Guide to therapy , questions and answers

©Scotlandtherapy 2014, revised 2018, revised 2020,2023
This information is presented by Scotlandtherapy and is not necessarily the view of any professional bodies we are associated with.

We do not provide any form of conversion therapy. We are an inclusive provider, and we will work with you over the therapy process to ensure we are the clinically appropriate service for your needs and that working with your needs will be within our competency, and match our service specialisms

Q
What is the process of therapy like?

A
Essentially therapy is a journey. On that journey you discover what is going on in the unconscious mind and gain new options, choices, skills, abilities, experiences and self determination. You are expected to attend regularly –  weekly or fortnightly and your contracted time is your commitment to the process. You can cancel with 7 days warning but are expected to do this sparingly (see cancellation policy)

Q
Does the therapist fix me?

A
No, the therapist accompanies you on the journey. They use various analytic techniques to help you access the unconscious, examining and better understanding patterns, beliefs and experiences. They may also offer methods of treatment like CBT, psycho-education or hypnotherapy to help make changes to perception or behaviour where you feel stuck or in need of assistance. The therapist helps you to change yourself, but the journey is yours. It is vital to take responsibility for your own journey.

As a colleague at the leading trauma education service Arizona Trauma Institute says –  we are on a journey of trauma recovery, your therapist is just a far way further down the path than you.

It is vital that you as the client engage with regular attendance, doing homework, practicing agreed methods and tools (such as self reflection, CBT, relaxation methods and mindfulness), completing journal or diary if asked. If you do not follow the structure of the therapy process, you will not be enabling progress. If you do not engage then the clinical duty of the therapist will eventually be to refer you on to another service / GP.

We do NOT do Quick Fix Therapy. We are specialists in long term complex issues. 

Q
Is the process all planned out?

A
There is a therapy structure over arching the therapy, but it is impossible to plan the process in advance beyond a basic overall strategy. This is because therapy in the psychoanalytic tradition is free flowing and follows the needs of the client as their journey unfolds. Stuart combines psychotherapy structure with analytic free flowing sessions so that there is a long term strategy {rooted firmly in the 3 stage Heller protocol), but not a strict and confining week by week plan. Over planning stifles progress and imposes values and judgement on the client. It has been shown that over adherence to a plan does not increase positive results and actually undermines therapist competence (Webb et al 2010)*. Over time it is a little like peeling away the layers of an onion, one can never fully predict each layer until it is revealed. What the client brings to the session is what is being processed for them, and thus is the focus of the session. From the start there is an overall strategy, and this is discussed with the client on a regular basis, but the client needs are fluid and this determines the path. We check in and informally review the progress about every 3 months, and after the first 5 or 6 sessions. We can also review it at any appropriate time you wish in session. It is also important where possible to spend 2 or 3 sessions at the end of the therapy processing “winding down” so that the “end” feels gentle and not like a rupture or rejection.

*Webb CA¹, Derubeis RJ, Barber JP. “Therapist adherence/competence and treatment outcome: A meta-analytic review.” https://www.ncbi.nlm.nih.gov/pubmed/20350031

Q
In trauma work is there a plan?

A
YES in trauma work we follow the three stage Heller model favoured by all major trauma experts internationally.
This essentially means stage 1: Stabilise and self regulate, Stage 2 Understand and process, Stage 3 Learning to thrive post trauma

Rushing to process trauma in C-PTSD cases in particular until stage 1 is complete is dangerous and contra indicated –  in other words harms the client.

Complex trauma develops over significant periods of time, often years or even decades. A patient, gentle and systematic healing and retraining process is required to fully recover and this can not be rushed.

Q
Can we get straight on with hypnosis or EMDR to fix my trauma?

A
No! Attempting any process method regression, exposure or processing of a traumatic memory before the client has properly stabilised and learned effective self regulation retraumatises and triggers the client. This causes harm to the client and is dangerous and unethical. Unfortunately some therapists with insufficient trauma training do attempt this and Stuart regularly receives clients made worse by this bad practice.

Q
Can we get straight on with analysis or CBT to fix my trauma?

