Frequently asked questions about psychotherapy/ counselling

Some answers to your questions

Concerns

Personal concerns

“Can you help me?” “Are you a specialist for my issues?”

Over time, I have successfully helped clients who present a wide range of issues and concerns.

One often assumes that seeing a “specialist” for a given presenting issue is the best strategy to adopt. However, this assumption ignores the fact that the presenting issues usually hide underlying issues and that the latter are usually more or less the same for most of us, human beings. For this reason, it is more relevant to seek a therapist who excels in their understanding of the more common underlying issues, which involve the fundamental structures and dynamics of human psychology.

Also, one should receive with caution the claim made by too many therapists, according to which specialisation in specific areas of human experience (e.g., anxiety, bereavement, alcoholism) is what allows them to be more competent in these areas. Such a claim lacks solid foundations. Specialism is an advantage in certain professions, especially where technical skills and knowledge are required, but it makes little sense in counselling and psychotherapy. It is actually rather counter-productive, as it places the focus on the presenting issues and runs the risk to miss the more crucial underlying issues.

In these conditions, why do therapists so often present themselves as specialists? There is an obvious marketing reason. Specialism enjoys a strong reputation in our societies, closely associated with the notion of expertise. Presenting oneself as a specialist often adds some kudos to one’s professional profile. On the other hand, few therapists possess enough in-depth understanding of human psychology to work at the level of the underlying issues. They feel much more comfortable dealing with the presenting issues, even if this condemns the therapeutic work to remain superficial or, worse, to be ineffective.

“Can I be helped?”

As a rule, there is no client who cannot be helped. So, whatever your issues, you too can be helped, like anybody else. However, help is only effective where you are involved in the helping process, which requires a sustained effort on your part. A major obstacle to the psychotherapeutic process is the client’s passivity in this process. Therapy is not something which happens to you or something which the therapist does to you, but rather something which you engage in. Therefore, it requires an active attitude. Of course, as your therapist, I will provide you with a context for your action, and I will coach you. But you cannot expect me to do the work for you. It is you who will be doing the work, and the effectiveness of your therapy with me will largely rely on your degree of commitment. Sometimes, one feels so helpless and devoid of energy, motivation and resources at the beginning of therapy that thinking in these terms may feel overwhelming. This is ok, as your engagement in the therapeutic process can be gentle and progressive. You only need to know that your action will be needed. I will help you prepare for the active part of your work and give you all the time, patience and support that you need until you are ready.

Another obstacle to successful therapy is client resistance. Psychotherapy (or counselling) is often a demanding process, emotionally and cognitively. As your therapist, I will facilitate a process of self-examination and accompany you where it hurts. Also, I will invite you into unknown and unfamiliar territories and, most likely, will unveil ideas and notions which expand and challenge your current understanding of yourself, your life and life in general. It is not unusual for clients to feel stretched and experience difficulty in revising their old familiar views and feelings about things. However, successful therapy relies on their ability to eventually overcome such difficulty. I provide effective support in this process.

“Will therapy be able to fix me?”

Therapy can include many things, including the expression of thoughts and feelings, some of which may have remained unexpressed or hidden, the development of a greater awareness and understanding of oneself and one’s life, the liberation from unchecked and biased assumptions, the liberation from old ways of doing things and looking at things which are inefficient and unhelpful, and the renewed and deeper engagement with one’s true self. However, it does not involve “fixing” the self or parts of the self. It does not involve mending or problem solving. There is abundant literature which says otherwise but it is not to be trusted. The notion of fixing a human being is often rooted in the reductionist mechanistic model which pervades mainstream western culture. Even modern western medicine very much looks at human beings as sophisticated machines which are either functional or deficient. However, the fact is that human beings cannot be reduced to the mechanical aspect. Psychotherapy is a good place to rediscover this fundamental truth and what it means.

“I have often been judged, will you judge me too?”

You can be assured that I will not judge you, not just because of my profession but also because I have an open and welcoming heart.

“I have lost my old self, will you help me get it back?”

