What happens in therapy?

Have you been thinking about therapy but feeling anxious about getting started? In this blog I talk about the practicalities of starting therapy, and what to expect when you get in touch with a counsellor.

How does counselling actually work?

When people ask me what I do as a counsellor, I sometimes find it hard to answer. I just ‘do it’. But when a prospective client asks me to tell them more about therapy so they can decide if they want to go ahead, ‘just doing it’ isn’t good enough!

So I decided to write this – for two reasons: firstly, for anyone who’s wanting to get an idea of what to expect if they start counselling, and secondly, to help myself articulate more clearly what it is I do – for the next time someone asks!

The questions ‘What happens in counselling?’ or ‘How does therapy work?’ can be answered in different ways (which probably contributes to my tying myself in knots answering them!) so I’ve split this blog into 2 parts.

  1. Part 1 looks at the practicalities of starting therapy, and what happens at a conscious level, including the sorts of questions I might ask, setting goals, boundaries, and the control you, as client, have over the direction we go in.
  2. Part 2 speaks more of what it is that makes talking therapy a useful contribution to helping people to ‘feel better’, touching on the neurology behind psychological healing – the unconscious stuff that’s going on while – and after – therapist and client talk.

I’m writing from my own perspective – i.e. about what’s likely to happen if you and I work together. While much of what I say will hold true for many other psychotherapists and counsellors, there will be variations in the way we work.

lucy hyde online therapy (image eileen-pan-unsplash)
Image: Eileen Pan on Unsplash

What happens in therapy – Part 1: The Practicalities

So………you’re thinking you might find it helpful to see a counsellor. Or someone’s suggested to you that it might help. Or perhaps they’ve told you that ‘being in therapy’ has helped them. What happens when you take the next step, and get in touch?

Initial contact with the therapist

lucy hyde telephone counselling

When you contact me, sometimes I won’t have space to start working with you straight away. If so, I’ll ask if you want to go on my waiting list, and I’ll usually suggest some colleagues who may have availability.

Sometimes by the time I get in touch to offer someone on my waiting list a space, they’ve found someone else, which is absolutely fine and to be expected. At this stage, I don’t usually ask you for information other than contact details, until I know we’re going to start working together.

That’s not because I’m not interested in you – it’s because a) I don’t want to hold unnecessary personal information about you unless we actually start a relationship, and b) your situation may have changed by the time I have a place, so the information I gathered is out of date anyway.

Even a brief email exchange agreeing the above should give you a bit of a feel for what I’m like, and at least a hunch as to whether you want to work with me. Forming a working relationship is really important in therapy (more on that in Part 2). If, for some reason, I get on your nerves, it doesn’t have to mean we can’t work together – but no matter how good the counsellor is, sometimes there’ll be personality clashes.

Trust your instincts UNLESS you reach the point where you simply think you will never find the ‘right’ therapist – it may be that something in you doesn’t want to! In which case, try someone – or a few people – who feel ‘good enough’, to get started.

We’ve agreed to start working together – what now?

The dreaded paperwork! I ask people to complete a brief assessment form to check I’ve the experience and skills required, and – if we’re going to be working online –  that I believe online therapy is appropriate.

Lucy Hyde online counselling (image shayna-douglas-unsplash)
Image: Shayna Douglas on Unsplash

I usually offer a chat over the phone at this stage – sometimes that’s the easiest way for us to compare diaries and find a time that works for both of us, and I can take some assessment notes at the same time, which some people prefer to the form-filling!

We’ll also talk about HOW we’re going to work together. At the time of writing this blog (early 2022), I’m offering:

  • online counselling via Zoom video call, instant messaging and email;
  • tele-therapy / phone counselling;
  • walk-and-talk therapy – counselling while walking outside.

If you’ve decided you want to work in-person with somebody in a room (the ‘traditional’ way of counselling) I can signpost you to other people who may be able to offer you this.

Again, this is an opportunity for you to get a sense of what it might be like to have sessions with me. If we decide to go ahead and book a first session, I’ll send you an agreement or contract to read over, complete and sign. The agreement goes over practicalities like fees, privacy and where/how to complain if you’re not happy. There’s no requirement to commit to a certain number of sessions.

What happens in our first counselling session?

There are a few areas I usually cover at the start of the first therapy session (e.g. confidentiality, cancellation policy), which are also in the written agreement – I go over them again because I think they’re important. At the end of the session I’ll check with you how the experience has been, and whether you want to continue; we’ll confirm further details, usually agreeing a review point after the first 5 or 6 sessions.

