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People often have different expectations for therapy, based on prior experience, reports from family or friends, or ideas in the media. As such, there are many mis- and pre-conceptions about what psychotherapy and counselling is and what it entails. Below are some answers to FAQ's that will offer you clarification.
A brief history of Psychotherapy
The idea of psychotherapy was first developed in Vienna over a century ago, by the famous Sigmund Freud. Freud’s work with patients led him to believe that mental health problems such as depression and anxiety were the result of keeping difficult thoughts and memories locked in the unconscious mind. Freud proposed that treatment should revolve around listening to the patient and by providing interpretation of their thoughts bring these memories into the conscious mind, thereby reducing symptoms. This idea led to the popular image of therapy, as individuals lying on the couch reciting their inner most thoughts to the therapist with a clipboard.
Although different forms of this therapy were established, the major change came in the 1950s, when a psychologist named Carl Rogers developed Person-Centred Therapy, which viewed all individuals as unique, and requiring unique solutions to their problems. Under this view, the role of the therapist was to create a comfortable, empathic and non-judgemental environment which would aid patients find their own solutions to their problems. While this view of therapy forms the basis of modern day psychotherapy, there are many approaches that are currently in use. At Knowthyself, this forms the base of all Therapies.
What is the difference between a Counsellor, a Psychotherapist and a Psychologist?
A Counsellor generally has specific training in Counselling Theory and Skills as well as clinical experience of face-to-face Counselling. Counsellors typically conduct short and medium term work. In the context of mental health, ‘counselling’ is generally used to denote a relatively brief treatment that is focused most upon behaviour. It often targets a particular symptom or problematic situation and offers suggestions and advice for dealing with it.
A Psychotherapist is also trained in Counselling skills and theory, but generally works in greater depth and thus Psychotherapy may be medium to long-term treatment focusing more on gaining insight into acute emotional and physical problems. Its focus is on the patient's thought processes and way of being in the world rather than specific problems.
A Psychologist must have a doctoral degree, and is a professional trained to conduct research, perform testing, and evaluate and treat a full range of emotional and psychological challenges. They may work in many different areas, such as research, teaching, administration or therapy. Those who specialize in therapy are called clinical psychologists.
A Clinical or Counselling Psychologist has a similar training to a Counsellor or Psychotherapist, but additionally will hold a degree in Psychology and need to complete a doctorate degree, internship and one to two years of professional experience in order to become licensed.
What is a Psychiatrist?
A Psychiatrist is a medically trained professional who offers diagnostic evaluation and a treatment program of drugs or psychological therapy.
The term ‘psychiatry’ literally means the ‘medical treatment of the mind’. It is concerned with the diagnosis and treatment of mental, emotional and behavioural disorders. In managing these conditions, psychiatrists have a number of methods at their disposal including pharmacological drug treatments, and psychological counselling. Unlike counsellors, psychotherapists and psychologists, psychiatrists can prescribe medication in the treatment of problems. Knowthyself is associated to a number of psychiatrists who are specialists in addictions, OCD, depression and anxiety, and we would be glad to direct you to the appropriate one if and when appropriate.
What is face-to-face Counselling & Psychotherapy?
Counselling & Psychotherapy takes place when a counsellor sees a client in a private and confidential setting to explore a challenge the client is having, distress they may be experiencing or perhaps their dissatisfaction with life, or loss of a sense of direction and purpose.
By listening attentively and patiently the counsellor can begin to perceive the difficulties from the client's point of view and can help them to see things more clearly, possibly from a different perspective. Counselling & Psychotherapy is a way of enabling choice or change or of reducing confusion; it is also a way of uncovering wounds and creating healing. It does not involve giving advice or directing a client to take a particular course of action. Psychotherapists & Counsellors would see a client with unconditional positive regard, empathy and in congruency with themselves.
How does face-to-face Counselling & Psychotherapy work?
In the counselling sessions the client can explore various aspects of their life and feelings, talking about them freely and openly in a way that is rarely possible with friends or family. Bottled up feelings such as anger, anxiety, grief and embarrassment can become very intense and Counselling & Psychotherapy offers an opportunity to explore them, with the possibility of making them easier to understand. The counsellor will encourage the expression of feelings and as a result of their training will be able to accept and reflect the client's problems without becoming burdened by them.