You may be able to recover part of your old self as long as it was a part of the real you. However, it is unlikely that you will recover those parts which were not really you, nor should you. Instead, you will discover the real you, which is going to be of much greater use and benefit. I will help you finding it.

“Will you help me find happiness or recover it?”

Psychotherapy is not about making people happy. Although this may be one of the possible outcomes, it cannot be the goal. Therapy is about personal development, and such a virtuous process brings fulfilment and contentment. It is also about feeling ok, which is different from feeling happy. Feeling ok provides the necessary foundations without which the pursuit of happiness - if such is your goal - would be impossible.

“I cannot cope or function any more, does this mean that I am a failure?”

As one’s focus in life is often on continuously playing one’s role in the social-cultural construct which makes up the matrix of our everyday lives, one is easily tempted to interpret one’s sudden difficulty or inability to keep up with playing the game as a sign of failure. However, a deeper look often leads to a reversal of perspective. The breakdown of one’s ability to keep up with one’s fake everyday persona, this false self-image behind which one usually hides, is actually a success. This auspicious breakdown generally marks the transition towards a different way of being which psychotherapy can help make sense of and engage with more deeply, allowing you to develop a renewed sense of self and, with it, more solid and fulfilling psychological foundations.

“Does starting a therapy mean that I am weak and without control?”

Feeling and expressing the need for therapy is sometimes interpreted as a sign of weakness and lack of control over oneself and one’s life. One’s inner voice may keep saying “Get a grip and move on”. One may also hear this from others. In these conditions, seeking external help to work on one’s issues is rarely perceived as something positive. However, far from being helpful, the concern for appearing strong and in control is often part of the problem. Indeed, this concern is often the sign that one’s self-image heavily depends on others and the way they think about us, therefore on external authority and approval. Such dependency indicates a lack of self-reliance and autonomy. It is a sign of alienation, thus indicating that one’s sense of self is in a position of vulnerability. So, contrary to what one may assume, far from being a threat to one’s sense of self, therapy is actually a remedy.

“Am I selfish to take care of myself?”

From a psychotherapeutic point of view, taking care of oneself amounts to taking care of one’s self. Taking care of one’s self is not selfish, it is an obligation and a necessity. The self that we are is a living entity which has been given to us and put in our care. We would be neglecting a fundamental responsibility if we were not honouring our duty of care towards the self that we have been given. On the other hand, such care benefits others, namely other living entities. A self which is in a poor state has a negative impact on communities and relationships. We owe them as much as we owe our self to take the best possible care.

“Is psychological suffering a curse?”

Embarking on a psychotherapeutic journey often leads to embracing a more positive outlook on the human condition in spite of all the trials and tribulations which are attached to human existence. Indeed, as this journey unfolds, one gets a chance to discover or confirm that existential issues and crises, with their load of psychological pain and suffering, are not merely challenges which threaten to severely harm or destroy us. They can also be used as, and indeed constitute, opportunities to explore ourselves, our relationships and also quite often human life in general and the world in which we live, at a level of depth and with a practical effectiveness which we rarely achieve otherwise in the course of everyday life. The fact is that unless we are disturbed and feel uncomfortable, even sometimes unbearably so, we rarely embrace or seek opportunities to engage in a process which entails opening and/or reconfiguring the structure of our understanding, and possibly also of our personality or the way that this personality presents and expresses itself in the world. As the poet and mystic Rumi said, “The wound is the place where the Light enters you.”

Can you help?

Be helped

Be fixed

Be judged

Old self

Happiness

Failure

Weak

Selfish

Suffering

About psychotherapy

“What is psychotherapy?”

As the word indicates, psycho-therapy is a therapy of the psyche, a Greek word usually translated as “soul” which refers to the human self. The existence of a variety of theoretical approaches and methods in psychotherapy reflects the existence of various conceptions of the self, its nature, its structure, its ways of being, its needs, as well as the type of issues and challenges which it encounters and how these can best be overcome or dealt with. In the context of psychotherapy, “therapy” should be understood in the broad sense of the word: providing a “treatment” means taking care of somebody.

