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Therapy with Liz PSYCHOTHERAPY IN SOUTH MANCHESTER & ONLINE

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I write blog posts and articles which sometimes are featured in psychotherapy and counselling publications. Details are listed below with PDFs for download for the articles.


Blog. Chamomile Small

How Psychotherapy Helps

How does psychotherapy help?

This is a big question of course. Beginning psychotherapy and counselling is a significant and potentially life-changing decision to make.

In order to help you with this decision, here I outline some of the ways in which psychotherapy and counselling is known to have helped, and also some of the components of psychotherapy and counselling that are known to contribute to a successful outcome.

Ways in Which Psychotherapy and Counselling Are Known to Be Helpful

First, I list a number of typical ways in which psychotherapy is known to be helpful. Perhaps items in this list are similar to the kinds of help you feel you need?

Psychotherapy and counselling can help in a number of different ways and on a number of different levels. These include:

  • Help for emotional difficulties including: depression, bereavement, eating problems, anxieties, self-harm, addictions, anxiety, abuse or trauma, relationship conflict or breakdown and migraine and chronic pain.

  • Providing a safe space to talk about experiences and how they are affecting you. A space to work through distressing feelings and think about how they might have arisen. Psychotherapists are professionally trained in helping find the origin of problems, in exploring with you how you might want things to be different and then to help you to create change.

  • Help to bring into awareness those ways of being which have become deeply set and lead to repeating patterns from the past. Such patterns may have caused you to get stuck in a lifestyle, in relationships or in behaviours which may not be what you want for yourself or your life.

  • Help when you may not know precisely what the problem is, or perhaps you know the problem but you want to understand it more clearly

  • Help for when you feel stuck. Psychotherapy and counselling can help to identify the obstacles which are preventing you from changing and moving on. For many this can entail working through blame, shame and various self-sabotaging voices from the past. Learning to identify what is your responsibility and what is not is often a first step.

  • Help for expressing – for sharing – important experiences. Talking about feelings and thoughts that you may not have been able to talk about before can bring a sense of relief. The security of having a space and time with your therapist each week may relieve the sense of being on your own and help to develop the capacity to create change in your life.


  • What Really Works in Therapy

    Next is the issue of how psychotherapy helps. Research on effective therapy has found that there are four common factors in successful therapy. Consideration of these may also help your decision about seeking therapy:

  • First of all, there is you. Your personal resources (hope, optimism, persistence, openness) and your social resources (friends, family, social support). These won’t necessarily all be in place at the beginning of the therapy. Perhaps none of them will be, but your therapist will support you in developing these resources so that the therapy can be effective for you.

  • Next there is the relationship that you have with your therapist. This is called the alliance and really means the strength of rapport or agreement about the purpose of the therapy and how to achieve the goals of the therapy. Choosing the right therapist for you is important, and I have written a separate blog post about this.

  • Next comes expectancy – a commitment or belief that therapy can help.

  • Finally, there are the techniques and the models the therapist uses to help you. My blogpost on diversity in therapy may be useful to read about this.


  • Overall Benefits of Therapy

    So, by taking into account both the ways in which psychotherapy is known to be helpful and how psychotherapy helps, a range of benefits can be experienced:

    • Relief from emotional difficulties
    • Identifying and working towards goals,
    • Creating meanings
    • Understanding lifestyle patterns and behaviours
    • Changing relationships (with yourself and others)

    Furthermore, it can do this with the greatest effect if you have the personal resources, the right therapist (for you) and the expectancy of success.

    To end this post, perhaps the words of Marianne Williamson express why people most often turn to psychotherapy and counselling:

    “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us.

    Psychotherapy can help with moving into the light. If you feel that it might be beneficial for you, I can be contacted by email or by phone on 07891 613580. We can then arrange an initial session or discuss any queries you might have.

    REFERENCE

    Hubble, M.A., Duncan, BL., and Miller, S.D. (eds.) Heart and Soul of Change: Delivering What Works in Therapy . American Psychological Association: Washington DC


    Blog. Internet Image

    Face-to-Face and Online Therapy - How to Know Which To Choose?

    There are a number of factors to consider when deciding on what kind of therapy works for you. When thinking about the mode - whether to visit your therapist in an actual therapy room or to do some kind of online therapy there might be several different things to think about.

