Psychoanalytic Psychotherapy

Psychoanalytic psychotherapy is a talking therapy founded on the understanding that our unconscious and early life experiences and relationships effect our development, our current experience and relationships with ourselves and with others. In making the unconscious conscious and understanding the conflicts within yourself, you will learn more about yourself, the decisions that you make and why you experience things as you do. This in turn, will allow you to make new choices about how you live with greater awareness and less distress.

Psychoanalytic psychotherapy provides a safe, personal space where you can talk about yourself and what troubles you, to try to understand the connections and patterns of your experiences. It aims to reach beyond the initial symptoms which may have lead you to seek therapy, to the underlying causes which reside in deeper layers of the personality. Working in this way can provide profound and lasting change.

During psychoanalytic psychotherapy sessions, you will be encouraged to say whatever is going through your mind, to help you become aware of hidden meanings or patterns in what you do or say, that may contribute to your problems. Our work with the unconscious may involve working with dreams and using free association alongside interpretations of symbolic experiences and material, as well as straightforwardly talking things through. Psychoanalytic psychotherapists wait for you to talk. This can feel like silence, but it doesn’t mean that I am being unhelpful. What I am interested in is what’s on your mind.

Psychoanalytic psychotherapy sessions last for 50 minutes. You may be offered different models of attendance from once a week to twice or more times each week. Therapy can take place over a time limited period, but it is more usual for it to last for some time, from several months to several years. It can bea slow process, but it is widely acknowledged that working at depth can bring enduring relief from suffering and lead to profound change for the individual.

Psychoanalytic psychotherapy can help with a range of psychological problems, and research shows that it is effective in the treatment of both mild and complex mental health problems particularly difficulties that can impact on relationships. Psychoanalytic psychotherapy is not recommended for psychotic illness, but can be very helpful in relapse prevention and when a psychotic episode has come to an end.

Studies show that psychotherapy in addition to antidepressant medication significantly reduces depressive symptoms, compared to antidepressants alone. Studies also show that for somatic disorders (physical complaints that initially appear to be medical but after investigation can’t be explained with a medical diagnosis) short term psychoanalytic therapy can be more effective than other therapies.

It can be painful to face the past and the truth. Talking and thinking about emotional problems can be difficult. For this reason some people can feel worse before they feel better. As your therapist, I will work with you to help you manage strong emotional reactions, however psychoanalytic psychotherapy is not for everyone. Sometimes the work involved can make some people feel too angry, make their depression worse, or feel too criticised. There is a range of
alternative therapies that I will talk to you about during our initial consultations.

Counselling

Counselling provides a safe and confidential space for you to explore how past experiences, worries about the future or current difficulties may be affecting your life and relationships.

Your counsellor’s role is not to tell you what to do or give advice, but rather to explore with you on how you respond to life events and how you relate to yourself and others. Through this process you can come to understand yourself better, find your own solutions and move from a situation where you may feel a victim of circumstance to feeling that you have some control over your life.

Most counselling takes place in planned, regular 50 minute sessions. The frequency of your sessions and how many sessions you have, will depend upon your circumstances and the nature of the issue that you wish to address. Deep rooted or recurrent problems may need weekly sessions for many months, while solution focused counselling for a specific problem may take a few sessions. In rare cases one session may be enough to resolve an issue.

What you talk about during a session will depend upon what you are seeking help with but could include: past and present life events, situations that you find challenging, your feelings, thoughts and behaviour, your relationships.

This first session is important for making sure that you feel comfortable seeing your counsellor and with their way of working. During this initial consultation, they will ask you to give a brief history of the issues that lead you to seek counselling and to tell them what is troubling you and we will explore how best to work together.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy is based on 2 assumptions
• It is not what happens but how you interpret what happens that matters
• What you do or how you act affects how you think and feel (including the physical sensations you experience)

CBT usually focuses on difficulties in the here and now rather than looking at the past. The therapy relies upon us working together, to identify and develop a shared understanding of the relationship between your thoughts, feelings and behaviour, so that you can understand how or why a problem developed and how the problem has been maintained. Identifying and modifying unhelpful and inaccurate thoughts and beliefs to help you change how you think and behave which in turn can change how you feel.

