What to expect from a therapy session (Short term)

My short term counselling model consists of 12 sessions. I always agree a set focus with the client, this is done in the initial assessment. I let the client know that whatever comes up during the sessions I will always bring it back to the agreed focus as that is what we will be resolving.

If something comes up during the counselling that does not relate to the focus, I acknowledge that we cannot explore that and bring the counselling back to the focus. The reason for having a focus in short term counselling is to be able to resolve anything in a short amount of time there needs to be a focus. 


What to expect from a therapy session (Long Term)

When you come to a session we will explore what ever you bring to a session. Unlike other modalities such as CBT there are no pre agreed objectives for the session. At first some clients find this daunting as they are unsure what to talk about. But this process becomes more familiar over time.

It is up to the client to bring what ever they feel they want to talk about. Some clients worry about the relevance of what they are talking about however everything a client says is relevant and it is up to me to help you to make sense of what your saying and to gain a deeper understanding of yourself.

Sometimes there will be silences in the session and that is ok. At first there maybe a degree of discomfort for the client to sit in silence but it is important that the client is allowed to feel safe in the silence and not feel they have to talk for the whole 50 minutes if they do not want to. There is no right or wrong way to be in a session.

How talking about your feelings can help!

As humans we experience an array of different emotional states. These differing states can take us by surprise or we can expect them. We are very complex creatures with the ability to feel more than one emotion at any given time. Just think how many times you have felt angry and sad at the time towards the same issue.

Emotions play such an important part in our lives but it is often the part of ourselves that is least talked about. Experiencing different emotional states can feel overwhelming and cause anxiety. Talking about what you are feeling is vital in order to move forward and to gain some understanding about what your emotions are trying to tell you.

What is the unconscious?

The unconscious is a state of mind that is different from the conscious. Your unconscious is something that you are not aware of. Whereas you are aware of what happens in your conscious for example making dinner.

What lies in our unconscious ultimately influences how we behave to ourselves, other people and how we view the world. Things that are too traumatic or frightening to process usually get pushed into the unconscious (repression).

What to expect from psychodynamic therapy?

Most people who start seeking therapeutic help are unaware of the different modalities that exist and as a result misconceptions can be made. Psychodynamic therapy consists mainly of exploring and understanding your feelings towards yourself and others.

Some people believe that they will be forced to explore their past in detail. This is not the case, the past will only be explored if the client chooses to bring it up. The sessions consist of exploring what ever material the client chooses to bring up.

I understand that many people who seek therapy want help to fix their problems. However in psychodynamic work it is through an understanding and exploration into the clients psyche that will lead the client to be autonomous enough to fix their problems. Psychodynamic therapy can also put you in touch with feelings that you had tried to avoid or push away, this can be an uncomfortable experience but a necessary one.

Therapy is not relaxing or easy nor is it a kin to a spa treatment. It is hard, uncomfortable and painful. But it is the duty of the therapist to make sure that they are providing a safe and secure place and that the therapist is containing and ethical at all times.

Change pt2.

In my previous post I spoke about change being both good and bad. I gave an example of two friends. One friend changed which was good for them however it changed the dynamic of the friendship and the other friend perceived the change as bad.

Ultimately change causes disruption and that can put people of changing. An individual may be aware of the changes they need to make but may feel put off due to the ripples it will cause to their nearest and dearest.

Change

Change is a word that gets thrown around a lot. In society we talk about change in our jobs, relationships and families. We can often think of change in a very concrete way. Ie: thats a good change or thats a bad change. But change can be good and bad.

For example, you may have a friend who is very emotionally taxing we will call them friend A. They always come to you for emotional support, they off load on you and they don’t see anything wrong with that. However you are unable to look to others for any support. If the friend who is unable to ask for support for themselves begins to recognise this and begins to ask for help this can be seen as a good change.

On the other hand friend A who is happy of continually off load may see this change as bad because they were happy with the dynamic that had been created. Now friend A can no longer use their friend in that way.

Complicated grief pt2.

As I said in a previous post that sadness is not the only reaction to loss. It is however the expected response. When someone has suffered a bereavement and does not immediately feel sad they will often judge themselves or feel that others will judge them for not being upset enough or at all.

Many people feel like they do not know how to grieve and can go years before processing a death of a loved one. Grieving is a very uncomfortable process and unexpected emotions can surface. Anger and guilt are common feelings to have towards death but in society sadness is the most expected and tolerated response to loss.

Complicated Grief

There are many people who experience loss and do not know how to process it. There is no right or wrong way that loss should be processed. However there is a straight forward way and a complicated way. Both are equally painful and people cannot choose how they deal with a loss.

So why do people process loss differently? Depending on your experiences and how you relate to people around you will determine your response towards loss. A person who is more connected to their emotions may have an emotional response straight away towards a loss.

Whereas someone who has more difficulty with their emotions may not feel any emotion towards the loss. It may take sometime before they begin to feel anything. This can be described as a complicated reaction to loss.

Death/grief

Grief is an extreme sadness associated with death. There is a lot of social awareness around grieving after suffering a loss. It is understood that if one has suffered a loss it is going to be a very difficult time for them. They will need time of work or school, they may not be themselves for a while. However where society lacks awareness is in those people that suffer from a complicated grieving process.

Most people will expect someone who has suffered loss to be very sad but what about the people who suffer a loss and don’t know how to feel sad. Instead they might feel angry, guilty or they may not feel much at all. These aspects of grief are less talked about. Please see my upcoming post on complicated grief.

Endings pt. 2

All endings are painful to some degree some much larger than others. Have you ever noticed that most toddlers all of a sudden become very shy when they are told to say goodbye someone. Saying goodbye is a tiny ending but will cause some difficult feeling. Think about when you’ve gone out and had a great time, you don’t want it to end but eventually it has to.

