I thought therapy was only for people with serious mental health problems, how do I know if psychological treatment is going to help me?
Lots of people are apprehensive about seeing a psychologist for the first time. Films and television often lead us to believe that you have to be "crazy" to see a psychologist, and if you seek therapy it means you are unwell or unstable. Unfortunately, these ideas prevent lots of people from seeking help. In reality, psychological distress ranges from mild (brief, fleeting episodes of anxiety and low mood) to severe and debilitating difficulties that last for a long time.
Broadly speaking, psychologists can support people with anything that is causing them distress or getting in the way of them living a life that is in keeping with their values. If you are not sure whether seeing a clinical psychologist is what you need, I would be happy to arrange a free phone consultation to talk through what you'd like to seek help for and explore any concerns you have.
Which problems do you offer treatment for?
I have experience in working with a range of different presenting problems. Examples of a few of the problems I have supported people with include sudden onset of panic attacks in public places, anxiety about eating in front of other people, adjustment to diagnosis and symptoms of a long-term condition, anger affecting relationships with partner and children, claustrophobia, depression affecting performance at work and social anxiety in relation to public speaking.
Please see the 'psychological therapy' page to find out about the different problems I can offer treatment for. If your problem is not listed, please feel free to contact me to see if I am still able to help you. If not, I may be able to direct you to someone who is able to offer you support.
What can I expect from the first session?
In the first session, we will complete an assessment. This will involve discussing what has brought you to see a psychologist, and why you sought help when you did. The history of the problem will be explored, and you will be asked to discuss examples of when the problem bothers you the most to help to reach a shared understanding of what is keeping the problem going. This will help me to determine which treatment approach is best for you.
It is important that a therapist and client are a good fit, so that you feel comfortable to speak honestly during sessions. The first session is also a chance for you to meet me and get to know me so that you can make sure that you are happy to proceed with sessions together.
What can I expect from therapy?
Through treatment, we will work together to help you to better understand some of the ways your thoughts, feelings and behaviours have been acting as a barrier to you living the life you want to live. The idea of therapy is not to tell you that these thoughts, feelings and behaviours are "wrong"; the aim is to help you to recognise coping strategies that you have developed that have become unhelpful.
Therapy can equip you with the tools to manage difficulties when they arise. This will help to prevent the difficulties from re-occurring in the future, and give you strategies and skills to manage if they do. This means that I like my clients to take an active role in treatment - not so that you are doing all the work, but because it is important that any changes you make are sustainable and are not limited to the period of time when we are meeting regularly. You will sometimes be given homework assignments to complete between sessions, and you will be asked you to feed back at each session about how things are going so that approaches are tailored to suit you.
Will I have to talk about my childhood?
Psychologists believe that what has happened to us in the past shapes the way we understand ourselves, the world and other people. The attitudes and beliefs we use to process our everyday experiences and interactions are thought to be rooted in experiences from earlier in our lives. These attitudes and beliefs can become troublesome, especially when they lead to problematic coping strategies being overused in times of stress. It can be very useful to explore some of your experiences in childhood and young adulthood to better understand what some of the attitudes and beliefs are that govern your behaviour in the present.
That said, not everyone is comfortable talking about their childhood. Exploring the past can feature as much or as little as you want in therapy; I always tailor the treatment to the individual and it can be unhelpful to place too much emphasis on the past if a client is not comfortable with this.
It is likely that some of the topics covered in sessions may be distressing to talk about - if they weren't, you would not be seeking support for them. However, setting expectations early in therapy and checking in regularly about how you are finding sessions can help to ensure that you are happy with what is being discussed in sessions.
How many sessions will I need?
The number of sessions will be decided by a number of factors: the problem you are seeking treatment for, what is recommended by research evidence, your preferences, insurance coverage/cost limitations and my clinical opinion. Clients can attend for brief interventions of just a few sessions, or for longer courses of treatment (over a period of a few months).
Usually, a number of sessions is agreed in the first instance (e.g. four to six). At this point, we will review your progress to see whether further sessions would be helpful. If you contact me for a free phone consultation, I should be able to give you an idea of how many sessions may be required for your problem (although an exact number would be confirmed in the assessment session when we meet in person).
Will what we discuss be shared with anyone else?
