Schedule a Visit

Call us:

01223-350-175

Send an email:
hollowayjcr@hotmail.com

8 months ago · · Comments Off on The sort of therapy I offer

The sort of therapy I offer

Many clients seeking in-depth talking therapy will already have been through Cognitive Behavioural Therapy. CBT is symptom-focussed and uses standardised techniques which make it testable. This makes it the treatment of choice in public health systems*.

 

The main strand within in-depth talking therapy is psychodynamic psychotherapy which means therapy derived from psychoanalysis. When this is standardised (a process that is at odds with its interpersonal character) to facilitate testing

 

I offer the following discussion of psychodynamic therapy’ because its necessary to have a label, but the tradition I work in is something to help me. It helps by orienting and deepening my thinking about personality. Hopefully its not important or particularly apparent to the client, because no-one gives the time and resources necessary for therapy because they want a ‘tradition’: you want to feel held and understood, look yourself in the eye, and feel better and more firmly rooted. You must be the complete focus of the work – you provide the material, the focus for each session and the therapy takes place in the language you use, certainly not in the language of my theoretical tradition.

Psychodynamic Psychotherapy

Psychodynamic psychotherapy draws on the theories and practices of contemporary psychoanalysis and Jungian analysis, which have the most extensive base of clinical experience and theoretical foundation of any mode of therapy.

 

As a therapeutic process, it sets out to help patients understand and resolve their problems by increasing awareness of their inner emotional life and its influence over their relationships.

 

There is an important first level in the work: the level where what is distressing or preoccupying the client is closely attended to. But, it works at others, including the direct level of experience, because (alongside our genetic inheritance) everyone is formed by experience, and can be changed by experience. Neuroscience has its own concerns, but broadly it confirms the two main premises of psychoanalysis: that emotion is the core of how animals, including human beings, experience life; and that the experience of our early relationships sets-up our emotional responses in later life*.

 

Since Freud and Breuer made the first steps around a 120 years ago, psychodynamic/psychanalytic psychotherapy has changed a great deal. In particular sex is much less important, but something Freud and Breuer discovered (to their discomfort) in relation to sex has taken over: that the client, however subtly, brings their precise emotional habits to bare on the person of the therapist.

 

The normal flux in human relationships is full of live emotion (like, like less, love, resent, disagree with, envy, feel smothered by…). Speaking analytically, it is the client’s relationship that is most vividly available to us for seeing what emotions are active. Its the unconscious ones that interest us most. They are unrecognised,  perhaps because they haven’t been given enough attention or because they are, for one reason or another, not things we wish to recognise. But they can drive us, and knowing they are driving us offers us the chance to take control of the situation using our intellectual power.

 

That written, it is important to realise, although intellectual analysis can create insights that are very interesting and allow us to change simple processes, it can’t change a person’s emotional makeup. Just knowing something about your emotions and controlling it puts an emotional cap-stone on it. What changes people is what sets them up in the first place: relationship with other people.

 

Psychotherapy is a longterm exercise in relationship. Done properly, it is a real (if carefully boundaried) relationship, and we know that both parties can be changed in a real relationship. A lonely person can be comforted, an angry person stilled, a self-obsessed person can learn to love, a depressed person can reconnect with what is good in the world, an envious person can learn simple appreciation… The relationship is by far the most important thing.

 

The therapist is not under analysis themselves from the client (although Ferenczi experimented with this). This is partly to give us the privacy we need for the work to be possible for us, and partly because not talking about ourselves allow us to focus on you. But we are live and present in the relationship. We cannot heal unless we are. I am describing something very unusual, yet completely human: one very highly skilled person dedicating themselves to feeling and thinking with another.
* Fonagy, P. (2015). The Effectiveness of psychodynamic psychotherapies: An update. World Psychiatry 2015 June 14(2): 137-150
** see for instance Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Lawrence Erlbaum Associates, Inc.

 

Choosing a Psychotherapist

What is the difference between counselling, psychotherapy and analysis?

There are three main sorts of talking therapist: counsellors, psychotherapists and analysts. I am a psychotherapist, which means I am qualified to conduct counselling as well as psychotherapy, but not analysis.

 

There are two quantifiable factors that distinguish counsellors, psychotherapists and analysts: the therapist’s level of training, including the amount of experience they are likely to have had themselves as a patient in a training analysis, and normally the frequency and duration of treatment.

