Through feeling lost, scared, or desperate, increasing numbers of people are relying on Google, ChatGPT, youtube, and social media to self-diagnose their suffering, and get advice on what treatment A.I. tells them is ‘the best’, for a self-diagnosis that may actually be wrong. Many are wasting their time and money on treatments that are not appropriate for their particular presentations because they are failing to see or understand the real causes of their problems. The recent boom in people seeking ADHD and ASD diagnoses and medication is an example. With little understanding of psychotherapy and how the psyche works, and grasping at a psychiatric diagnosis that seems to fit, it can be tempting to choose medical-sounding ‘alphabet therapies’ (those abbreviated into three or four letters) that seem popular, in the belief that these are the best way to feel better. When the reality is they may be too restrictive and narrowly focussed on techniques that have been derived from broader, deeper approaches to psychotherapy. Technique-driven therapies also often invite patients to think of themselves as if the psyche, mind and body are like a machine to be adjusted by an expert using a mysterious technical procedure. This is a bit like taking a specific vitamin, when what may actually be needed for improved health is a lifestyle change including daily exercise, good sleep, a less stressful career, and an organic diet comprised of nutrient-dense foods.

Alternatively, patients may seek something broad like person-centred counselling only to feel frustrated at the absence of feedback, guidance, focus, or direction. Some try the magic pill approach via medication that suppresses their feelings and thoughts, only to feel mentally dulled, emotionally numb and lifeless. Each approach can have its merits and downsides, depending upon who you are, the practitioner’s experience and skill level, and what you need and are able to work with.

To add to the confusion, there are now growing numbers of therapies with weird and wonderful names, and people offering therapies and counselling, with widely varying levels of training, skills, and experience. It’s important to know what type of help you actually need, and the level of practitioner competence and experience required to address your therapeutic aims. Broadly speaking, here are some categories of help you might encounter:

Counselling: This generally involves gentle supportive listening and very mild, occasional challenge. It can be good for helping you reflect, deal with loss, and gently rebuild self-esteem when feeling fragile. However, some patients who need more input or active guidance and who want significant change can find counselling too slow, unstructured, and frustrating.

Psychology: A very broad range of activities that do not have a central consensus, but are ways of trying to understand the mind and behaviour by using experiments, theoretical models and statistics to draw conclusions about ‘the average person’. Some psychologists are trained to work with patients (counselling psychologists, for example). Others help advertising companies market goods and services. Psychology does not, therefore, automatically mean psychotherapy.

Psychiatry: a branch of medicine that attempts to categorise socially undesirable aspects of human nature into medical diagnoses. Treatment is often by prescribed psychoactive medication to suppress or alleviate symptoms. But ECT, psycho-surgery, detention and restraint are still in use today. Some psychiatrists do additional training and offer some form of psychotherapy.

Symptom-Management: All psychotherapies do this to some degree. The broad range of ‘alphabet therapies’ that have derived their techniques from psychotherapies and other fields, generally focus on one or two aspects of the psyche and specific symptoms. EMDR and CBT are common examples. Heavily promoted by insurance companies and government agencies, the public now tends to believe that these technique-based approaches are ‘the best’ or ‘the only’ ways of treating specific diagnoses, when this is simply not the case.

Psychotherapy: A very broad range of approaches that can vary considerably in their remit, and that often have a counselling element to their delivery. Some are more interactive, dynamic, and directive than others, and may work quite deeply on resolving the underlying causes of problems as well as the symptoms. Others are indistinguishable from person-centred counselling.

Analysis: Depth psychotherapy that seeks to identify and resolve the original causes of your problems by understanding the deeper influences within the psyche, your history, relationships and degree of honesty with yourself. Examples are Psychoanalysis, Existential Analysis, Jungian Analysis, which are very different from one another, but may share some similarities, depending upon the practitioner.

