Therapy unlocked: a guide to finding the right therapist for you

There are thousands of therapists out there, but it’s not easy to assess their qualifications, particularly in the throes of a crisis. Here’s our guide to finding help

Irish Times, Saturday 10 January 2015

Kate Holmquist

When you have reached that difficult moment of emotional crisis where you’ve decided to reach out to a psychology professional, you will probably look online. Cue confusion. You see bewildering lists of accreditation letters – ICP, IACP, PSI, IAHIP, FTAI to name a few – and you notice that there appear to be several methods – Psychoanalytic Psychotherapy, Constructivist Psychotherapy, Couple and Family Therapy, Cognitive Behavioural Therapy, Humanistic Integrative psychotherapy.

You may see the words “counselling” and “psychotherapy” and wonder what the difference is. With so many phone numbers and emails you could use, for the uninitiated it’s a bit like putting a pin in an online map and hoping that the person who answers will be kind to you.

This feels like a shot in the dark, and yet you’ve never been more vulnerable because things have got pretty stressful for you to be phoning a complete stranger. As the phone rings, you may visualise yourself reaching Gabriel Byrne’s Dr Paul Weston of In Treatment, or Dr Jennifer Melfi in the Sopranos, Frasier Crane or even Sigmund Freud himself, with his goatee and couch where you will lie for an hour trying to remember your dreams. Who knows?

Finding a therapist is not like finding a dentist. Your friends will always have lists of dentists, and GPs and personal trainers to call. People tend not to discuss their therapists with each other, partly due to a lingering stigma in Ireland and partly because of the deeply private nature of the problem you are trying to solve.

Today psychotherapy in Ireland has developed to a high standard, even though there is no formal State accreditation of psychotherapists. Still, says psychotherapist Brendan Madden, many people still suffer for four or five years before seeking out a therapist and they may be at the end of their tethers, with sleep problems, anxiety or anger issues.

Whatever the reason for considering therapy, there’s no question that people feel extremely vulnerable when they finally decide to make the leap. Can you ask a friend? It’s a good idea, but you may not want to share your friend’s psychotherapist. Your GP may have a psychotherapist or counselling psychologist working in the practice, which can be a good place to start.

Comfortable

Finding a therapist may not seem as straightforward as finding a GP, but it’s actually a good idea to follow the same route. Do you feel comfortable with the person? Have they listened to you on the phone? Are they friendly, clear and otherwise consumer-aware (as in, telling you what they charge)? Are they nearby?

“In the same way we choose a doctor, we should allow ourselves the option of shopping around until we find someone we have a good fit with,” advises Trish Murphy, psychotherapist and Irish Times agony aunt. “This is not always easy and many people choose to stay with the person they first meet and this often works out well.”

Psychotherapists are trained to relate to and treat people who are distressed. They work to alleviate personal suffering and encourage change.

“The therapeutic relationship is very important and you have to be able to trust your therapist,” says Yvonne Tone, a cognitive behavioural therapist, one of the five “modalities” accredited. “It’s about collaborating with the therapist, working in a shared way to understand the problem, such as depression or anxiety, that you want to address.”

But first you have to figure out what all those accreditation letters mean and what the various forms of therapy are. Don’t you? “You can’t say that one therapy is better than another – for example, while CBT (Cognitive Behavioural Therapy) has been shown to be effective, there’s no evidence that it is better than other types of therapy,” says Brendan Madden.

Madden practises solution-focused “brief therapy”, where the client is encouraged to become “a solution detective” and discover their own strengths and solutions to whatever problem they’re facing, empowered by the therapist.

Psychoanalysis, on the other hand, sees the path of self-discovery, in cooperation with the therapist, as an end in itself. “Psychoanalysis respects the individuality of each person,” says Jose Castilho, psychoanalyst and chair of the Irish Council for Psychotherapy.

“It’s not about helping the client to adapt to the world, but helping the individual to adapt to him or herself.”

While it may have a reputation for being the scenic route to wellbeing, since it’s not goal-oriented, psychoanalysis has changed over the years and can help people who are in crisis from a breakup or the loss of a job over a short space of time. Others may remain in “analysis” or other talk therapy for years because of the insights they gain.

The uninitiated may think that any therapist of whatever ilk has a gift of insight into their personality that will eventually be revealed like the third secret of Fatima. You are bound to be disappointed, because like the Wizard in Oz, the therapist hasn’t got the answers, only you do. But an effective therapist will help you figure it out.

