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Many clients are curious about the different therapy approaches out there, and you might choose to do your own research to try to identify which is right for you. It can be hard to find clear and concise information about complicated, jargon-filled theory online. There are so many acronyms! It might comfort you to know that the evidence strongly suggests that the biggest indicator of the effectiveness of therapy is the relationship between the client and therapist. In other words, the therapists’ approach has less to do with how effective therapy is going to be. However, you might still want to know about what model your therapist is working with. Here’s my explanation of what my core approach, person-centred therapy, involves. The basics:
The details: Person-centred, sometimes called ‘client-centred’, therapy sits within the wider umbrella of humanistic therapy. The other umbrellas are psychodynamic (including Freud and the classic psychoanalysis often depicted in film and TV, such as in sitcom Frasier) and behaviourism (which includes CBT, widely used in the NHS). Humanistic therapy emphasises the unique nature of being human, and holds the belief that people are fundamentally, innately, good. Person-centred therapy was pioneered by American psychologist Carl Rogers in the 1950s, and the basic tenet is: we know deep down what is good for us, and what we need, and in the right conditions we will flourish and reach our potential. However, life events and other limiting factors get in the way and hinder our progress. A supportive and nurturing therapy relationship can provide the right environment for us to reconnect with our needs and to step back and identify what will help us meet them. So what does that actually look like? The person-centred model positions you as the client as the expert on your experience and choosing what to bring to therapy. My role is to help you explore the things you find difficult and to create a relationship in which we can be curious together about what is going on for you. This allows us to both step back from your immediate experience and to understand more clearly what is happening. From that perspective you can think about what it might look like to do something differently, and start to choose that. I sometimes get clients expressing impatience with the process. This is not a quick fix. People can want answers, solutions, more obviously active input. Me sitting opposite them, nodding and reflecting things back might feel frustrating. It doesn’t always look like much is happening. However, being fully heard and witnessed in this way can be transformative. You are in the driving seat as the client. You choose what you want to talk about. This can be difficult and unnerving at first, and takes some getting used to. Why do you use the person-centred approach? The person-centred approach calls for therapists to be accepting, non-judgemental, and congruent (or genuine). This particularly speaks to me because of my experience of being LGBTQ+. Perhaps (I hope!) all therapists seek to meet their clients with acceptance, a lack of judgement and congruence. I see putting those conditions at the heart of the therapy relationship as a way of counterbalancing the experiences me and my clients can have out in the world. It offsets the discrimination we encounter as a minority, the painful and discounting experience of not being seen. As queer people we are not accepted everywhere we go; far from it. To be accepted by your therapist, as your unique, glorious, complex full self is radical. It is also essential to a supportive and effective therapy relationship. This is not about mere tolerance, but true acceptance, being cherished. LGBTQ+ people experience judgement and criticism frequently in subtle and overt ways, and for a therapist to meet you in a way that categorically aims to shrug off judgement can be a novel experience. Many members of our community have to hide parts of themselves growing up, and into adulthood. To have a therapist who models a congruent, genuine way of being and relating can encourage you as a client to be more authentically yourself too. The person-centred approach is not for everyone, but I believe it has something to offer most of us. I hope this has given you a sense of what the approach is about- please get in touch if you’d like to arrange an initial assessment to see whether this could be right for you.
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I recently wrote an article for Counselling Directory about searching for a therapist as a member of the queer community, based on my experience as a client and therapist in that situation. Find the piece here
Since March 2020 I have been keeping a gratitude journal. I started writing it a couple of weeks before the first lockdown started, unaware of the pandemic that was about to turn the world upside down.