 

  • Counselling is therapy one or fewer sessions per week for a limited period generally working on a particular symptom or life situation. Counsellors tend to have a shorter and less intensive training and, recently, some of the regulators removed the requirement for counselling trainees to have any therapy themselves which will make the distinction with psychotherapists greater over time.
  • Psychotherapists are trained to graduate level and beyond. Like a counsellor, a good psychotherapist will work with you on what is happening in your life at the moment, but they will also be able to help you find connections between whatever is going on now and the underlying patterns, beliefs and expectations in your life which can then, over time, be better understood and resolved. They may notice the significance of something you had never really thought about before, and may be able to help you recognise and process any unspoken distress that is stored inside you. They do this partly because all good trainings require therapists to have had at least as much therapy as the patients they are qualified to see. Psychotherapy is one, or two sessions a week and ends when the client feels enough work has been done.
  • Psychoanalysts and Jungian Analysts are therapists who have had their own analysis for at least four years alongside a more extensive clinical and theoretical training than psychotherapists. Treatment involves sessions three, four or five times a week and are used by those requiring an especially high level of attention. Although this very intensive mode of treatment has developed enormously in both theory and practice, in intensity it is the same as that invented by Freud 120 years ago, and he invented it for people with more resources and time than are usual today. It is a huge commitment, but life-changing work can be done, usually strongly focussed these days on the relationship between the patient and the analyst.
There are a lot of counsellors, fewer psychotherapists, and very few analysts.

What should you look for and expect in a psychotherapist?

Psychotherapists hold a position of great responsibility towards their patients, and should be registered with one of the reputable national bodies such as the British Psychoanalytic Council. This ensures that your psychotherapist has undergone and satisfactorily completed a lengthy clinical training and that they are appropriately monitored, insured and supervised. It also means that they subscribe to a recognised Code of Ethics, ensuring that, if you should at any time have a problem with your therapist, there is a body to whom you can appeal who will take your problem seriously and offer you a way forward.

 

There are some things you should always expect:

  • your therapist to offer regular sessions in a room that is private, comfortable and reliable.
  • they must ensure confidentiality is maintained to the highest of standards.
  • they must treat you with care and respect, listening carefully and interpreting what you say constructively.
  • and, they must keep good boundaries, especially personal boundaries, so the work can continue safely at the depth and intensity that the client requires.

 

Finally, when you are thinking of starting therapy, I recommend you hold initial consultations with a couple of psychotherapists. Reputable therapists will generally offer initial consultations as an opportunity for both of you to ask any relevant questions, decide if working together is likely to be fruitful and feels right.

8 months ago · · Comments Off on Choosing a Psychotherapist

Choosing a Psychotherapist

What is the difference between counselling, psychotherapy and analysis?

 

There are three main sorts of talking therapist: counsellors, psychotherapists and analysts. I am a psychotherapist, which means I am qualified to conduct counselling as well as psychotherapy, but not analysis.

 

There are two quantifiable factors that distinguish counsellors, psychotherapists and analysts: the therapist’s level of training, including the amount of experience they are likely to have had themselves as a patient in a training analysis, and normally the frequency and duration of treatment.

 

– Counselling is therapy one or fewer sessions per week for a limited period generally working on a particular symptom or life situation. Counsellors tend to have a shorter and less intensive training and, recently, some of the regulators removed the requirement for counselling trainees to have any therapy themselves which will make the distinction with psychotherapists greater over time.

– Psychotherapists are trained to graduate level and beyond. Like a counsellor, a good psychotherapist will work with you on what is happening in your life at the moment, but they will also be able to help you find connections between whatever is going on now and the underlying patterns, beliefs and expectations in your life which can then, over time, be better understood and resolved. They may notice the significance of something you had never really thought about before, and may be able to help you recognise and process any unspoken distress that is stored inside you. They do this partly because all good trainings require therapists to have had at least as much therapy as the patients they are qualified to see. Psychotherapy is one, or two sessions a week and ends when the client feels enough work has been done.

– Psychoanalysts and Jungian Analysts are therapists who have had their own analysis for at least four years alongside a more extensive clinical and theoretical training than psychotherapists. Treatment involves sessions three, four or five times a week and are used by those requiring an especially high level of attention. Although this very intensive mode of treatment has developed enormously in both theory and practice, in intensity it is the same as that invented by Freud 120 years ago, and he invented it for people with more resources and time than are usual today. It is a huge commitment, but life-changing work can be done, usually strongly focussed these days on the relationship between the patient and the analyst.

