Author Archives: David

Face-to-Face Work Restarting

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

This week I am offering private clients, both new and existing, the opportunity to have sessions face to face. It will be quite a change, after three years of working using videochat, or occasionally just phone calls.

(What amused me about this is that for our work, the headings are the wrong way round – and I don’t have a dog)

I shall have to relearn how to make a decent cup of tea, for a start.

Before Covid restrictions, I had always offered online work as well as face to face, and that will continue. There will be occasions when clients will want an online session, e.g.

  • because they are concerned they might be unwell
  • because of the pressures of work
  • because they have moved house some distance away, and want to continue working with me

and I am open to online or mixed working, of course, PROVIDED that I have some notice. A few hours is likely to be sufficient.

(Not, in fact, my room)

Why the notice? – My face to face sessions are in a room at my home, and occasionally I need to arrange visitors to the property so that confidentiality is maintained. Sometimes, believe it or not, I can be untidy, and things need to be put away before you arrive.

 

 

So, video or face-to-face? – the choice is yours.

===========================================================================

For contractual reasons I cannot always offer mixed working to my EAP clients – clients whose sessions are provided by their employer, or through an insurance company. The provider will normally specify the way they want the therapy delivered, and we have to respect that.

Online or Face-to-Face?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Let me start with something that may surprise you:

Online/telephone work is as effective as face-to-face, according to the research. Is online/telephone work just the same as face-to-face then? – it does have a different feel. It can move slower sometimes, or faster sometimes. It can feel more intense, or less intense, at different times. Some clients can talk about issues over the phone/video more easily than face to face, and for some it’s the other way around.  So, the feel is different, but it works just as well for most people.

 

Most clients are pleasantly surprised at how well online and telephone counselling works for them, actually. To be honest, I have always preferred working face to face (although I started my counselling life as a telephone volunteer), and I prefer using video conferencing to a phone call – particularly now that smartphones can do everything. I have used all the methods for many years now, and I am well used to them.

The choice of a therapist is very difficult, because there are so many available.  Of course you will know that, whether you are looking for an online or face-to-face therapist it’s important to find a therapist that

  • you get on with
  • you can come to feel comfortable and relaxed with
  • who is competent and professional.

 

So how do you choose from the tens of thousands available?

Firstly, I do think that the best way to begin is to search professional directories for therapists in your own area. Why your own area? Your circumstances may change, and it’s then possible to move to face-to-face work if you want to, without having to start again with someone new.  So I suspect we would use online or telephone counselling during the times when we can’t meet in person – say if we think we might be infectious. I am open to creative solutions too – for instance I have had clients sit in their cars in front of my window, and talk on the phone to me while we nod to each other (fortunately my driveway is suitable for this).

Another advantage of working with someone in your area is that it is easier to make a connection with someone who has some shared experience with you – living in the same country is a good start! It can be a little difficult, for instance, having a deep conversation with another English speaking person from a different country, as the meanings of words, and the organisations of society are subtly different.

Using a professional directory means that the work of checking the therapist is qualified and experienced has already been done for you. For instance, I have chosen to advertise on the BACP website (my professional body), Counselling-Directory (I like their layout), and the BUPA Providers online website. (Spoiler alert, they all say the same thing, more or less – which is no bad thing).

Coming to feel a real connection when talking with your therapist is the number one predictor that your therapy will be successful. That comes as a surprise to most people, who think that face to face therapy must be better than the alternatives, or that one type of therapy must be intrinsically better than another.

Of course, when you are working online, some of that feeling comfortable and relaxed is down to you – a comfy quiet chair, privacy, a cup of tea, and decent phone or internet reception.

I think I can get a “feel” for a particular therapist by reading their website, however my wife would always want to speak to someone before making up her mind. It’s important that you find your own way. In my own practice, I find I get on very well with most people (surprise, surprise, I suspect that’s true of all good therapists, and anyone who is genuinely interested in hearing what the other person has to say), and very few clients have come to me since 1995 and just not got on with me. I don’t do trial sessions as such, but if a private client doesn’t want to continue after the first session, I refund all money received and am pleased to do it, – and as I say, it’s maybe happens once or twice a year. Take a look at the First Appointment page (link) if you need more details on that.

