What to expect from therapy

http://www.psychoanalysis.center/who/what-to-expect-from-therapy

What to Expect from therapy, some common questions

These descriptions are the product of Scotlandtherapy and not of any affiliated organisation.

Q
What kind of therapy should I expect from Scotlandtherapy?

A
Multi modal and integrative, based around research evidenced and NICE recommended methods.  Stuart is multi modal but is rooted in philosophical and humanistic practice.

Q
What is multi modal therapy?

A
Multi-modal therapists are trained in multiple different therapy models to competency, rather than just one main model. Stuart was trained in psychodynamic, cognitive behavioural and humanistic therapies as well as clinical hypnotherapy as core competencies requiring over 1,000 hours of supervision before training was complete

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, experiences and self determination. Because both therapists are analysis and hypnotherapy based, these conversations take place in either a state of relaxed discussion (feeling at ease), an altered state (relaxed but mindful and focused) or a formal deeper hypnotic state depending on the context and subject.

It is essential that clients attend regularly and prioritise their therapy as one might prioritise medical care. Therapy requires regular attendance and commitment, and PSA AR registered practitioners are healthcare professionals.

Q
Does the therapist fix me?

A
No, the therapist accompanies you on the journey. Therapy comes from a Greek expression to “walk with” someone. Therapists 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 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.

Q
Is the process all planned out?

A
No, it is impossible to plan the process in advance beyond a basic overall strategy. This is because therapy in the psychoanalytic traditional is free flowing and follows the needs of the client as their journey unfolds. Over planning stifles progress and imposes values and judgement on the client. 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.

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
Are Lesbian, Gay, Transgender, Bisexual and non traditional gender / relationship clients welcome? What about different faiths and cultures?

A
Both Stuart and Denise welcome LGBT clients, and as well as not discriminating against any group, actually have active experience working with a range of different groups, and therefore have an understanding of the additional issues faced by people in different relationship and gender types. All cultures and faiths are welcome and both therapists have completed CPD training in different philosophies and faiths to better understand and respect varied cultures and backgrounds. We are registered on the Pink Therapy LGBT directory and training body.

Q
I am on low income, is there any help available?

A
Yes, Scotlandtherapy has a three tier fee system so that people on middle and low income pay less than those on fully employed income. 

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 judgemental and non analytical way, giving you space to talk and heal. It is often humanistic and person centred.  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. Counselling is usually a more informal and “normal” conversation, without the relaxed states used in analysis and hypnotherapy.  Counselling provides non judgemental listening and healing space and an opportunity to talk, reflect and harness inner wisdom in the client themselves.

There are various forms of analysis such as communications analysis, process analysis, coaching analysis, linguistic analysis, cognitive analysis, Competing Response Training, Applied Behaviour Analysis, Active mindfulness thought process analysis, CBASP and psychoanalysis.

Also Stuart in particular uses Disciplined Personal Involvement (DPI) with clients. This is a way of working which uses disciplined reflection of the therapist’s transference and counter-transference. By doing this the client can learn how their behaviours and comments cause effects in other people. Clients who have had very traditional psychotherapy often expect the therapist to be an emotionless over professionalised “blank slate”. DPI means the therapist tries to give real human reactions when possible, while maintaining an observer position as well in order to analyse effects. DPI is part of the CBASP modal.

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. There are various forms of analysis such as communications analysis, process analysis, coaching analysis, linguistic analysis, cognitive analysis and psychoanalysis.

There are a range of different depths of psychotherapy, Cognitive Behavioural Therapy for example is a fairly functional system and is not for example considered sufficient in child sexual abuse cases. Such cases often involve severe depressive symptoms and therefore personal analysis, psychoanalysis or cognitive behavioural analysis might be more appropriate. [Bird J. (2015) Improving Mental Well-being for Survivors of Childhood Abuse and Neglect”Perspectives in Public Health Jan 2015, Vol 135 No1]

Q
What kind of analysis is used?