Depending on ones emotional landscape some people will find it easier than others to manage endings. For some the vast amount of anxiety an ending brings up can stop or hinder being able to start something new.

Endings

Life is full of endings, even as children we are exposed to endings. Whenever we leave a year group and say good bye to a form tutor. Changing from primary school to high school, going to college. Many of which I have just described are beginnings but before you begin something you will be ending something else.

A beginning of a new job will mean the end of a previous job or an end to having no job at all. Endings are difficult and painful. It is saying goodbye to something that has become familiar and saying hello to something that is unfamiliar.

At times an ending can go unprocessed until much later this can be especially true for painful endings. Avoidance might be applied as a defence against those painful feelings. Think about how many times you’ve heard someone say ‘i’m not that bothered’ or ‘you know what, I don’t even care anymore’ in relation to being fired, loosing a friend or a break up.

Verbal abuse pt.2

The differences between verbal abuse and conflict which is a healthy part of a relationship can be very subtle. Most people will often try and justify their partners verbal abuse towards them. ie: It is because they are stressed out and maybe if I was different. These justifications help to perpetuate the cycle. One of the biggest justifications is that they will change their behaviour.

The reality is that you cannot change someone else but you can create change in yourself if you want to. That change might be having the strength to realise that she/he will always be verbally abusive but I am choosing not to stay in that relationship. These are very big and difficult changes to make which is why some people become trapped in abusive relationships.

Verbal abuse

When we think of abuse the first thing we think of is physical abuse, either violent or sexual. But one of the most common forms of abuse within a relationship is verbal. People argue in relationships and sometimes say things that they don’t mean which is fairly common. Its healthy to be able to argue without it going to an extreme level.

However verbal abuse is not ok. Saying things to a partner that is going to repeatedly make them feel bad is abusive. ie: your so dumb you never understand anything. Verbal abuse is not only characterised by the vocabulary but the tone in which it is being said. It can be name calling, criticism, manipulation and blame. If the other person starts to tolerate this then it becomes a pattern of relating within the relationship.

Emotional support?

Being able to be emotionally supportive is important in any relationship and often it gives a relationship foundations. Being emotionally supportive does not mean that you have to fix the other persons problems or emotions. It is as simple as taking the time to be there for someone when they need and vice versa.

codependency pt. 2

It is important to be aware of the signs of when something is becoming codependent. Often there will be an overall feeling that the other person is responsible for your own happiness as opposed to feeling like you are in control of your own happiness. For example: ‘if only she would stop working so late, I would be better off’ or ‘I would really like to go to dinner with a work colleague but Im worried my partner will feel threatened by it if i do’,

There are just a few generic examples of what someone could potentially feel in a codependent relationship. There can often be a sense of needing to do everything together and go everywhere together. It is great to spend quality time with your partner but there is something very unhealthy about feeling like you need to spend all your free time with your partner.

Codependency is a way of relating and in some cases people who are in codependent relationships will have a history of previous codependent relationships whether it is with family, friends or partners.

codependency vs emotional support

At times it can feel difficult to understand the distinction between being codependent and being supportive. Codependency thrives where there is a serious lack of autonomy. Any sense of autonomy within a codependent dynamic will often be met with anger and rejection because it threatens the dynamic.

Emotional support does not depend on anything. It is being supportive, sympathetic and caring without making it about yourself. Some people may need more emotional support but as long as you do not need them to need you it is not codependent. In theory the two are fairly easy to differentiate between however in reality it is more difficult and the lines can become blurred.

What may have started out as emotional support can turn into something codependent if both people allow this to happen.

Codependency/Dependency

The definition of dependency is the inability to function without someone else’s help and codependency is specifically an extreme emotional reliance on someone. Both dependency and codependency are seen as emotionally unhealthy because within those two states there is no room for autonomy. The only way dependency can thrive is if there is a lack of autonomy to begin with. It is important to make the distinction between dependency and being supportive.

Often people will give examples of addicts being in codependent relationships. That one addict needs another to justify their actions. Codependency can be extreme but it can also be very subtle. Either way in the long term any relationship of that sort can be emotionally harmful. A more subtle example of a codependent relationship is a person who needs their partner to need them for emotional support and will somehow hinder their partners progression towards autonomy.

Codependent relationships exist in friendships, romantic relationships and familial relationships. Money can also be used to further entrench a codependent relationship. For example a younger brother may rely on a older sibling to regularly give them handouts. The older sibling is frustrated by this but yet keeps on giving his little brother handouts. There is an aspect of being relied upon and needed by his younger brother that keeps them locked into this codependency. Thus stopping the younger sibling from trying to sort out their own finances.

Disconnection/Detachment Pt.2

The emotional dangers of disconnection can be seen on a long term scale. The more a person becomes detached the more they are likely to be alienated from any real emotional response to somethings.

For example: A wife makes an inappropriate comment about a colleague to her husband. A non-detached response could be an expression of him feeling that the comment was not called for. A detached response could be silence or even an un-opinionated acknowledgement of the comment.

Not having an emotional response to experiences can create an internal void that leaves a person feeling empty.

Disconnection/Detachment

In society we often hear people talking about how detached they feel. Feeling detached is feeling cut off from a part of life or for some people their whole life. It is not being able to gain access to feelings and thoughts. Detachment or disconnection is a defence against difficult feelings but often was tends to happen is that eventually the disconnection develops so that it defends against all feeling.

There are different ways that disconnection manifests. It can manifest in response to a trauma of some kind. In certain family dynamics expression of feeling is not experienced as tolerable so a response to that experience is a turning away from feelings that are seen as inappropriate within that dynamic.