 

Covid-19 (Coronavirus & attending sessions)

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

(Update May 23) Although as I type this, there are still around 75000 new daily cases of Covid in the UK (according to Zoe), it seems clear that for most people the virus has mutated to a less toxic version and I have now begun working face-to-face again. I’ve left the post below as a record, and just in case it gets bad again.

=============================================================================

Covid-19

The bottom line – we need to work online or by phone for the time being. Distance work is a recognised and effective way of working therapeutically.

I have to adopt a minimum risk approach when booking sessions, of course . At the moment the best advice to protect society as a whole is not to meet in person.

Preparation for Telephone or Online Sessions :

If you would prefer to work over the phone, let me know ahead of time and then phone me on 07941-989887 at your appointment time. I can phone you back – I have unlimited minutes.

My Vsee detailsIf you would prefer to work using online video sessions, please prepare now! The best and easiest app or program to use is Vsee. It is a sort of very secure Skype, certified secure at the highest level – much more so than the phone, incidentally. If this is your first session, I can understand that you may not want to learn new software on top of whatever else is going on, and that’s fair enough, we’ll do it your way to start with. But when you have decided to continue, please download Vsee (the free version!) to your computer, and test it out, and then tell me what your username is so that I can add you to my contacts list ready for your appointment . Vsee is also available as a phone app. You can download Vsee by simply clicking this invitation (link).

For any kind of distance work, you need to be in a private, quiet space, without people or distractions around, and where you will not be overheard. Sitting in a parked car can work very well when using a laptop or phone.

The Rationale:

1. There seems little doubt that we are all at risk, but the longer we can delay catching it, the more likely the heath services will be able to cope. (Link to article)

2. I see a lot of clients who form an essential part of the infrastructure of society: e.g. NHS staff, ambulance staff, teachers, law enforcement officers. Aside from the fact that this is a group at risk of catching the virus, I do NOT want to catch it and then spread it further! There’s also the matter of confidentiality:  if I were to contract the virus I might be required to disclose the identity of clients I had come into contact with in the previous week. No.

3. There is also the matter of my own family – my wife and I are both getting on, and are in a high risk group in terms of the duration and seriousness of an infection. If I become ill, I will recommend a trusted local counsellor for you to speak to if you need to, while I am out of action. Once I have recovered from this virus, it will be back to business as usual.

4. Research indicates that, broadly speaking, online and telephone sessions are very effective in counselling work. A lot of it is personal “fit” – some people find it more effective than face-to-face, and some less. But the research shows that there is a very good chance that it will be effective for you. I have worked online and over the phone since 1995ish.

Thanks for reading.

The Benefits of Practising Gratitude

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Paul Mills, a professor from the University of California in San Diego, is the lead author of an article on the practice of Gratitude, and its effects on physical health and emotional wellbeing.
I have thought for some time that because – for obvious evolutionary reasons – the body is hardwired to prioritise danger and other bad stuff that happens or might happen to us, that we need to find a way to restore some balance by consciously remembering the good stuff, the stuff we can be grateful for.


It is particularly important for anyone who suffers from periodic episodes of depression, that when we feel “up” we make lists – the longer the better – of the good stuff, so that we have something to buoy us up when we feel “down.” The practice is also vital for those who are torn apart by their self-critical inner voices. I’ve prepared a leaflet detailing the practice for those clients,  but here some general information:

Now, when things are bad, we may think, quite naturally, that there is nothing to be grateful for, but AT THE VERY LEAST we can be grateful that things aren’t even worse. I may feel like an incompetent, unattractive idiot who doesn’t deserve to have any friends, but I can be grateful that not everyone agrees with me! And we can usually do a lot better than that minimal and rather grudging example of gratitude, with practice.

I’m not asking you to lie to yourself. I’m asking you to treat yourself as if you were a person you need to care about.

And as with everything, exercising makes Gratitude stronger.

The practice of gratitude is easy to explain: you get a small notebook and pencil, and place it by your bed. At really stressful times its a good idea to carry it around with you, actually. Every night when you get into bed and are ready to go to sleep, you open the book and, thinking back over the day, write down just three things that you are grateful for, as if you were your own loving friend. These items must be written as positive statements, so you phrase them without using not, never, don’t, etc. So, for example, instead of saying my leg didn’t ache so badly today, you would say that my leg felt better today. Instead of saying that I didn’t feel so depressed today, you say I felt a little lighter today. If it’s difficult for you to think of three things, then spend a few minutes reading back what you have written in your notebook already, and you will recall something suitable. If you have faith, you can think of it as the practice of counting your blessings from a loving God.