“Therapy is not a healing ritual or practice performed by the therapist to cure psychological distress. Recovery and emotional healing comes from the strong therapeutic alliance built over time between therapist and client – and it’s really the client who does all the work,” says Madden. Trusting relationship Murphy agrees that establishing a trusting relationship is the key to the success of the therapy. “It’s the relationship between the client and the therapist, not the particular model of therapy, that is most important.”

In recent years, psychotherapy has moved towards shorter, solution-focused therapies that can help the client get through a rough patch or to make a difficult decision. Some therapies, however, can involve much more time. Where there is a serious issue with depression or anxiety, the therapy could take years to get to the source of the problem, says Dermod Moore, chair of the Irish Association of Humanistic and Integrative Psychotherapy (IAHIP).

What qualifications should a psychotherapist have?  All psychotherapists should be accredited with a professional body that adheres to a code of ethics and has complaints procedures and standards of practice. Currently, the Irish Council for Psychotherapy (ICP) is the umbrella body for all psychotherapy in Ireland, representing more than 1,250 psychotherapists who have undergone in-depth training and are committed to the highest standards of professional conduct. Another professional body is the Irish Association for Counselling and Psychotherapy.

Currently, the qualifications required for ICP is seven years’ training, four of those at post- graduate level dedicated specifically to psychotherapy. Many Irish psychotherapists hold the European Certificate for Psychotherapy which qualifies practitioners to work anywhere in Europe.

What’s the difference between a psychiatrist and a psychologist or psychotherapistst? The key difference is that a psychiatrist has been medically trained and holds a medical degree. The suffix “-iatry” means “medical treatment,” and “-logy” means “science” or “theory.” Psychiatry is the medical treatment of the psyche, and practitioners are therefore qualified to prescribe medication, while psychology is the science of the psyche.

A psychotherapist can be a psychiatrist, psychologist or other mental health professional, who has had further specialist training in psychotherapy which focuses on helping people to overcome stress, emotional and relationship problems or troublesome habits.

What will it cost? Many therapists offer a sliding scale based on your income, so be forthright about what you can afford from the start. The cost varies depending on the psychotherapist but a regular fee is somewhere between €70-€120 per session . Less expensive therapy is available through training programmes or subsidised systems. Many psychotherapists offer a sliding scale for unemployed or retired people. Student therapists need to practise to become qualified, so you can see someone in a training programme for €50 per hour or less. The upside is that student therapists tend to be very enthusiastic, dedicated and well-supervised.

What should my therapist be like? The therapist should empower you to feel more confident, not less. Empathy is his or her most important quality. Trust your gut instinct about whether this particular therapist is right for you. “Keep it simple and don’t be blinded by jargon. It’s the therapeutic relationship that counts – you have to have a sense that the therapist will listen, understand and work with you towards your goal,” says Madden. If you don’t feel it’s good for you or not what you agreed, then don’t be afraid to find another therapist that’s a better fit for you.

How often do I need to see the psychotherapist? Usually the first session is used to see if there is a fit between the therapist and client and to agree what the need is about the number of sessions. The average is probably about 8 weekly sessions. Some psychotherapists work on a twice-weekly basis; these would be in the minority.

Are all therapists neurotic? To train as a therapist, you do need to have therapy and sort out your own issues. However, it’s fair to say that there is a tendency for people to be drawn to psychotherapeutic training to sort out their own problems, which probably leads to a higher proportion of neurosis and issues among therapists than among the general population. But that’s usually a good thing because the therapist has probably developed a good deal of compassion and understanding on their journey to mental wellbeing and personal growth.

I’m still not sure. Why do I need a psychotherapist rather than a friend who is a good listener? A psychotherapist will help to unravel the tangles of the issue and help to clarify what the problem is and what can be dealt with at what time. “Psychotherapy is a safe place to explore and discuss the most difficult of things, even those that are hidden,” advises Trish Murphy.

When should I seek a therapist? “When you are troubled, suffering, shocked, grieved, floundering and unable to reach decisions,” advises Trish Murphy. “When a relationship – at home, at work or elsewhere – is in trouble is another appropriate time. A critical event might be an ideal time to source help: loss, death, accident, injury, change of country/job, rape, hurt and so on.”

How do I know it’s working? Generally, how things are working out early on in therapy is predictive of how things will turn out. “You should feel change and notice progress fairly early in the therapy process, over a matter of weeks rather than months,” says Madden. “By six to 10 sessions there should be some early change.”

