What does it mean to be 'a man' or 'a woman'? More and more people seem to be asking themselves this question these days. Perhaps because our current cultural context makes it possible - or even necessary - to bring Gender issues up for re-assessment. These may be accompanied by questions about ones own sexuality (and this means a lot more than 'sexual orientation'). Gender and Sexuality relate to how we feel about ourselves as potential sexual participants in interactions with others. But they also relate to how we feel about and understand ourselves and what sexual (whatever we understand this word to mean and how we experience it in ourselves) experiences are relevant to us. We have long lived in a cultural context which tends to assume that understandings of gender and sexuality need to fit into rather fixed and limited/limiting moulds. In reality, both are extremely personal and there are possibly as many variations as there are individuals. Such standards may be constrictive and leave us feeling falling short of or different from these assumed prototypes (stereotypes) which are mostly just fictional abstractions at the end of the day. Our understanding of our Gender roles/presence and Sexual proclivities/preferences fluctuates enormously over time and in different contexts. How we feel about ourselves in our early 20s will likely be very different from how understand ourselves along the same 'lines' in mid-life or later-life for example. How we behave in embodying genders and sexual codes/rites in 'meeting to mate' environments is likely to be very different from how we feel in less 'sexualised' environments. Different countries/cultures may bring out different ways of relating to our gender and sexual identities, whether by choice or because of social pressure. What feels sexually interesting or attractive one summer may be very different from the next winter, and different people whom we engage with and relate to at a more intimate level may bring out different aspects of our femininity/masculinity or of our sexual fantasies, desires, mysteries and subtleties. It is important to find ways of familiarising ourselves with these most intimate and personal aspects of our existence so as best to gain control over what parameters we choose to apply when making decisions about how to engage with the world (others) along gender and sexuality lines. Freud famously highlighted the primacy of the Sexual Instinct in everyone's life. At a very basic level, we are biologically primed to follow instinctual forces which might ultimately lead to 'mating'. But the reality of our experiences goes much further than than these animalistic impulses. Later in life and in the body of his work, Freud highlighted the affinities between the Sexual Instinct (and the Libido) and the Life Instinct - a force to be understood in a much broader sense, one that operates in much more sophisticated ways throughout life. It drives our interest (in all degrees of intensity) in just about anything, from food to philosophy, from dance to politics, from going for a walk to building our lives according to our own individual vision. Not many people know this, but Freud's idea of what constitutes an instinct includes a lot more than its object. As far as Freud is concerned the gender of the person one may be attracted to (object choice) is only one of the elements at play. He considers the source (need) and aim (satisfaction) equally if not more important (he says the object is largely incidental in comparison to the other elements), but also the 'quantity of energy' (investment) pressing those pedals at any one time as crucial to understanding our (varying) experiences of the instinct within ourselves. Many other psychoanalysts have taken this much further (and the issue of object-choice appears as rather secondary if we consider the significance of everything else that plays into what we consider as 'sexuality'). From the angle of the 'Oedipus Complex' or of Attachment, from the different types of relationship (love, excitement, friendship, loyalty, dependence, cooperation, etc) we experience throughout life, from issues of 'projections' and the 'repetition compulsion' we sometimes unconsciously establish in patterns of behaviour or choice to aspects of our sexuality we repress (unconsciously driving that energy to come out in very disguised - and often pathological or 'neurotic' - ways) or consciously choose to suppress and 'sublimate' ('channelling' it into other pursuits), the field of gender and sexuality opens a huge territory which each individual needs to map for themselves as they deploy their individuality in the way they choose to relate to the external world of relationships out there. Many people suffer from getting caught up in a narrow perspective (often exploited in the language of 'popular psychology' espoused in glossy magazines or self-help books or soup-operas or rom-coms) which assumes that there are fixed 'recipes' for successful sexual relationships. This 'matrix' may often be more of a hindrance than a help. In experience, gender and sexuality are a journey - often experienced in the context of relationships - which even when the plotline follows the 'boy meets girl' prototype, is in actual fact subject to all sorts of variations, u-turns, surprises (welcome or otherwise) and learning curves. Navigating these may benefit a lot from careful attention to all the levels at which we relate to ourselves as well as to others. Our feelings are inevitably triggered (if they are not then that in itself may need attention) and processing them may help us move on with a sense of being able to have more choices after having learnt from the experiences. French Psychoanalysts (not only Lacan or the psychosomatic school) have paid a lot more attention to how we relate to experience life through our bodies (Freud did say that the Ego is primarily a bodily one) and their influence keeps reminding us that we separating ourselves from our incarnated experience may come at a high price.Learn More