I started it as a way to cultivate gratitude after reading various studies about the positive impact being grateful has on health and wellbeing. I remember a tutor on my therapy training speaking about a study which showed that the biggest predictor of happiness was gratitude, ahead of any other factors. I was struck by that, but hadn’t got round to doing anything about it until a year ago. I believed I was broadly optimistic as a person, trusting that things would generally work out ok. I realised that beneath that on a day-to-day level I could be quite negative, focusing on short-term worries, or things that were lacking. I wanted to change that. I wasn’t prepared for how transformative keeping a gratitude journal during a global pandemic would be. The format My version of keeping a gratitude journal involves writing down at least three things I am grateful for every day, just before I go to bed. Some days I find that easier than others. On tough days it might take a huge effort to scrape together something like: 1. Pie for tea 2. Cuddles with the cat 3. Walk in the local park. On easier days I’ll quickly list five, even six happy events- e.g: 1. Making a great pizza for tea 2. Watching a silly Netflix thriller 3. Wine 4. Cat purring next to me 5. Sunny walk 6. Long chat with a friend. These aren’t generally profound occurrences, but mundane ones. It’s hard to say whether outside of a pandemic I would be feeling the same level of gratitude for these little things. Everything has felt magnified over the last year, in the context of a life lived almost entirely at home, with my partner, my cats, my sourdough starter, the houseplants. When to write it
I find the habit of writing mine just before bed, every evening, really useful. There has been something anchoring about the routine of doing this throughout a year of pandemic-fuelled uncertainty. I have found that at the end of every single day of this pandemic I have been able to come up with at least three things that I feel genuinely grateful for. This has helped get me through some rough times. It’s shown me that whatever is happening in the world and however bleak it might all be feeling, I’m getting through it and there’s joy to be found. Other people like to write theirs every morning, to start the day on a positive footing. For some a daily practice does not suit, and writing once or a couple of times a week is more effective, perhaps writing in more detail about the things you are grateful for. It’s about finding a way of doing this that works for you, and only sticking with it if it's useful. Gratitude letters An alternative to keeping a journal is writing gratitude letters. This involves writing a letter to someone you’re grateful to, often (though not always) with no intention of actually giving it to the person. This could be a good option if it feels easier to focus your gratitude on a particular person, rather than on your daily experiences. I’m finding that the act of recording things I’m grateful for is changing my focus. I’ve started to register things during my day that I know I’ll write down that evening, things that may have otherwise gone unnoticed. I feel a greater sense of happiness and satisfaction in the little things, which add up to quite a lot actually, in the context of a year of a pandemic. With so much put on hold, postponed, cancelled. Taking joy in a blue sky, a cuddle with a pet, a triumphant sourdough loaf: these things matter right now, and bring comfort and- yes- happiness. It's 2020, we have equal marriage, LGBTQ+ people can adopt, why are Pride marches and celebrations still a thing? This year Pride month and Pride events took place virtually due to the global pandemic, but their existence is as vitally important as it’s always been.
Pride as protest Pride began as a protest, and it remains political today. The Stonewall riots in New York City just over 50 years ago sparked the movement. The patrons of the Stonewall Inn had had enough of the police raids, and on the evening of Judy Garland’s funeral (some have made a connection between the two), they decided to fight back. Trans and queer people of colour were key figures in this fight. Progress has been made in LGBTQ+ rights since 1969 but we still have so much further to go. One example of trans rights being currently under threat: reports that the government is going to scrap proposed changes to the Gender Recognition Act which would make it easier for trans people to change the gender on their birth certificates. A study by Stonewall shows that reported hate crimes against LGBTQ+ (especially trans) people have risen by at least 79% in the last few years. We continue to be underrepresented in the media, marginalised, discriminated against, erased. Pride as celebration Pride is a party, of the best kind. More than that, I see Pride as an act of “anti-shame”, a way of rebalancing the scales. Many LGBTQ+ people grow up with some level of shame about their identity, and inbuilt, internalised trans/homo/bi-phobia. Those strutting unapologetically down Oxford St covered in glitter, feathers, latex, etc. are owning their identity. Out and proud. The crowds cheering them on, waving their rainbow flags are part of it too, sharing the act of celebration, being affirmed themselves (I know I am). The importance of visibility for a community that was historically (and often still is now) closeted, hidden and shamed cannot be underestimated. Many of us have adapted to working from home in recent months, in most cases quite abruptly. I had a sudden switch from seeing all of my clients face to face one week, to meeting everyone over video call the next. Disorienting to say the least!