There are a lot of counsellors, fewer psychotherapists, and very few analysts.

What should you look for and expect in a psychotherapist?

Psychotherapists hold a position of great responsibility towards their patients, and should be registered with one of the reputable national bodies such as the British Psychoanalytic Council. This ensures that your psychotherapist has undergone and satisfactorily completed a lengthy clinical training and that they are appropriately monitored, insured and supervised. It also means that they subscribe to a recognised Code of Ethics, ensuring that, if you should at any time have a problem with your therapist, there is a body to whom you can appeal who will take your problem seriously and offer you a way forward.

 

There are some things you should always expect:

– your therapist to offer regular sessions in a room that is private, comfortable and reliable.

– they must ensure confidentiality is maintained to the highest of standards.

– they must treat you with care and respect, listening carefully and interpreting what you say constructively.

– and, they must keep good boundaries, especially personal boundaries, so the work can continue safely at the depth and intensity that the client requires.

Finally, when you are thinking of starting therapy, I recommend you hold initial consultations with a couple of psychotherapists. Reputable therapists will generally offer initial consultations as an opportunity for both of you to ask any relevant questions, decide if working together is likely to be fruitful and feels right.

9 months ago · · Comments Off on Types of therapy I offer

Types of therapy I offer

Open-ended Psychotherapy

There are times when it’s necessary to examine what has happened in our lives, and work through the emotional factors affecting us. Often, but not exclusively, these are at times of crisis. Psychotherapy helps contain crises and seemingly unmanageable emotional states that may be long-lasting, and approaches them as important opportunities for personal growth. Treatment is open-ended to allow space for a lot of the self to be examined, often, returned to, and slowly made more manageable.

   

Counselling

Counselling is therapy held once a week over a pre-agreed number of weeks. It can be important and efficient at times of trouble. We usually focus on a specific issue, for instance a predicament you are in or a symptom such as anxiety. We look at how your life experience and unconscious emotions determine how you are approaching things. This increases your freedom to think and act.

   

Online Therapy

Meeting online is different from meeting in person, but it is very helpful, especially during the Covid-19 crisis when it is impossible to meet in person. It uses straight-forward and secure technology. Clients from anywhere in the UK are welcome for online counselling.

 

9 months ago · · Comments Off on The sort of therapy I offer

The sort of therapy I offer

I practice from a psychoanalytic stand-point. That is in the tradition started by Freud and Breuer in Vienna in 1890s, but enriched over billions of client hours to the 2020’s by practicing therapists, and crystallised by writers like Jung, Klein, Bion, Winnicott, Bowlby, Lacan and Bollas.

 

Freud and Psychoanalysis are names that dominated mental health care in the twentieth century, but they carry a lot of baggage. Freud was a superstar and his conceptions of human nature have, by now, diffused into every part of our culture where they are difficult to see because they are so integrated. But ideas like the structure of the psyche (the Id, Ego, Super-Ego) or the Oedipus Complex – which is a very helpful and flexible framework for thinking about the family and internal dynamics that established a person’s character – were misrepresented by Freud himself who set them down as established fact, rather than ways of thinking about consciousness.

 

Early psychoanalysis, particularly its (now reduced) focus on sex, excited massive resistance from all but the free-thinkers of the day, and the early analysts had to fight. This made them set theory in stone rather than seeing it as a constantly evolving body of fascinating and difficult thought which the therapist keeps at the very back of their mind to help them make sense of things. Psychoanalytic theory is by far the most developed of any mode of psychotherapy, and there are many. But to my mind theory has little direct therapeutic value, beyond helping me think more deeply into the complexities and difficulties of the person I am treating. It keeps my mind sharp. But for the client, if generalisation is even possible, it is the experience of being known, thought about and held securely in the therapist’s skilled attention as they work through the incredible difficulties and complexities of their character that is therapeutic.

 

Working in a university town, it is perhaps worth noting before moving on, that psychoanalysis, as a huge repository of thought about how minds work has been plundered as an intellectual tool box in the social sciences and humanities. Regrettably this has largely disconnected the theory from its roots as an approach to help understand individual people and their distress. There is no heart in psychotherapeutic theory without the client, and it is practically meaningless unless you understand the link. This is why many people can’t understand theory until they have experienced being a client. I couldn’t.