How we impact on the world around us. Crieativity is a lot more than being able to draw/paint/sing/dance/write or invent whatever. As human beings we are constantly altering the physical environment around us in myriad ways, from the minute we make breakfast or write an appointment into our diaries we are altering reality through some sort of 'muscular' interaction with it. Sometimes this is not consciously intended - our mere live presence brings with it the temperature of our bodies, the CO2 we breath out, the noises we make as we move around. We often take all of this for granted, but if we think of it carefully, these are all ways of having an impact on the external world. At a very basic level our most primitive primate ancestors would have done the same by picking up a fruit from at tree or expelling the toxins from their bodies back into the ecosystems which transform them into manure to feed the complex cycles of nature. As we developed as human beings we developed more sophisticated ways of affecting our environments, from the basics of 'science' (making pots and pans, using fire to cook, making arrows to hunt, curing furs to protect from the cold, etc.) we went further and created language and art (at their most basic) - this is what anthropologists call 'civilisation'. What we understand as civilisation today is however a much more complex set of ways of operating than that. The psychological (in the broader sense) aspects of it are what tends to occupy our conscious minds most of the time these days. This leads to what we commonly call 'thinking' - we try and 'work out' what needs to be said or done in any given situation so as to use language (operating at many levels) to obtain the aimed results (that same fruit our primate ancestors would have picked up from the tree). The capacity to symbolise (the use of languages - and these are not just verbal/written) marks the development of our psyches as well as that of civilisation. Through languages (words, as well as gestures, expressions, visual signals or productions, etc - all building blocks of what is commonly alluded to as the 'arts') we are constantly affecting the (social) world around us -and not just to obtain the concrete results consciously aimed at, but to enrich our own internal capacity to 'think' (in ways which far exceede pragmatic concerns) to feel and experience, and to bring these out into the (social) world - what is commonly understood as 'expressing ourselves. How we are constantly developing our own individual ways of doing this is what Creativity ultimately is. Whether we are talking about Da Vinci's Mona Lisa or Bethoven's 5th, the palace of Versailles or Shakespeare, or whether we are considering how you chose to comb your hair today or how the tome of your voice of the twinkle in your eye as you asked for your coffee this morning, how you wish your office chair had more comfortable padding or what words you chose for your e-mail just now, we are talking about your own individual creative potential. Tapping into this vein empowers us with many choices. Many people suffer from feeling insignificant and impotent in the face of having to respond to an increasingly codified word in 'standard' ways. The internet is awash with such recipes... and they come not only with 'helpful tips' and templates, but also with pressures to conform... This pressure to conform can be experienced as reassuring (if we feel we know what is expected of us) but may also contrive to enslave us to a robotic existence which robs us of our creative leeway... No wonder feel they need to find 'outlets' for their 'creativity' and will look for (yet again) standardised and codified ways of doing so (by taking art lessons, learning to play an instrument, buying a fashion magazine). These often create the illusion of freedom that we hanker after but ultimately co-opt our creative impulses into regurgitating models devoid of spirit. Creativity is ultimately unforeseeable and learning to live with this force inside us is an endless source of life energies not to be underestimated. Creativity risks changing - not just the colour of your curtains or the sound of your voice or the shape of buildings we live in or the number of books the next best-seller sells - but the way people perceive, think and live their experiences for some time (sometimes for quite some time!). And this makes it a 'dangerous' force (which is the reason why it is often institutionally and culturally thwarted...) Finding - and making the most of - these precious sources within ourselves empowers us to live a fuller life. Failing to do so may lead to a build up in levels of conscious and unsconscious frustrations leading to many states of mental/psychological suffering, from an abiding sense of powerlessness and futility to dangerous levels of resentment and rebellious destructiveness (often turned against ourselves). Creativity also means really engaging not only with the constructive side of 'bringing sth into existence' but also with the inevitable destructive side of any such decisions we make in life. To paint a picture we deed to attack and destroy the blank canvas, to create music we need to be bold enough to break the silence, to write a story or say sth we make daring decisions about all the stories we shall not write, to build a house we destroy nature as it was on that spot, possibly for ever! Every act of creation (even a post on Facebook) entails some destruction and coming to terms with our destructive potential is sth psychotherapy does not take for granted. If we are not familiar with our own destructive potential we often end up acting it out in unconscious ways - either against others or against ourselves. Creativity helps us atone for such destructive impulses by making it worth while in what we choose to create. Life is a constant recycling of such forces: As we eat our bodies destroy the prime materials of nourishment and expertly (hopefully) choose which elements to metabolise into life and which to discard and get rid of. As we breathe we do the same. Other elements in nature will use our destroyed ejects to create (metabolise) life for themselves. In life we are always ultimately walking in the direction of self-destruction (natural death) and self-wastage (old age), but in the process of doing so we create the seeds of life that outlives us - whether our children, the houses we build, books we write, etc. but most importantly how we affect others in and through our lives - and these shall 'ripple' in ways we often cannot control.Learn More