The counsellor may help the client to examine in detail the behaviour or situations which are proving troublesome and to find an area where it would be possible to initiate some change as a start. The counsellor may help the client to look at the options open to them and help them to decide the best for them.
How do I know if I need Counselling or Psychotherapy?
The relationship between you and your counsellor is one of the most important factors in the effectiveness of counselling. As someone who is trained to listen empathically and with a non-judgemental attitude to your problems, your counsellor can help you develop an understanding of yourself and others, and provide you with different perspectives and the support to work through the problems you face, facilitating positive change. It is a way of reducing confusion and enabling choice; it is about empowering you to find your own answers and solution and making a personal choice about a particular course of action. As such, the therapist / client relationship is collaborative and based on trust, empathy and unconditional positive regards, so that you are able to confide in your psychotherapist your thoughts, feelings and emotions.
What issues can Counselling & Psychotherapy help with?
Counselling & Psychotherapy can help you deal with a range of issues, from day-to-day worries to more long term psychological problems. It can help you come to terms with anxiety (generalised anxiety problems, social anxiety, panic attacks, phobias), stress in the work place, work-life imbalances, relationship issues (break-up, divorce, affairs, choosing inappropriate partners, loneliness, life adjustments, marital problems, arguments, jealousy, wedding & premarital counselling), sexual problems (impotence, internet/pornography/sex addiction, loss of desire), infertility, trauma (including post-traumatic stress disorder from accidents, rape and other attacks/incidents), obsessive-compulsive disorder, depression (including suicidal thoughts, low mood, social withdrawal), addiction, low-self esteem & confidence, addiction & substance misuse, anger & abuse (including verbal and physical abuse), bereavement/grief/loss.
Clients present with wide-ranging problems including anxiety (generalised anxiety problems, social anxiety, panic attacks, phobias), stress in the work place, work-life imbalances, relationship issues (break-up, divorce, affairs, choosing inappropriate partners, loneliness, life adjustments, marital problems, arguments, jealousy, wedding & premarital counselling), sexual problems(impotence, internet/pornography/sex addiction, loss of desire), infertility, trauma (including post-traumatic stress disorder from accidents, rape and other attacks/incidents), obsessive-compulsive disorder, depression (including suicidal thoughts, low mood, social withdrawal), addiction, low-self esteem & confidence, addiction & substance misuse, anger & abuse (including verbal and physical abuse), bereavement/grief/loss. At Knowthyself, the most common reasons for searching for a counsellor are: Anxiety, Anger Management, Addiction (Drug & Alcohol Misuse), Obsessive Compulsive Disorder (OCD), Depression, Low Self-Esteem, Relationship Problems, Panic Disorder, Self-Development, Stress Management, Work & Career Issues.
What happens in a Counselling or Psychotherapy session?
There is no typical counselling session. The counselling session is time set aside for you and what you talk about will vary according to your goals and needs. You are free to discuss what you wish to, from everyday events, dilemmas, feelings, thoughts, memories and dreams. Your counsellor will provide a safe environment in which to explore your issues and work towards change, clarity, and if desired, self-improvement. If you prefer to approach your issues in a more practical way, then cognitive behavioural therapy, solution focused brief therapy may be a way to go about it.
What kinds of people seek Counselling & Psychotherapy?
Many types of people can benefit from and seek counselling. Therapy is frequently conducted on a one-to-one level with individuals. However, counselling is also beneficial with couples, adolescents and teenagers. My clients span across cultures, gender (male, female), sexual orientation (straight, gay, bi-sexual), religion (Christian, Catholic, Muslim, Jewish, Atheist) and employment groups. I welcome diversity and my discreet and professional approach can accommodate a wide client group.
How do I start with a Counsellor or Psychotherapist?
To book a general consultation, please phone, text or email for an appointment time at Knowthyself. If you prefer a specific Counselling or Psychotherapy approach: Existential Psychotherapy, Mindfulness Therapy, Person-Centred Therapy, Gestalt Therapy, ACT, Cognitive Behavioural Therapy (CBT) or Solution Focused Brief Therapy (SFBT), let me know. Otherwise, I, as a psychotherapist, will make an assessment and will recommend an approach or integration of approaches that I feel you would benefit most from. If what I have to offer is not suitable to your needs, I will recommend another psychotherapist or specialist for you to consider.