Psychotherapy is essentially a form of relational and psycho-educational intervention provided by a qualified professional who offers a setting, relationship and psychological understanding and support to individuals who experience existential difficulties and/or seek to develop. The relational aspect plays a crucial role in psychotherapy. One of the main tasks of the therapist is to offer a certain type of relationship, which is characterised by trust, openness, genuineness, reliability, confidentially, support, empathy and depth. The psycho-educational aspect concerns the free processing of thoughts and feelings, the facilitation of this processing, and where suitable the examination of these thoughts and feelings as well as the life circumstances to which they are related, with a view to foster greater awareness and understanding, with which comes power.

“What is psychotherapy for?”

Psychotherapy (or counselling) provides an opportunity to step out of everyday life to freely and safely express inner thoughts and feelings, and, with the help of a caring and adequately qualified professional who possesses a deep understanding of human psychology, give these thoughts and feelings all the attention that they deserve. It provides a confidential and non-judgemental relationship in which you can be truly heard and understood, where you can find empathy, acceptance and support, and where you can also develop a better understanding of yourself and your life to grow in awareness and power. Your reasons for seeking psychotherapy can range from existential struggles to pure personal development.

“What are the differences between psychotherapy and counselling?”

Therapists talk about counselling and psychotherapy. This difference in terminology may suggest to the unfamiliar public that we are dealing with two different professions or specialties within one profession. This is not the case. Historically, the term ‘counselling’ has merely appeared for political and ideological reasons which are internal to the profession. In the 1950s, Carl Rogers founded the person-centred approach to psychotherapy which has become very popular amongst therapists. However, Rogers' background was in psychology rather than in medicine. For this reason, the American psychiatrists objected to his use of the term ‘psychotherapy’ which at the time and in the American context had a strong connection with medicine. In response to this objection, Rogers stamped the term ‘counselling’, which allowed him to continue to practice psychotherapy without provoking disapprobation.

Nowadays, in practice, the terms counselling and psychotherapy are frequently used interchangeably by professionals who generally have little reason to distinguish between them - I personally conform to this usage. Having said this, due to the historical circumstances in which the term counselling has appeared and been used, it is more frequently associated with the humanistic tradition to which Rogers belonged than with the psychodynamic tradition, which takes its roots in psychoanalysis. Moreover, some professionals who have undergone longer training (five years or more against three and a half or four) prefer to use the term psychotherapy because it carries with it a higher degree of notability. The term ‘psychotherapy’ is also occasionally used to highlight a more intensive therapeutic process, with more than one meeting per week against one only in counselling, and longer term work. However, one must be wary of the potential for snobbism. On the one hand, the number of years of training does not necessarily reflect a higher degree of competence and skilfulness. Sometimes the opposite is true, as in certain schools greater engagement with a particular psychotherapeutic tradition too easily translates into an excessive attachment to a particular philosophy and theoretical framework, which results in narrowness of mind and a rigid approach to client work. On the other hand, if meeting a client more than once a week and for a longer period of time certainly impacts the work done in therapy, it does not however fundamentally change the nature of the work itself, nor does it imply additional skills.

In the end, it is up to the client to decide which therapist they feel happier to work with, should this therapist claim to be a counsellor, a psychotherapist or both. In every case, the most important question is: “is the therapist up to the task and able to make a difference for me?” The crucial factors in choosing a therapist are the personality and credentials of the professional, not so much their particular denomination unless they call themselves psychologist or psychiatrist, in which cases we are indeed dealing with different professions, the first one being academically focused (few psychologists receive practical training with clients) and the second one being related to the medical profession (which implies the use of drugs and other medical treatments).

“What determines the success of psychotherapy?”

As one can see, a lot relies on the depth and validity of the therapist’s understanding of human psychology and their ability to make a practical use of this understanding in the context of therapy. This in turn implies that, for the client, a successful therapy largely relies on choosing the right therapist.

“How will I know that my therapy is working?”

