Category Archives: Questions from Clients

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.

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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.

 

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.

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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.

Bipolar Disorder – does counselling help?

David Solomon MA MBACP(SnrAccred) MPractNLP Posted on by

My sister is waiting to see if she has bipolar disorder, and it is affecting our whole family. Would a few therapy sessions with you help while we wait for an NHS appointment for her? (You did not leave me an email address so I am replying to your questions here, having changed some of the details).

A diagnosis of bipolar disorder is life-changing for the sufferer and for their families, so here we might actually have two questions:

1. Would counselling help me, as a family member, cope with the stresses of living with my sister – yes it would, but it is probably not practical on a long term basis because of the cost. Perhaps occasionally when things are getting on top of you. Do keep a look out for support groups, often run by e.g. Mind, as they can be an alternative to therapy for the families of patients.

2. This really is a question for your sister, not for me. If she feels it will be of help to her to have somewhere to vent her frustrations while she waits for the NHS to come up with some help, then yes, it will. If she doesn’t think so she is very unlikely to attend often enough for therapy to help.

Unfortunately many sufferers of bipolar disorder, particularly in the “up” phase, are very resistant to attending therapy sessions or taking medication, and the patient’s willing cooperation is crucial when it comes to having private counselling.

There is no reason that I know of where counselling of itself would be unwise. Counselling/psychotherapy, along with medication, is the recommended treatment for bipolar disorder. Waiting times are a big problem still for mental health services, although the suicidal ideation that frequently accompanies bipolar disorder will mean that the appointment will be quicker.