Frequently asked questions

Should I seek counselling or therapy?

If you are reading this, chances are you are at a place in your life where you feel stuck in some way or you are unhappy in some form.

The reasons why people seek counselling or therapy are as diverse and varied as there are humans on the planet. Below are some symptoms you may be experiencing yourself which can lead you to want to talk to someone about how you’re feeling and what’s going on in your life.

Perhaps you are unhappy in a relationship, in your family, your work, or even your life in general. You might be aware of feeling depressed or anxious, have difficulty concentrating or difficulty sleeping (too much or too little). You may have trouble dealing with repetitive and disturbing thoughts or even obsessive actions that you can’t stop even if you want to.

Perhaps you are eating too much or not enough, perhaps you are drinking too much alcohol, taking more recreational drugs than you think you should, or than others in your life feel you should. Perhaps you know you are over-reliant on prescription or over the counter medications.

Perhaps you are withdrawing from friends and family, spending hours on the internet, watching porn or playing computer games. You may know that your work performance is suffering. Your family and friends may be telling you that your relationships are being affected by your mood and behaviours.

Perhaps you are finding that you are not really interested in anything and nothing makes you feel excited or happy any more. Perhaps you feel overwhelmed and stressed by your life. Perhaps you have tried to live up to the standards of a very exacting and punishing perfectionist internal standard, only to find that you keep not making the grade. You may feel discouraged and exhausted under the weight of your own constant self-criticism and judgement.

You may be having difficulties managing your anger and violence or aggression is an issue. Or you’re on the receiving end of someone else’s aggression or violence and you feel scared to take action and change the situation. Perhaps you are having trouble standing up for yourself and know that others are taking advantage because you find it hard to speak up.

Perhaps trauma, or old hurts from the past trouble you, haunt your life, disturb your sleep and continue to have a painful limiting effect on your relationships today. Perhaps you are questioning your sexuality and those troubling questions are not going away. Perhaps you are unhappy in your relationship as you or your partner have had an affair and you don’t know whether to stay and keep working on it or whether you should leave.

Perhaps you are facing a very difficult life stage or chronic illness, or someone close to you is going through one (such as an elderly relative developing Alzheimer’s) and you don’t think you can go on coping on your own for much longer.

Perhaps there are issues associated with your cultural background or your family’s cultural/ religious backgrounds that affect what you think the options are for you in your life. Perhaps you know what you would like to do but are afraid of the consequences you imagine might manifest if you act on your heart’s desire.

Maybe you have tried all sorts of things to make the feelings go away, adjusting your life to keep going in spite of them. Before people try therapy, it’s very common to try denial, being a workaholic, using drugs and/or alcohol, medications, overeating or under eating, and the compulsive use of sex and porn, the internet and computer games, religion, social networking sites, gambling, compulsive spending, or blaming others to compensate for how they are feeling.

Whatever it is you have been doing, you are now at a point where you may have found that none of these are working for you and the feelings aren’t going away. You have reached the point where your own solutions aren’t working and you would like to get an external point of view and learn some different skills to approach the situation.

This is where therapy or counselling comes into the picture. If you know it’s time, come and see me.

Why speak to a professional?

It takes a lot of courage to admit that it’s time to ask for outside help with a personal situation. Many people feel that to do so is admitting defeat, or even worse, that it must mean they’re weak. As a result, many people don’t get past this point because of the shame they feel about admitting there is a problem, let alone that they need help. Yet, if most of us have a problem with our home plumbing, we would not think twice about calling a plumber to help identify the problem and to help solve or alleviate the issue. Counselling or therapy is no different. It involves hiring a person who has made it their professional job to help others sort out emotional and mental life issues they have difficulties with.

Counselling or therapy involves working with someone outside of your usual circle of friends and acquaintances to listen to your point of view regarding the challenging situation you are dealing with. That external person can offer you a range of different ways of looking at your issues and offer different tools you might use to improve your situation. Your role is to be willing to experiment and try out at least some of these suggestions to see if they can make a difference.

If you choose to work with me, the advantage of turning to an outsider for help over someone known to you is that you have a guarantee of confidentiality. With this kind of separation between your personal or work life and the person you are speaking to, you can take the risk to bare your thoughts and feelings with complete honesty. Rather than managing your image with someone from your social or professional circle, you can get on with the more pressing business at hand: sorting out your situation.