Psychological change is usually something that clients notice, but not always, and it can be hard to measure. Such change rarely happens entirely behind the scenes, but part of it does. Moreover, it is often progressive and incremental, and takes place over relatively long periods of time. Because of this, psychological change will often be more noticeable retrospectively, as one traces back one’s journey to assess progress, perhaps with the help of the therapist and/or other sources (e.g., relatives, friends). Due to its emphasis on promoting greater awareness and understanding, and on putting what one learns in practice, including at the level of one’s personality structure, the type of therapy that I propose often leads to spectacular leaps forward which clients notice more easily. Various signs usually indicate to my clients that their therapy with me is in process and is working. I believe that these signs should always be present in therapy. I have listed some of the most important markers, but of course the list does not pretend to be exhaustive.

Therapy should open new horizons and be thought provoking. If you find that you are not learning new ideas, that none of your ways of thinking and looking at things are challenged, that none of your assumptions are contradicted, then you can safely conclude that something is lacking.
By opening up new ways of thinking as well as new ways of doing things, and by allowing you to notice what usually lies beneath the surface of things, therapy should help you deepen your awareness and understanding of yourself and your issues.

Another implication of freeing one’s true self is a greater acceptance of oneself as well as of reality, and an enhanced sense of personal worth and of one’s ability to deal with life challenges. Therapy should therefore allow you to feel liberated and empowered.
Therapy should feel hard work, both mentally demanding and emotionally challenging. It is a positive process but it may not always feel like that, especially in the first stages. Feeling uncomfortable, one may question one’s involvement and/or feel resistant. Paradoxically, this shows that the therapy is working. If it feels like an easy ride, there is something wrong.
Frequently, therapy also provides an opportunity to learn some techniques and/or practical strategies which can be applied in everyday life situations. These techniques and strategies may concern the management of boundaries, human communication or self-care, amongst other things.

“How long is a therapy?”

Psychological change sometimes happens relatively quickly, but it usually takes some time. A therapy can last between a few weeks and several years. For most clients, it lasts between 6 and 18 months.

The important thing to remember is that clients are under no obligation to be in therapy for any longer than they wish to be. They are at all times in control of their therapy and can end it whenever they see fit. In some cases, clients choose to give their therapy a pause and resume it at a later date.

“Why does therapy take time?”

Clients often wonder why they have to attend weekly therapy sessions over several weeks or even months, sometimes years, why psychological change is not quicker, especially when they think that they have reached a point where they can grasp what their issues are. The answer to this question is simple: a person is not a mind. Intellectual understanding is a good and useful thing, but it is not you. Psychological change concerns the person that one is, in my jargon it involves the self’s structure and its configuration. Understanding what this means and entails is part of the therapeutic process. And this also takes time.

“Can I attend one session and then reflect before I commit?”

Yes, you can. However, it takes several sessions to start having a feel for what psychotherapy is about. It is usually unfamiliar. Even if you know a little about it, it is likely that my ways of working will be unfamiliar to you. On the other hand, psychotherapy is a process the proportions of which cannot be appreciated without allowing some time. Trying to get a feel for what psychotherapy is about in one session is equivalent to trying to get a sense of what swimming in the ocean for weeks feels like by having a short bath in a pool.

“Why are the sessions weekly? Could I attend less frequently?”

Psychological change relies on a sustained and continuous process which can only be achieved with weekly sessions. For this reason, I do not offer fortnightly or monthly sessions to clients who are only starting a therapy.

“Which therapeutic modality is the best?”

Psychotherapists often introduce themselves to the public in terms of a particular modality or approach to human psychology and psychotherapy which refers back to a particular theory and its originator(s). To find out what I think about this practice and its limitations, read the page What to Expect.

“Is CBT the panacea?”

The general public is often misinformed about counselling and psychotherapy. This applies also to Cognitive-Behavioural Therapy, or CBT. The fact that CBT has recently been favoured by the NHS has also contributed to its misrepresentation. Nowadays, CBT is frequently seen as the panacea when, in reality, its institutional recognition primarily rests on its cost-effectiveness (6 weeks treatments done by quickly trained CBT practitioners) and its ability to fit within the main paradigm of modern western medicine, which mostly focuses on dealing with symptoms rather than the causes or roots of a problem. From this point of view, the term “Cognitive-Behavioural Therapy” is misleading as CBT is not a therapy, as frequently acknowledged by CBT practitioners themselves.