Genuine Openness to Change

Psychotherapy is, unlike medicine, not something that is done to you, but a relationship that encourages you towards the truth, kindling the desire to strive towards a better way of being. If you approach psychotherapy as if it is the therapist’s responsibility to ‘fix’ you, then you will likely struggle as you preserve familiar habits of learned helplessness and dependency that are, in fact, defeating you. If, on the other hand, you are willing to start therapy by taking full responsibility for your life, including your state of mental and physical health, and to face the choices you are making that maintain your suffering, and if you trust your psychotherapist to support you in facing the truth of your experiences, then you could benefit greatly from psychotherapy.

☞ Remember that psychotherapy is work, not passive listening or chatting. No matter what approach in therapy you choose, healing, change and growth ultimately come from being open to challenge, self-discipline, from facing feelings you may not be used to allowing in yourself, and from gradually stepping outside your comfort zone. If you have filled yourself up with fears to the point that you equate any challenge or deviation from your familiar ways of feeling, thinking or doing something as a threat to your life, then you are unlikely to gain very much from psychotherapy as you resist and avoid the initial, temporary discomforts that accompany changing, growing and actualising your potential. If you are this fragile, then counselling may be a better start for you.

Practitioner Authenticity

As our culture grows increasingly inauthentic and obsessed with appearances over inner substance, looking for a reliable service becomes more difficult. My inbox is inundated daily by emails selling fake review services and ‘reputation management services’, which is one of the reasons I’m no longer able to reply to email queries, as many emails that appear to be from new patients turn out to be from people selling something, for example. Patients must be aware of the unscrupulous nature of some practices, who perhaps being desperate for business and a need to appear special, resort to using fake reviews to boost their position in search results. My practice only publishes genuine reviews by patients who have actually worked with me, and I no longer attempt to promote my practice through advertising due to a strong personal aversion to the level of fakeness that exists in the marketplace these days. People who are looking for something real have no problem finding me.

If authenticity is important to you, be on the lookout for unusually high review numbers and reviews that don’t sound genuine. I’ve found accredited/ BPS registered psychologists around Glasgow, with unusually high numbers of 5 star reviews, using cut-and-pasted copies of my genuine reviews, which I’ve had to ask Yell.com to remove, for example. Beware of being conned.

Accreditation/ Registration

Psychotherapy in the UK is not regulated, but a counsellor or psychotherapist can voluntarily join a private management organisation, pay them a fee each year, and have their contact details put on their registers. This is ‘accreditation’ or ‘registration’. Currently, I choose not to be managed by a private company whilst it remains voluntary. Registration or accreditation neither guarantees practitioner conscience nor competence, in my experience in this field. However, if you prefer to see a therapist who is overseen by a management company, then by all means seek out a practitioner who subscribes to one. There are no shortage of practitioners in this category for you to choose from.

Assessment

Consideration of your particular history, needs, expectations, values, lifestyle, beliefs, self-care, and mindset, need to be taken into account to determine the right psychotherapeutic approach for you. This is done by professional psychotherapy assessment. Even one single session with an experienced practitioner could potentially save you a lot of wasted time, effort and money on misdiagnoses and the wrong therapeutic approach.

You can attend sessions in-person if you live locally, or online if you have a physical disability or illness. Or if you live elsewhere in the world. Appointments are booked the same way via the Appointments page.

I work online with patients from all over the world* including all parts of the UK, Europe, Canada, New Zealand, Australia and other places where English-speaking patients reside or travel. Wherever you live in the world and however you are travelling you can receive effective help and professional support at home or on the move: all you need is a laptop or smartphone with a decent broadband connection.

*Exceptions detailed on the appointments page

If you are on a budget and thinking that occasional sessions would be more affordable, I generally advise against ad hoc attendance due to the fact that it is very difficult to maintain therapeutic momentum with less than weekly attendance. Similarly, trying to address complex or long-standing matters in a few sessions is a false economy, and won’t tend to work. Fortnightly sessions, in my experience, extend therapy proportionally much longer than weekly attendance to achieve the same results. And trying to squeeze your needs into only a few sessions will only create stress and result in little, if any, real change.

My advice to patients where funding is a concern is to save some money, so that they can comfortably afford weekly attendance with an experienced, skilled practitioner offering the right psychotherapy, rather than fewer or cheaper sessions with someone less experienced or skilled who may be offering what ChatGPT says is the best approach. Like anything else in life, accurate assessment, quality and regularity of support are better value for money that ‘quick and cheap’.