There’s sometimes a notion that you have to get worse before you get better. Madden disagrees: “If it’s getting worse, something isn’t effective. You should be feeling more hopeful after six to 10 weeks and start to feel better. If not, discuss this with your therapist and consider doing something different .

How will I know if it’s not working? From the start, the psychotherapist should be professional and organised and give clear, reassuring answers about their qualifications and experience. The time, date, fee and location of the appointments should be fixed and agreed. The psychotherapist should be empathetic and always put the client’s needs first (for clients at risk of self-harm or abuse, safety needs come first). All psychotherapists are guided by their association’s code of ethics that guide practice and meeting client expectations. If clients are not making progress, therapists are obliged to listen to their feedback, change the direction or focus of therapy, or make a referral onwards.You should feel listened to and heard – that is the core of empathy, a necessary condition for change. With the exception of classical psychoanalysis, the client shouldn’t be expected to do all the talking. The therapist should take turns to summarise, paraphrase and clarify what the client is saying.

Are there cases where a couples therapist is better? Where there are difficulties in an intimate relationship, there is often a case for seeing a couples therapist. Where someone is undergoing personal therapy for depression, for example, and relationship issues arise, this does not necessarily mean leaving the individual therapist. Where both parties are willing, the therapist might seek to work specifically with them on couple issues for a period of time, which can be enormously helpful for both the individual’s depression and the couple relationship. Familytherapyireland.com is the professional body for couple and family therapists.

Many family therapists work with people on an individual, couple and family level. Other therapists offering couple therapy would be expected to have additional training or experience in this area.

Intimate relationships key for healthy mind, says therapist

Trish Murphy describes free mental health talk as virtual medicine for the mind

Irish Times 3rd October 2014

Virtual medicine for the mind is one phrase psychologist and Irish Times columnist Trish Murphy uses to describe her forthcoming free talk on mental health next Wednesday. The talk is part of the Irish Times Pfizer Healthy Town initiative in Portlaoise.

Murphy will look at a range of issues, including relationships. “The most enduring relationship you have is with yourself,” she says. “And we can be very nasty to ourselves a lot of the time.”

Murphy will show you ways of dealing with this issue as well as stressing the importance of intimate relationships in our lives which she says are very important for a healthy mind. Research has found that there are four factors that can lead to the breakdown of a relationship.

These include contempt, (such as rolling your eyes when the other person is talking), defensiveness (Murphy says that defensiveness is very destructive to a relationship), criticism (which she points out can be implied or silent rather than spoken, and stonewalling).

Murphy explains that stonewalling is an emotionally blocking of things. “You can be physically present but emotionally unavailable because you cannot take any more. It’s a tactic which men use a lot.”

She says this can signify the end of a relationship because “you can’t have a relationship when one person isn’t there.”

Happily, it is possible to reverse these situations. She says there is a mathematical formula for it, “which is very interesting” . Murphy says in such situations you need five times more affection, humour and personal liking of yourself.”We all need to lighten up, she says, “ we need some humour.”

To find out the exact ingredients, you will have to go along to her talk which is on in the Heritage Hotel, Portlaoise next Wednesday, October 8th at 7 pm. Admission is free and you can register in advance by contacting Rachel Ahearne at WHPR, on 01-6690030. Or you can email: rachel.ahearne@ogilvy.com

Murphy will also touch on a range of other issues including how important it is to mind yourself if someone you know is having difficulties. “It is very easy if someone close to you is having problems, you can get sucked into it very easily and start demonstrating the same symptoms yourself.

She will talk about how to do the best for them, but discuss how important it is to mind yourself first.

Dr Trish Murphy is a psychotherapist with a private practice in Rathmines, Dublin. She also works in Trinity College two days a week and is a regular columnist in The Irish Times, dealing with emotional and other issues confronting readers.

Tell Me About It: My married lover also has a younger, single woman
Irish Times 11th March 2014 – Kate Holmquist

It was heaven for a while, until recently, when I discovered he was in love with someone else (much younger and single)

Q I am broken-hearted. I fell madly in love with a married man recently. (I too am married but the love is long dead ). He lives with his wife but I know there is not much love there either. We got on brilliantly, and he asked me to trust him and “give myself to him”, which I did.
It was a relationship where we would meet up every other month or so and contact each other by email. It was heaven for a while, until recently, when I discovered he was in love with someone else (much younger and single). He met this girl many years ago.
If he loved her so much why did he bother with me, as they were together before he met me ? She knows he was being unfaithful and knows also he is married. I hope that she has the sense to get rid of him.
I just can’t cope with this. Is there any advice you can give me to help me move on?
I know I don’t deserve help as what I did disgusts me now in hindsight, especially as I realise he just used me for sex . My self-esteem is at rock bottom.

