Some common questions
Q. I don’t know what to expect when I see a psychologist for the first time. What’s it like?
A. Usually, when you’re referred to a psychologist, an initial assessment is arranged. This involves meeting with the psychologist for up to about 90 minutes to discuss the reasons you have been referred. You will be asked questions about when the problem began, how it came about, and how it continues to impact on your life. Your goals for what you want to change will also be discussed and an opinion on how psychological treatment may help will be shared with you. If it is felt that psychological treatment is not suitable for you, this will also be discussed, along with possible alternatives for you to consider. If you have not spoken about your difficulties in depth before, answering some of the above questions might be difficult. There are no ‘right’ or ‘wrong’ answers. Beginning to talk about it during the assessment is the starting point to understanding more about the difficulties and therefore being able to make changes in your life.
Q. What is a ‘Clinical’ Psychologist and how are they different from a psychiatrist or a psychotherapist?
A. Many people are often confused about these differences. A Clinical Psychologist is someone who has undergone in-depth training (often to doctoral level) in the scientific study of behaviour and mental disorders. They usually receive training in several psychotherapeutic models and often refer to themselves as ‘eclectic’ in approach, which means that they draw on a range of therapeutic approaches according to the individual needs of the client in order to relieve psychological distress. They focus heavily on formulation, which is a theoretically-driven explanation of a person’s difficulties that usually follows a clinical assessment. They work in a range of health, social care, and forensic settings. Due to their role as ‘scientist-practitioners’, they are also heavily involved in research and in the evaluation and development of services. Compared to psychiatrists, both professions work with similar patients but there are significant differences in their training and overall approach to mental health. Psychiatry is a specialisation of a medical degree. Due to this medical background, psychiatrists often prescribe medication for psychological difficulties. Psychotherapists, by contrast, are individuals who have had a core training in one of the main disciplines in mental health (e.g. mental health nurse, social worker, psychologist or psychiatrist) who have undertaken further in-depth training in one therapeutic approach (e.g. cognitive behavioural therapy, psychodynamic psychotherapy).
Q. How can therapy help, and will it ‘cure’ me?
A. People sometimes question how talking about their difficulties can help. There has been an increasing amount of evidence over several years which demonstrates (through scientific studies) that it can, and it achieves this in different ways according to the specific needs of the individual. Firstly, talking to a professionally trained therapist, in confidence, can help someone express feelings that they have not had the opportunity to do. Talking about problems also enables a person to begin to make sense of what things might be going wrong (or those things going right) in their life. By stepping outside of the problem and developing this awareness, opportunities for change become possible. In some cases, for example someone who has intrusive and distressing memories of a past event, talking it through in a controlled and therapeutic way has been shown to create the conditions for the memory to be ‘processed’, which in turn, can lessen the impact of the distressing event. ‘Cure’ is not usually a word used in psychological treatment; the emphasis is on helping the individual to find alternative ways of coping with their difficulties, to break out of negative cycles of thoughts, feelings and behaviours, and to discover ways of using their own strengths and skills to reduce the likelihood of those (or related) difficulties occurring again in the future.
Q. Is it confidential? Will it go on my records?
A. The nature of confidentiality, and the limits of it, are usually discussed with you at the initial appointment. Depending upon who referred you, and the reasons for your referral, your GP details will be requested. However, no information will be shared with the GP without your consent. The only time contact with your GP would be undertaken is when the psychologist believes you are at an imminent risk of harm, either from yourself or others, or others are at risk of harm from you. If such contact was absolutely necessary, this would be discussed with you and your consent requested.
Q. How many sessions will I need?
A. This will be entirely dependent upon your own individual needs and will be discussed and negotiated with you after the initial assessment. Sometimes, a one-off assessment is all that is required. If treatment is recommended, the length and intensity of treatment can vary from a small number of sessions (e.g. 4 – 8) for relatively minor or ‘single’ problems to longer-term treatment for more long-standing, entrenched, complex or multiple difficulties (e.g. 24+).
Q. Will it be distressing and make things worse?
A. Sometimes, talking about upsetting things can be distressing and is often a normal part of the process of therapy and recovery. In fact, one of the goals of the therapy might be to learn how to talk about, or at least think about, the problem whilst managing your emotions. However, the pace of the therapy will always be led by the client.
Q. What’s the difference between the treatments you offer, and how do you know what’s right for me?
A. The different treatment approaches are often selected according to the published evidence on their effectiveness for the particular problems of the individual. Other important considerations include the person’s choice and the ‘fit’ of the approach with the client’s preferences, the length of the treatment, whether more structure is required, as opposed to more open and exploratory approach. There is a lot written about each of the main approaches offered and we would encourage a potential client to read around the similarities and differences between the approaches. In a ‘nutshell’, CBT tends to be quite a structured approach that focuses on challenging ways of thinking that have a negative impact on the behaviour of the individual. CAT is a time-limited approach brings together understandings from cognitive psychotherapies and from psychoanalytic approaches into one, user-friendly and collaborative therapy. Its emphasis is on the repeating patterns of problems that people often get into, both in relationships with others and with themselves! DBT was developed to help people cope with extreme and distressing emotions and self-destructive behaviours (e.g. self-harm, substance misuse, eating disorders). It balances the need for change through skill development, and acceptance. The Zen Buddhist practice of mindfulness is woven throughout DBT. Schema Therapy is based upon CBT but is focused much more on early childhood experiences which have caused lifelong difficulties and the influence of schemas (or deeply held core beliefs) on these difficulties. EMDR is a short-term treatment for post traumatic stress disorder that is based on an 8-step protocol that includes a client recalling a distressing image while engaging in one of several types of bilateral sensory input, including side-to-side eye movements. It has been shown to be effective for symptoms of trauma although the reasons (or mechanisms) for this effectiveness is still unclear.
Q. Who can refer me?
A. Self-referrals from members of the public are welcome. Referrals are also accepted from health insurance companies, solicitors and medico-legal companies, occupational health departments, emergency services, GPs and hospital consultants
Q. How much does it cost?
A. Fees vary according to the type of work undertaken and number of sessions. Please contact me to discuss this further.