Don’t expect instant results. It takes time for your brain to respond to this new, and initially difficult, way of thinking.

Gratitude practice activates the mammalian care-giving system which releases feel-good chemicals in our bodies (oxytocin and intrinsic opiates) and allows you to be self-compassionate, to deprogram the ingrained thinking habits, to feel much better.

By offering support and kindness to ourselves, we find that the body responds by feeling better.

And it has been shown to achieve a lot more for the body than “just” allowing it to feel better. Research using brain scans shows that after three months practice the medial prefrontal cortex has become much more sensitive, which helps to explains the steadily increasing effects of Gratitude practice that you will notice.

But Mills’ article talks about the physical effects too: “better mood, better sleep, less fatigue and lower levels of inflammatory biomarkers related to cardiac health.” The study involved 186 men and women who had been diagnosed with asymptomatic (Stage B – structural damage but no symptoms) heart failure for at least three months.
“We found that those patients who kept gratitude journals for those eight weeks showed reductions in circulating levels of several important inflammatory biomarkers, as well as an increase in heart rate variability while they wrote. Improved heart rate variability is considered a measure of reduced cardiac risk,” said Mills. “It seems that a more grateful heart is indeed a more healthy heart, and that gratitude journaling is an easy way to support cardiac health.”
Wow!
The full study is published by the American Psychological Association here (link to pdf)

I originally published this article in January 2017, but have updated and renamed it as new research is reported.

How Do My Results Compare With IAPT / NHS Therapy?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

(Spoiler alert – very well!)

This essay came about because of two things happening around the same time.

Firstly, I was questioned as to whether private therapy was good value compared to the NHS – “The NHS has got to be doing it cheaper, hasn’t it!” was what was said to me. And there certainly wasn’t a question mark at the end of her sentence.

I looked it up, as to be honest I thought it would be around my charge of £30 to £60 per hour session.

I was rather annoyed and disgusted to discover that it costed £95 a session for “low intensity work,” and around £175 for “high intensity.” I can deliver either.

But never mind the cost, what about the quality, was my next thought…..

 

The second thing that happened was that a blog I follow (which looks at the application of statistics to therapy, amongst other things)  published an article on the measured recoveries made by clients given therapy in the NHS. It’s here(link).

Quite frankly I found the results shocking.

So will you, and I reproduce the bare bones of the NHS/IAPT results below .

For comparison,  I have worked out my own matching statistics, and show those in blue, together with some thoughts on the discrepancies.

It is recognised that the primary characteristic of a high-quality counsellor/psychotherapist is the ability to enable clients to maintain engagement, i.e. to help them to keep coming until they have what they need. This can be measured by:

A. The proportion of those entering therapy who have a managed/planned ending. In my service, it is 82%, compared with the NHS at 58%.

B. The proportion of clients who have had a managed ending that show demonstrable improvement (using recognised psychological tests). In my service it is 98%, compared with the NHS at 51%, and of course the NHS is starting from a lower percentage anyway (51% of 58%, rather than my 98% of 82%).

That’s the bottom line really, but if you want a further breakdown, I’ve put some of the calculations below.

Why is the difference so stark? – Well, here are a few guesses.

  • The NHS/IAPT controls what therapies are available there, and how they are practised – the process is carefully “manualised” and there is little flexibility in the approach.
  • The whole idea of “low intensity” and “high intensity” therapy seems to me to be missing both the point, and the research, actually.
  • With me, my approach is tailored differently for every client. A psychiatrist that one of my client’s sees occasionally said that he felt that I was delivering “A Bespoke Service.” Unsurprisingly, I liked that.
  • Although I do do some pro-bono work, client’s have to be able to pay for my services, and that does mean that I get a greater level of readiness and commitment, and ability to engage with the world.
  • The NHS is all about seeing as many patients as they can, regardless of staff readiness and morale (sorry, but it’s true, and it isn’t the fault of individual therapists). I try my best to put people off from coming if they are not ready, I really do NOT want to see someone who isn’t ready to work with me.
  • I run my life around the delivery of a high quality service, including lots of meditation, down-time, reading, learning, and no late nights, excess alcohol, etc etc. I didn’t become a therapist as a career move, I became a therapist because it was very clear to those in the volunteer service I was helping at, and clear to the therapists I attended in my own personal therapy, that I had a natural ability to do it well, and the commitment to do the required training.

