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Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

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Death Anxiety

This blog follows on from my previous blogs – Existential Therapy and A consideration of some vital notions connected to Existential Therapies.  

In Existential Therapy reflecting on death anxiety would not be the same without a consideration of Heidegger. Heidegger (1927) regarded human beings as always ‘being towards death’. He asserted the significance of anticipating death as a vehicle to address the possibility of being itself.  Heidegger (1927) described the earnest recognition of our being towards death and its possibility in the following way:

“Impassioned freedom towards death – a freedom which has been released from the illusions of the ‘they’ and which is tactical, certain of itself, and anxious”

(p. 266) [1]

To me it seems Heidegger postulated that by confronting our finitude we can take responsibility for our existence and be released from the illusions surrounding a life of conformity.  However, this does not remove anxiety from living but reframes it as something inherent in being.

To a greater and lesser extent ‘death anxiety’ is considered by existential therapists as a central theme. One’s mortality is recognised as a continuing condition of human beings. It is perhaps the only thing that belongs to us,  and we can knowingly and unknowingly be living in the anticipation of its possibility and eventuality. This theme holds much uncertainty and reflects back to us the pervading uncertainty of life. It gives birth to the existential angst inherent in the human condition. This angst is generated by the fragility and unreliability of a life lived in this existence.

This does not have to be a pessimistic view. It is in fact allowing an exploration of the boundaries of life. By confronting our mortality, and in fact any pain and suffering experienced along our path, we have the opportunity to clarify our limits and identify that which is out of our reach rather than evading it. Simultaneously it can support us to become aware of our potential and the elements in our lives that it is possible to do something about. It can make us feel more adventurous and alive.

Existential Therapy frequently espouses the importance of facing up to our life and death and all that is experienced between the two poles of our existence, whether it be inevitable suffering or joy. We must find the capacity to confront our difficulties in living and permit the experience to feel it, without needing to linger for too long.

Equally we must see the good in our existence and recognise these times as they happen. Allow learning to ensue so that we can augment this in our lives, but without getting caught in the pursuit of unending happiness. Ultimately all aspects experienced, wherever they fall on the spectrum of suffering or joy, do not stand alone. They are all parts of the same indivisible perspective that each individual experiences as they travel within their existence.

So whether or not death anxiety is viable to consider, angst or anxiety is seen as an inevitable part of existence by Existential Therapists. Many will emphasise the significance of valuing, understanding and tolerating anxiety. Many recognise anxiety as a sign that something in our life needs our energy and attention rather than it being a threat or something to be eliminated. Perhaps it may be the very thing that unshackles us from conformity and seeking validation or permission from others. Perhaps it is the vehicle within which we may feel our aliveness, engagement,  and vital connection.

 

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice and Lewes Practice.

 

Further reading by Susanna Petitpierre –

A consideration of some vital notions connected to Existential Therapies

Existential Therapy

Being embodied in Therapy: Feeling and listening to your body

 

Resources –

[1] Heidegger, M. (1927) Being and Time (transl. J. Macquarrie and E.s Robinson) Londo: Harper and Row, 1962 edn.  

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A consideration of some vital notions connected to Existential Therapies

 

 

This blog follows on from my previous blog – Existential Therapy.  This is how I have interpreted some vital notions connected to existential therapies.

Existential therapy is a diverse approach which is used to understand and clarify a client’s problems and possibilities for living their existence. Below are some more of the vital principles (as I see them) typically considered by existential therapists. I would like to make clear that what I have written is not exhaustive, conclusive or necessarily a general order of things.

1) A belief in the relational nature of being as a central aspect of existence [1].

This suggests two things to me. That we are always in relationship with the world, and how we relate to it is often fundamental in how we are and what we become. It is interesting to note that in therapy the relationship has been continually found to be the key to efficacy whatever the approach.

In contrast to the relational sense of existence some existential philosophers have asserted we are ultimately alone in our existence. For instance, Kierkegaard emphasised the individuality of being human, describing human existence as a solitary affair.

Wherever one falls on this spectrum the discussion of how one is relating to their world can be a fruitful enterprise in existential therapy.

2) Seeking to understand a client’s subjectively lived experience and how it is taking place within a framework of temporality (past, present and future), tensions and contradictions. [2]

For me this means the intention is to understand that human existence is full of paradoxes. The aim is to clarify a client’s life as they have lived it, support them to reflect on what has happened and allow them to determine how they would like to live in the future in line with their values.