Time and Tide wait for no Man. Change is the only constant. We are always changing and so is life and everything around us. That is the nature of all living things, and even the so-called inanimate world is always passive to being changed somehow. Change may be cyclical, day to night, summer to winter, cold to hot, dark to light, big to small (and vice versa in all directions as in the Yin/Yang symbol the seeds of movement into ones opposite are always there in and in operation). But evolution is also change. As babies we change very fast - there's a lot to learn and much growing to do! But in the face of so much change (which babies often relish in as they know the direction of their lives is evolution) we need to deal with much anxiety: How are these changes coming about? who is helping? Are they reliable? Does their help match my needs? In good enough contexts, the final balance of how we experience the 'answers' to these 'questions' (felt, not articulated) is 'good enough'. We find what we need is sufficient quantities, of a good enough quality, and sufficiently frequently. We gain confidence in both the environment's capacity to provide and in our own capacity to make good use of what it provides. And we may thrive or fare well in our relationship with changes (external and internal). This balance is however, not matter how well achieved, always to some extent precarious (as is our life - as any picture of the planet seriously considered quickly demonstrates.). Our vulnerability in the face of much bigger and powerful elements (the sea, mountains, outer-space, a vulcano, etc.) is paradoxically the source of what has been conceptualised as the 'sublime' but also the 'uncanny'. Undersdanding our insignificance and our mortality (and the passage of time and of everything else) is often what paradoxically gives meaning to the ephemeral nature of life. Despite such grand aspirations, the survival instinct is always on the alert for 'the next meal'. It needs reassurances: shall I have what I need tomorrow? It craves constant provision (what Klein called 'the perfect breast' - always available, and providing all I need, just when I need it, and just the way I need it!). Any changes to such reliability is a challenge that may bring up big anxieties (and sometimes they do feel like life-or-death!...). Much as the toddler wants to develop their ability to walk and run and go places, it likes to know that mum is within reach and so looks back to check (reassurance). What we commonly call 'confidence' largely depends on this: as we develop our ability to deal with the challenges of the world and day-to-day life, we like to know what we can fall back on, what we assume we can always count on 'just in case'. This can be our families, our home, the particular strengths that have served us well, a 'comfort blanket', a faith, social structures (like the Swiss trains, the salt in the sea, 'bricks and mortar', or pay cheque at the end of the month). Stable societies and cultures, above and beyond any reservations or critique, often provide this 'bedrock' of social, economical, philosophical foundations which allow people to feel secure enough, regardless of what happens to them. When changes break these assumptions we experience them as traumatic.... Trauma shakes up our whole World View. Suddenly we no longer know what is reliable and what is not, because what we previously considered 'impossible' has just happened... The human psyche finds it very difficult to cope with this. It may 'choose' to 'withdraw' from reality (and even deny its existence) or to concoct other ways (called defences) to compensate for or concoct a sense of safety in some other way (often fictitious), in a desperate attempt to recover the lost sense of trust and reliability on what we had assumed would never let us down. Disappointments always hurt, sometimes more than others. And the scale comprises feeling disheartened or even disillusioned, or completely betrayed (and rather shattered in what we had previously believed to be the truth of reality or of ourselves). Despite the fact that we may know that change is always there and inevitable, we find it much more difficult to deal with change which we do not expect, understand, want, which we had not sought, have no choice over or power to control, and which have a knock-on effect on other areas of our lives which we had not anticipated... The 'back to the drawing board' position is often unpleasant (and it may take us some time to realise that we even have a drawing board to go back to!...). Loss is a constant in life. And the concrete objects we are often sorry to lose only stand for changes which entail much more meaningful changes: the loss of childhood, of innocence, of loved ones, of status, power, position, popularity, abilities, capacities, and ultimately that of our own lives. All cultures develop ways of ritualising the passing of significant losses and of honouring the objects of our experiences of loss. This shows our instinctual appreciation for the significance and profound impact (and risks involved) in such transitions. Our emotional/psychological well-being is invariably affected - even if temporarily - by such experiences and for our own sake it is important to find ways to process ('mourn') our losses. Freud's paper 'Mourning and Melancholia' is the seminal psychoanalytic text in this respect - and the ultimate acknowledgement of the risk of Deppressive states of mind when the processes of facing loss go askew... In our psyches (and in our hearts) we do not lose 'suddenly' - it is a gradual process - and never completely 'accepted as a matter of fact' - it depends on a series of internal transformations. Like when a tree in the middle of a forest falls, all the other trees need to adjust gradually to the clearing that is left, and what results is often a landscape of negotiated alterations, rather than a like-for-like replacement, or a simple 'leaving the lack as it is'. These adjustments are what we mean by the psychological experience of transition - not a simple - or linear - task. But, as the clearing in the forest also offers new possibilities, so do the meaningful losses in our lives. Ultimately the person we become is a collection of all the losses we have had and how we have dealt with them. Here again, there is no recipe. Each individual creates their own internal landscapes as they go along. Like the veins in the trunk of each tree are never the same, each developed organically according to innate tendencies as well as circumstantial conditions. Psychotherapy aims to honour this process and facilitate its organic unfolding while making space for the internal richness that comes with pain.Learn More
