This counselling service is strictly:
• NOT crisis intervention (See important notice for emergencies).
• NOT for individuals who are currently abusing drugs or alcohol. In order to see me, you must already be well into your recovery, be clean and have a comprehensive and well-established support network. An individual psychotherapist in private practice is unable to offer the resources that people need when they are just starting on their recovery journey from serious addictions to substances.
• NOT for individuals with a serious psychiatric diagnosis such as bi-polar disorder, personality disorders, schizophrenia, psychosis, etc. I am simply not trained to work with these or similar conditions. Working ethically means working within my competency and training and not risking doing harm by attempting to use an approach that is inappropriate given the person’s diagnosis.
• NOT a substitute for necessary medical attention or hospital care.
• NOT a ‘repair shop’ for the mind. People are not broken objects like cars that need fixing in a garage. People are developing beings that need support to grow and develop.
• Please be aware that I cannot see members of the same family or people in other close personal relationships at the same time for individual therapy, unless it is in the context of family or relationship therapy. Working with individuals who are related or in a close relationship when it is not for relationship/family therapy, can compromise the quality of the therapy. As a professional I am able to maintain excellent boundaries, however there is alway an ethical concern that people would, consciously or unconsciously, limit or censor what they say to the therapist if they know the therapist is seeing another member of their family, a close friend, partner/spouse, etc. Once therapy with one person has well and truly ended, it can be possible to see other people from the same family or the other person in the relationship. This will only be done after careful consultation with the people involved and with the intent of safeguarding clients’ confidentiality and wellbeing.
• I do not accept referrals from EAP companies or other referral companies. I only work directly with clients. I can provide direct EAP service to employers. If you are an employer and would like your employees to have access to my services please contact me.
• I do not practice CBT (Cognitive Behaviour Therapy).
I am opposed to CBT as an approach to mental health and therapy for a number of important reasons, which I discuss below. I am writing about CBT here in some detail because of my concerns about the fact that the NHS offers it to everyone as a matter of routine and because a lot of people are misled to believe that it is an ‘evidence-based’ therapy and therefore a good quality or effective therapy that is suitable for everyone.
In Australia (where I trained and where I practiced for the first eleven years) psychologists specifically are trained primarily in CBT and not much else. Here in the UK there is this incredible idea that you can train nurses and other people who are otherwise not qualified mental health professionals to ‘administer’ CBT. This suggests that a therapist is a kind of a technician who administers a ‘cure’ to the client in the same way that a doctor might administer an injection to cure an illness. It also suggests that psychotherapy is something you can learn in a short training course and then be allowed to practice. While I do understand the need to enable access to psychological therapies to as many people as possible, I do not believe that this is an appropriate way to go about trying to help people who might be traumatised or otherwise in distress.
EAP companies (Employee Assistance Programmes) contracted by big employers offer a limited number of free counselling sessions to employees (typically five or six sessions) that the employer pays for. Most EAP companies require their counsellors or counsellors they sub-contract to use CBT because it is seen as a ‘quick fix’ that can get people back to work as quickly as possible. Remember that in EAP work the counsellor works for the employer not for the end client. It is the employer that pays the bill, not the person who sees the counsellor.
Effective therapy in EAP is not measured by whether the client is actually better, but by how quickly they can get back to work and perform their job regardless of how they really feel or what else is going on in their lives. While it is important for people to do the job they are paid for, if something goes wrong there are usually good reasons behind this and they have to be addressed. Focusing only on pushing people to get back to work as quickly as possible can do more harm than good and lead to long-term stress and to people taking more stress-leave.
My comments below are about CBT when it is practiced in its purist form. Please be aware that there are many therapists out there who say they practice CBT because it gets them contracts with EAP companies or the NHS, but in reality they practice better therapies and only pay lip-service to CBT. If you are going to see someone who says they practice CBT, it would help to find out if they practice it in its ‘pure’ form or if they just incorporate some CBT techniques in their work but primarily use other approaches.
Here is a summary of my thoughts on CBT
CBT is out of step with neuroscience. It is based on incorrect assumptions about mental health, especially: that thoughts create feelings, that there are ‘good’ and ‘bad’ feelings, that there is such a thing as ‘faulty’ thinking or that uncomfortable feelings are a problem to get rid of. CBT makes people assume that only nice feelings are OK and that not feeling good is a sickness that has to be eliminated.
I consider CBT harmful because it leads people away from the neural integration work that is essential for good mental health, development and recovery from trauma or other psychological injuries. It also constitutes ‘more of the same’ as most people have already tried to push their uncomfortable feelings away, ‘think’ them away, manage or control them. For good neural integration which is what’s needed for a healthy and fulfilling life, feelings need to be listened to properly as nature intended. In CBT feelings, especially the less pleasant ones are treated as a problem that needs to be controlled or eliminated.
