There is a strong tendency in modern mental health care to move quickly from identifying a problem to selecting an intervention. Sometimes that is entirely appropriate.

But psychological difficulties are not always straightforward problems with straightforward causes. The same symptom can arise from very different circumstances, and a person can have several things happening at once.

For this reason, I believe it is important to understand enough about the person and their circumstances before deciding what needs to change. This does not mean endlessly analysing the past or avoiding practical change. It means trying to make sure that the intervention fits the problem rather than assuming that the problem must fit the intervention.

Good psychotherapy requires both understanding and action.

Sometimes understanding changes something in itself. Sometimes it tells us what needs to change. And sometimes it tells us that psychotherapy is not the most appropriate form of help.

Clinical judgement lies in knowing the difference.

An Introductory Meeting is a no-obligation opportunity for us to meet, discuss what has brought you to therapy, and consider whether working together might be appropriate.

It gives you time to explain what you are experiencing, what you would like help with, and what you hope might be different as a result of therapy.

It is also an opportunity for you to ask questions about my approach and to get a sense of whether you feel comfortable talking with me.

I will also consider whether I am the right person to help you. There may be circumstances in which another therapist, service or form of help would be more appropriate.

You are free to stop after the Introductory Meeting. There is no obligation to continue.

Please note that an Introductory Meeting does not automatically lead to an assessment or a regular psychotherapy space. This depends on your circumstances, what you are looking for, whether psychotherapy is appropriate, and the availability of suitable spaces.

If we decide that assessment may be appropriate, I will ask you to read and sign my professional boundaries agreement before beginning an assessment. The agreement sets out the conditions under which we work together and provides a clear framework for the therapeutic relationship.

Psychotherapy Assessment

For people considering psychotherapy, the assessment is more detailed than that required for counselling. You will complete an initial form and we will explore your history, current difficulties, relationships, circumstances, ways of coping, and what you would like to change. A comprehensive assessment can take several sessions.

The purpose of assessment is not simply to identify symptoms or assign a diagnosis. It is to develop a clearer understanding of how your difficulties have developed, what may be maintaining them, and what might be helpful in addressing them. The assessment may also identify obstacles that could affect the work, as well as possible therapeutic tasks or areas to focus on.

At the end and throughout the assessment sessions, I will discuss my understanding of your situation with you and we can consider whether ongoing psychotherapy is appropriate and, if so, what form it might take.

If my practice does not appear suitable for your needs, expectations or circumstances, I will tell you and, where possible, suggest other forms of help you could investigate.

Counselling

If you are seeking counselling rather than depth psychotherapy, a comprehensive assessment is generally not necessary. We will still discuss your history, current difficulties and aims sufficiently to understand what you are looking for and whether counselling is appropriate, but counselling assessment only requires you to share your details via my assessment form without an in-depth assessment exploration thereafter.

Assessment does not automatically mean that a weekly psychotherapy or counselling space will be available. If psychotherapy appears appropriate but a suitable space is not immediately available, you may be offered the option of joining my waiting list.

If we decide to work together, sessions normally take place at the same time and on the same day each week, either in person or online.

Regularity provides continuity and allows us to maintain a clear focus while giving enough time for changes and understanding to emerge.

The nature of the work depends upon what you need.

Counselling

Counselling is generally more focused on talking through a particular difficulty, gaining perspective, exploring choices, or working through a period of change.

Psychotherapy

Psychotherapy is usually more exploratory and interactive, and may involve understanding longstanding patterns, relationships, attachment, trauma, emotional development, identity, ways of coping and other difficulties that have developed over time.

Depth Psychotherapy and Analysis

Where appropriate, the work may go further into the underlying causes from which difficulties have developed and continue to affect your life. This can involve looking at experiences that are not always immediately apparent from the surface of everyday life, as well as the ways in which you relate to yourself, other people and the wider world.

All of the work is collaborative and requires openness and engagement from both of us. It may sometimes involve considering things that are uncomfortable or difficult to recognise, but the purpose is to understand rather than to judge.

The approach and depth of the work are determined by your circumstances, your stated aims, and what we discover together, rather than by applying a fixed programme to everyone.

Sessions are normally 50 minutes once a week, but occasionally 90 minutes sessions may be possible when specific trauma methods are required to complete a piece of work.

Duration

The overall duration of therapy varies according to what you want to work on, what you want to achieve, and the depth of the difficulties involved.

Some work is relatively brief and focused. Other difficulties, particularly those involving longstanding struggles, complex or developmental trauma, ingrained relationship habits, may require a longer period of psychotherapy.

We can review the work as it develops and consider whether the current approach and frequency of sessions remain suitable for you.

A trial period of six weeks of initial work after assessment, also gives both of us an opportunity to establish whether we are able to develop a sufficiently collaborative therapeutic relationship.

Frequency

Frequency of attendance is dictated by your needs and clinical presentation. Normal attendance is one session per week, with a secured day and time slot reserved for you that you can rely on.‍ ‍You can also attend less frequently where spaces are advertised on the appointments page, but these may not be regularly available.

Psychotherapy is not intended to continue indefinitely without active reflection.

The work can be reviewed periodically to consider how things are developing, whether your aims have changed, what you have gained from therapy, and whether there are areas that still need attention.

You can also request a review at any time if you are uncertain about the direction of the work or want to reconsider your aims.

When you feel ready to finish, we can use the final sessions to reflect on your journey, consider what you have learned and what you want to carry forward, and address any remaining issues.

Patients can choose to stop therapy at any time. If possible, giving at least seven days' notice is helpful because it gives us an opportunity to bring the work to a considered conclusion rather than ending abruptly. Where appropriate, we can also discuss follow-up sessions or other ways of maintaining the progress you have made.

Ending therapy well is itself part of the therapeutic work. It can provide an opportunity to reflect on the relationship, the changes that have taken place, and how you want to move forward.

Psychotherapy is not suitable for everyone at every point in their lives.

There may be circumstances in which a person needs a different kind of support before undertaking depth psychotherapy — for example, during an acute mental health crisis, when there is a significant risk of harm or hospitalisation, or when current circumstances make any kind of therapeutic work particularly difficult.

Psychotherapy also requires a reasonable degree of willingness to participate in the process, to reflect on your own behaviour, and to take responsibility for your choices. This does not mean that you need to feel completely confident or comfortable about therapy. People often begin therapy with uncertainty, apprehension or mixed feelings.

What matters is that there is enough willingness to explore what is happening and to engage with honesty, and to work collaboratively together.

If I believe that another form of help would be safer, more appropriate or more likely to meet your needs, I will discuss this with you openly.