CBT is not a “talking” therapy and, as such, does not belong to the realm of psychotherapeutic and counselling approaches, although it is often placed amongst these, wrongly. Indeed, it does not entail facilitating the expression and exploration of the individual’s thoughts and feelings with a view to gain a better understanding of their existential issues. While CBT allows in some cases to reinforce the individual’s superficial coping mechanisms, it does not allow them to deal with what causes them to seek therapy in the first place.

Some aspects of my work may be reminiscent of CBT, as I am also interested in highlighting and overcoming false assumptions and other cognitive biases, which generally have a detrimental impact on feelings and everyday ways of being and doing things. However, there is a major difference, as this work is not associated with intellectual discussions, exercises and measurements, but takes place within the context of a caring and holding accompaniment of my clients as they express and explore their deepest thoughts and feelings, and progress in their awareness and understanding of themselves and their issues.

What psycho is for

What is psychoth

Dif bet psychoth & couns

Conditions of success

Assessing success

Duration

Why does it take time?

Attend one session

Frequency

Which modality

CBT

Psychotherapy

For this reason the British Association for Counselling & Psychotherapy (BACP), a membership organisation and a registered charity that sets standards for therapeutic practice and provides information for therapists, clients of therapy and the general public, indeed the main body in the UK which represents counselling and psychotherapy at national and international levels, is not meant to cater for two professions but for one profession with two different names.

This question is vast and complex, as it concerns the entire process of psychotherapy and the client’s experience of this process. I will keep my answer short and simple. A successful therapy primarily rests on the client and the therapist’s ability to engage with their respective tasks in their collaborative endeavour. The client’s responsibility is to engage as fully as possible in the working relationship which is offered by the therapist and remain committed to it over a period of time, with regular attendance. The therapist’s task is to assess the psychological profile of their client and, while providing a quality of relating and accompaniment, mobilise their understanding of human psychology to heighten the client’s awareness and understanding, and facilitate whatever work of reconfiguration of the client’s psychological framework and self structure is required.

The length of a therapy rests on many variables, amongst which the nature of the underlying issues (usually only revealed in therapy), the client’s objectives (essentially, how deep and how far they wish to go with their therapy), the level of the client’s engagement in the work which is required to address their issues and the client’s availability over time. Individuals and couples who come to see me are usually interested in developing an in-depth understanding of their issues with a view to empower themselves. Their willingness to commit to the work which is required to achieve their goal typically leads them to engage in therapy which is medium to long term. However, in practice, clients usually only make a decision concerning the length of their therapy as they go along.

Therapy frequently entails a degree of reconfiguration of the self structure whereby the true self, namely the pillar of one’s personality structure, is becoming more present and active than the conditioned self. Therefore, while in therapy you should be able to observe changes in your personality, not because you are turning into somebody else but because you are becoming more yourself.
Granting a greater role to the true self usually leads to a more extensive use of feelings and intuition. Therapy should therefore lead you to recognise the role and value of feelings and intuition in guiding your steps and decisions in life. This, in turn, should lead you to redefine the place and role of the intellect and societal ways of thinking as sources of authority. Although important, they are best subsumed and critically assessed.

CBT is task-based and involves performing a series of exercises and measurements under the guidance and supervision of a qualified practitioner. The aim of these exercises and measurements, many of which involve homework, is to identify cognitive biases and distortions in the individual’s explicit cognitive apparatus with a view to correct them. By bringing the individual to a supposedly more realistic view of their everyday life, it is hoped that some of the individual’s negative tendencies, which generally find an ideal breeding ground in distorted ways of thinking, can be reduced or removed in order to improve feelings and behaviour.

Often misunderstood, the relationship between psychotherapy and medicine deserves to be clarified. One frequently reads that psychotherapy is primarily concerned with treating so-called “mental pathologies”. However, the widespread notion of psychotherapy as a discipline which involves the “diagnosis” and “treatment of psychological disorders” or “illnesses” is incorrect. This amounts to confusing psychotherapy with psychiatry, which belongs to the medical world. The current use of the notion of “mental health” in psychotherapy does little to bring clarity. As with the notion of “therapy”, one needs to refer to a broad sense of this notion (the same with “healing”) if one wishes to make sense of what psychotherapy really is about.