For instance, if a client comes to see me I am not going to attempt to fit them into any theory or model. I am also not going to tell them what to do.  I do hope to hold an openness to each client’s way of being-in-the-world and support them to get clarity on what is going well and what needs to be changed. I may employ an exploration of philosophy and other wisdoms as well as psychological theory to support a client’s inquiry, but I will always lean towards emphasising a client’s lived experience as key to the investigation rather than any theoretical understanding.

This leads me to another understanding that frames existential therapy.

3) A consideration and discovery of a client’s freedom and responsibility

For me this element is summed up nicely by Nietzsche’s words  “Follow not me, but you”. [3]

When he said this I think he was responding to people’s attempts to pinpoint his ideas into an all-encompassing approach to life. For me, it feels like a relevant description of every individual’s existential responsibility.

An existential therapeutic perspective typically strives for the clients to take responsibility for their lives and see their very existence, their being-ness, as the source of their potential as well as an opportunity to confront their limitations.[4] This possibility of being also upholds a fluid sense that we are always becoming and not a static substance. It invites a platform from which clients might begin to take responsibility for their existence and what they value. In this movement we may begin to reveal, understand and clarify their choices and actions. This takes courage though. It takes courage to birth and live out one’s potential, especially in the face of adversity and limitation.

This links into another significant understanding or theme underpinning existential therapy: ‘being towards death’.  Please also read my blog on Existential Therapy and Death Anxiety.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice and Lewes Practice.

Further reading by Susanna Petitpierre –

Existential Therapy

Being embodied in Therapy: Feeling and listening to your body

 

Resources – 

[1] Spinelli, E. (2007) Practising Existential Psychotherapy. The Relational world. London: Sage

[2] van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: an Existential Approach to Therapy and Counselling. Chichester: Wiley.

[3] May, R., (1958) Origins of the existential movement.  in Existence. (Eds: Rollo May, Ernest Angel & Henri, F Ellenberg) Rowman and Littlefield Publishers: USA.  p. 31

[4] van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: an Existential Approach to Therapy and Counselling. Chichester: Wiley.

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Online Therapy

We spend much of our lives online these days and increasingly more services are available online that traditionally would have been conducted face to face. This is the same with psychotherapy and counselling, and there is a growing availability of online therapy services around on the internet. So, is online therapy for you?

There are many ways to engage in therapy online, but for the purposes of this blog I’ll be considering online therapy that uses live video. This can be done with apps such as: Skype, Zoom, WhatsApp, FaceTime, BotIM etc. Whatever app is used, the most important thing to consider is the security. Only use an app that has a secure and encrypted connection.

There are many benefits to having therapy online and the most obvious might be the convenience of it. Rather than having to spend time travelling to a clinic, you can be at a location of your choice where you feel comfortable. This might be at home, in a private office at work during your lunch break, or anywhere where it is confidential and you won’t be overheard or disturbed. However, you will need to consider what you will do after the session has ended. Do you have time to compose yourself before you step outside the room and back to the office or family life?

Another benefit of working online is that you might have a greater choice of therapists available to you. Rather than having to choose those in your local area, you can work with the therapist of your choice wherever they are in the country. This can be particularly beneficial if you live in a remote area, or live abroad and want a therapist who speaks your native language. Additionally, if you travel around a lot, it can make it possible to access therapy wherever you might be.

Another advantage of online therapy is that it can make it easier to engage with therapy if you are anxious about going to a clinic in the first place, or have any difficulties with leaving home or accessing certain locations. Being able to engage with your therapist online can remove any of these potential barriers and you can get the support you need.

A lot of people wonder if online therapy is as good as face to face therapy, and that is an important point to consider. Certainly, there is a big difference. The rapport and connection you have face to face with a therapist will be different to what you build online. Some of the non-verbal clues to communication can be lost online so it’s important to be able to tell your therapist if they haven’t understood you, or if you don’t understand them. However, once you get used to working online with a therapist, the distance and technology can ‘disappear’ and you can feel very connected with your therapist.