 

The thing that survives in my consulting room almost intact from Freud is the framework for the analytic meeting. It is a confidential meeting of two people for 50 minutes governed by a private contract and fees agreed between us. It is personal. The normal noises of life come into the room, but the focus of both is on the client, taking their inner life in and gradually and gently making known the unknown/unappreciated/unconscious emotions that are driving their experience of life – getting a handle on them. With a handle on, they can be understood and reacted to by the client, sometimes mourned; and empathised with and accepted by the therapist, helping draw the poison. This is work from the heart from both sides.

 

Jung emphasised the point that the therapist is alive and changed by the client’s hidden love, hate, anxiety, envy, mistrust, guilt, grief… and by being alive and open to the client, makes the client amenable to change themselves. Keeping good boundaries, for instance not touching and keeping sessions to the allotted length, normally 50 minutes, allows security for the client to trust the therapist with their inner life and for the therapist to take it into themselves deeply without being overwhelmed.

 

Powerful emotions can come up safely in the relationship between the client and the therapist in an interaction called ‘transference’. The study of the client’s transferences, which is done less in counselling and more in my open-ended psychotherapy, is the hallmark of psychoanalytic therapy. What does it mean? Someone might be pained by the behaviour of, say, a shop assistant or a colleague toward them; or they might find working remotely unbearably lonely. The pain they feel is the action of an emotionally charged expectation learned by that person, frequently in childhood, and ‘transferred’ onto an ordinary situation. In normal life these transferences are ignored. In therapy the client’s feelings about the therapist can be discussed. Certainly the therapist is studying them because they are complex and ever changing, like sunlight on water. Transference is an immensely eloquent expression of the underlying emotion that gives character to how the client experiences their life.

 

Contemporary thinking about the brain – which has an anatomical form and functioning structures shared by all humanity – supports the premise of ‘transference’ although it is individual. The brain is patterned by individual experience, particularly in childhood when its plasticity is greatest. One of the main characteristics of the brain and nervous system is powerful affect, or emotion. Hunger, for example, is experienced as a physical pang in which emotion is an integral part. The human mind in its complex contemporary setting is the same mind that experiences real fear at the prospect of not having enough to sustain them for a couple of hundred thousand years, and still does. My sort of psychotherapy seeks to access this level of emotion.

 

In today’s intellectual environment, science and the public services demand evidence that can be generalised and made accessible to numerate analysis. ‘Transference’ is personal, or ‘subjective’, and thus impossible to pin down in this way. Fortunately Attachment Theory, pioneered by Bowlby and carried forward in academic science and in the NHS by the work of organisations like the Anna Freud Centre and Psychoanalysis Unit at UCL, is amenable to numerical analysis. This provides an isthmus between psychoanalytic therapy that is very personal and subjective and a scientific climate that requires data. Examples of the data driven studies of the efficacy of psychoanalytic therapies have been conducted by the NHS Tavistock and Portman mental heath trust, and the University of Colorado. I include the later because it says a bit more than I want to here to define the characteristics of this sort of therapy.

 

I see such studies as my profession addressing government commissioners of healthcare or insurance companies. I’m glad it is being done, but for me on the ground what matters is that my clients are using therapy as an opportunity to  to work through their suffering and suppressed emotion and understand their own character; and that this deepens their potential to manage their personality and suffer what Freud called the ‘normal miseries’ of life (loss, aging, death) with greater resilience, and to reduce the amount of pain and energy expended in sometimes intricate knots of defence that they have created to protect themselves from hurt.

 

The last point I want to make is that this sort of therapy was designed by doctors to make people feel better, but it is not an intervention like administering a drug. It takes time and is about enlightenment regarding yourself and the way you interact with the world, other people and the frequently extremely hard realities of life. It is a privilege for both parties in psychotherapy to be part of the process.

12 months ago · · Comments Off on Psychodynamic Psychotherapy

Psychodynamic Psychotherapy

Psychoanalytic or psychodynamic psychotherapy draws on theories and practices of analytical psychology and psychoanalysis. It is a therapeutic process which helps patients understand and resolve their problems by increasing awareness of their inner world and its influence over relationships both past and present. It differs from most other therapies in aiming for deep seated change in personality and emotional development.