    Firstly, are you someone that can easily ‘talk’ over the internet, whether by video or text, or do you feel more comfortable with face-to-face contact. Seeing the person, feeling their presence.

    Or maybe you like to get to know people in-person first and then are comfortable with talking over the internet, but you don’t like using the internet to talk to people before getting to know them first.

    Therapy can work like this too. You can begin by meeting your therapist and having some sessions face-to-face and then move to online therapy if that is more convenient. Sometimes, when you have got to know your therapist by visiting her in person first, online sessions can feel very similar because you have an established relationship.

    You might have a need for online sessions because of your personal circumstances or because the therapist you want to work with does not live local to you, but this might not necessarily make it the right choice for you if you are somebody who needs to see the person they are sharing precious and perhaps anxiety-provoking information with. Psychotherapy is an interpersonal process at its heart and not everyone can re-create the relational aspect of therapy online.

    Alternatively, because sometimes when you haven’t met your therapist in person it may feel more difficult to talk about what is troubling you and what is bringing you to therapy in the first place. That is not to say that online therapy couldn’t work for you but just that this kind of difficulty may mean that getting started may feel a bit on the slow side, while the work is done of forming a connection with your therapist.

    Finally, it is important to consider that while some aspects of online therapy can feel challenging - such as sharing emotions, or not having facial expressions as a guide in text-based work, there can also be aspects of distance which make the therapy feel easier - being in the comfort of your home with the therapist in their office can feel safe and there can still be a sense of presence - being with your therapist that supports the expression of what can feel difficult.

    So, what format of therapy you prefer is a very individual choice. Neither is better than the other. Both can be effective but which is right for you is dependent to some extent on how relationships generally work for you.



    Blog. Ellery Wood Trees Rotated

    Finding the Right Therapist

    “Oh that’s easy, I just google and I can easily find the right therapist” you might say.

    Of course, that is true.

    A psychotherapist can easily be found that way. That is the finding part.

    However, what about choosing the right therapist for you at this moment in your life? What is really important if you are to be able to work through your difficulties or concerns with your therapist?

    Well, one of the keys to successful therapy is finding that therapist with whom you can have a relationship which includes:

  • Trust – you can trust your psychotherapist enough to be able to talk honestly and openly with them
  • Feeling Understood
  • Feeling Safe

  • Another central component to successful therapy is whether your psychotherapist’s way of working is a good fit for you:
  • Do they specialise or have experience in working with the kind of issue you are bringing to the therapy?
  • Do they work at a time that suits you?
  • Is the location convenient for you?
  • Is the therapy frequency what you are looking for?
  • What sort of commitment are you making when you begin the therapy?

  • All of these concerns can be addressed at an initial consultation – a first meeting where you have the chance to explore in conversation what you need from therapy

    I may be the right therapist for you but equally I may not. If not, then the session will have helped you in your discovery process – you will have a clearer vision of what you need from your therapy and the kind of therapist that you want to work with.

    Of course, if it turns out that I am the right therapist for you, then we can begin to work through your difficulties and concerns together.

    Why not email today to arrange a no-obligation initial exploratory session. It may well be the first step towards life feeling a whole lot better?


    Blog. White Flowers Attached

    Different Kinds of Benefits from Therapy

    An article I was reading recently addressed a myth of psychotherapy and counselling. In essence, whether everyone can receive benefits from psychotherapy.


    The author held a personal belief that most people can benefit in some way or another but I think that whether this is an accurate statement will depend on what “benefit” is taken to mean, and also on what form of therapy an individual experiences.

    The author of the article I read seemed to presume that all therapy is the same. It isn’t.

    There are variations in terms of focus, depth, intensity, duration, as well as in terms of support versus exploration.

    Considering one of these criteria, that of depth, it is often said that psychotherapy is a deeper, longer-lasting, more intense form of therapy, while counselling tends to be more problem-focused, focused on the present and on practicalities and also shorter-term.

    In this blogpost, I will be talking mainly about psychotherapy, so those therapy experiences which are experienced as deeper, more intense and longer-lasting. In these cases, can everyone benefit?

    I think that the answer here will depend on what people are benefiting from? What are the components of therapy? What do people expect from the therapy process?