How long should I expect to have to continue with Counselling or Psychotherapy?
The number of counselling sessions depends on you as an individual and your unique presenting issues. A first consultation will enable you to see if counselling is indicated. Usually you will start with six sessions and review after that. Solution Focused Brief Therapy is designed to be short term, between one and four sessions, Cognitive Behaviour Therapy is medium term lasts six to 24sessions, depending on how deep one needs to go into core issues. Existential and Psychodynamic therapy tend to be longer term and may last for many months or even years. Since I work privately, you are not limited in the number of sessions you can have.
Will my Counselling & Psychotherapy sessions be confidential?
The content of your therapy sessions is absolutely confidential. The Counsellor or Psychotherapist would only breach that confidentiality if it was believed that you were at risk of harming yourself or someone else. In that case, your Counsellor or Psychotherapist would advise you of their obligation to breach confidentiality to protect you and/or others.
Can a counsellor or psychotherapist prescribe medication if I need it?
I am a Psychotherapist and Counsellor, and I am not eligible to prescribe medication. I am associated with psychiatrists who work with me and who can assess you for a prescription, and this can complement your therapy work. Please note that the fee for psychiatry is to be paid separately and is higher than counselling.
Can I speak to a Counsellor or Psychotherapist before my appointment?
Yes, you may have a short conversation to answer some of your fundamental questions. It is best to make an appointment for a first consultation which will give you the chance to bring in any questions, to find out more about how we will work together and to discover if you connect with me as a psychotherapist and counsellor. If you wish to find out about my background, please read my profile here. Whilst the majority of first consultations will proceed to a full course of treatment, neither you nor I are committed to continue beyond the first counselling consultation session.
Will my Counsellor or Psychotherapist be available for me in a crisis?
I will be available in a crisis only during working hours, otherwise you will need to seek other resources. In an emergency I may refer you to either Mount Elizabeth or Raffles Hospital, or MIH, as may be relevant and appropriate. Note that emergency fees are higher.
Why do I need to attend weekly sessions?
Regularity is important for productive therapeutic work. The standard format of weekly sessions helps you make gradual and steady progress a step at the time. In special cases more than one or two sessions a week may be required, and on other cases, a session once every two weeks may be sufficient.
Why would I choose Skype Counselling, and how does it work?
Convenient when you are abroad
Therapy in the convenience of your preferred location
Confidential - your discretion is assured.
How it works
Contact us to book
Pay for session by bank transfer or PayPal
Book a 50 or 80 minute session
Call therapist on Skype, WhatsApp or FaceTime on a designated number
Do I have to pay for missed/cancelled appointments?
If you proceed with therapy sessions after the first consultation, the therapist will reserve a time slot (of 50 or 80 minutes) for you at an agreed upon date and time. Any missed sessions or cancellations with less than 24 hours will be charged at the full fee. The cancellation policy applies to holidays, work commitments, illness and other emergencies. This cancellation policy will be shared with you prior to your first appointment and at your first session.
How can I pay for a therapy session or a course of sessions?
The therapist will take payment in full at the end of the first session by cash or cheque should no more sessions follow. Should the client choose to continue, the sessions would be either of 50 or 80 minutes and are paid in advance in groups of six sessions at a time, unless otherwise agreed with the therapist. You will be invoiced for any sessions missed or cancelled with less than 24 hrs. If requested, a Summary Statement may be given to you every six sessions reflecting the time used at each session, the total of hours and the payments made/outstanding.
Will my insurance cover the Counselling & Psychotherapy sessions?
This depends on the nature of your policy. You should check with your provider to see whether psychotherapy and counselling sessions will be covered, how many sessions can be included and if there are any other restrictions. This is solely your responsibility.
Can I refer someone for Counselling or Psychotherapy?
Friends, family and colleagues may be looking for support, and in that case a referral to Knowthyself is most appropriate. If, on the other hand, you are very concerned about an individual's well being and would like to see them have counselling, we are able to take enquiries from you on behalf of someone else, but it is advisable that you have their full consent. It is most helpful if the individual in question can make contact themselves, as it is an important step in acknowledging that they may need assistance.
