be found on each website)

You may wish to use a directory such as Counselling Directory to search for a verified, accredited counsellor/therapist. We have been incredibly fortunate that counselling has become more accessible recently, it’s now available online or on the phone, although there may be pros and cons, see this recent blog. There are specific platforms where this is all that’s offered so that it’s available across the world (e.g. Better Help and My Online Therapy). However, location may be a priority, should you wish to return to face-to-face counselling at some point. When browsing profiles a few red flags to beware of:

  • A counsellor who claims they deal with too many areas—some very experienced counsellors may have expertise in a number of areas but watch out for inexperienced counsellor’s who’re just trying to look more attractive.
  • Offering too many therapies—integrative is a type of therapy that is a specific way of blending therapies but being a specialist in more than about 4-5 therapeutic interventions means the therapist may not know the therapies in any depth. Also beware of the opposite—very specialist therapies claiming to cure-all are spinning you false hope!

Before you go to meet you counsellor/therapist, try to be clear with yourself what you want. For example, they don’t/shouldn’t diagnose or offer advice, the sorts of things you might achieve involve understanding yourself and why you repeat unhelpful patterns better and developing more helpful ways of coping with life’s ups and downs. It’s not up to them to decide what you need. During the introductory session, it’s important to find out if what you want and what they offer align.

Once you meet a therapist, you may think that feeling a sense of connection is the most important thing; while you’re not wrong there are some other important points to consider:

  • Do you trust them to keep the boundaries? These are the framework on which everything else hangs—they help you maintain trust and they’re where the work begins! For example, if the sessions always run over time, do you trust them to maintain confidentiality?
  • Will you be able to form a working alliance with this person? This is the relationship that exists between the counsellor and client that means they are able to work together in a judgment free zone towards shared goals. Do you understand how they work and will this help you?
  • Will this person challenge you? If you feel too comfortable with this person, if they’re too similar to you, it can be difficult to push yourself outside your comfort zone and make the changes that are needed.
  • Have you been able to ask all the questions you have? Do you know how much it’s going to cost? Are you signing up for a specific number of session or is it open ended? How will you be reviewing you progress?

Obviously you don’t want things to go wrong but if at any point you’re uncomfortable or wonder if they’ve behaved unethically, have they told you what to do? (Speak to them initially, then contact their membership body.)

Counselling/therapy can be hard but fantastically rewarding.

A life unexamined is not worth living—Socrates
  • *BACP = British Association for Counsellors and Psychotherapists
  • UKCP = UK Council for Psychotherapy
  • NCS = National Counselling Society
Lady using phone and laptop

Therapy in a post-covid world

Imagine you’ve been seeing a therapist once a week to help manage a mental health condition, then the COVID-19 pandemic hits your country and you’re suddenly in lockdown. Everyone around you is concerned with whether they can buy enough toilet roll, work from home, arrange childcare or finish buying the supplies for their DIY project; while these things are important to you, you’re world has been turned upside down because the one place you felt completely safe was your therapist’s room and you have no idea when you’ll be able to return.

There are a number of issues to consider when thinking about delivering therapy remotely, it’s important to think about keeping everyone safe:

  • Is the client’s space confidential? How comfortable do they feel? Might they be distracted/interrupted by other people/chores etc? This is particularly important for cases involving domestic abuse or relationship issues.
  • There are a number of options—phone, text only or video conferencing all have pros and cons for client and counsellor. Security of the software is a consideration as well as how the clients data will be managed.
  • It’s important to assess the psychological needs of the client, it may be inappropriate for certain people to engage remotely/virtually due to the type or severity of their problems—this needs to be handled sensitively.

For some agencies in March 2020 (when lockdown hit in the UK), their automatic reaction was shutdown, there was no way that they could function if they couldn’t meet their clients face-to-face. For their clients this could have hit them incredibly hard, they could have felt let down, even abandoned, past hurts may have been recreated. Of course, at ever point, risk assessments were carried out to try and meet the needs of the clients, check in calls were offered and referrals were made to ensure high risk clients could be supported by other services.