I had previously worked with some clients online where they regularly travelled abroad, and so the logistics of video sessions were not new to me. However it has been strange to be working entirely remotely when human connection feels such a crucial element of therapy. Talking to other therapists there are differing opinions out there about the suitability and value of online working, with some viewing it as an exciting and flexible way of working and others feeling it’s a poor substitute for in-person work. This position seems to depend on the individual therapist and their client group. I feel very thankful that most of my clients have been able to switch to video sessions and I am finding this way of working very rewarding now I have settled into it. I enjoy the flexibility of it for me and my clients, and I’m interested in the new challenges and material it throws up. To suddenly be in my clients’ living rooms, bedrooms, kitchens, etc. is strange, as is inviting clients into my space, complete with cats making cameo appearances. It is simultaneously more intimate and less so. Online working demands creativity and adaptability. Some people don’t have a private space they won’t be overheard in, and so we might do sessions where they are outside and walking around, or even do the sessions on video using the chat function so clients can type so they are not overheard. It’s not for everyone, but I’m finding it can work really well. I know I will return to meeting clients in person again in the future, and I’m really looking forward to that- the easy connection, the quality of being present, being able to read body language cues. But I think I’ll also retain online working for clients who prefer that, not seeing it as a second-best way of working, but as a valid space in its own right. As we come towards the end of the 10th week in lockdown in the UK I’m reflecting on how I’ve adapted to this strange present reality. Though the government is starting to lift some restrictions, the general consensus is that it will be a while before life resembles normality again. In learning to cope and adjust to this a lot of what I’ve been learning comes back to being kind to myself. For me that looks like:
Slowing down I saw a lot of talk about productivity at the start of lockdown, and for a moment it seemed like everyone was getting on with creative projects (writing that screenplay, learning a new language, starting to knit). We were being asked to make the best use of all the time we suddenly had- we might not ever get that again! The problem with this pressure to be productive is that it ignores the fact that we’re living through a global pandemic which understandably brings up a lot of anxiety, worry and uncertainty. Not a good foundation from which to be our best creative selves. Concentration and focus can be hard to muster in a crisis, or that’s my experience anyway. Instead of pushing myself to do more, not to ‘waste’ this time, I am letting myself do less. Life is slower at the moment and I’m accepting that, settling into it. I’m finding cooking to be a type of productivity I can really appreciate. It’s simple, methodical, tangible. It’s nice to have time to bake bread, make pasta from scratch, things that would ordinarily feel too laborious and time-consuming. I’m tending to my houseplants with more care, which they seem to appreciate. Taking it day by day Just getting through things at the moment is enough- that takes a lot. I’m finding myself saying that to my clients a lot. We’re doing well if we’re getting out of bed in the morning, feeding ourselves, meeting our basic needs. Anything on top of that is a bonus! Some days I can get more done than others and that’s ok. Sometimes things feel more manageable. Other days it hits me. Maybe a family member or close friend has a birthday and I can’t give them a hug. Perhaps a client has some kind of milestone and I’m not able to share in that joy in person, and suddenly feel very aware of the distance between us. Avoiding the news I’m trying to step back from the news cycle a little. I’m usually pretty good at not checking the news and social media multiple times a day, not feeling I need to be constantly updated on what’s happening in the world. That went out of the window when the global pandemic really hit the UK and dramatic changes seemed to be happening almost constantly. For a few days I got into a habit of repeatedly checking news website live blogs, keeping up to date with every new development. However, I’ve realised the importance of giving myself a break from the news. Yes, I need to be informed and able to act responsibly and follow government guidance correctly. But no, I don’t need to know the minutiae of how every country is responding to the pandemic, and what the Covid-19 facts and figures are across the globe. It’s overwhelming and unhealthy, it's too much information to take in. If I don’t check the news I will find out what I need to know in some other way. And once we're through the other side of this thing I can process it properly, with some distance from it. Staying connected to people I’m trying to be more in touch with friends and family and putting effort into that. I’m checking in regularly with people who may be finding things particularly difficult at the moment, when I’m feeling up to doing that. I’m calling people more than usual, in a very un-millennial kind of way. I’m sending more voice notes, videos, anything that helps me connect with people at a time when face to face social interactions are rare. Though we’re increasingly allowed to see people in person this currently still feels quite fraught, and strange, and it's not clear when we will easily and freely be able to do that again. These are my lessons so far, and maybe some of them will stick after lockdown. I'm not putting any pressure on myself to come out of this any 'better' in particular ways, though if that happens that's great (my bread making is coming on leaps and bounds). Just getting through it will do. It's that time of year again- new beginnings, fresh optimism and for lots of us, a long list of new year's resolutions overhauling our health, hobbies, lifestyle...the list goes on.