A
No! When a client is in distress and is dysregulated, the neurological state of the client means that the dominant sympathetic nervous system is almost always activated. This has the effect of reducing the client’s capacity for emotional learning, memory access and higher complex thought. The client is unable to cooperate with the kind of processes used in analysis and CBT until stage 1 is complete, and a stable, self regulated state has been achieved. Sadly many CBT therapists, psychologists and NHS practitioners have mistaken this for being “uncooperative” or “non compliant”, not understanding that the poor client is unable, not unwilling to do the work! Neurology has fortunately shown us how the brain simply can not function in the way needed for these therapies to work in a dysregulated state, and we understand how to move the client to a state of self regulation where they become effective.

Q
Can I really recover from complex trauma?

A
Yes –  conclusive research evidence shows the ability of the brain to change both with trauma to a “survival mode” (often called adaptation), and back to a healthy long term state of self regulation and self care. This process is referred to as neuroflexibility and has been evidenced with brain scan studies in a number of leading universities including Oxford University, UCLA, Harvard and others. The manifestation in experience and behaviour of the initial adaptation, and the retraining back to a long term health state has also been researched in depth by leading experts such as Professor Stephen Porges, Professor Dan Siegel (Professor of Psychiatry UCLA) and Dr Bessel Van de Kolk.

Q
Does the therapist get a full understanding of me at the initial assessment?

A
No, it provides a snapshot in time and an opportunity to ensure the service is suitable, to risk assess, and to identify any obvious starting needs.

Q
What about solution focused therapy?

A
Solution focused therapy aims to deal with simple, stand alone problems. For example fears, phobias, public speaking, sports hypnosis. It does not address deeper personal patterns or issues. If a problem is deep routed and addressed in a solution focused or rapid intervention manner, the route cause will be unaddressed and the same or alternative symptom will reoccur. A typical solution focused method is CBT, and although this is a useful tool in psychological therapy, it is not generally suited to deep routed issues or self discovery, focusing instead on functional knowledge and change. This often results in temporary relief when deeper work is not completed.

Q
What’s the difference between analysis and counselling?

A
Counselling is Listening in a non judgmental and non analytical way, giving you space to talk and heal. Analysis uses the conversation to focus in on areas, analyse them and their effects, employ a variety of analytical models and encourage self analysis and change.

Q
Is psychoanalysis the same as psychotherapy?

A
Psychotherapy is a general description for psychological therapy. Some people believe that psychotherapy includes counselling, CBT, analysis and even complementary therapies like Hypnotherapy and mindfulness. It therefore a vague term. Psychoanalysis is based on psychoanalytic models and theories, and is by definition analytical. Analysts often draw on a wide range of psychological and philosophy models within the overall analytical tradition. Forms of psychoanalysis include (but are not limited to) psychodynamic, cognitive behavioural, mindful analysis, hypno-analysis, transactional analysis, Gestalt analysis, language analysis, philosophical and Socratic analysis.

Q
How frequent are analysis, psychotherapy, coaching, counselling or hypnotherapy sessions?

A
Traditional psychoanalysis was twice weekly or even more frequently. Now days it is usually one per week or fortnightly. Some people prefer 2 hour sessions, others 1 hour sessions. Less frequently than fortnightly does not work well since the conversation does not remain live. Counselling or psychotherapy is weekly or fortnightly. Coaching can be monthly once underway. Hypnotherapy sessions are about the same frequency but when used to supplement analysis, can be every 3^rd or 4^th session. Often a double session will be three quarters analysis and one quarter hypnotherapy using the information discussed to craft a live session.

Q

Are the sessions the healing time?

A
Sessions are not the only healing or discovery time. Sessions are exploration times in their own right, but also act as a catalyst for reflection between sessions. Additional homework such as CBT, hypnotherapy recordings, mindfulness exercises or activities may be agreed for between sessions.

Q
What is meant by integrated therapy?

A
There is an old expression, “if all you have is a hammer, everything begins to look like a nail”. Therefore having multiple methods is like having a toolkit, rather than just a hammer. This enables a wider range of people and issues to be helped. Also certain therapies work well together. For example analysis may reveal issues or patterns which then respond well to additional CBT or hypnotherapy work. Thus the analysis enables change through self awareness and choices, but also informs other methods too. The term “integrative” is often used to reflect combining therapies, “multi-modal” is often used to acknowledge that multiple models are being combined. Integrated therapy is particularly recommended for Complex PTSD trauma work, where it has been discovered that it is far more effective than single model “talking therapy” alone. In PTSD work Stuart uses a framework agreed internationally as part of the Certified Clinical Trauma Practitioner process. 

Q
Is psychoanalysis regulated?