What are the pros and cons of virtual therapy and what does it really fell like?!

Not meeting a client face-to-face, obviously, a lot of the nuance is lost. Depending on whether the communication is on the phone, via video call or text based, you may lose body language, eye contact, facial expression or even intonation of voice. Experts say that 70-93% of language is non-verbal so you lose a lot when you’re not in the same room as the person you’re talking to.

young female looking sad texting

But everyone has been struggling during this global pandemic and it’s been vital for people with mental health difficulties to get support. So many therapists and counsellors have stepped up and sought appropriate training. It’s important to take the following into consideration:

  • From the client’s perspective, meeting in their home could feel invasive, or they may not be able to find a confidential space. However there could be benefits such as the client not having to commute. If, however, the client finds it difficult to wind down after a session, grounding exercises can be used.
  • The therapist may continue to use their therapy room but if they use videoconferencing in their own home, they need to consider what’s in the background (books? photographs? things they wouldn’t usually choose to disclose?). If the therapist chooses to use a photograph to conceal the background, how does that look to the client? What are they hiding?
  • It has been found that clients are less inhibited when remote from their counsellor, they will therefore find it easier to criticise the counsellor and will also talk about deeper issues more quickly than when they’re not face-to-face. The counsellor will need to be prepared for the former and it will be important to remember the client may feel vulnerable if the latter occurs.
  • When using phone or text only medium, it’s harder to use silence as a therapeutic tool. If videoconferencing, breaking the silence with “has the screen frozen?” isn’t particularly therapeutic!
  • Contracting needs to have additional consideration e.g. what happens if the technology fails? what do you do if there’s an interruption?
  • Counsellors need to be aware of the blackhole effect. This is the impact that occurs when a client disappears and is not contactable (what to do if this happens will need to be in the contract). Although this can bring up difficult feelings when the relationship has been face-to-face, it has been found the clients are more likely to do it when the relationship is virtual and the feelings that surface in the counsellor can be difficult to manage if counsellor is unprepared or inexperienced.
Lady on video call

I’ve wondered why it took such an extraordinary event, a global pandemic, to open up the world and ensure that people with disabilities could access work and services equally? It’s fantastic that remote counselling is now so widely used and so many more people are now able to access it but there’s a lot to consider.

It’s important that therapists and counsellors are confident in their abilities and fully trained as there are many differences between face-to-face and remote counselling. Since the world of counselling isn’t regulated, this is another layer that has required professionals and students to act responsibly with regards to our ethical framework.

If you’re looking for a counsellor, it’s more important than ever to ensure they belong to a regulate body, such as the UKCP or BACP and that they have suitable training if you’re going to meet with them remotely.

What is safety?

TW – Trigger warning for detailed content about suicide and suicidal feelings. Please considering moving onto a different blog if you may feel particularly distressed reading about these subjects. It’s important to practice self care and only read content on the internet that will benefit you.

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While Covid-19 is spreading through our society, we’re being asked to stay at home to keep safe. But this is only keeping us physically safe from a virus. I do understand that this virus is especially contagious and virulent therefore physical safety at this time is a priority but I want to spend a few moments reflecting on the meaning of safety and it’s different forms.

A feeling of safety can be captured through routines and familiarity, this is why people so often struggle with change. Nearly all of us are coping with huge upheaval as Covid-19 is sweeping across our nations. Working from home, not working at all, stopping social activities, home schooling our children, doing more or fewer activities than previously – some of these may have positives, negatives or a mixture of both but change is always hard.

Cortisol is our stress hormone. Usually it is released to help us cope with a peak in stress and it aids managing the stressful situation. However at times of long term stress, cortisol being released over a prolonged period leads to all sorts of side effects such as fatigue, irritability, headaches, intestinal problems, anxiety, depression, weight gain, increased blood pressure, low libido and erectile dysfunction.

Lots of people are being brought to our attention as people who need care/support: the elderly, those living with an abuser, the unemployed, the homeless, people with chronic illnesses and many others – each group has its spokes people. But I fear for those we don’t hear about – who’s helping the people we don’t know about?

