David Dixon Psychotherapy & Counselling in Central London
London Bridge and Hackney

Frequently Asked Questions

Melissa Miles — at the time, a psychology student and someone who had been in psychotherapy in the US — wrote this frequently asked questions (FAQ) file about psychotherapy that has some good information about psychotherapy and the therapy process.

She wrote "So many people have asked me questions about therapy and there is so little information out there on the web that I decided to write this Psychotherapy FAQ. Its purpose is to help people who are not yet in therapy but would like to try it out."

Why go to a therapist?

Not all therapy experiences are alike, nor should they be. In this FAQ I explain about therapy and the people who provide therapy, but to simply answer the question Why? the question I would ask you is: What do you want out of therapy? This is important because a lot of the success between the therapist and client depends on your expectations. I would argue that success in therapy depends on what you expect to happen, and whether those expectations are compatible with what a therapist can and will do.

Going to a therapist can be a worthwhile growing and stabilizing experience, good for times when you have specific problems, interpersonal problems, or are generally feeling down. You can go to a therapist once, for a few months or embark on long-term therapy. Each depends on different expectations and goals.

The time when most people tend to go to a therapist is during a crisis. A crisis is an immediate threat to your life, where you feel in danger, suicidal, or an inability to live your life in a normal productive way. Examples of a crisis includes: the death of a loved one, breaking up in relationships, times of depression or if you feel in danger or have been harmed in some way. The reason for going to therapy at this point is to be able to stabilise your life so that it is not in any immediate threat. Sometimes, this entails only a short visit, in which the therapist uses crisis counselling. The point in this case is not to uncover any underlying motivations or access you for long-term treatment, but to provide "intervention". Sometimes, however, people go into a therapist's office with a crisis and find that there are things that underlie it that you want to uncover or work on. At this point it is no longer intervention, but on the path to psychotherapy.

People also commonly go a therapist for non-specific problems, such as insomnia, procrastination, low grades, or a feeling of depression. One thing to keep in mind is that your problem might be like a symptom. An example of this could be a person who comes to a therapist's office because they are having trouble at work. This might be the result of many factors, such as problems at home, an addiction or alcoholism, an eating disorder, etc. and so they may benefit from looking at the wider context as well as the specific problem.

Sometimes people go into psychotherapy in order to work on problems which seem more nebulous. Often people go in for growing, rather than stabilizing. An example of this might be a creative block or perhaps a couple in a long relationship who are dealing with an affair. A crisis intervention or dealing with the affair as a specific problem might be what brought the couple in but it might turn out that more is going on, such as years of resentment, an environmental pressure, a death in the family, etc. Another reason people go into psychotherapy is to work on psychological problems. These can range from being abused and having intimacy problems to having a smothering family which may, for instance, have led you to overeat. As you can see that these are problems which need a more in depth analysis than intervention or counselling would provide. Psychotherapy is often a long-term commitment, however short-term therapy has been "in" for awhile and there have been studies that show it can be effective under the right conditions. This is a discussion that is best had with a therapist you are considering going to. They would give you advice based on an assessment of your situation.

You don't need to have a "major" problem to go to a therapist. Just feeling unable to deal with your problem or feeling unhappy makes you a good therapy candidate. As I have shown, therapy can have many different levels, all which might be more appropriate at certain times than others. I once had a psychology professor who said that at times, going to the gym will help more than going to a therapist. I know from experience that sometimes art, or writing will do the trick. But therapy should be viewed as a tool which can be used to work on even problems you consider "minor." So, Why go to a therapist? Now that you have read some reasons people go to one, remember that therapy is the commitment to improving your mental health, and sometimes this can be done with out a therapist, and sometimes a therapist is a god-send. And anyway, it doesn't hurt to try one out.

What kind of therapist do I choose?