☞ Ad hoc attendance is possible for counselling only. But sessions can only be booked when they are specifically advertised on the appointments page.

Alternatively, if money is tight, you could try asking for a referral to free NHS psychotherapy via your GP or psychiatrist. But where you might be fortunate enough to have an NHS Trust that actually offers psychotherapy, the NHS tends to focus on very brief therapy, and is often heavily dependent upon a few sessions of counselling or CBT, perhaps up to 12 sessions. Some NHS Trusts have a bit more of a range of therapies, such as psychodynamic, cognitive-analytic, or CBT-derived approaches like DBT. But again, typically NHS budgets only allow for minimal sessions, and in my experience of working as a psychotherapist in the NHS, both the types of therapy and the numbers of sessions offered are often inadequate to cater for patient needs. Waiting times also tend to be lengthy, and there is rarely scope for being able to choose who you work with.

Some charities may also be able to offer free counselling, or donation-based support. But again, the number of sessions offered is generally limited. I was a volunteer counsellor with Cruse Bereavement Care many years ago, who offered free counselling at the time.

Generally speaking, brief work is anything up to 12 sessions. Short-term work (up to 25 sessions) is more appropriate for counselling and symptom-management that focusses on specific symptoms and methods to address those symptoms. Medium- (up to 45 sessions) and longer-term work is required for depth psychotherapy, including Trauma Work, and for resolving the root causes of your symptoms.

Regular weekly sessions of 50 minutes duration are standard practice regardless of duration of therapy. 50 minute sessions allow you to concentrate on your goals at a steady pace, maintain momentum, develop new habits, and apply what you gain from each session during the week.

Various modalities and levels of support and challenge are available in this practice that are explained to you in detail so that you can understand what is best for you. You can adjust support and challenge at any time throughout your therapy.

Level 1

Counselling is the least challenging approach, offering the most space to explore your experiences with usually fairly gentle input from your psychotherapist. It can be helpful for making sense of an experience, for getting things off your chest, and for regaining perspective.

Level 2

Symptom-management is more structured, and focussed on containing, managing, regulating, channelling, and expressing your experiences, so that you can feel more grounded in yourself, with relief from inner struggles and tensions as you learn to self-regulate experiences that may have felt emotionally and mentally overwhelming.

Symptom management of trauma-related symptoms is also possible, using a variety of trauma-informed approaches, such as EMDR, BioFeedback Training, and EFT, specific yoga tuition, meditation tuition, stress release tuition, somatic awareness work, and other specific protocols developed by this practice. Trauma Work is not simple symptom management, however, and must be done within a therapeutic relationship where trust and understanding have been well established between patient and therapist to make the work secure and effective. It thus requires support and challenge at level 3 and above.

Level 3

Integrative Psychotherapy - as I practice it* - can help you bring your mind and body into harmony, reducing the internal struggles you have with yourself and others that may appear as addictions, phobias, social anxiety, relationship problems etc. The somatic or body focus of psychotherapy can help you heal your nervous system and strengthen your ability to manage and ground your life around self-care, greater meaning and purpose.

Patients who benefit from Integrative Psychotherapy the most are those who place greater value on long-term truth and harmony, than on short-term comfort or pleasure, and who prefer more interaction and open collaboration with their psychotherapist than is commonly offered by conventional approaches. Patients who are open to having their lifestyles, beliefs, habits, assumptions and self-defeating behaviours explored, and challenged when appropriate, will readily make gains in depth psychotherapy. (Those who remain defensive and resistant to change and any challenge to their comfort zone will benefit little from any form of psychotherapy, in my experience). New skills and awarenesses can then be formed for greater authenticity, self-reliance, self-respect, better self-care, self-confidence and clarity of purpose in life, as you turn your fears and insecurities into confidence and courage.