A
Analysis is provided as free association, in an altered state, or as a guided conversation in a relaxed state. Hypnoanalysis uses a formal trance. All analysis and conversation is provided in a form of relaxed state, ranging from feeling “at ease” and able to talk more freely than usual, down to formal and very relaxed trance. Mindfulness and regular use of hypnotherapy recordings is also encouraged as part of the process, and therefore all our analysis / psychoanalysis takes part in relaxed states, and therefore comes under hypnotherapy standards. Conversational, linguistic and pattern analysis are different to traditional psychoanalysis and take place in a relaxed conversational state. Thus our primary National Occupational Standards and regulatory standards (CNHC and AR) are hypnotherapy standards. Within the styles used each therapist chooses from cognitive behavioural, mindfulness, Lacanian, Jungian, Kleinian, Freudian, Integrative or person centred depending on the case and the needs of the client.

Cognitive behavioural analysis is also provided by Stuart including Competing Response Training, Applied Behaviour Analysis, Language Analysis, Active Mindfulness (thought) Analysis. Psychoanalysis (psychodynamic and philosophical) include influences of Lacan, Jung, Freud and Klein.. Stuart trained in a combination of psychoanalysis and cognitive behavioural analysis (1993-1996) and is completing additional post qualification training in the CBASP method which was specifically designed for severe depression, including mood disorders e.g. Bipolar. Cognitive behavioural analysis is far deeper and more intense than Cognitive Behavioural Therapy since it looks in far more detail at developmental, relationship, perceptual and consequence of behaviour patterns. Stuart has completed competency training in CBASP at Dundee University in conjunction with NHS Tayside, and is completing additional training. CBASP is recommended as being provided alongside medication from a medical doctor, and has been shown to produce a success rate of 85% when provided in combination. [Keller, M. et al. A Comparison of Nefazodone, the Cognitive Behavioural-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000. ]. Here in Scotland a 60% improvement was noted in a similar study. [**Swan et al (2013) “CBASP for Chronic Depression: Clinical Characteristics and six month clinical outcomes in an open case series” Journal of Affective Disorders]

Q What are humanistic therapies?

There are essentially three different models of psychological therapy in the west: the “first” –  psychodynamic, the “second”- cognitive behavioural, and the “third” – humanistic.

Humanistic therapy does not treat symptoms, or consider the client “ill”, but rather focuses on positive change and the potential for self healing and self development inside all of us.

There are western humanistic traditions, often closely related to philosophy, and eastern humanistic traditions, rooted in philosophy and faith methods such as buddhist psychology and mindfulness.

Common humanistic methods include person centred counselling, gestalt therapy, philosophical therapy and mindfulness therapy, there are however many variations and many humanistic practitioners are integrative.

Stuart is dedicated to combining western traditional psychological therapies and eastern methods and his therapy work is rooted in philosophy from both. At core, despite his multi modal nature, Stuart is humanistic and philosophical in practice.


Q How frequent are  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. Hypnotherapy sessions are about the same frequency but when used to supplement analysis, can be every 3rd or 4th session. Often a double session will be three quarters analysis and one quarter hypnotherapy using the information discussed to crafty a live session. CBASP sessions for clinical depression are weekly, or fortnightly double sessions, and less frequent sessions reduces effectiveness. Counselling and psychotherapy sessions are often around one hour and weekly.

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.

Q
Is analysis regulated?

A
No, in fact many analysts object to regulation since it risks imposing values, judgements and limitations on the process. Because we provide all our analysis in relaxed, altered or trance states we are subject to hypnotherapy standards. Psychoanalysis is sometimes thought to be a form of psychotherapy. Hypnoanalysis is a form of hypnotherapy. Conversational, linguistic and pattern analysis are something similar to coaching. Other people consider analysis either to be a tool used in multiple therapies, or something completely separate. Because analysis crosses all those boundaries it is not easy to define or regulate it. CBASP has it’s own international professional body, and this is the organisation Stuart has trained with (and continues to train with). It is more important that the therapist providing the analysis is subject to regulation or AR registration for a core discipline. For clinical psychologists this might be via HCPC, for counsellors it might be a counselling AR scheme, for hypnotherapists like Stuart and Denise it is via the voluntary regulator and AR scheme the CNHC, and the AR scheme of FHT. In March 2015 the CNHC regulator acknowledged in a meeting in Edinburgh that analysis and counselling are essential skills and job functions within clinical hypnotherapy. Stuart is also registered on the UKAHPP PSA AR scheme under Psychotherapeutic counselling.

