Tag: Therapy Southwark

Frequency

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I talked a bit about how long counselling should be in a previous post but I didn’t mention frequency.

The most common is to have a weekly session. This is so that the client has time to process what may have come up for them and review where they are before the next week while still keeping things fresh in memory at the next session.

However, this a huge commitment for some people both in time and money so every two weeks has become something that a lot of people choose. I work online this way but not face to face for personal practical reasons. I only have office hours on Fridays so I would have to find two clients that would use the same slot on alternating weeks which wouldn’t necessary be easy, otherwise I would be wasting a time slot every two weeks.

However working online I do offer every two weeks as I can be a lot more flexible with my working hours that way.

I really wouldn’t recommend planning to work on a longer frequency than every two weeks. I believe it would make it very difficult to build a therapeutic relationship and then see change occur. It may be that after a period of regular therapy then the client would like some check in sessions after a longer period to see what progress has been made and if it is being sustained. This could be useful towards the end of an alliance once an relationship has been formed and worked on. However again for practical reasons I could only offer this online.

How long is long enough?

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How long is long enough?

It’s one of the hardest questions to answer from a client. How many sessions do you think I will need?

It’s just like the question how long is a piece of string?

I have worked with people who got what they wanted from one session, others needed years.

I recommend giving the start of therapy six sessions. This six session model has become a bit of a standard. It gives the client and counsellor some time to get to know each other which I believe is the most part of the therapeutic process. There is time to address a specific issue the client wants to focus on and maybe see some results.

I say maybe because it really does depend on the issue. For example, if the client wants to use the space to offload about some work related stuff that is going on, then this can happen.

Some clients have an initial group of sessions and then come back later. E.g. they may want a few techniques for improving their behaviour when they are angry. They can get these and then take some time to put these into practice. They may choose to continue therapy during this process or take and break and come back to explore the results.

There are some issues that clients bring that may have built up over years and may need longer term work. Low self esteem, anxiety, bereavement and depression can take time to work on and it’s impossible to guarantee the outcomes or how long it will take. But there are always exceptions to this and sometimes the six sessions are enough.

It may be that the six sessions are enough for right now and the client may find what they are really looking for is coping mechanisms for the present time so that in the future when they are in a better place they can address more of the underlying issues.

So the answer to the question is no real help I suspect for people. All I can say is that when people commit to the process I have seen real change occur and I believe it is possible for anyone. Give yourself time to heal from the wounds of the past.

Loneliness

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I found this article on loneliness very moving and sad. there are so many lonely people yet it seems harder and harder for us to make meaningful connections with each other.

Its an issue that affects all age groups. I know how distressing it can be for younger people and children not covered by this survey as well who find it hard to learn how to develop social connections in the first place. This then follows them throughout their life.

Its important to acknowledge the difference between being alone and being lonely. An introverted person may be perfectly content with spending a lot of time alone and yet have enough connections in their life to never feel lonely.

An extravert may be surrounded by people at all times yet feel they are missing meaningful intimate connections and feel desperately lonely.

Its a complex social issue that impacts so many of us, but it also gets hidden because of the shame that comes with admitting it. So many of us are pretending that we are ok. Comparing ourselves negatively to others who seem to have it all and not noticing that actually we are not the only ones experiencing it. It takes enormous bravery to say “I am lonely”.

Do you know what makes you happy?

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I’ve been doing some training (as counsellors always do a lot of additional training every year) and came across something called the Easterlin Paradox. It may be something you already know about but the name was new to me.

 

The basic premise is that while some money makes you happier, lots of it doesn’t increase your long term happiness. There are lots of fancy graphs online if you are interested in those but I found it gave me something to reflect on.

What makes me happy? What makes you happy? It may be different for each of us, but how often do we really take the time to explore it?

Giving ourselves the gift of time for self-reflection is such a valuable thing, possibly one of the greatest gifts we can actually give ourselves. Thats one of the things therapy gives us, the space for this self-reflection. To explore our values, what we really want out of life, what enhances our well-being and allows us to live a fulfilled – and happy life.

Why not give yourself that gift?

Reflective practice

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Have you heard of the term reflective practice? For counsellors it is incredibly important and plays a big part of our work.

As counsellors we have duty to provide the best service possible to our clients. You trust us with your inner thoughts and feelings, we have to respect that by ensuring that we give you the best of ourselves.

We have a number of ways to do that. The first comes during our initial training. We explore our own history in detail and attempt to identify our sore spots, the parts of ourselves that are difficult to revisit and cause us pain. This includes our prejudices and why we want to be counsellors.

But as we are only human we have to keep checking into these things and watching out for new things that may come up in our lives.

If a client brings something into a session that we can identify with but haven’t worked on in ourselves that will block the client from being able to deal with it. For example if we have had a bereavement that we are still struggling with we would find it very hard to stay in the clients frame of reference.

So we spend a lot of time reflecting on our practice and the sessions we have with clients to pick up any areas we need to develop. This can start with some initial reflections after each season but we also have supervision.

We are duty bound to our professional organisations to have a minimum of 1.5 hours a month supervision. During this time we look in detail at some of the things coming up in our work to ensure the client is getting the best service we can provide. This can be one to one with a supervisor or in a group environment to get different perspectives. Our clients anonymity is still held in this space, by that I mean that although we may discuss some of the things they bring to sessions they are not identifiable. Confidentially is still covered.

We also engage in a great deal of training each year to ensure we keep are professional knowledge up to date and we are working on the areas that we feel we need to develop. We identify these from our own reflections, from the sort of themes our clients bring and feedback both from clients and those we have supervision with.