Some feelings can be uncomfortable. But whether they are pleasant or not feelings are nothing more than information generated by our ancient limbic (mammal) brain about what’s going on with us. We need this information in order to live a full life, manage our adult responsibilities within a complex modern reality and make good, adult decisions. The more uncomfortable feelings are, the more we need to listen to them and they won’t go away until we do. Feelings are not in themselves a problem, or the problem, no matter how uncomfortable they are.
Feeling bad does not mean that something in your brain is malfunctioning but there might be something in your life now (or in your past) that does not (or did not) work right or is (or was) not good for you. Feelings are a reaction to our environment, past, present or both. It is the information that tells us about what’s going on in our environment and in our lives, or what went on in our past that we might need to start paying attention to. Most people’s limbic brains work exactly as they are meant to and do not malfunction. CBT essentially assumes that people are malfunctioning. It therefore, unfortunately, tends to reinforce people’s fears about their mental heath or sanity.
Please be aware that CBT is intended by its own definition only for symptom relief. It was never developed and was never intended for growth or development or for exploring the past, feelings, life, development or purpose. CBT is unable to help people work through the underlying causes of their problems. It is only intended to help people function, even if the conditions they live in are wrong or harmful for them. CBT might help to cope in the short term but in the long term the problems would still be there waiting and would usually be worse. CBT is really a form of counselling rather than psychotherapy.
Because pure CBT doesn’t work, I believe it can also cause further harm because it tends to leave people feeling even more like failures. Over more than two decades of practice, people have reported to me that the pure CBT programme, which involves filling in a lot of forms and paperwork, recording thoughts and feelings, etc. feels sterile, irrelevant and boring and the vast majority of people are unable to follow it.
This is not surprising at all because the brain only grows, develops and changes its architecture when we feel inspired and motivated and when there is energy in the therapeutic process (or in anything we do). To feel inspired and motivated and to feel there is energy in the therapy process the therapist has to be more than a technician but someone the client can really engage with. In pure CBT the therapist’s job is to administer the CBT ‘programme’ not to engage with the client in any other way.
CBT feels dead and deadening to people. But when a client tries to tell this to a CBT therapist or explain that they don’t like to fill in forms, they are made to feel that they are non-compliant and avoidant or even ‘difficult’. A purely trained CBT practitioner has nothing other than the CBT programme to offer. Pure CBT can therefore cause many people to conclude that their problems are too big or too complicated to resolve and that they are doomed to feel bad for the rest of their lives. Of course this can lead to an even bigger sense of desperation and despair than the original feelings that brought the client to therapy in the first place.
CBT can be especially harmful for people with trauma because it focuses entirely on the inside. It ignores the complex context of trauma and what caused it in each individual. It reinforces people’s belief that trauma is their fault and that regardless of what had happened to them or what was done to them, they should be OK. (See this brilliant TED talk by Dr Nadine Burke Harris who explains how Adverse Childhood Experience affects our brain)
In CBT the therapist is not interested in anything to do with the client’s history and pure CBT practitioners have no training in processing the difficult feelings and emotional and physical flashbacks that people with trauma can often experience in therapy and between sessions. In fact they would consider these to be the problem and see them as a distraction. I have had clients who were told by pure CBT practitioners that they should not express difficult feelings in sessions and that there was no room for these emotions in sessions…! People with trauma already tend to feel that their problems are their own fault and CBT risks reinforcing this message. (To read more about this, see a link to my trauma booklet below).
The vast majority of people are capable of much more than just symptom management. Most people are able to change the architecture of their brain — something we do each time we learn something new — in the ways necessary for growth and development and for moving towards a more fulfilling and satisfying life.