As a general rule, what we speak about in our sessions is confidential, and will not be shared with anyone else. There are a few exceptions to this rule, as follows:
If something you tell me makes me concerned for the safety of you or someone else. I have a duty of care to keep you safe, and I am obliged to share information with the appropriate people if it will help me to do this. If I do have to share information with another professional or the authorities, I will try to discuss this with you beforehand;
I may share details of your case with my supervisor so that they can offer guidance, to ensure that you get the best possible treatment. I will not share your name or any other identifying details with my supervisor;
If a subpoena is served requesting details of our sessions as part of court proceedings.
Brief electronic notes are kept to document what has been discussed in our sessions. These are stored securely and will not be shared with anyone else, other than in the circumstances described above.
Do you offer sessions via Skype or Facetime?
Most sessions are conducted in person at the clinic. However, I understand that work or family commitments can make it difficult to attend regular sessions in person. I can offer sessions over Skype or Facetime if this will enable you to engage in therapy. Please use the contact form to arrange a phone consultation to discuss your needs further.
What is the difference between a clinical psychologist, a psychiatrist and a counsellor?
I hear this question a lot, and it’s often because people can be confused by the different services and fees provided by different professionals. I have summarised the main differences below – with the caveat that these definitions do not apply uniformly to all members of the professions, and each individual comes with different training, experience and preferences.
A psychiatrist has completed general medical training, then gone on to complete specialist training in mental health. Psychiatrists treat people who are experiencing mental health difficulties from a medical perspective. This includes prescribing and reviewing medication, and looking after someone’s safety when they are unwell. Psychiatrists often work very closely with clinical psychologists, and there is some overlap in their work. Although some psychiatrists offer talking therapy, it usually is not a substantial part of their role.
A counsellor has completed training in counseling, which is usually a Masters degree, but is sometimes a different type of course. Counsellors are trained to talk to people who are experiencing distress and mental health problems. Many counsellors use techniques that are similar to those used by clinical psychologists. Counselling sessions are seen as a space to talk about and process upsetting feelings and experiences. Traditionally, counselling is more focused on processing stressful life events, and less focused on examining why you feel the way you feel or making changes to prevent difficult feelings and experiences from happening again in the future.
The most obvious difference between a clinical psychologist and a counsellor is in years of training. To become a clinical psychologist in the UK, you have to complete doctoral training, which involves intensive clinical training, placements across a number of areas and advanced research methods. You have to complete a doctoral research project, write it up and be examined by experts in the field of your research. Before embarking on the training, you are expected to have gained a few years of experience in the field of mental health. As a result, qualified clinical psychologists generally have broad experiences of working across different settings, and can draw on a range of different techniques to treat the problem that you are coming to therapy with.
Clinical psychologists are skilled in working with common mental health problems, such as depression and anxiety. In sessions, they will aim to generate a formulation of what is keeping your difficulties going, and work with you to identify these problematic patterns and change them so that difficulties do not recur in the future. Clinical psychologists are expected to adhere to the evidence base, and treat you with the methods that have been proven to be most effective for your problem.
As you can see, there are many areas of overlap for these professionals. However, different training and approaches to treatment can help to explain the difference between these professionals and the fees they request.
What is cognitive behavioural therapy?
Cognitive behavioural therapy (CBT) is a type of talking therapy. It assumes that there is a strong association between thoughts, feelings and behaviour that can help to explain why people experience distress at particular times or in specific situations. CBT is widely used by clinical psychologists and other talking therapists, as research has shown it to be very effective in treating lots of different types of problems (e.g. depression, social anxiety, OCD and many others).
If your therapist is using CBT, you can expect a fairly structured approach to therapy. You and your therapist will often write or draw diagrams during sessions to identify what is keeping a problem going, and understand how to reduce your distress. You may be given homework tasks, which often involve monitoring a particular feeling or behaviour in between sessions and trying out different ways of responding to see whether these improve your mood or reduce anxiety.
“Pure” CBT is not for everyone, and a good therapist will tailor therapy by incorporating techniques from other approaches that are best suited to your difficulties, personality and preferences. This may include things like mindfulness, acceptance and commitment therapy, which are compatible with CBT.
If you have any questions about CBT or other types of therapy, I would be happy to discuss this with you if you get in touch.
What is acceptance and commitment therapy?
Acceptance and Commitment Therapy (ACT) is a method of treating psychological difficulties. It is one of the 'third-wave' behavioural approaches that brings together principles of CBT and other methods, incorporating mindfulness as an important skill for managing emotional distress.
Here, Dr. Sugarman has answered some of the questions that often come up when people are considering meeting with a psychologist. If you have a question that is not listed here, please feel free to get in touch.