London EC1 - Clerkenwell
+44 (0) 20 7490 0026
MBACP (Accred & Reg) 630469
Continual Professional Development
Psychoanalytic Psychotherapist at Fitzjohns' Unit - Tavistock & Portman Trust
Counsellor / Psychotherapist at King’s College London Counselling Service
CITY UNIVERSITY Student Counselling Service
University of Law (Bloomsbury) Counselling Service
GUY’s Hospital MUNRO Clinic
PACE Mental Health Promotion Counselling Service
WLCC – West London Centre for Counselling
Southwark Carers Counselling Service
ELOP – East London Out Project – Counselling Service
Anxiety, Exam/Work Stress/Pressures, Competitiveness, Procrastination, Social Anxiety, safety anxieties, pervasive dissatisfaction, Panic attacks, Phobias, self-sabotage, Performance Anxiety, Generalised Anxiety, Phobias, Sleep Disorders, Eating Disorders, career/life decisions, Cultural Identity, Sense of Self, Self Confidence
Loss, Bereavement, Depression, Bereavement by suicide, Ageing, Mid-Life Crisis, Sense of Meaning, Doubts & Regrets (professional, educational and personal choices/decisions), Post-Natal Depression, isolation & loneliness, lack of Self-Esteem, lack of Assertiveness, self-neglect, impending bereavement, Post-retirement Depression, professional failures, Suicidal feelings & ideation, Complicated Bereavement, unemployment, homesickness, Rejection, low Self-Esteem, Disappointment, Aphanisis, Acopia, Disability, Immigration/Displacement/Transitions and adaptation difficulties, Isolation,
Relationship difficulties, Sexual Orientation & Gender Identity, pregnancy, Strict Religious upbringing, patterns of abusive R/Ss, problems with grown-up children and in-laws, relationship break-ups (post and during), Trans Identity, Sibling Rivalry, Sexual difficulties, Marital/Family/Work conflict, brewing resentment, abusive dependants, teenage children, inability to engage in relationships, Social Services involvement, Child Protection issues, coming out & Homophobia, Mental Ill Health in the family, Repressed/Suppressed Anger & Aggression & Aggressive Fantasies/Phantasies,
Trauma, Bullying, Childhood Sexual Abuse, Childhood Physical Abuse, Abuse & Assault, Panic Attacks, PTSD, discrimination, bullying & harassment, Paedophilia, Rape Crisis, inability to re-engage in professional market,
Personality Disorders and other Psychiatric Diagnoses, Bipolar Disorder, Forensic Potential, ADHD, Substance Misuse, Community Mental Health Team support, risk-taking behaviours, Internet addiction, etc.
CPD: Working with Personality Disorders, Autistic Spectrum, Eating Disorders, Body Dis-morphia, Treatment-resistant Depression, Internet Counselling, Working with Refugees and Asylum Seekers, Working with Trans-Identified Clients, On-line Counselling, Suicidality & Risk Assessment, Sexual Health, Substance Mis-use/Abuse/Dependency/Addictions, Working with Carers, Bereavement & Depression, Working with younger (14+) Clients, Community Support structures.
I am also able to offer therapy in French, Portuguese and Spanish (and have a working knowledge of Italian and German).
Previously a Corporate Manager for HSBC and British Airways: Finance Manager, HR Manager, Marketing Manager
Theatre (Sets and Costume) Designer +Exhibitions and Events (BA Hons Theatre Design Central Saint Martin’s).
Secondary School and College Languages and Literature Teacher/Lecturer (Joint Hons B Ed & PGD in French Studies).
Many people only think of looking for 'professional help' once they start experiencing 'SYMPTOMS': the words 'ANXIETY' and 'DEPRESSION' have become so commonplace in our culture that they have largely lost clarity of meaning. What each person EXPERIENCES is different and largely UNIQUE (although there are always 'universals' inasmuch as we are all human).
Symptom is a term that belongs largely in the MEDICAL model and way of thinking: an INDICATION that there is 'something wrong' in the way our 'SYSTEMS' are working. (Western) MEDICINE will tend to either treat the symptom (painkillers, for example) or try to find the ROOT CAUSE of the symptom (tests, exams, scans, etc.) and treat the CONDITION (while striving to 'manage' or minimise the symptoms).
In PSYCHOLOGICAL terms, the approach is more complex. There may be some OVERLAP with MEDICINE (and any PHYSICAL symptoms always need to be thoroughly medically investigated - in case it may have a physiological cause, before it can be assumed to have a purely psychological origin). But, although we ACKNOWLEDGE - and work with - the INTERPLAY between BODY and MIND (both ways), PSYCHOTHERAPY is mostly concerned with the PSYCHE (which is not the same as the brain).
Our CULTURE of fast answers and quick fixes has popularised a plethora of terms: 'panick attacks', 'OCD', 'overthinking', 'stress', 'anger issues', 'control issues', 'suicidality', 'personality disorders', 'addiction', 'dependency', 'comfort zones', 'trauma', 'impostor syndrome', 'victim mentality', etc. Much as these can be useful as DESCRIPTIVE terms, their adoption in the service of (self)DIAGNOSES is rife with DANGER: (unprofessional) LABELLING creates an illusion of identification without providing any UNDERSTANDING of the INDIVIDUAL EXPERIENCE alluded to (their origins, subtleties, consequences, modifications, etc...). The other major PITFALL in this way of thinking is to BUY INTO the MYTH that there is such a thing as a NORMAL human being, and - worse still - that such a STANDARD is ALWAYS 'happy', sociable, 'highly functioning', successful, (self)confident, 'capable', unflappable, resilient, 'healthy', etc... The notorious photoshoped facebook profile picture of idealised perfection.. This MYTH is dangerously DEVOID of COMPLEXITY, and IN DENIAL of REALITY. More of a sign of how sick our culture may be, than a measure to be misguidedly adopted.
