What happens in psychotherapy
Each client, and their story, is different and unique. There are no clichés.
In listening to a story I am attentive and focused on every word a client utters. In this way I am able to feedback what I am hearing overtly as well as the hunches I gain from those nuances.
This attentiveness directs me to the real meaning of the client’s world – their world, not a world contaminated by my own experience of life. In listening, I am not waiting for them to finish in order to launch into my own diatribe, a mistake so common in a field where guru status is rife (and encouraged).
Each person is, in their own way, trying to understand their (often dysfunctional) world and how it came to be so. It is much too common for adult clients with traumatic pasts and little or no emotional support, or acknowledgement, to understand what their authentic response was to what was happening to them at the time.
To bear witness to a client’s distressing, frightening, neglectful or traumatic early life is the mainstay of psychotherapy and hence a healing, curative process. Sadly, many people negate their own past, believing it was in no way the prelude to what they are now suffering. This is rarely the case.
Every person who arrives at my practice is wanting an enriched, fuller life.
These lives have been derailed by a history of discounting. Sometimes these things are not overtly traumatic (though often they are), making it easier for the self and others to discount them.
All too often I hear that divorce (acrimonious or not), illness and/or loss of a parent, bullying, sibling rivalry, even immigration, are not considered reason enough to believe there is something left behind – creating the dysfunction in peoples ‘today’ lives.
This discounting is preventing them reaching their real Self.
I hope through this website, blog posts and my book I am able to bring you a wealth of knowledge about the fascinating world of psychotherapy.
Finding a psychotherapist
Here I outline the necessary criteria for practitioners who train in a psychotherapy framework. I include this so you are able to understand the rigorous training a psychotherapist must undertake in order to practice and work with you.
Prior qualification in a related field
It is an expectation that your practitioner has a qualification – degree or similar – in a field related to psychological and / or mental health. This qualification may include but is not restricted to: social work, social science, counselling, psychology, sociology, psychiatry or even occupational therapy.
Psychotherapy training – beyond the ‘prior qualification’
Following is a broad description of the training process for a psychotherapist proper. My hope is that this may assist you when interviewing a potential health practitioner for yourself.
For too long the trusting public have assumed the skill and qualification of the practitioner they visit.
Let us be clear that psychotherapy training is not obtained online or in a speedy one, two or even three years. The very nature of the training is that the practitioner must develop, grow and evolve into the role over the course of time. Any psychotherapy training worthy of the title will have been run over a minimum of four years (even with prior qualifications, and that includes psychology and medicine).
Once the four-year training in psychotherapy is completed, the trainee prepares for assessment, which takes two avenues.
The first is a written dissertation in which the trainee shows their understanding of the theory by writing about client casework, overlaying the theory. This is done with recorded live casework, transcripts and intense supervision. It is, in effect, a thesis.
The written work consists of several components.
It includes information about the practitioner and how that practitioner works, how the theory informs their work and their own relationship with the theoretical biases.
There is a personal account of the practitioner’s journey that reflects a deep understanding of the Self as a result of their training and, more importantly, of their own journey on the psychotherapy couch as the client (a prerequisite of the training).
While the greater part of the written exam is a deep and thorough thesis, the case study is of a client over a long period in psychotherapy. It includes all levels of understanding of the practitioner’s own thinking, interventions, treatment planning and diagnosis, using various theory and more.
The assessment of this thesis is done by two to three different professionals. Much care is taken that it is not assessed by someone local or someone known to the trainee. Certainly not someone who has been part of the training body through which the practitioner is training.
As Transactional Analysis is taught worldwide under the same specifications and guidelines, the assessment of papers (for this modality) is frequently done in other countries.
After the joyous news of a thesis pass, the trainee embarks on the second segment of the assessment process. This is usually referred to as the ‘oral examination’.
Preparation for the oral examination takes no less than one year and usually much longer.
Here the trainee presents verbal narratives (through transcriptions) of sections of client sessions to the examination board. Members of this board can ask any questions regarding theory, treatment planning, the psychotherapist’s thinking or even the psychotherapist’s life.
It is a time to show the board your professional thinking on all levels. The board panel would usually be made up of three to four examiners. Again using Transactional Analysis as our example, these exams are scheduled for the days before an international conference, so the panel is preferably comprised of international examiners.
Concurrent requirements during the training process
Many of the parallel emotional, psychological and mental health professions have a high burnout rate. It is a relatively simple process to avoid this crisis.