There have been many occasions in my life when I’ve felt unsafe and it’s been my own thoughts that have been working against me. Mental health crisis is hard to explain, trying to explain what it’s like being suicidal is like trying to describe colour to someone who’s been blind from birth.

Being suicidal feels like all your senses have been taken away included your senses of dignity, perspective and reality, it feels like one by one everyone is giving up on you and this makes sense because the situation is completely hopeless; you’re a worthless human being with nothing to live for, gradually the grey numbness you’ve been feeling for a while turns to an active hot feeling of desperation – “whatever this is, it is unbearable and it just has to end.” Eventually calmness and serenity is felt once a plan to end the suffering is in place. (At least, this is what it was like for me.)

So, this lockdown (in whatever form it’s taking in the country you’re in) is designed to prevent the spread of a virus but at what cost? I‘m definitely not saying we shouldn’t be following government advice – I’m the first to do as I’m told! What I am saying is we need to ensure we look after our physical and our mental safety.

Specific links about how to look after our mental health during the lock down can be found at the bottom of the page.

A “place of safety” is somewhere designed to help an individual through a mental health crisis, to support them while they’re feeling suicidal, to prevent them carrying out any plans they may have made to end their life. Usually this is a specialist mental health unit but it can be A&E or a police station. Unfortunately I have been detained in a police cell; I was scared, yes, but realising I was too unwell to make decisions about my care myself, it was a relief that they took over responsibility for my safety when I couldn’t do it myself.

I recently returned to therapy because my mental health has been challenged. For me, the therapists room is a place of safety because it’s somewhere I can be myself. Most people are different versions of themselves in different environments but when suffering with mental illness most people are familiar with the feeling of putting on a mask. Most of the time this mask ensure the world has no idea what’s going on underneath. At work I’m professional, competent Frances; socially I’m friendly, pleasant Frances etc. In the therapy room, my therapist doesn’t judge me for being anxious, confused, angry, annoyed – it’s safe to take my mask off.

As the weeks of this pandemic drag on, people start to talk about cabin fever or “going stir crazy”. These phrases refer to feelings of being cooped up too long. This place that was meant to be keeping us safe has become a prison! This is exactly why most lockdowns include being permitted to go out for exercise and it’s vital to take advantage of this if possible. If it’s not possible, sitting in the garden or by an open window as often as possible is really important.

So, if you’re doing as the government has asked and you’re staying at home, thank you for keeping your community safe from the virus. But it’s really important to spend some time thinking about what makes you feel mentally and emotionally safe:

  • Keeping busy? – try learning something new
  • Seeing friends and family regularly? – connect with them however you can.
  • Having time and space to yourself? – timetable 15-20 “me time” in a separate room and let other people in your household know that’s what you’re doing.
  • Keeping familiarity and routine? – build some habits into your day to build a new routine.
  • Having freedom to move around? – use the permission to exercise daily if possible.
  • A hug? – whether it’s someone you live with, a pet or a cuddly toy it’s ok to to give it a really good squish everyday!
  • Having autonomy and control? – focus on what you can control not what you can’t. I find the serenity prayer helpful!

If you’re feeling unsafe or uneasy, can you work out what’s missing? Whether it’s about feeling empowered and in control or being allowed to be vulnerable and looked after for a short time. Perhaps at the moment it’s not easy to get exactly what we need but can you simulate it? Maybe we don’t have freedom to move around but how about planning a holiday for when it’s over because, this is going to end. We don’t know when, but it will.

It may also be important to take things out of your daily routine that is harmful to your mental and emotional safety. These links provide really good hints and tips for looking after your wellbeing during this time of uncertainty.

Specific links:

  • Mind – a wide variety of information including managing wellbeing, work, anxiety and social care rights
  • Beat Eating Disorders – really good specific questions related to managing eating disorders and recovery
  • Mental Health Foundation – information including mental health tips, relationships, finances and talking to children

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