Therapists are not doctors who will PRESCRIBE 'CURES'. Although recent trends in Psychology have emphacised a more solution-focused PRESCRIPTIVE approach, traditional Psychotherapy tends to be more PERSON-CENTRED and to espouse more philosophical/humanistic rather than concrete values and approaches.
AFFECTS - feelings, emotions, and states of mind
Feeling 'LOW' or SAD, TIRED or SHOCKED, ANGRY or AGGRESSIVE may well be a very APPROPRIATE (and therefore NOT PATHOLOGICAL) RESPONSE to particular situations or experiences. LOSS of motivation (or libido, or enthusiasm, or energy) may not be a SIGN of 'depression' but that something needs to be REASSESSED in our lives and world. Feeling ANXIOUS before a job interview, or an exam, or in the face of a big decision is a NECESSARY condition for us to be able to take stock of the challenges inherent in the situation and to perform well in the tasks at hand. Feelings/emotions (or AFFECTS) and states of mind are always moving/changing. Like the weather, they come in all shapes and sizes, they come and go, in all sorts of - predictable and unpredictable - ways, some are familiar, but some catch us by surprise, some last for what it feels like a long time, others shift away so quickly we can hardly notice or comprehend. But they do not tend to be PERMANENT.
They may, however, like a broken record, get STUCK in PATTERNS. Fear may cease to be an appropriate response (to real or perceived threats) and become a more or less permanent (neurotic) state of mind... Distress, Dread, Terror, Horror, may become disproportionate (phobic). Worries may no longer be natural, but become obsessive. Tiredness may become un-shifting fatigue. Sadness may feel endemic. Disappointment - in the face of obstacles, adversity, challenges - may become a state of disillusionment. Frustration may turn into resentment and cynicism. Anger may escalate into Wrath and lead to Violence, Aggression into regrettable Destructiveness.
To cope with such escalations, we develop COMPROMISES ('DEFENCES'): In the face of fears, caution may turn extreme and start to get in the way of living a reasonably fulfilling and engaged life. Feeling unable to handle certain challenges, we may turn to artificial 'crutches', and start 'self-medicating' (with alcohol, drugs, or a dependency on other rituals and beliefs, activities or people), we may swing the other way, and buy into an inflated sense of our own capacities, embracing bravado (instead of courage), grandiosity (instead of a realistic assessment of strengths and weaknesses), and adopt reckless behaviours (rather than taking stock of risks and opportunities). To compensate for powerlessness and feeling not in control of certain things (situations, outcomes, people, etc.), we may become 'controlling' (of others, and of ourselves, our body and routines, our feeding and toilet habits, of our desires - for objects, clothes, money, success, power - and sex). In the face of UNBEARABLE ANGER and/or GUILT we may TURN AGAINST OURSELVES - and find relief only in things, acts, and people that HARM us in some way.
LIFE EXPERIENCE, in all its diversity, is a RICH RANGE of POTENTIALS. Like singers, actors, and other artists, to more we EXTEND our RANGE, the more we can ENJOY a full SPECTRUM, and GROW.
Attachments, LOSSES and CHANGES
Life is a constant series of changes and losses - which ends in death (which does not mean that our lives are lost. The point of life is not to live for ever, but to experience). LIFE is not the opposite of DEATH, but what happens between BIRTH and DEATH. Being ALIVE is always a precarious state of TRANSITIONS.
Adjusting to and dealing with CHANGES and LOSSES is per force challenging. Bereavement is a profound experience and Grieving a complex (and largely individual) process. Breaking up (as the song goes) 'is hard to do'. Relationships are 'not easy'. We are hardwired (mostly) to AVOID PAIN, and 'once bitten' really does make us 'twice shy'. Letting go is easier said than done, and missing something or someone we have lost is neither a fault nor a disease. On the contrary: 'THE ONLY WAY OUT is THROUGH'. FACING difficulties (not easy) is - PARADOXICALLY - the best/only way not to get STUCK in REPEATING them again and again (in other guises).
RELATIONALITY - the 'live wire' in Therapy
Most people's lives are made of relationships. Even those amongst us who prefer and choose to be alone most of the time, are always 'in relationship' - either with themselves, or with those who may have represented MEANINGFUL ATTACHMENTS to them in the past. In the animal kingdom Human Beings have the longest PROTRACTED process of development towards INDEPENDENCE. We need our care-givers (usually, but not always, Mother and Father) for much longer (as a percentage of our lifespan) than all other animals: there are so many things we need to LEARN from them (and from other figures along the way), to be able, not just to survive (in the natural world), but to OPERATE in the context of CIVILISATION, that our process of 'INDIVIDUATION' is the most COMPLEX of all species.