In between the beginning and the end, though, the first session varies greatly depending on you. You might have a very clear idea of what you need to ‘get off your chest’ and the relief of having a space where you can do that means that you don’t need any help to get started. This can be especially true if you don’t have much opportunity to talk to other people about how you feel, or if you’re anxious about burdening people by telling them.

At the opposite extreme, you might not know where to start. If that’s the case, then I may ask you some questions…………..

lucy hyde counsellor whats your story

Things the therapist is likely to ask about:

More information about why you’re seeking counselling

-and why now? Has something changed or brought things to a head?

Your previous experience of therapy

If you’ve had therapy before, I want to know what you found helpful or unhelpful, partly because I don’t want to do more of the unhelpful stuff, but also so I can look out for similar dynamics repeating in our relationship so that I can flag them up and we can talk about them; they might be a feature in relationships in your life generally, so we could learn something from them.

What do you want to GET from counselling?

If this is where you are now, where do you want to be? You might not know at this point, in which case we’ll come back to it at some point down the line.

Your current circumstances

Your living situation, significant relationships, occupation – this helps me understand things like support networks that you have available to you and factors that might contribute to your overall wellbeing.

Your family of origin

Information about what it was like for you growing up can be really useful as it’s likely to influence your behaviour and relationships as an adult, and getting more understanding of ‘no wonder I do this when I had that experience as a child’ can help you be more forgiving and compassionate to yourself.

Lifestyle and self-care patterns

Mental and emotional health is completely interwoven with physical health; there may be changes you want to make at a practical level that will help you mentally.

Anything that feels important to you about your identity or sense of self

You may have a very strong sense of who you are – or you may not know at all.

All these areas may have a bearing on why you’ve decided you want to have therapy, and talking about them can help you better understand yourself. We might not get to any of them in the first session, but I’m likely to ask you more about them at some point.

Reviewing how it’s going

It’ll take us at least a few sessions to settle into a rhythm and get used to each other. I normally suggest that we review how it’s going at session 6 (assuming that you’ve decided you want to carry on that long).

therapy helps you find your way (robert-ruggiero-unsplash)
Image: Robert Ruggiero on Unsplash

I’ll ask you how you’re finding the experience and I’ll share things that I’ve noticed – patterns that we get into, things I’ve not asked you – to see if they feel significant. I’ll want to know what has felt helpful, but I’ll also ask what has felt challenging or unhelpful, and what you think I or we might do differently – for example – do you find it difficult to stay on topic, and want me to flag up when you’re going off on a tangent? Do you feel as if you’re trying to guess the ‘right’ answer when I ask you questions?

Contracts and goals for counselling

I see my role as being to help you change. That might be:

  • making changes in your life
  • changing the way you respond to situations, circumstances or people

So, when we review how it’s going, I might ask what you want to change. Sometimes people find this a difficult question to answer – either because they don’t know, or because voicing what they want to be different, out loud, feels risky. But that’s useful information for both of us, too, as there isn’t a right or wrong answer to this question.

You’re the expert on you, and it’s your right to direct the course of the therapy. It might be that I’m not prepared to agree to work towards the change you want, in which case I’ll say so (gently!) and why. Usually this will be because I don’t think the particular change is within your – our – power.

For example

You might say you want to change the way other people treat you.

I’d point out that we can’t make that change as you don’t have control over other people’s behaviour, and suggest that we could focus on changing how you respond if other people treat you badly.

This might involve, building your confidence in speaking out; choosing not to engage with such people; or developing your self-compassion when you feel bruised by the behaviour of others.

Lucy Hyde counsellor therapy goals

And if my suggestion doesn’t feel right for you, we can carry on negotiating, or we can agree to park it and come back to it. From time to time I might check with you whether the goals we’ve agreed are still relevant or whether they need tweaking.

Is it just the client talking and therapist asking questions?

To an observer, a counselling session might look like two people having a chat. It’s known as talking therapy, after all. Often at the start of our relationship, a large chunk of sessions might be you telling me your story – what’s caused you to get in touch. Early in therapy, I’ll probably ask you more questions  about your life now, and your history, as I try to get more of a sense of who you are and the influences that have shaped you.

walk and talk therapy (georg-arthur-pflueger-unsplash)
Image: Georg Arthur Pflueger on Unsplash

I don’t tend to give advice and certainly don’t tell you what you should do. But equally, I don’t hold back on information which might be useful to you, and so will sometimes share models to help you understand your thinking or behaviour patterns, or introduce some basic neuroscience – this can be helpful in reassuring you that what you see as ‘something wrong with me’ is often a normal biological response to past experiences.