Another advantage of speaking with someone who is not in your personal or professional circle is that it is easier to give them a mandate to challenge or confront you, based on their skills and expertise. Chances are, if a partner, relative, friend or colleague tried to tell you the same home truths, you would be more likely to dismiss their suggestions. You would also be more likely to take offence and this can damage your relationship with them.

While a lot of people think of therapy or counselling as being about support, it is about much more than that. It is about resourcing you in ways you may not have thought or known about, helping you to develop a different perspective on yourself, your situation and your role in it, and it is about challenging you as needed.

Often, therapy is about educating us about life and how to get the most and the best out of it. The kind of quality support a good therapist can bring to the table is about challenging the ways you might be working against your own interest; this often means challenging your set ideas and beliefs about the situation. Someone in your friendship network, on the other hand, may feel pressure to preserve the friendship and want to avoid conflict and unpleasantness, and this may be at the expense of honesty.

As your therapist, my priority is first and foremost to reach the goals for which you have engaged me to help you with.

Counselling? Therapy? Coaching?

These are terms you will come across everywhere. It can be confusing and I’m often asked what’s the difference. Here’s how I see it.

Counselling – involves listening to the issues and feelings you bring up in a non-judgmental way. Counsellors work towards helping you to see your situation from a range of perspectives that are more useful than the one you are currently relying on. Counsellors may or may not have academic training.

Therapy – usually involves someone with some sort of academic qualification in the social sciences who has then gone on to train in one or more ways of working with people to help them effect change. These may be Social Workers, Counselling Psychologists, Occupational Therapists or other professionals with a background in the social sciences.

Coaching – may or may not have academic qualifications and usually involves a very limited, task and goal focused orientation. A coach will typically focus on what your goals are, find out what is in your way, and design some sort of program to help you tackle the obstacles that you both identify are in the way. They will also work to resource you to achieve your goals. There is a very practical, pragmatic orientation involved in how issues are approached.

Psychology – involves either a Bachelor’s degree in Psychology and or a Master’s degree in Clinical Psychology or a Ph D. They may or may not engage in doing some psychological tests as part of their approach to finding out what your situation involves and will work with you to overcome your issues using a number of approaches such as Cognitive Behaviour Therapy and relaxation training.

Psychotherapy – involves someone with one or more academic qualifications in the social sciences who has then gone on to train in one or more other therapeutic approaches in how to work with a diverse range of clients and a wide range of issues. The issues addressed are more wide ranging, we may include delving into the back story behind the problem. The approaches available to the practitioner are usually be more tailored to the client’s needs.

Psychiatry – involves a medical doctor who has specialised in diagnosing in the area of mental health and mental illness. Psychiatrists generally diagnose the medical and usually drug related treatment of such conditions. Your General Practitioner and psychiatrists are the only ones who can prescribe medication such as anti-depressants and mood stabilisers in Australia.

As a Psychotherapist I am fully qualified to assist you with therapy and counselling. My approach involves looking at the deeper aspects of what factors have contributed to you being in the position you find yourself in. I will assist you with finding the resources you need to make the changes you want in your life. .

Therapy requires me to be a little like an optician: depending on how the person in front of me sees the world, I need to have different lenses to offer them to ‘see’ more clearly; at different times, and in working with different issues, some of these lenses will prove to be more helpful than others. Therapeutic approaches are like lenses of varying usefulness, depending on the person, the context they live in, and the issues they want to deal with.

What to expect in counselling?

It depends on the kind of issue and the kind of ‘work’ we will need to do together to help you.

At any point in time, I might be in the role of counsellor, coach, or therapist as we address the particular issues you want to focus on, moving across issues from the past, looking at how they are manifesting now, resourcing you to better deal with them in the present, and helping you to clarify and make the changes you need to make in order to have the kind of future you want for yourself.

At times I will coach you to help you learn new skills, unlearn old patterns that are no longer serving you and set goals for a more satisfying life.

At other times I will share information on how our brains work and the strategies that have been known to work to resolve situations like yours.

Whether you come in to work individually or as a couple on your relationship issues, we will look at your communication patterns, attitudes, assumptions, family history and behaviours are contributing to the pain you find yourselves in. We will experiment with new ways of looking at things as well as different ways of communicating and behaving with each other, and I will coach you in trying on these new skills.