==========================

More Detailed Statistics Follow (for the Strong-Willed Only):-

  1. The journey from referral – 30% of IAPT referrals don’t enter treatment [I’m afraid I have no way of capturing this data for my own clients, as I rarely hear from people who decide to go elsewhere,  or nowhere.]
  2. The journey from entering therapy – 45% of IAPT clients that enter therapy don’t complete. [17% of my clients do not complete a course of six sessions,  or where they have decided to have more than six sessions then cancel what turns out to be their last session.  In these cases, having no closing data from testing, I cannot say definitely whether the client has met the standards for significant improvement or recovery. In some cases, I think it likely that the client feels that the process is not helpful to them, but decide not to talk to me about it and thereby come to a managed ending.. But some also leave suddenly,  having made good progress,  because they find it difficult to do endings,  or because they intend to return at some point, but haven’t needed to so far.]
  3. The outcome at therapy ending for all clients – 53% of IAPT clients do NOT achieve  recovery [the lower the number the better for this one. I use the CORE-OM test, an internationally recognised test for assessing risk, health, improvement and recovery. My percentage of completing clients who do NOT achieve recovery is 18%.]
  4. The outcome at therapy ending for clients that were at case level at the start – 51% of those clients achieve recovery (reach a point on psychological tests which are below the scores of a clinical population) in IAPT therapy [for my clients,  83% achieve recovery, and 98% have measured significant improvement in their symptoms. For my clients the main limiting factor is the budget in these cases. Often their employer will only pay for six or eight sessions and the client is would have to pay for further sessions with me once this number has been reached. These clients may well go on to other agencies – I often recommend local or online resources to clients who have finished but who would benefit from further sessions .]

Leaflets I have Written for Clients

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Over the years I have written several leaflets for clients.

These are to act as memory aids once the course of therapy has finished, and also to save expensive time during the sessions, in describing self-help methods.

Amongst recent ones are quite a long one on Depression, and a short one on Mindfulness. I’ve done about fifteen or twenty in all.

If you have been a client and want one of these leaflets, or have had a leaflet and want to update it, contact me. I’m keeping up-to-date versions on dropbox, and I’ll send you the link to your leaflet.

You are welcome to give the leaflets to friends and family – I must warn you they may contain shameless recommendations about my expertise!

 

What’s here:

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Received wisdom is that every website should have a blog. Mine contains (see on the right under “From David’s Blog):

  • musings about therapy, clients, counsellors, and society
  • answers to questions that I’ve been asked
  • if I’m taken ill, or there’s another reason why I can’t be reached, then I’ll try and post a notice here.  (so it would be a good idea for clients to tick the box below “Notify me of new posts by email.”)

 

Suggestions for additions (and subtractions) welcome.

Playing N.I.C.E.

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

NICE, the National Institute for Health and Care Excellence, has come up with another set of guidelines on mental health. Why is this important? Because if NICE recommend a treatment, it gets used as a matter of course, and if they don’t, it doesn’t.

The problem is that Mental Health is very hard to assess. Very hard indeed. And NICE are not doing a good job at assessing the different methods of delivering talking therapy..

In the area of health generally, the standard of proof that NICE requires is the “double blind randomised trial.” In brief, this is where neither the patient nor the doctor knows whether the patient is being treated, and neither do they know what they might be treating the patient with. This is good, because it stops the doctor from putting his own bias onto whatever results s/he is collecting.

Of course, this kind of research is quite impossible to carry out in the field of mental health. How can a counsellor not know whether or not he is counselling a client, for instance? Success in counselling depends on the relationship between counsellor and client, and that means often (shudder from NICE) the results come from asking the clients’ opinions. Good lord, how would the NHS function if effectiveness and quality was measured by the patients. Mmmmmmmmmmmmmmmm.