I might also share exercises for you to try inside and outside sessions. Sometimes we’ll agree homework tasks that we can discuss from session to session.

Sometimes I teach a practice called ‘Focusing’ (read about it here) during a session. This is somewhat similar to mindfulness. It can be really helpful as a way of learning to respond to very strong emotions in a way that doesn’t involve avoiding them or being driven by them; instead, you can learn to acknowledge that they’re there and ‘sit next to them’ which can help lessen the intensity of overwhelming feelings.

Doing this in session means that I can help you pace how you do this, a little at a time, especially if you find the thought of engaging with strong feelings, such as anxiety, shame, or fear, is really scary, and worry that they’ll take over – using the session as a space to practice in can be helpful. 

Focusing can also be helpful when you’re not sure how you feel, or when you feel numb – it can help you tune in to the feelings that really will be there, below the surface.

Talking about boundaries

The counselling relationship is a very specific one, like no other. We’re often sharing things that are really intimate, revealing the most vulnerable parts of ourselves. And yet this is happening within one 50-minute session, once a week (or whatever frequency we agree).

I’m firm about the boundaries of the relationship, both for the client and for myself. When we sign our agreement to work together we’re also agreeing the parameters within which that takes place. I don’t engage in conversations outside sessions, other than administrative ones where something unforeseen happens and one of us needs to rearrange the session.

This doesn’t mean that I’ll ignore you if you contact me, and it doesn’t mean that we can’t agree extra sessions sometimes if you’re in distress, but – as I don’t offer a crisis service – in general, we’ll keep to the principle that therapy takes place within the session time boundaries.

Lucy Hyde online therapy setting boundaries (image jan-canty-unsplash)
Image: Jan Canty on Unsplash

This is partly because I take my responsibility as a practitioner seriously, and that means taking my own self-care seriously; I’m not good at multi-tasking and need to keep my work and leisure time separate.

But it’s also because many clients I’ve worked with, struggle to maintain good boundaries, which can lead to various difficulties, such as burning out because you can’t say no when someone asks you to do something. My maintenance of boundaries models to you as a client that taking care of oneself is important; this is much more effective therapeutically than simply telling you that boundaries are important without practising what I preach.

In Part 2 of this blog I’ll talk more about how ‘modelling’ by the therapist is a key part of the effect of  talking therapy, as well other aspects of how the therapist and client relate, and I’ll delve a bit further into the internal changes that take place during the therapeutic experience.

Everyone’s experience of therapy is unique because every relationship between two people is unique. If you want to know more about what it might be like for you to work with me, please get in touch and we can have a chat.

What I learned about myself from wild camping (and how I wasn’t anxious)

The value of pushing yourself to do something new in learning more about yourself.

At the end of September I took a solo trip walking and wild camping. In this blog I share my reflections on what it taught me, and the value of doing something new to learn about yourself.

the winding road Lucy Hyde counsellor

Lone camping was a first for me. I’ve done plenty of walking alone, and I’ve camped with my partner occasionally, but I decided to do this 2-night trip, because the notion came to me one sleepless night, and I wanted to see if I could.

I was excited about the prospect of being in my own company for 48 hours. This feels like quite a new thing for me; traditionally I’ve sought out the company of others and am quite gregarious. But I’ve come to understand recently that partly, that’s because I didn’t like being left alone with my own thoughts, that being around other people was a way of keeping busy. AND (thanks to the lockdown experience) I realised that actually time alone is needed recovery time, as my people-pleaser aspect tends to be on alert when I’m around other people – I’m always trying a little bit harder.

Don’t get me wrong – I still enjoy spending time in company. But the idea of not having to think of anyone else – and in fact, being unreachable through circumstance (i.e. no phone signal) rather than avoidance – had an appeal. No one was going to expect anything of me for the whole of that time. I was going into country I’d not walked before. It was going to just be me, and my food for 3 days, and my ‘home’ for 2 nights, and the hills, and the birds. Writing this now, the idea of it seems exciting all over again!

Lucy Hyde walking therapy

And the reality?

Lucy Hyde walk and talk counselling

Yeah, there were some moments when I was really happy to be in the middle of nowhere with the ravens, where I was excited to think “I’m doing it!” These mostly coincided with sunny bright weather and feeling confident having successfully put the tent up (or having successfully stowed it away).