Life coaching

Psychotherapy & life coaching

“What is the relationship between life coaching and psychotherapy?”

To create a niche for themselves in the market of personal development, many life coaches promote the idea that life coaching differs from psychotherapy. However, the arguments used by life coaches often rest on a misrepresentation of psychotherapy, which they describe as a form of medical intervention which deals exclusively with so-called mental health issues. I am proposing a corrective view which clarifies the relationship between life coaching and psychotherapy.

On the other hand, contrary to the claims made by many life coaches, far from being primarily linked to medical culture, the therapeutic process involved in psychotherapy is essentially psycho-educational in nature. This aspect has been highlighted quite rightly by various authors who wrote about psychotherapy, such as A.C. Ferrari (1989) in an article eloquently entitled “Psychotherapy as an educational process” (Clinical Social Work Journal, Vol 17(3), pp. 271-283), or J. Marmor (1962) in “Psychoanalytic therapy as an educational process” (In Masserman, J.H. ed. Psychoanalytic education. New York: Grune & Stratton, pp. 286-299).

The main differences between psychotherapy and life coaching lie in the training and ethos of the professionals who offer their services to the public. In other words, the difference is not so much between life coaching and psychotherapy than between life coaches and psychotherapists. While the former use a managerial approach rooted in self-management ideology and techniques, the later use a psycho-educational approach based on an understanding of psychological and personality structures and human development.

The brief but suggestive comments made in Psychology Today (online) under the title “The Difference Between Coaching and Therapy is Greatly Overstated” echo my views.

“Should I see a life coach or a psychotherapist?”

The answer to this question depends on the style of coaching that you are after.

Life coaches have introduced personal development in the business and financial world. The kind of ideas and methods which inform mainstream life coaching bare the mark of these origins and demonstrate a corresponding drive for commercial success and profitability. Moreover, at the core, we find a managerial approach to life and self, and a focus on strategy and planned action. Mainstream life coaching is therefore well adapted to and helps meeting the needs of the business world as well as of those who wish to preserve the managerial approach to life which is promoted in that world. However, one should be aware that such an approach is limited, as it entails a strong cultural bias which makes it difficult to engage with the reality of human psychology.

For those who wish to engage with a form of coaching which is more scientifically informed and therefore an understanding of human psychology which is less biased, psychotherapy offers a useful and powerful alternative, especially in its humanistic version (like psychoanalysis on which it is grounded, psychodymanic psychotherapy also has a strong cultural bias). As a specific form of psycho-educational action, the kind of coaching that I practise as a psychotherapist entails involving clients in a learning process which leads one to making a fuller and more effective use of what one already knows and to developing new knowledge and understanding where necessary. Rather than engaging with fashionable cultural trends, this learning generally implies challenging and transcending such trends with a view to free the self from cultural conditioning and allow it to come closer to reality. The primary virtue of this work of liberation is to allow the self to align itself on internal rather than external authority and validation, and to engage with a life which is more congruent with its true nature.

Rel bet life coaching & psychoth

Life coach or psychoth?

The fact that a fair proportion of individuals who engage in psychotherapy are anxious or depressed, have experienced trauma and/or other life difficulties, should not hide the more fundamental fact that the main common denominator amongst those who seek psychotherapy is a deep-seated need to better understand themselves and their lives, to gain a new sense of direction and to take practical steps to change how they do things and possibly how they live. Amongst other things, the role of the therapist is also to provide clients with the logistical and human support which they require to make the necessary cognitive and practical changes. This type of work can rightly be seen as coaching. Not only, as a psychotherapist, I see coaching as an important part of what I do, but some of my clients also see it like this, as reflected in their Testimonials.

Guy Van de Walle PhD, MBACP (Accred.) Psychotherapy, Counselling, Life coaching
Chelmsford (Essex) and online - Bilingual: English & French