So NICE is going to prefer the type of therapy that can generate statistics closest to the double blind model. By it’s nature, CBT is easier than others to collect that kind of data. NICE, therefore, seemed to have been of the opinion that CBT was the only talking therapy that is proven to work, as that was the only type to have generated the statistics they considered reliable..

Gradually, NICE has been dragged kicking and screaming to the realisation that other methods of talking therapy, and indeed other methods of undertaking valid research, might just work as well in the treatment of, say, depression. However CBT has maintained it’s place as the first line treatment, the one most recommended, in the current guidelines.

At last we can get to the point: the research clearly shows that other talking therapies are at least as effective as CBT. It’s just that NICE are wary of looking at research that doesn’t have that humanity-excluding double blind methodology. And recent research shows that counselling delivered better results than CBT in fewer sessions. Add to this the huge number of trained counsellors who don’t want to work to a CBT model, myself included, and you could cure the massive problem with access to mental health services overnight. It would be cheaper too, per course of treatment.

Incidentally, the photo is of Nice, France. It has nothing to do with this article at all, but looks like it would be a nice place to recover from almost anything. Anyone who wishes to pay for me to undertake the research personally, get in touch.

A Leaflet about Depression

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

For some time now I have felt the need to write my own leaflet on the holistic approaches which are very helpful for depressed clients. I say clients, because becoming a client is certainly the most effective item of self-help a depressed person can do. Along with the therapy, I suggest researched self-care topics in this leaflet that are very likely to help speed and maintain your recovery. It’s value-for-money (VFM), really – if you don’t do the self-care, you will likely end up being in therapy a lot longer.

Reading a leaflet is more VFM than spending lots of time in the session, too, writing the stuff down when quite often your mind is pre-occupied. It can be used as a reference at home, and to support you when you have recovered. Each item has a clear evidence base in depression.

You can give the leaflet to people around you who want to help and be supportive, and several of the items , e.g. diet, will allow them to do just that.

The leaflet got quite large quite quickly!- too large to put on here, and too large to read in one sitting. I think I covered all the main points, though, in eight pages. Here is the self-care checklist that I put at the end of the leaflet, as a quick reminder, to be looked at every week by my clients – if you are depressed, how are you doing?

Checklist. Mark yourself out of ten as you progress with these ideas.

Be kind!

Becoming aware of when my brain starts to brood/ruminate?

Remembering to laugh at the critical inner voice?

Counting my blessings before going to sleep?

Practising mindfulness/meditation every day?

Going to therapy?

Watching and choosing what I eat?

Working on my own hidden anger?

Exercising in the open air?

How sociable and friendly have I been?

Have I done things that I used to enjoy doing?

Amusing myself with a funny book, film or TV show?

Have I congratulated myself for what I have done of the list above?

Each topic on my leaflet, reflected very briefly in the questions above, has been researched in it’s own right and shown to have a positive benefit on depressed clients.

Can I Have A Free Trial Session?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

Only if you don’t want to come for another session!

Many therapists, particularly when newly qualified, will offer a free first session so you can see how you can get along. My way is to insist on payment for the first session, usually in advance, with a guarantee of a refund of that payment if either of us doesn’t want to continue for any reason at all after having attended for the first session.

Yes, if you come to the first session, you are welcome to leave, having had a full session, and with a refund, if you decide for any reason that you do not want to continue.

So, what’s the difference? In practice very, very few clients fail to show up for the first session if they have paid in advance. This is very much to their own benefit, as if they just vanish without attending or paying, they are not going to come back and give therapy a chance to make a difference in their lives. And it has been proven over and over that therapy can make a huge difference in their lives. So I don’t want to discourage them from having that opportunity to better themselves.

It’s true that most clients who come for the first session will continue for a course of sessions, be that six sessions – my suggested course – or longer. And the overwhelming majority of those clients will come to feel that the experience offers extraordinary value for money. But if they don’t want to return I am delighted to offer a refund. In a way it could be argued that I’m paying these clients not to return!  Why? – because I only want to work with clients who really, really want to work with me.

Of course,on occasion, I believe that I am not the right therapist for a client. Obviously they get a refund, and suggestions as to other therapists who may be more suitable. Sometimes, I want the client to think hard about their motivation and expectation of therapy before coming for a course of sessions. In those cases I will insist on giving a refund immediately. If the client then decides they want to return for a course (and it has to be said that most do), they will pay me for the first session too.