Here are a few points you might want to consider if you want to access therapy online:

  • You will need to have a good, stable internet connection for the duration of your session.
  • It is best to have a few connection options available – such as wifi and data, and a couple of different options of apps – such as Skype and Zoom, to allow for tech difficulties.
  • You need to be comfortable working online and familiar with the tech you are using. It’s a good idea to turn off any notifications for the duration of your session as these are very distracting when you are trying to work with your therapist.
  • You need to ensure that the location you are in is private and confidential.
  • You should check the credentials and qualifications of your therapist before you engage in any online therapy. There is a growing number of people setting up online as ‘therapists’ with little or no training. Make sure your therapist is registered with a professional body such as UKCP.

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

Further reading by Dr Simon Cassar –

Student mental health – how to stay healthy at university

Four domains – maintaining wellbeing in turbulent times

What is an integrative existential therapist?

What is Existential Psychotherapy – Video

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Existential Therapies

“A rich tapestry of intersecting therapeutic practices, all of which orientate themselves around shard concern: human lived experience” (1)

What is existential therapy? I’m asked this a lot. I even ask myself from time to time. In some ways it could be described as an attitude held by the therapist. It is certainly, in my experience, a continually unfolding enterprise due in part to its emphasis on relationship, non-directive stance, non-structured framework and an openness to wonder and mystery rather than reduction and categorisation.

In this blog, and future blogs I will begin to reflect on some understandings within existential therapy.

It is perhaps safe to start with reiterating what many have said before: there are as many ways to be an existential therapist as there are existential therapists (2) (and clients may I add). I am aware how vague that sounds, however, I believe it is actually what makes existential therapy so valuable. Its variety and openness invites connections and relationships to be developed in an authentic and unique way with each client. It also challenges some illusions regarding life (and therapy) including that it is and can be objective, manualisable and unambiguous.

Existential therapy is framed around a variety of existential thinkers, and other philosophers. Many have been influential in its development. At times the diversity of understandings about human existence reveals contrasting understandings which can be confusing. However, this is also the very ingredient that permits the aforementioned subjectivity, diversity and disagreement.

Existential therapy recognises the significance that each individual interprets from their particular context, therefore rejecting the notion that one size fits all. It invites every individual to recognise and bring forth their unique potential. Its very nature permits consideration of life in all its complexity and nuance, and recognises how uncertainty is intricately connected with living life.

What underpins existential therapy is the starting point: May (1958) (3) described existential therapy as an exploration that seeks to understand individuals as being. It invites a person to experience and have awareness of their own being, their own existence, their own aliveness, their own relation to one’s self and one’s world as a precondition for unraveling and working through their difficulties. Its focus is on the existence of each individual being sitting with the therapist, and what occurs between them. It does not disparage investigations about behaviour patterns or dynamisms but it recognises these elements are only really understood in the context of each individual’s structured existence. It is existence, or as May (1958) described the ‘I am’ experience, that underpins everything else.

So what does this mean in practical terms? Typically, existential therapy does not employ diagnostic frameworks to label or categorise personal characteristics or experiences. Abstract knowledge about a person, an assessment report or a theoretical understanding about a certain type of experience or behaviour is less important than the reality and experience that emerges between two people (client and therapist for instance) encountering each other in a room.

How else does this show up in an existential therapeutic session? In other ways, and always depending on the client’s needs, clients may be encouraged to understand their relationship to, and come to terms with, the ‘four ultimate concerns’ of existence as understood by Irvin Yalom (1980). Yalom described these as death, freedom, isolation and meaninglessness.

Additionally, clients may be invited to consider how they are being and relating to four basic existential dimensions (4). This may take the shape of exploring their relationship to personal, spiritual, physical and social aspects of their existence.

As mentioned in other blogs what has been written above and before is not a blueprint for what to expect in existential therapy. It is also not an exhaustive discussion of ideas within existential therapy. However, if you are interested in reading about other significant ideas in existential therapies, as I understand them, please read my other blogs.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice and Lewes Practice.

 

Further reading by Susanna Petitpierre –

Being embodied in Therapy: Feeling and listening to your body

 

References

(1) Cooper, M. (2003) Existential Therapies. London: Sage. (p. 1)

(2) Cohn, H. (2002) Heidegger and the roots of Existential Therapy. London: Continuum

(3) May, R., (1958) Origins of the existential movement. in Existence. (Eds: Rollo May, Ernest Angel & Henri, F Ellenberg) USA: Rowman and Littlefield Publishers, (p. 31).

(4) Van Deurzen, E. (2012) Existential Counselling & Psychotherapy in Practice. London: Sage

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