Sometimes in the session we may try different techniques and you may also be given homework tasks to try out. You will find you get the most out of therapy if you put into practice the things that come to light in the sessions.

How long will it take?

It’s hard to say how long counselling/ therapy is likely to take. The usefulness of doing something about what bothers you when you’re ready is that the motivation is there. It is likely that we will get traction faster and the more you implement the changes in your life between sessions, the sooner you will move through your issues.

That said, it is to be expected that some things take longer than others. A more discrete issue such as localised workplace conflict, will most likely involve a coaching focus, education, skill building and perspective changing, and is very likely to be behaviourally task/ goal oriented. This work helps you deal more easily with an existing situation by ‘fixing’ what isn’t working and focussing on where it can be fixed. This is likely to take between 2 and 5 sessions.

A more substantial issue, say a relationship problem, will mean we need to ‘open up’ some of the structures that are getting in the way to address where the problem might stem from. In addition to the education, skill building and perspective taking mentioned above, this usually incorporates counselling to do more involved investigations and troubleshooting of underlying issues which may be contributing. This will most likely involve more experimenting, in and out of sessions. It does not necessarily involve major life changes, but is more about making your existing life circumstances more liveable. This is likely to take somewhere between 5 and 10 sessions.

A long-standing issue where a number of difficulties, often in a number of life areas, have existed over a number of years will involve longer work. Together we will deconstruct unhelpful aspects of how you view, respond to and do things and experiment with seeing what might work better for you in the future. This kind of work is more transformational, as it involves questioning and often changing the very foundations for the way you have seen yourself and approached your life until now. Rather than just helping you live the life you have, this work helps you create the life you want for yourself. This work tends to go over a longer period of time, depending on the kind of changes you are seeking.

Mentoring for living – this is more for people who feel their life is going well but want more satisfaction from it. They are interested in going beyond seeing their life in terms of what’s not working but see it as a way to build on what is already working to make it into what they really want. Typically, I work in this way with people with whom I have already had a therapeutic role.

Frequency of sessions tends to be affected by a number of factors including severity of the presenting issue, urgency, availability of time and other resources as well as finances. Research suggests that it is usually best to schedule the earlier sessions closer together (say, weekly or fortnightly if possible) to get the momentum happening and put things in place quickly and then space the sessions out to allow more time to implement and integrate changes made.

How effective is therapy?

Research over the past thirty years has shown that therapy is effective around 80% of the time. This means that about 80% of the time, people who start out with a problem are better off from having undergone therapy than are people who have a problem and do not access therapy[1].

What this means is: effective therapy needs to be focused on you: your strengths, your resources, what you find helpful, and building your hope and expectancy that things can change.

Effective therapy also needs to be relationship focussed: we need to make sure that the relationship between us is working really well . Through the kind of relationship we forge together on our journey, your determination and courage, and my experience, we work out how to reach your goals. Every day I see people do amazing things with their lives. I see feats of courage, ingenuity, determination and strength.

Ultimately, when you’re abseiling, when you’re on the side of the precipice it matters how you feel about the person you’re tied to in addition to the level of skill and experience they possess! That means that you need to tell me what I’m doing that works for you and also what it is that doesn’t work. That way I have a chance to make adjustments quickly and hopefully, help you get the outcomes you want faster.

What constitutes change is different for different people. Some people come to therapy wanting some adjustments in their situation or how they feel about some aspect of their life and they are content with the result if this is the outcome. They mostly like their life the way it is – they just want to tweak some things. Others want more out of life and know that their life holds the potential to give them much deeper satisfaction in all aspects. Depending on what it is you see as ‘change’ and how badly you want it, you will get out of therapy what you put into it.

If you are ready to be honest and really look at things as they are, if you are willing to take the risk to try new things, hear difficult things, face your fears, risk the disapproval of others, reach for what you think will make your heart sing, stand up for what you really believe in, question and maybe let go of beliefs and behaviours that are no longer serving you, then you may be amazed at what you can achieve.

I rejoice in seeing people give themselves the kind of lives they have always wanted to have and I feel privileged that they have chosen to undertake this process with me. It inspires and reinforces me to do the same in my own life.