I used to make the same old clichéd resolutions on an annual basis to lose weight, learn a new language from scratch, begin exercising regularly, etc. I rarely made it to February with any of them in tact, leaving a lingering sense of failure and disappointment. My new approach is not to make resolutions that involve a complete overhaul of my eating habits, an entirely new exercise regime or setting myself near-impossible tasks. Instead I propose more manageable, positive and fun resolutions. This year one of them is to go to the theatre more often. I made that one last year, too. I believe I went to precisely zero plays in 2017. So what will be different this year? According to BBC Reality Check, we are more likely to keep our new year’s resolutions if we involve other people. In 2018 I have resolved to see more theatre with a friend who is also a drama enthusiast and who has independently made the same resolution so I may be on to a winner. My conclusion about new year's resolutions generally is that the broader improvements to my life such as doing regular exercise do not come about from a rash decision made on a foggy-headed early January morning. Rather they should be habits formed gradually. With exercise the ongoing benefits to my physical and mental wellbeing have lead to them becoming simply part of my life now. Drastic changes don't seem to be sustainable, boring as this realisation may be. Last year I tried to go vegan a number of times. The first time I went cold turkey (or should that be cold seitan?!) I found it unsustainable, going back to dairy after a few short weeks. The second time was successful for slightly longer, but ultimately the pull of cheese was too strong and I returned to my cheddar-chomping ways, making up for lost time. I tried again, for the third time, but this time I tried a new approach: flexibility. I gave myself permission to be flexible in my newly-formed veganism. I decided to chill if there weren't any decent vegan options when eating out (less and less of an issue nowadays), allow myself to buy eggs occasionally, nibble the odd piece of cheese without beating myself up. I now eat a roughly 90% vegan diet. Hard-core vegans and carnivores alike may scoff at my lack of total commitment to the cause. But my mostly vegan diet makes me feel like I'm making a difference, living compassionately and, crucially, I know that it is something I can sustain in the long-term. I have realised that with new year's resolutions and changes I want to make to my life being kind to myself is key. Allowing myself to 'fail', not do something every day, sometimes have a break from whatever change I'm ultimately trying to make. As the Guardian's guide to making New Year's Resolutions states, “the biggest obstacle to new habits is self-criticism. Study after study shows that self-criticism is correlated with less motivation and worse self-control, in contrast with being kind or supportive to yourself, as you would to a friend – especially when confronted with failure.” That's the bottom line, and one I plan to hold onto in 2018. “What do you hope to get from coming to therapy?” I recently asked a new client. She replied that she didn't really know what to expect. “All I know about therapy is what I've seen on TV.”