When asked how I work all day with clients’ sad and traumatic stories, I reply that there are four imperative pillars to prevent burnout:
– Proper and specific training in long-term psychotherapy,
– Being in one’s own psychotherapy (as a guideline; for a minimum of ten consecutive years, although usually much longer for any practising psychotherapist)
– Regular, ongoing clinical supervision – supervision by a professional trained to supervise, not simply a practitioner with seniority.
– Ongoing professional development (workshops, conferences, residential meetings and so on, related to the field. This does not include reading or online professional development.)
Probably the single most important aspect of any training is the requirement to have done, and be in, one’s own psychotherapy.
To quote Carl Jung:
‘We are only able to take our clients as deep as
we have been ourselves.’
It is important here to reiterate that your psychotherapist does not have to have had the same life experience or trauma as you to do this work. In fact, it is the thinking of many that sometimes this may be contraindicated. This is because, as humans, our own material can and will be triggered when working with a client carrying parallel issues.
Herein lies one of the crucial reasons for the psychotherapist to have done (and be doing) their own personal work. Perhaps this could be described as clearing out the ‘ghosts’, leaving us emotionally available to be entirely there for our clients.
Serious questions are raised if a trainee is reluctant to go into their own psychotherapy. What does it say about someone’s capacity to expect another to do so?
Finding the right psychotherapist
When you are looking for an emotional, psychological and/or mental health professional to work with, it is important to find someone who is not only appropriately qualified but who is also appropriate for you. Here are a few points you might like to consider and look out for.
Not just any ‘therapy’
If someone refers to themselves as a ‘therapist’ it might be a hint they are not a psychotherapist.
From the description here, on this website, of the training to become a psychotherapist is long and protracted. A practising psychotherapist would not discount that level of training and work by using a word that has little specific meaning.
The word ‘therapy’ is from a Greek word meaning to service or to wait on. Hence its use in occupations such as physiotherapy, hypnotherapy, beauty therapy, occupational therapy. It is only when the word has the descriptive addition that it gives clarity, defining the occupation.
The word ‘psycho’ is also from a Greek word, meaning the mind, and is used in terms of ‘relating to the mind’. To use a crude form, which perhaps the ancient Greeks might flinch at, ‘psychotherapy’ means to serve the mind.
What type of emotional mental health practitioner are they?
If someone’s business card, advertising or website uses several titles, please take the time to ask them to clarify their discipline. Titles may vary from coach to counsellor, psychotherapist, psychologist, hypnotherapist and more.
The issue of concern for the public here is that, if the practitioner is confused about their occupation, you can be very sure you will be as well.
This is often the result of people achieving one type of training, then engaging in other types of training or courses and tagging on titles. Having said this, they may well have done full and complete training in one, two or all of the titles. It is your prerogative to ask which of those titles or ‘skills’ will inform your treatment plan.
Questions to ask a psychotherapist
A counsellor is a counsellor, a psychologist is a psychologist, a coach is a coach, and a psychiatrist is a psychiatrist. They are not psychotherapists unless they have done a training similar to what is described above. Having done a medical degree and one year of training in psychodynamic psychotherapy does not make a practitioner a psychotherapist. Again, the simplest thing to do is ask three questions:
How many years of their own personal psychotherapy have they done?
(Remember, you will accept nothing less than a consecutive ten years if you are to work with them.)
What training of four to six years did they do specifically in psychotherapy post their initial qualification?
How often do they attend clinical supervision with a trained psychotherapy supervisor to manage their caseload?
Please remember, if you are looking at doing long-term work, you have the right to ask these questions.
We, as practitioners, are answerable to you, the public.
My mission is to educate and empower everyone!
The importance of a psychotherapist’s own personal analysis
The reason it is important for a trainee, then after completion, to undergo one’s own psychotherapy, before working long term with clients is that it assists the practitioner in developing areas of their character that are paramount in long-term work.
This work will allow an openness (as opposed to a defensive approach), stability, maturity and flexibility while working deeply with clients. Personal analysis for practitioners fosters an ability to better reflect and observe ones own thoughts and feelings when working with clients. This then allows the practitioner to work without contaminating the client’s space with their own world.
Without this work, many of our own psychological issues, vulnerabilities, character traits, traumas and family histories will interfere with the work we are doing. These often stem from our own biases, defences, trauma and relatedness.
A practitioner’s own work is designed to assist in removing these complex and troubling conscious and unconscious feedback loops.
As a result of this personal development, the practitioner is able to understand the value of analysis, thereby having the conviction of the work done in the frame of psychotherapy. This is never more important than when working in the areas of a client’s childhood experience.
Personal analysis for a trainee (and eventual fully fledged psychotherapist) forms the core of all that goes into working deeply with a client. Without such it is uncategorically impossible to assist another person through their journey of pain, loss, trauma, depression, anxiety and more.