[1] Lambert, MJ and Bergin, AE (1994) “The effectiveness of psychotherapy”, In A.E. Bergin and S.L.Garfield (Eds.), Handbook of Psychotherapy and Behaviour Change (4th ed., pp.143-189). New York: Wiley. See also, Hubble, M.A., Duncan, B.L., and Miller, S.D. (1999). The Heart and Soul of Change: What Works in Therapy. Washington D.C.: American Psychological Association.

Measuring outcomes

Since 2005, I have used an outcome measure in my practice, which was developed by psychologists in the US in the 1980s. This system is very brief and only takes a couple of minutes to do. It has been well researched and well validated against older well established measures (such as the OQ45).

It is entirely based on the client’s view of how they are progressing. I chose it because it gets my clients to provide real time feedback about how they are experiencing therapy with me on a session by session basis. We measure what impact (if any) therapy is having on your life through looking at your level of wellbeing from session to session. We also track how you experience the work itself with me. If I am off track in some way, I can correct what isn’t working for you right away.

This measure not only lets you know whether or not your results are tracking as you might expect them to if you were getting average or better than average results compared to another person in a roughly similar position to yours.  It also lets you know how effective I am as a therapist, in comparison to other therapists worldwide who use such outcome measures. For some years, my effectiveness score has been tracking at ‘above average’ with between 81% and 83% of my clients reaching or exceeding the baseline needed to demonstrate that they have reached significant and sustained change.

Accountability

In addition to reviewing with you each time we meet to see whether you are getting the results you want out of our work together, I am also in supervision. I hire someone to review my own work and to make suggestions when I need additional input or clarification. When I review a client situation with her, our discussion is confidential and all identifying data is removed.

Medication

These days, more and more people believe that the solution lies in a taking a pill. The use of anti-depressants has doubled in Australia between 2000 and now, and they account for two out of every three psychotropic medications prescribed (Uni of Sydney, 2012)[1]. Similarly, the use of anti-psychotic drugs has also increased in that period[2] .

Professor Iain McGregor of the University of Sydney has gone on record saying that there are major concerns about this given a range of issues including the questionable effectiveness of anti-depressants, particularly in mild to moderate cases of depression, and their associated side effects (which may include fatigue, weight gain, and sexual dysfunction)[3].

While anti-depressants have been shown by some studies to be effective some of the time with moderate to severe depression, it is unclear as to how effective they are with mild to moderate depression[4]. As most people presenting to a GP are presenting with symptoms of mild to moderate depression, and yet most of these appear to be sent away with a script for anti-depressants, it is unclear what benefits, if any they are getting from the drug treatments they are being prescribed.

On top of that, recent analysis of published studies on drug effectiveness has shown that a very clear bias has occurred in reporting, skewing the perceived effectiveness of those drugs[5].

While our society mottos continually exhort us to “soldier on”, “keep it together”, and “move on”, these create an expectation that we “get over” whatever disturbs us – preferably quickly.

The idea of being able to take a pill and feel better fast appeals to the expectations we seem to be developing in our modern world to get fast and easy results. Unfortunately, being human and sorting out what makes for a satisfying and meaningful life doesn’t happen that way.

Chances are, we didn’t get to the way things are overnight. So why should we expect the situation to be resolved so quickly? Often, the situations we find ourselves in are the result of a complex mix of our family upbringing, cultural and political heritage, gender, race, religion, sexuality, life experiences and traumas, significant life events, health, and socio-economic and education background. No pill is about to make it all better instantly! Depending on the severity of the issues, the person’s resources and other presenting challenges in the situation, research suggests you should be seeing signs of change within the first four to six sessions for most issues.

[1] “Australians double their anti-depressants”, Univ of Sydney website.

[2] ibid

[3] Stephenson, CP, Karanges, E, and McGregor, IS, (2013) “Trends in the utilization of psychotropic medications in Australia from 2000 to 2011”, in Austr NZ Journal of Psychiatry (9)2012,

[4] Harald Baumeister, “Inappropriate prescriptions of antidepressant drugs in patients with sub-threshold to mild depression: Time for the evidence to become practice”, Journal of Affective Disorders

[5] Erick H. Turner, et al., “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy”, N Engl J Med 2008; 358:252-260January 17, 2008 DOI: 10.1056/NEJMsa065779