Evolution of Psychotherapy

1 year ago · · Comments Off on Evolution of Psychotherapy

Evolution of Psychotherapy

Three takes on the experience of psychotherapy

Much of the talk about psychotherapy in Britain today is dominated by the idea that it is a medical intervention providing strategies for coping with psychological conditions that are defined by their symptoms. Alleviating painful symptoms is very valuable, and the speed of an approach that says “contain the symptom and the main part of the job is done” is appropriate for a public health system treating millions of people. But – although symptoms are alleviated, and lives saved – that is not the goal of psychotherapy.
A very different understanding of what it’s about comes from the German poet Rilke at beginning of the twentieth century:
“If you were in some prison the walls of which let none of the sounds of the world come to your senses—would you not then still have your childhood, that precious, kingly possession, that treasure-house of memories? Turn your attention there. Try to raise the submerged sensations of that ample past; your personality will grow more firm, your solitude will widen and will become a dusky dwelling past which the noise of others goes by far away.”
From the perspective of modern psychotherapy, Rilke is over-stating the importance of childhood, which, although very important, is one of several arenas for exploration, including your current relationships. But early in the twentieth centuries the focus was on childhood more directly, and the early psychotherapists would have read Rilke’s Letters to a Young Poet. Freud knew him.
As medical doctors they naturally translated his call in health terms, and the ‘prison’ is a good image because it captures the idea of constricted space, disconnection from love, suffering and loss of freedom that frequently characterise conditions like depression, anxiety, eating disorders, and many others. As in modern Britain, this medicalisation of psychology did a lot of good, but the early therapists didn’t lose sight of the fact that looking inward is a poetic endeavour as well – the healthy, deepening personality as a worked-for and invested-in creation of the self.
Before we move onto the third of these perspectives on psychotherapy, it seems necessary to put our finger on a paradox: when we are imprisoned emotionally our relationships are impoverished, yet the treatment is to look inward. Following Rilke’s path down into ourselves, we gradually learn to re-connect to other people more creatively, freely and truly.
Finally, an animated film written and narrated by the popular philosopher Alain de Botton makes the point more clearly, “knowing how to live isn’t an instinct. Its a skill” that has to be learnt.

Online Counselling is the same, and different, but it works as well

1 year ago · · Comments Off on Online Counselling is the same, and different, but it works as well

Online Counselling is the same, and different, but it works as well

Psychotherapists and their patients have been working together by sitting in the same room since the beginning in Vienna more than one hundred years ago. Things have come a long way, and Freud wouldn’t recognise the gentle, if realistic, process of uncovering what the patient brings, not in the light of theories, but in the context of the client’s complex and subtle individual experience.
The Room, which was essentially the same for the last 100 years, has changed in the last 100 days, and this awful epidemic has shown that online counselling and psychotherapy – although different – work really surprisingly well.
In those days, if you wanted to find a good therapist you had to live near a great central European city – Vienna, Budapest, Berlin, Zurich; even in the 1920s there were only a handful of psychotherapists in London and a couple in Edinburgh.
There are still parts of the United Kingdom where it is very difficult to find a therapist who is well qualified and has been through enough work on themselves to tread the pathway downward into your own unconscious with you.
What has been unexpected during the Covid-19 outbreak was how possible it was for therapist and client to connect and co-operate in the way that is needed on their joint task – through Zoom.

Online Counselling and Online Therapy

Of course, online counselling, online therapy and online psychotherapy are different from working together in the room. The very private, neutral, and protected space of the consulting room can not be replicated online. Being there in the room together physically is emotionally containing. The journey to therapy is a ritual and time to think into and out of your session. These are some of the things that are lost with the move online.
But the outbreak has shown us that they are partly made up for by certain advantages: Working from your own home or office, somewhere you are responsible for the environment can also provide material, which otherwise we wouldn’t get, for us to use in understanding your inner world together. The physical distance allows different things to be said and experienced. And the convenience of having your therapy where you are is something helpful so long as the space is protected properly.
And some things are the same: The work is still an intensely personal and a shared endeavour. Consistency and privacy in the space you speak from is still important. Knowing that you are talking in complete confidence with me is still a necessary condition for the work.
You can always get in touch with me to talk about COVID 19 counselling, online counselling, and online therapy and how this can help during the current crisis.