    There are many answers to these questions but some generalizations can be made. People enter therapy because they want to feel better about something, or to change something (either externally or internally). Often both.

    The therapist helps the person to meet these goals in various ways but the process may be conceptualized as involving several stages:

    1) Initial contact
    2) Evaluation
    3) Early treatment
    4) Deepening
    5)Working through
    6)Termination or Ending.

    In short-term therapy there may not be a deepening stage, but otherwise irrespective of whether feeling better or changing something is the desired outcome from therapy, there tends to be something of a multi-stage process.

    In terms of what happens in therapy, perhaps the words of Jung about when therapy can be effective or ineffective can help here:

    “For psychotherapy to be effective, a close rapport is needed .... The rapport consists ... in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. ....”(Carl Jung).

    Achieving benefits from psychotherapy, then, comes about from being willing to develop and maintain a rapport with the therapist, a rapport which feels safe enough to be willing to challenge conscious awareness. Of course for this to happen choosing a therapist who is a good fit is fundamental. See my blogpost on Finding the Right Therapist for help with this.

    Assuming that you have found the right therapist for you, however, and that you have an enduring and close rapport with your therapist, what can be achieved then? If we return to the main question here, about whether everyone can receive benefits from psychotherapy, it seems that the core issue is about whether everyone is willing to take the step of confronting their internal reality. This can be challenging, scary and unsettling at times. So for some people, different kinds of benefits from therapy might be preferable, or even enough.

    Not everyone may be ready to confront their realities, or feel that it is necessary, but there may be certain other benefits or outcomes of psychotherapy which can be made use of in daily life:

  • The Capacity to Listen – having experienced sitting in a room and being listened to by a therapist, an individual may enhance their
    ability to listen. They know differently how to pay attention.
  • The Capacity for Empathy: Having had time to explore and reflect on relationships, often the way other people are viewed is with
    greater empathy. New insight has been gained about other people’s issues and concerns. There is a different way of understanding and
    making sense of.
  • The Capacity for Deeper Conversation: There may be a new realization that difference kinds of conversation can enhance understandings and make for more fulfilling relationships. So the weather may not be such an attractive topic anymore!


  • So, can everyone benefit from therapy? Well, yes and no. It depends. It depends on the meaning of “benefit”, and the kind of therapy you are seeking.

    As I hope that I have highlighted here, there are different kinds of benefits to be had from psychotherapy.. Exactly which kind you experience, though, will depend on the depth of the process as well as the nature of your desires for change.

    REFERENCES
    Howes, R. (2013) Four Unexpected Benefits of Therapy. Available from http://www.goodtherapy.org/blog/four-unexpected-benefits-of-therapy-0924137. Accessed 28 September 2014.

    Seeman, G. (2005). Getting the Most Out of Psychotherapy. Available from http://drgaryseeman.com/resources/writing/getmost/. Accessed 28 September 2014.

    Answers to Questions about Jungian Psychotherapy. Available from: http://www.thejungiantraining.org.uk/jungian_psychotherapy.html
    Accessed 28 September 2014.


    Blog. Yellow Flower Anxiety

    Blog: Living Life Anxious

    Being Anxious

    Being anxious can be described in many different ways: as tension, feeling on edge, nervous, insecure, or worried.



    Other words used to describe anxiety include uncertainty, vulnerability, and feeling apprehensive, scared or insecure.

    Describing the experience of anxiety, a fairly common expression is “Anxiety is an inevitable part of life”. Or, there might even be some comfort taken from a diagnosis of anxiety. A feeling of reassurance may be provided by a certainty of having an “anxiety disorder” Yet, there might also be a normality to being anxious. Erich Fromm, for example says that: The experience of separateness arouses anxiety; it is, indeed, the source of all anxiety.

    The Emergence of Anxiety

    Taking Fromm’s view, we might consider how feeling anxious can begin at birth with an experience of a primal separation from our mother. Being attached to her feels safe and secure, and separated from her as danger and threat. Later in life, the polarities between separation and attachment, and being at risk, insecure, or under threat may lead to a constant sense of danger. But danger of what exactly? Melanie Klein, according to this line of thought, considers that anxiety signals danger in the relationship with our internal maternal object (the internalised image of mother). The loss of this object, this image, or relationship is feared.