Ethics for Counselling & Psychotherapy
This statement marks an important development in approach to ethics within the British Association for Counselling & Psychotherapy, which is respected and adhered to at Knowthyself, as one of the characteristics of contemporary society is the coexistence of different approaches to ethics.
This statement reflects this ethical diversity and supports practitioners being responsive to differences in client abilities, needs and culture and taking account of variations between settings and service specialisations by considering:
Personal moral qualities
This selection of ways of expressing ethical commitments does not seek to invalidate other approaches. The presentation of different ways of approaching ethics alongside each other in this statement is intended to draw attention to the limitations of relying too heavily on any single ethical approach. Ethical principles are well suited to examining the justification for particular decisions and actions. However, reliance on principles alone may detract from the importance of the practitioner’s personal qualities and their ethical significance in the counselling or therapeutic relationship. The provision of contextually sensitive and appropriate services is also a fundamental ethical concern. Variations in client needs and cultural diversity differences are often more easily understood and responded to in terms of values. Therefore, professional values are becoming an increasingly significant way of expressing ethical commitment.
Values of Counselling & Psychotherapy
The fundamental values of counselling and psychotherapy include a commitment to:
Respecting human rights and dignity
Protecting the safety of clients
Ensuring the integrity of practitioner-client relationships
Enhancing the quality of professional knowledge and its application
Alleviating personal distress and suffering
Fostering a sense of self that is meaningful to the person(s) concerned
Increasing personal effectiveness
Enhancing the quality of relationships between people
Appreciating the variety of human experience and culture
Striving for the fair and adequate provision of counselling and psychotherapy services
Values inform principles. They represent an important way of expressing a general ethical commitment that becomes more precisely defined and action-orientated when expressed as a principle.
Ethical principles of Counselling & Psychotherapy
Principles direct attention to important ethical responsibilities. Each principle is described below and is followed by examples of good practice that have been developed in response to that principle.
Ethical decisions that are strongly supported by one or more of these principles without any contradiction from others may be regarded as reasonably well founded. However, practitioners will encounter circumstances in which it is impossible to reconcile all the applicable principles and choosing between principles may be required. A decision or course of action does not necessarily become unethical merely because it is contentious or other practitioners would have reached different conclusions in similar circumstances. A practitioner’s obligation is to consider all the relevant circumstances with as much care as is reasonably possible and to be appropriately accountable for decisions made.
Being trustworthy: honouring the trust placed in the practitioner (also referred to as fidelity)
Being trustworthy is regarded as fundamental to understanding and resolving ethical issues. Practitioners who adopt this principle: act in accordance with the trust placed in them; strive to ensure that clients’ expectations are ones that have reasonable prospects of being met; honour their agreements and promises; regard confidentiality as an obligation arising from the client’s trust; restrict any disclosure of confidential information about clients to furthering the purposes for which it was originally disclosed.
Autonomy: respect for the client’s right to be self-governing
This principle emphasises the importance of developing a client’s ability to be self-directing within therapy and all aspects of life. Practitioners who respect their clients’ autonomy: ensure accuracy in any advertising or information given in advance of services offered; seek freely given and adequately informed consent; emphasise the value of voluntary participation in the services being offered; engage in explicit contracting in advance of any commitment by the client; protect privacy; protect confidentiality; normally make any disclosures of confidential information conditional on the consent of the person concerned; and inform the client in advance of foreseeable conflicts of interest or as soon as possible after such conflicts become apparent. The principle of autonomy opposes the manipulation of clients against their will, even for beneficial social ends.
Beneficence: a commitment to promoting the client’s well-being
The principle of beneficence means acting in the best interests of the client based on professional assessment. It directs attention to working strictly within one’s limits of competence and providing services on the basis of adequate training or experience. Ensuring that the client’s best interests are achieved requires systematic monitoring of practice and outcomes by the best available means. It is considered important that research and systematic reflection inform practice. There is an obligation to use regular and on-going supervision to enhance the quality of the services provided and to commit to updating practice by continuing professional development. An obligation to act in the best interests of a client may become paramount when working with clients whose capacity for autonomy is diminished because of immaturity, lack of understanding, extreme distress, serious disturbance or other significant personal constraints.