In the initial sessions, we will explore the nature of your difficulties, how they developed and what keeps them going. Although CBT tends to focus on the here and now, you will be asked questions about your background and earlier experiences, so you can understand how they affect you now. I will also be interested to know what has helped before now. Together we will develop a shared understanding of your difficulties (this is ‘formulation’ may be drawn up on a flip-chart and worked on together over a small number of sessions). Goals for the therapy will also be agreed and treatment plan developed. I may ask you to complete questionnaires during these early sessions to help us to monitor the progress of our work together over time.

Individual CBT usually takes place on a weekly basis with each session lasting 50 minutes. As you come to the end of therapy, sessions maybe spread out to give you a chance to put what you have learnt into practice. This helps build your confidence to manage without ongoing therapy.

In line with best practice some CBT sessions may be longer than 50 minutes. The fee for such sessions is calculated as a multiple of the normal fee. I will always discuss arrangements for longer sessions with you in advance.

Behavioural experiments (experiential activities undertaken in or between CBT sessions) to enable you to test out the validity of unhelpful beliefs and assumptions are sometimes helpful. Such experiments can include activities, for example, driving a car or standing in elevated places. Expenses incurred whilst arranging and conducting such experiments (including the fees of advanced driving and motorcycle instructors) are charged at cost. I will always discuss arrangements and expenses with you before hand.

Towards the end of your therapy, we will explore how you can manage future challenges as they arise, to reduce the likelihood of your difficulties coming back.

Research shows that cognitive behavioural therapy (CBT) can be as effective as medication in the treatment of some mental health problems. CBT can also be completed over a relatively short period of time compared to other talking therapies. However, to benefit from CBT, you need to commit yourself to the process. I can help and advise you, but I can’t make your problems go away without your full co-operation. Due to the structured therapy sessions CBT may not be suitable for people with more complex mental health needs or learning difficulties.

Cognitive behavioural therapy (CBT) is not a quick fix. In CBT you need to confront anxiety to overcome it. This can make you feel more anxious for a short time and I will help you with this.

Trauma Focused Cognitive Behavioural Therapy

Experience or exposure to (single, multiple or repeated) traumatic events such as a violent personal assault, traffic accidents, natural or manmade disasters, being taken hostage, sudden and unexpected death can give rise to a range of confusing and sometimes distressing responses that can have a significant impact on the physical and emotional wellbeing of those affected.

Trauma focused cognitive behavioural therapy can assist by helping you:

• Safely process traumatic memories
• Understand your responses to the traumatic event(s)
• Process trauma related emotions including shame, guilt, loss and anger
• Modify those thoughts and beliefs that are causing you emotional distress and relationship, social and occupational difficulties.
• Develop strategies for managing heightened arousal, anxiety, flashbacks and safety planning
• Safely confront situations, people and objects associated with the traumatic event that you may be avoiding because they evoke strong emotions or cause physical distress
• Focus on re-establishing relationships, work and other activities that are important to youAll the therapy provided is evidence based and conforms to National Institute of Clinical Excellence (NICE) guidelines and standards.Typically therapy lasts 8-12 sessions although this can vary depending on individual circumstances and the nature of the trauma experienced

  Individual trauma focused CBT sessions are usually 50 minutes long, however in line with best practice some trauma focused CBT sessions may be longer than 50 minutes.
  The fee for such sessions is calculated as a multiple of the normal fee.
  Arrangements for longer sessions will always be discussed with you in advance.

  
  Follow up sessions are sometimes helpful particularly around significant dates such as the anniversary of the trauma. The usefulness of such sessions is something we can discuss towards the end of therapy.

 EMDR (Eye Movement Desensitisation & Reprocessing)

EMDR is a therapy which was developed to help people deal with the symptoms and emotional distress which are associated with traumatic or disturbing life experiences such as an accident or loss. It is now considered a useful approach for a range of difficulties including anxiety, depression, OCD and phobias. It is used alongside, or integrated within, another therapy.

When something traumatic or disturbing occurs we will often process this through a period of reflection, or “talking it through”. This allows us to make sense of our experience and what it means for our sense of ourselves and the world (physical and interpersonal). But sometimes this is not achieved. This may be because we do not have the resources we need, perhaps because of our age or lack of support. It may be that there have been other things going on, so we have had to put our distress to one side. Or it may feel too overwhelming to feel the impact of our experiences, so we keep our memories and the emotion attached to them, at arm’s length.