A You do deserve help, and so much more – empathy, intimacy, sex and feeling loved. You’re afraid to seek help from people you know because you think they will judge you as harshly as you’re judging yourself. I’m glad you wrote to me, if only to hear that no one should judge you for being human. Many of us have been fooled by an illusion of love, so please be kind to yourself.
After years in a loveless marriage, you were craving intimacy and closeness. This man offered it, but meeting once every couple of months and exchanging emails isn’t a relationship, no matter how exciting it may have been. You believed your lover was being honest when you gave yourself to him, so no wonder you are devastated.
Psychotherapist Trish Murphy says: “This is an issue that can and does happen – and the idea that the woman was being used for sex may not be entirely true, but devastating nonetheless . . . It feels like total betrayal to discover that the lover was not being honest and indeed was loving someone else at the time they were supposed to be devoted to you.”
Your judgement was compromised by desire and hope, so you may feel you’ve lost your ability to judge what’s real and true and that it’s impossible to trust anyone or anything. You ask why he bothered with you. It’s possible that this man is so practised in self-deception, believing himself to be “in love” with whomever he is with, that he cannot see what he is doing, Murphy suggests.
“When found out, he may be ashamed but unable to face this and takes comfort in repeating a pattern where a lover sees him as a wonderful person, better than he really is,” says Murphy.
Heartbreak can feel like grief. First comes the shock, then anger when you learn that you weren’t the only woman in his repertoire – plus she’s younger. No wonder your self-esteem is at rock bottom. Anger turned inwards becomes depression. Direct your anger where it belongs: that callous womaniser.
It will take time for you to recover your confidence, but when you are ready, “you have to have the courage to tackle the reality of the marriage – either face separation or work on the relationship. It is an opportunity to look at your life and take the time to investigate what direction you want to take. This is hard to do when you are feeling so lonely and betrayed and it may need some short-term professional help,” Murphy advises.
You may be grieving the loss of the sensual, sexual part of yourself that you suppress to stay married. The affair was a fleeting taste of being a full woman once again, making your marriage – the real issue – even more painful.
Your husband, though, deserves the same love and happiness you do. When you’ve built yourself up again, you two need to talk with the help of a relationships counsellor and find a way towards a more satisfying future for both of you, whatever that may be.

Tell Me About It: I am a happily single woman of 37 – do I need to find a man?

Irish Times 25th March 2014 – Kate Holmquist

Will I look back in a few years and realise my laissez-faire attitude to romance was a mistake?

Q I am a 37-year-old woman, living in rural Ireland. I enjoy my life, am close to my family, have good friend s and lots of interests. I have never felt better about myself, nor looked better. Right now, I am in a happy relationship with myself.
I have been single for two years. The break -up of my last relationship was painful and protracted, but I understand why it did not work. He was a great guy and most of the fault lay at my door. I learned valuable lessons from it.
I have dated guys since, tried online dating and seem to attract men without difficulty. But none have been the right fit, and no, I am not looking for perfection. The right fit for me is a man who I would still love to have conversations with when I am old .
After 20 years of dating and relationships , I am tired of the pursuit of the supposed norm. I have adopted a “what will be, will be” attitude . I do not have a pressing desire to have children and do not feel any biological clock ticking. My friends are concerned at my lack of interest in pursuing romance . But I too am concerned for myself : am I being short-sighted and will I look back in a few years and realise that my laissez-faire attitude to my romantic life was a mistake? Do I need to reboot my attitude to dating and men, and how can I do that?