There was some swearing– when I snapped a tent pole, and at the steady increase of the rain just as I arrived at camp.

There were NO moments when I thought “I wish I wasn’t here” or even “I wish I had someone else here”. (Though there might have been, had I snapped the tent pole when I was putting it up in the rain, rather than when I was taking it down on my last morning.)

And there was, more than anything else, a lot of just-keeping-going and not particularly noticing how I felt at all. It surprised me how much ‘in-between’, neutral time there was, given that I had imagined that, with all that time alone, I’d be likely to get lost in my thoughts, or to get busy worrying. Yet I found myself taken up with being, with getting through it.

For example, a day’s walk on fairly good paths and gently hilly terrain felt more of a feat of endurance with a heavy pack than I’d bargained for. I found myself going more slowly, taking smaller steps. I was careful to eat regularly, yet often didn’t feel particularly hungry – instead I was focused on making sure I had the necessary fuel to make sure I was capable of putting my tent up at the end of the day. 

At some level, even though I wasn’t scared at the remoteness, I suppose I was aware of the reality of having to depend on me, of being careful of husbanding my strength, of not risking injury by sudden movements.

And this process, I guess, kept me very focused in the now, and that’s probably why there were very few points when I felt anxious. My anxiety is often linked to worrying about what I need to do, or anticipating problems (that may or may not arrive), or imagining or assuming what others think about me. Somehow, here, there was less space for worrying about the future: too much attention on ‘now’ (my shoulders hurt, how can I adjust my pack?) to leave room for anticipating problems; and no one around, or expecting anything of me, for me to worry about.

So what DID I learn from the experience?

A few things……..

Sometimes comparing your situation with others’ CAN actually be helpful.

This is not at all a maxim I normally believe in. Many times I’ve had a conversation with a client where we’re trying to undo their tendency to punish themselves because they think other people have it worse than them so they’re not allowed to find things tough. Yet in this situation I was doing something similar.

reading for inspiration

I was halfway through a book before I’d headed off to the hills – A Woman of No Importance by Sonia Purnell (check it out – it’s quite the adventure story). It’s a biography of Virginia Hall, who was an Allied forces agent during World War II, who built up and coordinated units in the French resistance. She had a prosthesis following a leg amputation, and the tale of her having to escape through the Pyrenees in winter with insufficient clothing and food are astonishing.  Yet she survived, and even thrived, in gruelling conditions.

She came to mind when, 4 miles from the nearest available shelter, I‘d just pitched my tent in the pouring rain and had crawled into it, damp, trying to keep wet and dry stuff separate, and to get warm. In that moment I managed to make a little bit of space for the part of me that was finding it All A Bit Much and say “yeah, of course you’re finding this hard! You’ve not done it before”, and to remind myself that Virginia Hall had gone through way harder things and come out OK on the other side – and I would too.

What was important in this moment was my attitude towards myself. Instead of telling myself I wasn’t allowed to find it hard because my issues were too insignificant, I reminded myself that people can come through difficult times and still be OK, while also validating my reaction. (My Focusing practice helped with this – you can learn more about that process here.)

It’s OK to find something challenging even if you’re not the first person ever in the world to do it.

You wouldn’t think this was rocket science, but apparently it’s a lesson I need to keep on learning.

I’d borrowed the kit off a bike-packing friend, and I knew that ‘lots of people wild camp’. And that’s when the more unhelpful side of comparing myself with others kicked in. You know, comparing apples (people who are experienced) with pears (me, the novice). I realised, only when I was catching up with friends afterwards, that a part of me had assumed I wasn’t allowed to find my trip difficult at times.

Finding your path online therapy

When I was met with the Wow, that’s quite an undertaking – weren’t you frightened? I recalibrated that judgment of myself as somehow inadequate at not immediately being a comfortable camper. And even allowed myself a little glow of satisfaction that I hadn’t been frightened (well, not much).

On the upside, I can see, looking back, that my survival instinct actually prompted me, when feeling a bit low, to be compassionate towards myself and – in the moment – reassure the wearied bit of me that it was OK to find it a bit tough, so that the judgmental part didn’t take over.

Compartmentalising can make me miss the obvious.

The obvious being: carrying stuff is hard work. I know! Who could imagine?