    Perhaps there is also fear of a more generalised loss – loss of control, of all relationships, of identity. Fear of a ripping apart, perhaps, because while anxiety may begin at birth it also may have many triggers, arising not only from internal sources, but external ones too – our own neurobiological makeup on the one hand and our life experiences on the other.

    So, we might say that anxiety reflects our state of self, the extent of development of our internal structure, the state of our relationships, and our sense of security and satisfaction. Perhaps when anxiety is present and overwhelming there may be deficiency in one of these areas.

    Yet, anxiety is not simply a thing that exists. It is dynamic – both a signal of danger and an initiator of a defensive response. It may signal danger to our sense of self, of wholeness, or of completion. We may fear destruction, engulfment or fragmentation and we may seek to control or to avoid a range of circumstances or situations.

    Psychotherapy for Anxiety

    The good news is that psychotherapy can help.

    It can do so by, first of all, by understanding the individual history of each person’s anxiety. If we take the view that who we are, and who we are becoming, emerges from our anxieties, then the first task is to understand each person’s history of anxiety. Then, acknowledging and understanding the protective role of anxiety may be important. To see anxiety as the best strategy for coping with what has been felt as scary or uncertain. Then, perhaps to work through, or re-work through early relational histories, and the insecurities (feelings of not being safe) that may have emerged in these. All of this is possible when the therapeutic environment is felt as safe, and is experienced as a place for curiosity and exploration. A space can then emerge for new feelings, new reactions and responses, and a reframing of the lens through which life is experienced. It may not then be one of psychological danger, but instead one of safety and security.

    If you feel ready to begin therapy for anxiety, or want to explore the possibility, please visit the anxiety page on my website for information about how to get started.



    Blog. Courage

    Courage and Vulnerability in Psychotherapy

    It is often said that it takes courage to begin therapy, to begin to open up about personal material, and to reveal your innermost thoughts and feelings. It can feel frightening. Yet, in the context of a safe and supportive therapeutic relationship, particularly one like a relational transactional analysis approach, which believes that profound and deep change occurs in response to relational experiences, there is the opportunity for you to work through these fears.

    To work through fears of criticism, of shame and even fears about exposing or revealing yourself. You might also fear feelings and be fearful about bringing into the open various aspects of yourself and your life.

    Indeed, these fears may be so great that you might feel safer to stay with the difficulties that brought you to psychotherapy in the first place, rather than to take chances to reveal yourself. As Brene Brown described her fear ‘not knowing whether I could literally physically withstand the criticism’.

    Fears and the Courage to be Vulnerable

    Yet these fears can be worked through in psychotherapy. Here, in this safe space, there are opportunities for change. Opportunities for new beliefs to emerge and new stories to be created. The rewards are potentially great. However, relinquishing relational armour is necessary in order to reach them. Letting go of the urges or pulls to keep parts of yourself hidden and stepping into an arena (in this case a psychotherapeutic one) where you allow yourself to be seen.

    Courage and the Possibility of Change

    This is an act that provides possibilities to create new life stories (or scripts). Perhaps changing the story you tell yourself.

    Rather than the story that says that to risk exposure is to invite criticism, shame or intolerable feelings, there may be opportunities for creating new stories - stories of something different, something better. This can begin with your relational experiences with your therapist.

    Here then we have a courageous act, an act that requires a willingness to be vulnerable - there is uncertainty, risk and emotional exposure and yet the rewards are potentially great.

    You want change. You want something different for yourself and your life and yet perhaps you also want to stay in the darkness. You may be afraid to let yourself be seen and also to see people, even to see yourself.

    Yet this change, this different thing is possible, despite the struggle.

    . In psychotherapy trust and vulnerability evolve together. They begin with you bringing and sharing your story - a story that is treated with honour and respect. You bring your courage. It is a privilege to witness.

    New Life Stories (or Scripts), Relational Experiences and Change

    Later that original story merges into the background as the new here-and-now story in the therapy room evolves from the relationship between you and your psychotherapist.