This got me thinking about how the media portrays therapy, and the Hollywood version of it that we regularly consume. Often when therapy is shown on TV or film I am left frustrated by the therapist's lack of boundaries. For example, Naomi Watts' baffling Netflix show Gypsy in which, among other cardinal sins, the therapist embarks on an affair with her client’s ex-girlfriend and turns up at the house of another client to offer emotional support. Even when the (fictional) therapist adheres to boundaries I'm left banging my head against the wall as the 'expert' therapist tells their client what to do, completely disempowering them in the process. An example of this presented itself in the otherwise excellent HBO series Big Little Lies (spoilers follow). In Big Little Lies the therapist explicitly tells their client (Nicole Kidman's character Celeste) what she has to do. Celeste is in a vulnerable position. She is in a domestically abusive relationship with a man who is controlling, manipulative and holding all of the power. Her therapist witnesses this and makes a plan for the client to get out of the relationship, urging her to follow it. The process is not collaborative. The therapist dictates the plan to the client with no attempt to empower her in doing so. There is no regard shown for the complexities of the situation. Statistically the most dangerous time in a domestically abusive relationship is once the survivor leaves the perpetrator. According to domestic abuse charity Standing Together, 76% of domestic homicides happen after the point of separation. Ordering someone to simply up and leave that relationship is not therapeutic, nor is it necessarily the safest option. Celeste is a privileged woman with the means to secretly rent her own apartment to take herself and her sons to at a moment’s notice. Leaving may be simpler for her than for most women in this situation who face relocating to a completely new area, finding work, childcare, housing, with the ongoing fear of being discovered by the perpetrator overshadowing it all. I am not arguing that a therapist should sit back and say nothing when a client is in an abusive relationship. But our role is to meet the client where they are, and start from a place of understanding and affirming them. In therapy the client has a space that is theirs alone. In a therapeutic relationship where they are valued, accepted and understood I believe that the client will connect with their strength, resilience and power as the therapist reflects this back to them. We must start from a position of 'you're ok, you're doing your best.' Not 'you are wrong. You should be doing this instead.' I always stress early on that I am not there to tell a client what to do, or offer my opinions. This can be met with disappointment or frustration. The therapeutic process may be slow and laborious. It certainly would not further the plot of a TV show very efficiently. Real life therapy would probably make for dull viewing. I understand why therapy is glamorised in TV and film, but it's worth remembering that a client's expectations of therapy may be informed by these portrayals, and taking a moment to be clear about what real-life therapy might look like. It might not be pretty, it will not be glamorous, but ideally it will be a nurturing space in which the client will grow and achieve something meaningful and substantial. The recent Children's Commissioner report into vulnerability shows 800,000 children in England aged between 5 and 17 are experiencing mental health issues.
The facts are shocking. There is a pervading sense that young people nowadays have it harder than previous generations- greater academic pressures, constant social media scrutiny/competition, the economic reality of post-Brexit Britain beginning to filter down... But are we looking back with rose-tinted glasses on our idyllic childhoods and making unfavourable comparisons? Perhaps the 80s and 90s of my childhood were a more innocent time in some ways. After all, ignorance is bliss! How many of us were were struggling in silence, lacking the language to say how we were feeling? The BBC reports that five secondary schools in Cardiff have taken part in a pilot study by Samaritans Cymru teaching mental health lessons. Afterwards students reported having a better awareness of mental health, and Samaritans propose that these lessons should be mandatory. My school days are not that far behind me. I don't recall mental health ever being discussed in my lessons. Had the curriculum covered mental health or wellbeing I may have known what to say when a friend was off school for a while with depression. Perhaps I would have had more compassion for myself when I struggled during sixth form and put this down to a mysterious chronic fatigue-type condition which with hindsight I believe was, at least partly, caused by depression. Research by in-school children’s mental health charity Place2Be, showed that of children who received individual counselling:
There are a number of charities doing great work to promote discussion about young people’s mental health and wellbeing, and providing essential support where schools are falling short. Young Minds campaigns to raise awareness and works with policy makers in the UK. They also provide practical support and expertise for young people, their parents and professionals. The Mix (formerly Get Connected) offers online support, a helpline, and telephone counselling to anyone under 25. Encouraging school students and teachers to talk about mental health can only be a good thing. Providing therapy and emotional support to our young people and keeping an open dialogue about how we are all feeling is essential. The more we talk about it, the more we understand ourselves and each other. We can start to take better care of ourselves, prioritising our mental health as much as our physical health. |
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