The PSYCHES of others leave MARKS on ours. The popular stereotype of Psychotherapy 'delving into the PAST' comes from this realisation. It is not uncommon for people to think (and say) that they do 'not want to talk about parents or childhood', that 'there is no problem there', that they 'had a normal childhood in a normal family', and that their parents 'did nothing wrong'. The FEAR of BLAMING one's parents is inscribed in the HUMAN PSYCHE - the tension between ACKNOWLEDGING possible grievances and the GUILT incurred as a consequence may feel like a TABOO. A client in therapy always has the choice of not talking about whatever they do not want to talk about. The idea of the therapist as somebody who will force us to talk about certain things is in itself a SADISTIC PHANTASY of an INTRUSIVE overpowering FIGURE who believes they 'know best'...
The reality in the consulting room is very different: UNCONSCIOUSLY we bring to bear upon our relationship with our therapist the ASSUMPTIONS developed in our relationships with our primary (early) caregivers ('Transference') - PATTERNS (of RELATING) are handed down in this way (as well as culturally) by the 'NURTURE' of FORMATIVE experiences and relationships. The less aware we are of these, the more we tend to CARRY them with us, and simply REPEAT them (with most people we meet). Added to the 'NATURE' factor (PERSONALITY styles and preferences), these are POTENT FACTORS in the difficulties we often experience in life. And need to be addressed in therapy (if GROWTH is to be given a chance)
Any therapy that views the PSYCHE as imminently COMPLEX will strive to create 'space' for such COMPLEXITY to UNFOLD and BE THOUGHT ABOUT.
Caught between INSTINCTIVE needs and desires on the one hand, and the limitations necessitated by relationships and civilisation/society on the other, the human PSYCHE is always in a state of DYNAMIC TENSION/conflict/AMBIVALENCE - between 'parts' of ourselves, pushing and pulling in different directions as they face the diplomatic dilemmas inherent in the Human Condition.
Freud (and all controversies surrounding him and his work for over 100 years now) remains the greatest theorist and scholar of the COMPLEX PSYCHE (although many more have developed and elaborated the field of Psycho-Therapies - in both theory and practice/technique - with unflinching dedication and genius. Their contributions and learning inform contemporary practice in equally powerful measures).
In this 'internal fight', UNACCEPTABLE/UNBEARABLE thoughts, feelings, and wishes, get REPRESSED into the UNCONSCIOUS where they remain 'hidden', but OPERABLE nonetheless. Despite the restraints/constraints (disappointments and hurts) of the 'Reality Principle' and the 'Facts of Life' (Time, Space, and DIFFERENCES), under the pressures of the 'Pleasure Principle', they are still searching for 'compromise' (indirect, displaced, amalgamated, etc.) SATISFACTION and EXPRESSION. This PRECARIOUS BALANCE means that human beings are never too far away from the 'pathological', and often SWINGING backwards and forwards closer or into it. This makes for not only our potential for the most shocking behaviours and crimes, but also for our most CREATIVE CAPABILITIES!
The basic idea inherent in the practice of a Psychoanalytically-based Therapy is to FREE UP the EXPRESSION of the UNCONSCIOUS: 'FREE ASSOCIATION' may help bring profoundly suppressed contents to the surface: dreams, fantasies, slips of the tongue or pen, and ASSOCIATIONS - and the CONCATENATION between them (spontaneous LINKS, pace, tempo, styles of delivery, connotations, multiplicity of possible meanings, and the 'atmosphere' created through these, etc.).
The client is invited to talk about whatever crosses their mind.
The more TRUST is developed in the Therapist and in the process of Therapy, the FREER this process becomes - particularly the more the client feels COMFORTABLE bringing/showing parts of themselves they may feel uncomfortable showing in other relationships.
The Therapist strives to be RECEPTIVE to the COMMUNICATIONS taking place at various levels (and in many ways) and to help 'make the unconscious conscious'. The process of ARTICULATING and SYMBOLISING these INSIGHTS bit by bit is what constitutes most characteristically a Psychoanalytic approach and experience. The Therapist works through 'INTERPRETATIONS' - of both 'material' and behaviour - in the context of how the Therapeutic Relationship is panning out at any particular point.
EXPRESSION is all permitted. And VERBAL ARTICULATION is encouraged. At times, when the client unconsciously feels (assumes) some contents cannot be expressed (for whatever reason), they may 'ACT OUT' (by being late, or missing sessions, wanting to push the boundaries of the sessions or of the therapeutic relationship, forgetting, loosing their train of thought, engaging in relationships and activities, both in and out of the consulting room, that 'get in the way' of the process described above ('RESISTANCE' is a natural response).
As the work progresses, both Therapist and Client gain increasing awareness of the individual's 'Internal World/Landscape': the 'figures/objects' (assumptions, expectations and forces) that populate it, and how decisive they may be in influencing and controlling how the individual responds to and even chooses and 'creates' the elements of their experience in life. SELF-UNDERSTANDING ('Know Thyself') - in the PRESENCE of and within THE RELATIONSHIP with an-OTHER - expedites CHANGES in the way they RELATE to each other, and CHANGES - both internal and external - tend to HAPPEN SPONTANEOUSLY (above and beyond conscious control of cognitive or behavioural habits).