An indication that difficult experiences have not been processed may be flashbacks or nightmares, emotional detachment and avoidance –from avoiding places and activities to avoiding relationships and intimacy – and negative beliefs about ourselves and the world around us.

Therapy is based on an understanding that EMDR facilitates the processing of memories and emotions associated with trauma or adverse life events. Processing of life events is considered to involve communication between different parts of the brain, including our alarm or “fight or flight” system.

Therapy involves using bilateral stimulation (such as eye movements) within a structured framework to support the processing of memories of traumatic experiences and current triggers along with focusing on future events. It is understood that bilateral stimulation is connected to the biological mechanisms associated with rapid eye movement (REM) sleep. Just as we may use interventions to support the body to recover from physical trauma,
EMDR is considered to support it to process & recover from psychological trauma.

EMDR can lead to a reduction in the distress and state of high alert associated with memories of traumatic or adverse life events, a reduction in avoidance behaviour and a shift in the meanings regarding ourselves and the world which may be associated with the event(s). We do not forget our experiences, but they no longer have the same powerful impact.

EMDR is supported by ongoing research.

NICE (National Institute for Health & Care Excellence) recommend EMDR or Trauma-Focused CBT as a treatment for PTSD (post-traumatic stress disorder).

CAT (Cognitive Analytic Therapy)

CAT is an integrative therapy, in particular, it integrates CBT and psychoanalytic approaches.

It can be a helpful approach for individuals experiencing a range of difficulties, including depression, anxiety, or interpersonal difficulties such as difficulty in sustaining relationships.

It is a relational therapy. By considering our experience of relationships, including our early and current relationships, along with the therapeutic relationship, we can begin to formulate -or reformulate – how we construe relationships, both with others and with ourselves. For example, our experience of feeling not good enough for others, may be associated with experiencing others as finding us “not good enough” but also an “internal critic” telling us we are not good enough. Such experiences of relationships with ourselves and others can impact our mood and self esteem.

Along with this identifying how we construe relationships, therapy considers the strategies developed to manage these, such as striving to please others or not asserting our own needs. These strategies may have been essential, have been ways of protecting ourselves, but may have become “outdated” and can also inadvertently “backfire” in terms of limiting the fullness of our lives or relationships.

Therapy involves becoming more aware of these patterns, noticing them as they occur and considering how change might be achieved, how these cycles might be broken. This can involve anything from developing assertiveness skills to undertaking EMDR to process relational trauma.

Clinical Psychology

Psychology concerns understanding perception, thought, behaviour and emotion. Clinical psychology is a specialist area within this wider field of psychology, focusing upon understanding difficulties that individuals may experience and therapies to treat these.

Clinical psychologists first study psychology and then complete post graduate training in clinical psychology. This training involves developing knowledge and skills to equip them to provide therapy to individuals or groups across the life span and in different settings.

Once qualified, clinical psychologists may work in one or more area of psychology, for example, adult mental health, physical health or child and adolescent mental health.

Clinical psychologists provide evidence-based therapies, including CBT (cognitive behaviour therapy). They may have completed additional post qualification training in other therapies or areas such as neuropsychology.

Clinical Psychology is regulated by the Health & Care Professions Council (HCPC) and practising clinical psychologists are required to be registered with the HCPC

Mentalization Based Treatment (MBT)

Mentalizing is the process of making sense of ourselves and others in terms of underlying mental states – or how someone is thinking and feeling. It is what we do when we are imagining what might be going on in the mind of someone, underneath the behaviour that we see on the outside. Mentalizing is a uniquely human process, and it is something that we do automatically, often without conscious thought in our every-day interactions with others.

Increasingly mentalizing is thought to be one of the core processes that effective therapies have in common. When we are mentalizing effectively we are more able to make sense of our own and others’ behaviour, and to better understand the social world in general. Good mentalizing also helps us to regulate what we focus our attention on and to manage our emotions, to form a strong sense of self and develop good interpersonal relationships.

Mentalization based treatments place mentalizing at the centre of the therapeutic process. The aim is to promote mentalizing and resilience in individuals and families so they can feel better equipped to tackle the problems that brought them to therapy and to learn how to make better use of supportive relationships