Rather than being regulated as such, Analysis, Psychoanalysis and related methods are represented by substantial professional bodies such as NCP, SSM and NACHP, whose members also have access to voluntary regulation and PSA AR via the CNHC hypnotherapy voluntary regulation process.

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. Cognitive Behavioural Analysis (especially CBASP) may be used to treat chronic depression. 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. NICE also recommend hypnotherapy to treat Irritable Bowel Syndrome and Anxiety UK recommend hypnotherapy, counselling and Cognitive Behavioural based psychological therapies for treating anxiety, phobias and IBS.

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. They are subject to medical standards and the BMA.

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

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 may be AR registered.

Analysts are analytical but not biomedical. They use analysis and guided conversation to gain deeper insight and capacity for choice and change. Many use relaxed and altered states for free association, relaxed discussion or even hypnoanalysis. Analysts are often registered as psychotherapists or hypnotherapists under their AR schemes. Analysts may provide psychoanalysis (a psychodynamic theory based style), cognitive behavioural analysis (based on cognitive and behavioural psychology theory) or a combination of these or other theory based styles.

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. Hypnotherapists are subject to voluntary regulation (CNHC) and AR schemes. The CNHC has acknowledged that analysis and counselling are essential skills and job functions for clinical hypnotherapists.

The AR schemes, the CNHC voluntary regulator, the BMA and the HCPC are all overseen by the Professional Standards Authority, which is essentially the regulator of regulators and is accountable to the UK Parliament.

Q
What are Stuart and Denise?

A
Stuart is clinical psychotherapist, an analyst and clinical hypnotherapist with additional psychology, counselling, mindfulness, coaching, NLP, CBASP and psychotherapy training including a MSc in psychology. He employs eastern psychology and philosophy from East and west in his work. Stuart uses relaxed, altered and hypnotic states in his work, thus his primary registration is as a hypnotherapist. His style is analytic and psychoanalytic. After going through an officially accredited route in hypnotherapy training, which was also in psychoanalysis and humanistic counselling, Stuart then went through an accreditation process with the NACHP for hypnotherapy, psychotherapy and counselling.

Denise is a clinical psychotherapist, an analyst and clinical hypnotherapist with additional training in psychotherapy, counselling, mental health support work, psychology and complementary therapies including a BSc open degree in psychology and health topics. Denise provides her analysis in relaxed meditative states using light trance, altered state and formal hypnotherapy. Thus her primary registration is as a hypnotherapist. Her style is cognitive behavioural and person centred. Denise is AR registered as a hypnotherapist and for providing nutritional advice. She is currently unavailable for health reasons.

Both therapists are integrative in nature. Both use mindfulness, a form opf relaxation often combined with hypnotherapy as in the work of Michael Yapko. Both are professionally registered, regulated (as CNHC hypnotherapists) and insured. Both are members of professional bodies registering them to provide psychotherapy, counselling, coaching, psychology, complementary therapy, hypnotherapy, and analysis. Both are registered on the CNHC and FHT Accredited Registers under hypnotherapy, maintained by the Professional Standards Authority. Stuart is also on the UKAHPP PSA AR scheme under psychotherapeutic counselling.

Q
What are the different levels of relaxation using hypnosis processes?

A

Conversational hypnosis:  Client and therapist engages normally in conversation but hypnotic language and Ericksonian method is employed positively.

Relaxed altered state: Client feels relaxed and at ease and able to talk more openly than usual. Achieved through atmosphere, body language and putting the client “at ease”. Used in active mindfulness.

Light trance or mindfulness: Gentle feeling of being relaxed, focused on other things or simply “different”. Often used for free association, passive mindfulness or NLP processes.

Medium trance: A more formal state of relaxation used for hypnotherapy processes such as visualisation, affirmation and suggestion.

Deep trance: A deep and formal state of relaxation used for time distortion therapy and regression.

Key Words
Psychotherapy, psychoanalysis, psychodynamic, psychotherapist, psychoanalyst, analysis, analyst, counselling, counsellor, hypnpotherapy, hypnotherapist, hypnotist, hypnosis, hypnotic, language, mindfulness, MBCT, MBSR, DBT, relaxation, Edinburgh, Glasgow, Falkirk