The FRAME / STRUCTURE
Unlike most other services provided, the 'WORK' is an 'engagement'. Perhaps more like a 'course' (where learning is not only cumulative but progressive, and elliptic too), it is always in a state of 'work in progress' - it grows more ORGANICALLY (more like a tree - in all directions, with changes through the 'seasons', and requiring constant change of all parts) than in a LINEAR, mathematical/industrial fashion.
The client's ENGAGEMENT in the process is CRUCIAL - this includes their COMMITMENT as well as their capacity to ACTIVELY PARTICIPATE in it.
For this to happen an 'AGREEMENT' over a 'FRAME/STRUCTURE' of REGULARITY is necessary. Appointments are on the same day(s) at the same time(s) every week (usually once or twice a week - Psychoanalysis requires attendance 3, 4, 5 or even 6 times a week). They last for 50 minutes and start at the time they are set to start (even if the client is not present yet) and finish at the time they are set to finish (even if the 'material' is interrupted - it can be continued later 'within the frame').
This pattern is usually maintained for about 42 weeks in the year. There are usually 3 (planned) breaks a year: 2 to 3 weeks around the end of the year, 2 to 3 weeks around Easter, and 4 to 5 weeks in the summer (usually August/September). I strive to give every client notice of the dates of such breaks well in advance. These breaks are not just 'holidays' but an important part of the work (as separations are both a disruptive and a potentially constructive element in the process of growth). It would be desirable for clients to plan and arrange for their breaks/absences to coincide with mine, so as to minimise further disruptions or un-necessarily extended breaks in the progress of the work.
Occasionally, it may be necessary for unplanned breaks to be incorporated - either for health reasons or other factors that may necessitate unforeseeable interruptions. Notice of these may not be much advanced.
If the need or wish arises to consider an interruption to the work (of a month or more, or open-ended), it is important to discuss this in the therapy. It can be helpful to try out periods of 'independence', before an ending is agreed.
Endings need to be considered carefully, and time is needed to prepare for and to 'process' them. It is usual to agree a notice of one week per month in therapy, or one month per year in therapy (if more than 2 years). (I would be committed to the same time spans if the initiative to trigger an ending comes from me for whatever reason.)
The AGREEMENT/ CONTRACT
Fees are charged per planned session. These do not include my planned or unplanned breaks, but would include any sessions missed or cancelled by the client. (Sometimes it is possible to re-schedule sessions - to a different day or time during the same week, but this is not desirable and should not become a feature of the pattern of the work. There is no guarantee that this could be practically possible at any point.) If the pattern of attendance needs to be changed, it is desirable that plenty of notice should be given, both for practical reasons, but also because of the impact it is likely to have on the therapeutic relationship and on the 'frame' of the work.
Invoices are presented at the end of every month (for all sessions planned for that month) and payment is expected to be expedient (within a couple of days, by direct debit into my account) or immediate (in cash or by cheque).
Fees are agreed at the beginning of the work and reviewed every year (usually in September). I operate a 'sliding scale' so as to facilitate affordability according to individuals' financial means. Peak time appointments (early morning, lunchtime, and late afternoon/early evening) command full fees. Fees for Mid-morning and Mid-afternoon appointments are more negotiable.
Assessments, Limitations & Referrals
Psychotherapy is not 'the only option' available for those who would like to enhance their personal development. It is not always the 'best' option either, and in some cases and in some situations it may be counter-indicated.
For this reason an initial 'assessment' is important. It is an opportunity for you to meet your potential therapist and discuss your needs, wishes, and circumstances, and to ask any questions or clarifications and express any concerns. It is an opportunity for me to assess your suitability for what I can offer, and whether my approach and areas of expertise/experience would be your best option. It is also an opportunity for both of us to assess our potential 'match' (for working together).
It is usually conducted over 2, 3, or 4 (weekly) meetings, before we agree to commit to an open-ended contract.
Some 'presentations' may be better suited to other services/professionals, and if this becomes clear - either in the course of the Assessment or during the work, I shall discuss this with you and endeavour to locate the best pointers for you.
Some more complex presentations may require 'coordinated care' and the input of various professionals. Presentations which include psychotic elements or high risk of suicide or self-harm (including chemical dependencies) usually require an institutional approach, where more and diverse resources and services are in place to 'contain' possible crises. It would not be wise for these presentations to be taken on in Private Practice, and could be detrimental to the client's health in the longer run.
Accessibility - my consulting room is on the 3rd floor without a lift (45 steps up) - please bear this in mind if your mobility is limited.
NB - please note that I do not have a waiting room/area. I ask clients therefore not to arrive before their agreed appointment times. There are plenty of cafes and restaurants in the area, should you find yourself arriving considerably before your appointment time. Finsbury Library is open from 9 am to 5 pm every day and until 8 pm on Mondays and Thursdays.
CONFIDENTIALITY is a crucial part of the work due to the very PRIVATE nature of it. Material is exclusively discussed with my Clinical Supervisor (who is bound by the same terms of CONFIDENTIALITY). Case material may occasionally be alluded to in the context of clinical discussions in professional circles, but identifying details are omitted (or changed) to protect the client.