Non-malfeasance: a commitment to avoiding harm to the client
Non-malfeasance involves: avoiding sexual, financial, emotional or any other form of client exploitation; avoiding incompetence or malpractice; not providing services when unfit to do so due to illness, personal circumstances or intoxication. The practitioner has an ethical responsibility to strive to mitigate any harm caused to a client even when the harm is unavoidable or unintended. Holding appropriate insurance may assist in restitution. Practitioners have personal and professional responsibility to challenge, where appropriate, the incompetence or malpractice of others; and to contribute to any investigation and/or adjudication concerning professional practice which falls below that of a reasonably competent practitioner and/or risks bringing discredit upon the profession.
Justice: the fair and impartial treatment of all clients and the provision of adequate services
The principle of justice requires being just and fair to all clients and respecting their human rights and dignity. It directs attention to considering conscientiously any legal requirements and obligations, and remaining alert to potential conflicts between legal and ethical obligations. Justice in the distribution of services requires the ability to determine impartially the provision of services for clients and the allocation of services between clients. A commitment to fairness requires the ability to appreciate differences between people and to be committed to equality of opportunity, and avoiding discrimination against people or groups contrary to their legitimate personal or social characteristics. Practitioners have a duty to strive to ensure a fair provision of counselling and psychotherapy services, accessible and appropriate to the needs of potential clients.04 Ethical Framework for Good Practice in Counselling & Psychotherapy © BACP 2001, 2002, 2007, 2009, 2010
Self-respect: fostering the practitioner’s self-knowledge and care for self
The principle of self-respect means that the practitioner appropriately applies all the above principles as entitlements for self. This includes seeking counselling or therapy and other opportunities for personal development as required. There is an ethical responsibility to use supervision for appropriate personal and professional support and development, and to seek training and other opportunities for continuing professional development. Guarding against financial liabilities arising from work undertaken usually requires obtaining appropriate insurance. The principle of self-respect encourages active engagement in life-enhancing activities and relationships that are independent of relationships in counselling or psychotherapy.
Personal moral qualities in Counselling & Psychotherapy
The practitioner’s personal moral qualities are of the utmost importance to clients. Many of the personal qualities considered important in the provision of services have an ethical or moral component and are therefore considered as virtues or good personal qualities. It is inappropriate to prescribe that all practitioners possess these qualities, since it is fundamental that these personal qualities are deeply rooted in the person concerned and developed out of personal commitment rather than the requirement of an external authority. Personal qualities to which counsellors and psychotherapists are strongly encouraged to aspire include:
Empathy: the ability to communicate understanding of another person’s experience from that person’s perspective.
Sincerity: a personal commitment to consistency between what is professed and what is done.
Integrity: commitment to being moral in dealings with others, personal straightforwardness, honesty and coherence.
Resilience: the capacity to work with the client’s concerns without being personally diminished.
Respect: showing appropriate esteem to others and their understanding of themselves.
Humility: the ability to assess accurately and acknowledge one’s own strengths and weaknesses.
Competence: the effective deployment of the skills and knowledge needed to do what is required.
Fairness: the consistent application of appropriate criteria to inform decisions and actions.
Wisdom: possession of sound judgement that informs practice.
Courage: the capacity to act in spite of known fears, risks and uncertainty.
Why are there codes of Ethics in Counselling & Psychotherapy, and where do they come from?
The challenge of working ethically means that practitioners will inevitably encounter situations where there are competing obligations. In such situations it is tempting to retreat from all ethical analysis in order to escape a sense of what may appear to be irresolvable ethical tension. These ethics are intended to be of assistance in such circumstances by directing attention to the variety of ethical factors that may need to be taken into consideration and to alternative ways of approaching ethics that may prove more useful. No statement of ethics can totally alleviate the difficulty of making professional judgements in circumstances that may be constantly changing and full of uncertainties. By accepting this statement of ethics, members of the British Association for Counselling and Psychotherapy are committing themselves to engaging with the challenge of striving to be ethical, even when doing so involves making difficult decisions or acting courageously.