What happened was: I looked at my route before setting off. My longest day’s walk was 11 or 12 miles. Quite a long way, but I knew it was within my capabilities, especially on good paths. I also packed up my rucsac, completely, a couple of days before going, so I could check everything fitted in, and put it on to see how heavy it was. Heavier than I’d usually carry on a day trip, but within my capabilities.

road to find yourself Lucy Hyde therapy

What I omitted to do was to put ‘long day’s walk’ and ‘heavy rucsac’ together. Oops. It didn’t take many miles before I was feeling that, in various parts of my body in turn. Somehow that principle I share with clients, of noticing when you’ve got more than one stressor in your life, cos the impact is greater, fell by the wayside…….which takes me onto my next discovery.

It’s surprising what you can do when you don’t have the option NOT to.

My walk was harder going than I’d estimated, AND it was also fine. By the time I’d realised the miscalculation of effort, I was well into the moors and would have had as far to go back as I did to continue. If my foot (or hip, or knee) was sore, the only thing I could do was adjust things slightly to see if that helped – and to carry on. And actually that knowledge stopped me focusing on the discomfort, and so I wasn’t as aware of pain.

This was a helpful learning for me. I really value listening to my body. But this experience flagged up that I can sometimes allow fear to stop me pushing myself  – in this case anxiety about damage to my body, and worry that I can’t do as much as I used to (probably linked ultimately to a fear of age and even death). It reminded me of the key role that the brain has in the way we experience physical pain (you can read more about the mental – emotional- physical connections of pain here).

sunshine beyond online counselling

I discovered that I can control time!

When was the last time you did nothing? Like, literally, NOTHING? I honestly can’t remember, prior to this experience.

I’ve got much better at giving myself a break over the last decade or so. Gone (well, mostly gone) are the days when I would feel inadequate or a failure if I hadn’t been somewhere new or achieved a significant task on a weekend.  Now I let myself sit and read the weekend papers over breakfast for an hour or two, I potter, I lie on the sofa with a book for an hour.

But even though I don’t think of myself as ‘keeping busy’, actually doing nothing – that’s very unfamiliar. When I was camping, there was around 12 hours of darkness. I was in a tent I couldn’t sit up in. I had limited power and no signal on my phone. So I lay in my sleeping bag pretty much from 7pm to 7am, even though I wasn’t tired enough to sleep (and didn’t, much, even when I was).

And yet, most of that time, I wasn’t particularly bored. I was just, kind of………..there. Existing. Tuning in and out to the noises around me. Noticing my toes warming up in my sleeping bag. Wondering whether it was going to pish down again the next day.

It felt weird to be in that not-doing space.

Time behaves differently when you’re not doing. For many of us, that’s WHY we keep busy, right? We’re often scared of the empty space because we’re not sure what will creep into it. Empty space fosters anxiety, and over-thinking. We avoid it at all costs. The flipside of that is that we keep so busy that times passes quickly, the more so as we get older, and we end up feeling like we’re running out of it!

I felt like my two nights out were way longer than a weekend. So, perhaps a way of stopping time feeling like it’s going so quickly, is to stop ourselves – and just do nothing. How much time just disappears when you’re scrolling through social media, for example?

I’m not sure how easy I’ll find it to do nothing now I’m back home, surrounded by all the things that ‘need doing’, with my phone available to distract me. But I’m going to give it a go.

It’s good to do something new, even if it’s hard.

I feel like I gained a lot from this experience. That’s not consciously why I did it. I wasn’t on some mission of personal growth. And when it was challenging I thought “I don’t know if I’ll do this again”. But I learned some new stuff about myself because it was sometimes hard, and – as I told my therapist later – it feels like this experience is a little resource that’s sitting on my shoulder. I don’t know quite what to do with it yet, but I like that it’s there.

finding your way Lucy Hyde online counsellor

So…..would you take the plunge to do something new?

To be honest, I don’t recommend heading off on your own wild camping experience right now. Winter is coming (if you’re in the northern hemisphere) and nights are colder. But if there’s something you’ve thought you’d like to try but are a bit scared of, or not sure whether you’ll be good at it (hint: probably not, the very first time) I would really encourage you to give it a go.

Final tip:

if there IS something you have in mind – tell someone about it. In one step, this makes it more likely to happen. Getting to the point of telling someone is a move in itself – it can be scary, if you think ‘I can’t back out if I tell someone!’ – yet actually, that’s not true, is it? But if you tell someone you have a dream, it makes it a little bit more real.  It brings it closer. And then it’s more within your reach.

walking in the rain Lucy Hyde walk and talk

References and further info:

Book: A Woman of No Importance by Sonia Purnell

Pain: Not all in your head, it’s in your brain

Focusing and how it can help manage anxiety