    Hopefully, in the end, this new story can be part of the transformation, the change that you seek. For many people this is a process that feels worthwhile because, to paraphrase some more words of Brene Brown, while vulnerability is hard, scary and feels dangerous, it is not as hard or scary as getting to the end of our lives and asking ourselves ‘what if I would have shown up, what if I would have stepped into the arena, answered the call to have courage and created the change that at first might have been unimaginable.



    Blog. Head in Hands Migraine

    'Not Another Headache'

    The pain of migraine is physical. It is a sensation that ravages and incapacitates.

    Does your day often begin with you saying to yourself 'Not another headache!' Do you perhaps take painkillers? Often? Every day even?
    Perhaps you find that sometimes they help and sometimes not. For many people their headache is diagnosed as chronic daily headache. For others frequent migraine is the bug bear.

    Yet medication is not always the answer. Frequent use of pain-killing medication can lead to overuse headache (rebound headache) and perhaps even make your headache pain worse. You may also wonder whether your problem is really a biochemical one.

    Is taking a pill really the answer? Might your problem be more than a physical one?

    In fact, it has been known for hundreds of years that emotional distress triggers headaches. Being angry or sad. Even being happy or excited can trigger a headache.

    In 1743. Junkerius talked of migraine being caused by suppressed anger. Other, less common reactions, linked to emotions have also been identified as root causes for headaches, such as resentments, dissatisfaction and anxiety.

    There are many factors which may combine to give an embodied experience of an emotion or feeling. The 'real' pain is perhaps an emotional one, which is hidden, or embedded within an experience of headache or migraine. This can be due to some, or all, of the factors in the following short list:

  • You suffer from alexithymia, an inability to identify emotions
  • Feelings may be conflicted, or not allowed
  • You try to control feelings in order to manage your pain

    An alternative way of describing these kinds of headaches, then, is as a conversion headache, the explanation being that psychological distress is 'converted' into a more manageable physical symptom

    So whether headache can be attributed to the inability to manage difficult emotions (such as anger or anxiety), or to alexithymia (the inability to identify emotion), what seems to happen often is that some sort of converted, or embodied emotional experience lies at the root of chronic headache and migraine

    The good news is that these experiences can be unravelled in psychotherapy or counselling. Headaches can be investigated. Emotions can be explored.

    If you have tried all of the medications and still are in intense pain on a frequent basis from your migraine, it may be time to explore the root of your migraine as being not only biochemical but also psychological and emotional.

    If you would like to begin to explore migraine and work through the pain of migraine in psychotherapy please email using this form or by calling 07891 613580



  • Blog. Book Review Freud and the Spoken Word

    Book Review: Freud and the Spoken Word

    For the Autumn 2016 issue of Private Practice, I reviewed a book by Ana-Maria Rizuto. The idea that nothing takes place between client and therapist except that they talk to each other is explored by considering the development of all of Freud's theories, with On Aphasia: A critical Study (1891) and The Interpretation of Dreams (1900) given particular prominence. In my review I comment on how fascinating I find Freud's various understandings of the use of words in the therapy room and how the book provides an insight into Freud the man as well as his theories.



    Blog. Portfolio Approach Article

    Article: Portfolio Approach

    Published in The Transactional Analyst in Summer 2013, this is an article advocating a portfolio approach to Transactional Analysis training. The article’s full title (not shown in this publication) is Negotiating the Frame in Transactional Analysis Psychotherapy Training. With this title the idea of trainees choosing the frame of therapy is highlighted. There is the possibility of a containing, stable space on the one hand (in an integrated four-year programme) and on the other hand, for those people for whom this may represent a limiting and restricting environment, there is the portfolio approach which, I suggest, provides a less limiting and restrictive environment for the training process.



    Blog. Wounding the Healer or Healing the Wounded Article

    Article: Wounding the Healer or Healing the Wounded

    Published in The Transactional Analyst, in Autumn 2012, this piece of writing explores the value of personal therapy for psychotherapy trainees. In it I consider the potential benefits for trainees (insight into personal conflicts, sensitivity to experiences, learning effective therapeutic procedures and demonstrating a personal belief in the efficacy of therapy) as well as the opportunity to learn about personal limitations, and to experience deep emotions. I also present my personal view of why personal therapy for trainees should be separate from training programmes, and not integrated into it, citing the avoidance of dual relationships as a primary concern.


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