Level 4

Existential Analysis - as I practice it* - is a form of depth psychotherapy that goes deeper into the psyche by looking at the internal and external dynamics that create your life struggles, and the bigger perspective of your place in life personally, relationally, culturally and spiritually. Analysis can be as challenging and supportive as you need it to be. But the deeper you go into your psyche the more honesty and courage are required of you in the relationship. Many people, for example, like the idea of being more authentic, but far fewer are able to rise to the challenge because it is scary and difficult to do so in a society that has conditioned all of us from childhood to confuse and conflate our identities with the social masks we have rehearsed and worn all our lives. This ‘appearing to be genuine’ starts in childhood with people pleasing. Many people say they want to be more authentic, for example. But in our society this often means creating a more authentic-looking appearance, rather than actually becoming more honest or genuine in our thoughts, intentions, words, or actions. This is a common fallacy of revising one’s social mask as a make-over, rather than working to deepen one’s inner truth, courage, integrity, and conscience so that one’s outward actions are driven from the inside-out. Great honesty, however, allows you to face and resolve deeper conflicts that drive more enduring problems and to develop the courage to live with greater wisdom and integrity.

Level 5

For the braver, working on your personal authenticity can include electing to address and resolve your the less appealing aspects of your Ego, personality and habits: things that most individuals make great efforts to conceal or deny in themselves. Again, many people convince themselves they want to be more authentic, but then balk when challenged, as they realise that qualities they have denied, suppressed or tried to hide have, in fact, been visible to others all along. Facing denied aspects of the psyche (some call this ‘Shadow Work’) is very challenging when done properly. It is not designed to make patients feel comfortable or good about themselves, but to face the emotional discomforts of truths they have been routinely denying within themselves. Facing one’s darkness at least allows us to accept what we find hidden, and to start the process of transcending and growing through previously denied aspects of our Ego. These denied aspects drive destructive behaviours we push out of awareness.

Whilst very challenging, some of the many benefits of this deeper work on the Ego include resolving both personal and culturally-acquired narcissism. Illumination of the shadow brings greater inner peace and feelings of wholeness for most people, as the direct result of fostering greater personal integrity and honesty. Enduring security and a surer sense of identity typically follow, with genuine confidence founded on reality rather than on maintaining a facade or fantasy about oneself; greater humility, clarity of one’s true values and purpose, a deeper and more courageous trust in your own personal wisdom and intuition. Greater authenticity gives us the opportunity to drop the false social masks that often drain our energies, ruin our intimate relationships, deepen our insecurities, and defeat our efforts to realise our true nature and potential.

Level 6

The deeper we travel into authenticity, the more the spiritual relevance of one’s life becomes apparent. This is the level at which existential awareness helps us see the landscape of our lives with greater perceptual clarity and a felt sense of intuitive knowing and perspective. It becomes possible to live with greater meaning; going deeper instead of of allowing the Ego to race further ahead. Even if your worldview is firmly rooted in atheistic or scientific beliefs, the spiritual dimension remains just as relevant at this level. It is often only the vocabulary that is different. And by ‘spiritual’ I’m referring to something quiet, expansive, personally meaningful and serious, not a New Age religious veneer or fashion statement we adopt externally to make ourselves appear spiritual. Genuine spirituality tends to be inwardly private, humble, genuine, and self-effacing, not outwardly showy or pretentious.

What level is right for you?

If you only need to focus on your everyday life struggles with much less effort and challenge in sessions, then opting for counselling may be a good place to start. If you have neglected yourself for a longer period of time to the point where you struggle with discreet and difficult symptoms, then symptom-management might be best for you as a starting point until you can go deeper into what is causing your symptoms. If you want challenge, depth and resolution of the root causes of your life difficulties, and are willing to do the work, then depth psychotherapy will suit you. Depth work can stay at Level 4 or go deeper if you want. You can work at any and all of these levels of support and challenge within this practice according to your specific needs. If you are an intelligent, conscientious person who values living with greater personal integrity, then depth psychotherapy will suit you well.

*These approaches are not formulaic methods practiced from text books or learned on courses. Practitioners formulate their own ways of working based on core values and principles rather than fixed protocols or psychological tricks and techniques.