All of this effort put into reflective practice means that as counsellors, we are working safely and within our competency levels. It also means that we can identify our limits and recognise when self care is required.

Social Anxiety and counselling

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What is social anxiety?

Social anxiety can be a crippling condition for those who experience it.

Can you imagine what it’s like to try and anticipate every social interaction you have, from the person you walk past in the street, to the man on the bus sitting next to you, to the woman in the shop. Not only are you anticipating what they might say but also what they think of you and what you could say to make them think differently and what they might then do and how you will look and what will they think of your voice and ….. breathe

Breathe

The thoughts have got out of control. It’s as though they have taken on a life of their own. You don’t want to be like this, but you are trapped.

Suffers may find it’s different groups of people or situations that trigger the anxiety and the thoughts. Having to give a presentation or a big meeting at work.

But it can just as easily be a casual invitation to a pub for a night out with friends.

Social interactions

If you are friends with someone who is suffering this, you may not realise just how hard it might be for them. They want to be with you, but sometimes their thoughts stop that happening. They want to have fun and relax in your company, but it isn’t always possible. If it feels sometimes like they aren’t being the friend you want, please don’t assume you don’t mean much to them. It might be because you mean so much, that your opinion is so valued that they worry about letting you down.

It can be really hard to get to know someone with social anxiety as they may be so busy trying to be who you want them to be that who they are gets lost. Or their thoughts will stop them being able to show you who they really are as they might be telling them how uninteresting and boring they are compared to you.

How to improve social anxiety

The thing is things can improve, the horrible irony is that it may mean doing the thing that they find most difficult which is engaging with someone new. Those first steps to contact a counsellor might be agonising.

And make no mistake, counselling can help. It’s not a magic bullet, it’s not going to wash all the problems away. But the experience of giving voice to anxiety with (hopefully) a therapist who is empathic, congruent and non-judgemental can help ease them. Being accepted, having your anxiety accepted is a good place to start finding ways to reduce it.

If you want to contact me but are finding it difficult to take that first step, just use the contact form or click the email button and mention social anxiety. I will understand how hard that has been for you and will get back to you as soon as possible.

 

Generalised Anxiety and counselling

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Are you a worrier?

What is that like for you? Is it everyone now and again, or does it happen most or all of the time?

Yes, its normal to worry, that’s true. But for some people that worry becomes excessive and uncontrollable. Lying in bed worrying about where you are going to find parking for the car when you go out at the weekend is the sort of things that might be deemed excessive and uncontrollable, especially if it happens every night of the week.

People who are suffering from generalised anxiety disorder may not even recognise it as that. You may always have worried and not realised how much more you do it to others. Worrying when something stressful is happening in your life is bound to happen, but if you worry as much when you don’t have a much going on might be a sign of anxiety.

Example of GAD

For example, parking the car above, if you are going somewhere new and don’t know the roads you might choose to check before you go. Once you have checked you can be content with that, or if you suffer from anxiety it might go something like this.

  • I’ve checked, but what if I misread the map.
  • I need to check again…
  • and again.
  • But what if all the spaces are full. What do I do then?
  • Is there a car park?
  • How much does it cost?
  • What if there aren’t any spaces in there?
  • Or I don’t have change for the machine.
  • How do I get change?
  • What if all this means I am late for my appointment?
  • What will I do then?
  • Will they wait for me?
  • What if they don’t.
  • Does that mean they resent me for messing them around even if they do wait?

And so on, as you can see one worry about knowing where to park can grow and more and more worries get added to it.

So, what can I as counsellor do to help?

One of the first things I do is exploring what anxiety is for you as it can be different for everyone. Some people will be having a lot of physical symptoms along with the thoughts, others won’t, or won’t necessarily realise they are.

Recognising your anxiety is important, understanding what you are worrying about and how often allows you to acknowledge what is really going on. A lot of anxiety is a bit stealthy and sneaky, we have thoughts we don’t even notice and I will work with you to shine a light on them.

I do this because it is easier to work on what we know than what we don’t.

I may then look at some coping strategies to use when you notice your anxiety growing to help you manage it when it is happening.

In the longer term, we can start exploring some of the reasons and beliefs you have that underlie your anxiety.

However, each client is different so I might adapt depending on what they are bringing.

I do know that counselling can have a long-term impact on reducing anxiety, for some people that can be achieved in a short timeframe of 6-12 sessions, other people need longer. It can be hard work but worthwhile.

 

Separation Anxiety

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You have probably heard of separation anxiety. Your child or a child you know may have found it difficult being away from their parent, it may have caused problems for them going to nursery or school. It may be something you feel is a normal part of growing up and becoming used to being more independent and some children just take longer than others.

Did you know though that it can still apply to adults?

For both adults and children, the diagnostics criteria are the same, but for adults the symptoms have to be persistent for a longer period of time. Typically, it is 4 weeks or more for children and 6 months or more for adults.

For adults, the symptoms may have been something that began in childhood and weren’t addressed but more often they are not. I’ve found a study that says approx. 77% of adults developed it in adulthood.

They can still be anxious about separation from a parent figure or caregiver, for example finding it difficult to take the steps needed to leave home and live alone for the first time. It can also though be about separation from a partner or even from their own child who may have moved away.

Exploring the fears that these adults are experiencing and the way they are limiting their ability to function is key to treatment. They may be coming across as controlling, dependent or overprotective and it could be having a negative impact on their relationships. Working on the issues in therapy can help develop healthier and more fulfilling relationships.