RISK of HARM - to Self and/or others - is the main factor which legally binds me to take matters outside of the therapeutic relationship. If the client is at risk I may need to discuss this with your GP or other Psychiatric Services (if and as appropriate). If there are indications that others may be at risk, I may need to approach Social Services or the Police. In any case, I shall endeavour to discuss such needs directly with the client, but this is not possible, your consent is assumed.
I do keep handwritten notes of all sessions/contact and these are kept in a secure place which only I have access to. These are records of psychological processes observed during the work for my own reference and largely unintelligible even to other professionals. I do not keep clinical notes electronically as the risk of confidentiality breaks is higher. ( I do not currently offer either telephone or skype sessions for the same reasons). Clients are discouraged from sharing personal material or attempting to engage in conversation with me about such matters by any other means (telephone, e-mail, letters, etc.) or in other contexts outside of the 'frame' of the consulting room and agreed session schedule. The effectiveness of the work depends on the interraction between us and this would be precluded elsewhere or through other media.
I hope you don't mind me emailing, I just wanted to say thank you so much for your help last year... I'm so grateful to be happy and feel normal again. I tell everyone how amazing you are and how much you helped me so just wanted to say thank you again and let you know that I'm doing really well!! :)
Although I found it difficult to talk about the issues I have been facing, I did find the sessions very helpful. Thanks for the time and space to explore everything, I really appreciate it.
I wanted to say thank you again for your fantastic sessions. I feel I made progress each week to help me to think more clearly and challenge some of my thoughts. It was very helpful.
I am so glad I had a chance to continue the process of counselling with you. It was a very precious experience and I feel much stronger and more relaxed now, which also has a positive effect on my concentration capacity. Also, I had a long talk with my boyfriend about the counselling experience this week; it was great to share and exchange quite a few ideas. It certainly has been an honour for me. I've enjoyed the sessions very much and feel I have learned so much. Thank you.
I wish to take this opportunity to thank you for taking the time to listen and help me understand the issues affecting my life and helping me to understand, reflect and move positively forward.
Many thanks for all your help and support. I wouldn't have been able to get through the final year of my phd without it! I am glad I came back today for the final session. After all the challenges it was good to be able to reflect on the progress we made in the counselling sessions. I can't thank you enough for your patience and understanding.
I also want to thank you for all you helped me to achieve, I think it was no small feat. I hope that you will take some satisfaction from knowing that you have made a tremendous difference to my quality of life. I am very grateful indeed.
I've really appreciated your support and your insights over the past few months - I feel like I see things so much clearer now, and without the weight of so much judgement, and as a result I'm a lot more confident in deciding what I want, and admitting that I need help. I was really touched by the fact that you seemed to want me to succeed and get what I wanted - it was great to have you on my side. I'll try to remember to make space for myself, and check that I'm not just taking the path that is easiest for everyone else!
The support and guidance you were able to offer in our time together was some of the most constructive and helpful I have ever had. For fear of offering 'fluffy BS', I don't know how much longer I could have carried on without addressing it and your help was essential in dealing with it. Thank you. I wish you all the best. Keep up your incredible work.
Thank you also for these sessions I do think they helped me unravel a lot of my thoughts and allowed me to glimpse into its complexities. Thank you for your help during this process.
Thank you again for helping me during our sessions. It has really made a difference for me. I also really enjoyed your company.
As I told you in person, I am thankful to you for your deep understanding and professional support. It has been a very interesting experience to have these few but fruitful sessions with you.
I'd also like to thank you again for your help, it was a valuable experience for me and gave me a new perspective on how I can tackle the issues I have - I feel very positive about this coming year and I'm determined to make the most of it :)
I think this is absolutely fascinating and think this may be the message you were trying to put across to me. It really made an impact on me.
Thank you for listening and helping me think more clearly. I certainly won't forget everything you've done for me. it has been incredibly helpful to me. I cannot appreciate it enough. I hope you continue your good work and aid the many others out there.
You helped me a lot 2 years ago. It was even better this time.
I used to be YOLO (You Only Live Once) – now it’s like you are my YODA, sitting on my shoulder and helping me think.
I cannot believe how much of a difference these sessions have made! And it’s all because of you. You were spot on.
I have been carrying all these for so many years… And now I’m a completely different person! Life is not heavy anymore! I’m doing well and enjoying myself and looking forward to my life in the future.
Judging from my experience with other counsellors before I did not expect this to do much, but it is clear I value these sessions so much – I wish they would never end.
I have come to be so much more comfortable with myself. I used to want to be other people – now I think I prefer to be myself.
When I first came here I thought I was mentally ill. Now I know I’m not a monster.
The first time we met I thought: ‘this guy gets me’
I was sceptical about counselling but decided to give it a go. I had not idea it would be this good. I feel I am able to think now – thank you so much. It exceeded all expectations.
I thought counselling was just an opportunity to get things off my chest. This has turned out to be much more. An experience I shall never forget.