Here is what the great Existential Psychotherapist Professor Irvin Yalom has to say about CBT: “Yalom … expressed regret that so many new counselors work in environments that focus solely on cognitive behavior therapy (CBT) because it is labeled an evidence-based model. “CBT omits the essence of psychotherapy — the interpersonal nature of the therapeutic relationship …” (Full article is here)
And this too: “Someone’s got to do some more research, but I would really like to know: when a CBT therapist really gets distressed, who does he go see? I just have a strong sense it’s not another CBT therapist. I think he wants to go out and search for somebody who’s wise and can help him explore deeper levels. There’s probably psychotherapy research out there that I haven’t read, but it would be interesting to know that. If you come across the data let me know. I certainly see a lot of them in therapy.” (Full interview is here)
My core values are humanistic and existential and CBT is based on anti-humanistic/anti-existential values and principles:
Humanistic/existential therapy is based among other things:
- on a sense of equality between the therapist and the client, on an understanding that we are all human and all deal with similar difficulties and challenges. Therefore a good therapist shouldn’t be ‘playing a part’ in the therapy process but actually be real and engage with clients as a real human being;
- on the idea that most people already have the answers or insights into their problems and that nine times out of ten people know what it is that is going wrong with them, they just need the right environment to help them get clarity, face what they need to face and be offered ways to experiment with different ways of being in the world;
- on the idea that the client, not the therapist is the expert on the client’s world and life;
- on the idea that everyone has a need for their life and existence to mean something. People need purpose and life has to be about more than just ‘coping’ or surviving. No human being will do well psychologically and emotionally if all they have is a life that is focused only or mostly on survival and on coping, with little opportunity to fulfil their purpose or potential. Therefore for psychotherapy to be effective and useful to people it has to be approached fundamentally as a developmental process, not as a way to put a plaster over problems or to help people find better ’strategies’ to just ‘cope’ with life.
- on the principle that feelings are not an enemy to get rid of but are a valuable source of information about what is going on with us and that living a full life means being able to feel and experience everything, the pleasant as well as the unpleasant. When most people don’t feel good or are troubled they are not ‘malfunctioning’ but there are good reasons for how they are feeling.
There is more of course but I think this is a reasonable summary of the main principles behind humanistic/existential psychotherapy.
Effective and good quality psychotherapy from a humanistic/existential perspective often leads to people making important life-changing decisions. Sometimes it is necessary to make these decision to make sure we are choosing a direction that is likely to be more fulfilling and right for our full development not just for our survival from day to day. But a good therapist would never push a client in any particular direction. A good therapist would support his or her clients’ natural developmental process so they can make their own choices and move in the direction they need to move. CBT therapists presume to tell clients that their thoughts are ‘faulty’ and how to think ‘better’ about things… This assumes the therapist knows better than the client what is good or right for the client.
• I do not offer therapy by phone, email, Skype, or any other remote method except very occasionally to clients who I otherwise see or have seen face-to-face, and under certain circumstances if a client cannot make a face-to-face appointment. I do not have the specialised training needed to practice psychotherapy by remote methods or online.
• I do not offer symptom management or ‘techniques’ to manage emotions. My practice focuses on the real work that needs to be done in order to grow and develop. Symptoms begin to disappear as a byproduct of real and effective psychotherapy. What I pursue is integration (growth), not symptom reduction or management.
• I do not offer techniques like EMDR, hypnotherapy or EFT (the tapping technique). Nor do I offer shortcuts, tricks or ‘quick fixes’ simply because there aren’t any in human psychology. Anything that promises to re-wire the brain quickly is out of step with how our brain actually works. You cannot ‘fix’ psychological difficulties overnight for the same reason that you cannot learn a new language or skill overnight, no matter how hard you try. Change to any aspect of our being means changes in brain connectivity and structure. The human brain takes time to wire and re-wire itself. Just like with learning anything new, getting better at a new skill requires the right information, practice, repetition and reinforcement.
In terms of what the brain does in psychotherapy, psychotherapy in many ways is similar to any process of learning. Everything in the brain works according to the same principles. Neurones connect when they fire together repeatedly. They then form permanent neural networks in the brain that contain whatever it is we are learning and it becomes a part of who we are. In therapy the connections we need are between the executive brain — our most modern brain — and our ancient limbic brain where our feelings are generated. Real and lasting change takes time and a great deal of practice.
Therapy often takes longer for people who suffer from the effects of early trauma. This is not because they are stupid but because their brain has more to do and more to integrate than people who are fortunate enough to not suffer from the impact of trauma.
Practice of the right emotional skills (and there is right and wrong when it comes to emotions!) leads to neural integration between our executive brain and our limbic brain. Better neural integration is responsible for what we think of as good mental health, healthy self-esteem, healing, maturity, confidence, healthy boundaries, feeling grounded, fulfilled and peaceful. Therapists play an extremely important part in this if they offer a lively and energetic engagement and help clients process (meaning join up neurones) in a safe, creative, intelligent and supportive environment. (If you want to read a bit more about this, take a look at my booklets. The link is to Amazon UK but the booklets are available on amazon worldwide and also on Kindle.)
• About Facebook — Because of professional boundaries I don’t ‘friend’ clients on my personal Facebook page. (To learn more about professional boundaries please look at the Ethics page on this site.) Clients and members of the general public are welcome to ‘Like’ and post questions or comments on my Fully Human Facebook page.