A
YES, but like with other therapies through voluntary “right touch” PSA AR regulation, in fact many analysts object to regulation since it risks imposing values, judgments and limitations on the process.  It is important that your therapist is subject to either Statutory Regulation (e.g. HCPC for psychologists), or voluntary PSA AR registration (“right touch regulation”) for a core therapy of psychotherapy, counselling or hypnotherapy. Your therapist does not need to be regulated for every therapy, just a core therapy, since then standards of ethical practice, fitness to practice and qualification etc apply.

Q
Do you treat your patients?

A
Generally the concept of treatment is a medical model which pathologises the patient and makes them “ill”. Psychoanalysis works with the effects of the natural human condition, with potential neurosis, emotional issues, developmental problems and so on. In psychoanalysis you are considered to be having normal human reactions to difficult situations, rather than being “ill”. Patients often have pre existing or medical labels however, and these may respond where appropriate to CBT based psychological therapies or hypnotherapy as recommended by NICE. Analysis looks at the deeper issues and as the human being as a whole. Working in a positive way often results in psychosomatic conditions or psychological patterns falling away, which might have been labelled as illness. We base our therapy work around research evidenced and NICE recommended models of “treatment”, but also soften these by adding other methods for individual needs and holistic effect.

Psychological therapies work, and this is well evidenced in recent neurology advances. All the therapy Stuart provides, is rooted in research evidenced core tools and methods so as to enable effective treatment.

Q
Job titles in mental health and psychological therapies are confusing, help?

A
Psychiatrists are medical doctors specialising in mental illness. The model is biomedical and uses drugs and sometimes ECT.

Psychologists are usually cognitive behavioural or behavioural. Some complete additional counselling training. The model is experimental and quite biomedical. They are HCPC regulated.

Counsellors use non judgemental unconditional positive regard to provide a healing space for the client to talk. They are non medical model and non analytical. They are usual graduates and hopefully subject to a PSA AR.

Psychoanalysts are analytical but not biomedical. They use analysis and guided conversation to gain deeper insight and capacity for choice and change. There is no one organisation or model for psychoanalysis despite some bodies trying to dominate the term unofficially.

Hypnotherapists use a specific form of psychological and complementary therapy to assist change. Hypnotherapy can be “off the shelf” and scripted, but is more effective when tailored to the individual through analysis and information gathering. Many hypnotherapists are trained in using psychotherapy with and without hypnotic trance, and this means that hypnotherapy contains analysis, psychotherapy and counselling as vital job components. Hypnotherapy is subject to voluntary regulation as a complementary therapy via the CNHC, which is a PSA AR.

Specialist practitioners in Trauma are integrative and use a combination of talking therapy, body work, somatic work, psycho education, relaxation based tools and other related methods.

Q
What are Stuart and Denise?

A
Stuart is a clinical psychotherapist, psychoanalyst, stress management consultant, and clinical hypnotherapist with additional psychology, counselling, mindfulness, coaching, NLP and psychotherapy training including a MSc in psychology. He employs eastern psychology and philosophy from East and west in his work and has a BSc (Hons) in Philosophy and psychology. Stuart is a Certified Clinical Trauma Practitioner (CCTP) and Certified Clinical Anxiety Treatment Professional (CCATP), which are internationally set standards of integrative practice.

Denise is a counsellor, clinical psychotherapist and clinical hypnotherapist with additional training in psychotherapy, mental health support work, psychology and complementary therapies including a BSc open degree in psychology and health topics. Denise takes a “back seat” role at present due to health limitations.

Both therapists have primary accreditation from, and are permitted to use the listed terms by the NACHP, a registered charity and long standing professional body.

Both therapists are integrative and multi-modal in nature. Both are professionally registered, regulated (as  hypnotherapists on the FHT PSA AR Scheme) and insured. Both are members of professional bodies registering them to provide psychotherapy, counselling, coaching, psychology, complementary therapy, hypnotherapy, and in Stuart’s case analysis. 

Key words:

Hypnotherapy, psychoanalysis, counselling, psychotherapy, NLP, CBT, Edinburgh, Falkirk, Stirling, Glasgow, Dublin, mindfulness, CBASP, MBCT, MBSR, Hygge, hypnotherapist, psychotherapist, counsellor, stress management hypnosis, hypnotist, analyst, analysis, psychodynamic, cognitive behavioural, meditation, complementary health, healthcare practitioner.

Contact via the contact us page HERE