A You sound confident, you don’t feel the biological clock ticking and you like yourself. You’re happy in your own skin and you have a full life with family and friends.
“You have all the qualities that people are looking for – the very definition of being attractive,” says psychotherapist Trish Murphy. “By continuing doing what you are doing and enjoying your life, if someone were to come along, you are doing all the things to be attractive to them.”
So the question isn’t how do you reboot your attitude, but why do you think you need to reboot? My guess is that well-meaning friends and family may be saying that you must be in a relationship with “the one” to have a happy life. Nothing could be further from the truth. You have had imposed on you a fear that in the future you will regret being single.
“A lot of people have that fear,” says Murphy. “By living in fear you are bringing fear into your life and into your future. By living happily in today you are creating happiness in the future.”
Single women live longer, healthier lives than married women, statistically. Murphy suspects that this is because many women work very hard to keep their marriages functioning. All of what seems like nagging could actually be women’s attempts to keep their marriages alive, and it takes effort. “If I can’t do all in my power to keep this relationship going, I will regret it,” they think.
Regret can be harmful from the opposite perspective too. Many women – and men – fear that they will regret it in future if they commit themselves by moving in with someone or marrying them. I have a friend who was in a relationship for a couple of years, but the very day that she and her boyfriend moved in together, she ended the relationship. Her fear of waking up in five years’ time and regretting settling down was that intense.
“Fear of regret can cause a lot of problems in relationships,” says Murphy. Some people decide to give it a go, then leave, then return, disappear, over and over again, “driving the other person away because they can’t take being picked up and dumped over and over again any more,” she says.
Instead of buying into the fairy tale that we are completed by “the one soulmate”, you have created a rich and fulfilling existence. “There is an abundance of everything in life,” says Murphy. You are doing everything right. You have already found what everyone is looking for, if only they knew it.
“It’s not somebody else’s job to complete you or make you happy. That’s your job and always will be,” says Murphy. So don’t change anything and, if it’s meant to be, the man you want to be old with may just come along.

Married to the Job
Going into business with your spouse can be a dream or a nightmare – good communication is the key to making it work
Sheila Wayman – The Irish Times Nov 11 2013

When Jamie and Lisa Cobbe gave up jobs in Dublin to start a business together in the west, they had to learn to speak to each other as colleagues – not as a couple – during working hours.
It took a good six months to sort out their working relationship, after starting Water Babies, a baby swimming programme, in the west.
“If there was an issue in the office we would argue it out as a couple instead of discussing it like colleagues,” says Lisa. “It made me realise that if we were going to stay together, we had to learn how to speak to each other properly.”
Even after that realisation, it was a conversation they had “to revisit a couple of times”, says Jamie.

Family’s future
As with any new venture, there were initial financial difficulties and self-doubt. But for the Cobbes, who had two young children, there was the additional pressure of staking the whole family’s future on the business.
“We had for a long time wanted to move to the west coast but we had never been able to figure out how to do it,” says Jamie. For him, surfing was the big draw; for Lisa, it was having her mother, sister and brother living in Galway.
It was only after taking their first child, Leon, now aged four, to Water Babies in Dublin, that they spotted a franchise opportunity that might make it all possible.
But two significant life events – the death of Jamie’s father and the birth of their second child, Marley, now aged three – delayed their pursuit of a better work-life balance.
It was March 2011 before they moved and then faced the reality of trying to make a go of their own business.
“We had both given up really good jobs and the recession had just hit,” says Lisa, who was an archivist in the National Library, while Jamie was the manager of a centre for young adults with intellectual disabilities.
“There was a lot going on and we did question for those months had we made the right decision.”
The word “copreneurs” has been coined for couples like the Cobbes and, whether the intimate partnership or the working relationship was established first, keeping both on an even track can be tricky. Home can no longer be a total escape from work, and vice versa.

“I think it is definitely challenging,” agrees family therapist Ann Campbell. “While you realise it is a professional relationship, you are much more likely to get short with somebody you are in an intimate relationship with.”
Good communication is important in all relationships but here it is doubly needed – clarifying in advance the roles and ground rules. And listening is the one part of communication that gets lost very easily, she advises.
It would be a good idea if couples moving into this two-dimensional relationship acknowledge that it requires a huge readjustment and talk about how things between them might be different.
Another aspect of being copreneurs is that employees will judge you as a couple, as well as employers.
“The other part that is huge for couples working together is family life,” says Campbell, who is vice chairwoman of the Family Therapy Association of Ireland.
“Gender issues come in here; when it comes to the crunch, whose responsibility are the children? Are they both business partners’ responsibility or is there an idea that one is the stronger partner, therefore they do less family stuff?”

Expectations
Their own childhoods will colour expectations and, as they have had different upbringings, they really need to discuss how they are going to handle this. Likewise housework, which has been shown to be the thing all couples argue about most.
Yet couples working together, who may have spent the day talking business, can’t go home and argue with somebody else about who hasn’t done what, she points out. “You’re faced with that conversation with the same person as well.”
She advises co-workers going home together after a bad day to “name it and park it”. Acknowledge there is a problem at work but agree you are going to leave it aside and talk about it in the morning.
Self-care is really important, particularly when there are multiple demands on the one relationship. There is a fair expectation of a certain amount of care and minding in the intimate relationship, says Campbell, “but can you be black and white and just get on with work and have a different connection in the workplace”?