Sometimes this depends on the reason you want to go to a therapist, while other times this only amounts to a personal preference. More important though than the type of therapist is the amount of training and experience with patients, that they are compatible with your problems and personality and that you feel comfortable with them. Basically you need to feel as if you trust the therapist, and knowing that he or she knows their stuff or is compatible with you will help this trust.

Psychologists can be broken down by their emphasis, such as cognitive-behavioral, psycho-analytic, Rogerian, etc. However, often most therapist are eclectic, meaning they use the techniques that work best/are most appropriate for different disorders or with different types of people. This is not really of much concern to the prospective therapist client, but if you are really interested you can check out some books on types of therapies. However, I think the trust issue is much more important and can be more readily accessed than their type of therapy.

How do I pay for this therapist?

A therapist can cost up to £100 an hour so this is a big factor for most people. Therapy doesn't have to be expensive. There are "sliding-scale" therapists or clinics who will determine how much you can afford. They can be very reasonable, and depending on your financial situation can discount it to as low as £40 pounds a session especially where your time is flexible. I suggest people assume they will pay something anyway because studies have shown that people do better in therapy when they view it as an investment; you will be a lot less likely to skip a session or avoid real engagement if you have to pay even a little bit. And you will be more active in getting your therapist to do what you need, so that you get your "money's worth."

What do I ask to determine if the therapist is a good match?

The first visit is where you get to assess the therapist and they get to give you an "in-take" interview. They will differ in what information they need to know from you, but it is important that you have in mind what you want them to tell you. Here are my suggestions of things to say or ask:
◾Tell them why you are here…inform them that you are shopping around. This will help them know what they can tell you.
◾Tell them why you want to be in therapy, and then ask them if this fits their training or interests.
◾Ask them what kind of therapy they suggest, how long they would want to do therapy, how much it costs, up front. Compare this with your preferences and needs.
◾If it doesn't fit, tell them what you want and ask them if they would be willing to accommodate. Either way, be prepared to shop around more.
◾Pay close attention to how you feel–it is normal for you to feel a little uncomfortable or nervous. Sharing personal information can be nerve-racking. However, do you feel like you would be unable to trust them? Tell them your feelings and ask them how they would deal with it if they were your therapist.

Should I choose a male or female therapist?

Many people have asked me this question, and I have always been wary of answering this with a either/or answer. I try to emphasize the trust factor, so I am more likely to suggest the gender in which you would feel most comfortable and trusting with. However, I think that even if you are uncomfortable with one gender it could turn out that it could be a worthwhile experience. One reason for this is the fact that not all people's personalities are typically male or female, e.g. a women therapist could have pronounced male qualities, making it hard to determine just by gender whether they would be a good fit. Yet, I have known certain people who are argued vehemently that they would only go to a female therapist, since they feel that their experience as a women would be best understood by the female therapist. But, you could say the same for race or class, and some people do use these as factors in choosing therapists, just as we use gender, class and race in choosing friends, employees and lovers. So, I would suggest to people who have stringent preferences, that there is no reason to go to someone you can not trust. For example, if you are a woman who has been abused by a man, it might be really hard for you to trust the male therapist.

Yet, there aren't hard and fast rules for this. I have had both male and female therapists, and I think the differences between them occurred more from their techniques, or simply because they had different personalities. It is hard for me to point out gender as the factor in what made them more compatible. Now I have a therapist who is female and has a very similar background–yet, I am aware of the fact that she emphasizes our similarities as a way to both form trust between us and for me to work out problems using her own experiences as a reference. But having a male therapist before helped me when I was having problems with a boyfriend–it gave me evidence that men could be trust-worthy, good listeners, and especially made me feel validated when he supported "my side" when my boyfriend and I had a disagreement. So if you are up for a challenge, or even just for an experience that could be worthwhile, I would say there is no reason not to try a therapist of a different gender, or race or class. No matter what therapist you get you need to pay close attention to your progress and your comfort level–and don't forget that it helps if you discuss these kind of issues with a prospective or current therapist.


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