psychotherapy training UK Archives - Brighton and Hove Psychotherapy

When working with trainees and supervisees, I frequently refer to the need for a psychotherapist to ‘stay in their chair’. Let me explain.

Psychotherapy is a relationship. It is a very intimate and unique relationship between the clinician and their patient, which is principally about the needs of the patient. This, however, does not mean that the psychotherapist acquiesces to every whim or request a patient may have. On the contrary.

The key to any successful relationship, whether a friendship, a romantic relationship or a parent-child relationship, is that there are clear boundaries. Often, if not always, when a patient comes into therapy it is because they have grown up in an environment where the boundaries were poor, inappropriate or non-existent. In other words, they grew up with relational deficiencies.

Poor boundaries create a psychological and at times physical environment, where there ceases to be a differentiation between self and other. This is often referred to as a merger. Where children grew up with a parent or parents with poor boundaries, the experience can be hugely impactful on their psychological and emotional development and, in attachment language, leads to insecure or disorganised attachment styles. In simple terms, it makes it very difficult for these individuals, once adults, to have healthy boundaries in two-person relationships; they are either at the mercy of the other, or conversely, make everything about themselves and fail to recognise the needs of the other.

As a psychotherapist with fifteen years of experience, I have yet to meet a single patient who crossed my threshold, who did not have issues with relationships and thus had attachment damage. It’s the work.

One of the primary roles of the psychotherapeutic relationship is to have a caring, loving relationship with the patient, that is in their best interests. It therefore is boundaried by definition.

One of the tenets of working as a psychotherapist is that it is always in the best interest of the patient for the clinician to hold the boundaries. Even if the patient pushes against these – and they will. Just as it is a parent’s role to hold the boundary with their child and hold their best interests in mind, since they cannot.

So, now we are coming to the meaning of ‘stay in your chair’ which I mean both literally and figuratively. Put simply it means stay in your role and hold the boundaries, because without boundaries, the psychotherapy ends.

Patients who have not grown up with clear and supportive boundaries will unconsciously try and recreate a familiar dynamic, generally stemming from their childhood, in the psychotherapy. Us clinicians refer to this as transference, which is a form of projection from the patient onto the clinician. The difference between projection and transference is that the role of the psychotherapist is to think about and understand the projection onto them, and within this to recognise the relational blueprint of the patient and whom the psychotherapist represents for the patient. In simple terms, the patient will attempt to ‘play out’ the most influential relational patterns from their childhood with their psychotherapist. And if this is not caught and thought about, then the therapy simply becomes a repeat of the patient’s childhood experience.

Whether a patient attacks or seduces, our role is to stay in our chair – to remain consistent and constant and to hold the boundaries. Patients will invariably ‘act out’, which is to say that they will embody and play out dynamics that are counter-productive to the therapy, but familiar to them. Our role as a clinician is to survive these acting outs and to protect the therapy at all costs, Sadly, the concept of psychotherapy has become increasingly diluted in the UK, in part due to a lack of differentiation between counselling and psychotherapy and a general ‘race to the bottom’ amongst training institutions. The result is that therapists increasingly have no concept of ‘staying in their chair’ and either move towards the patient when seduced into a collusion, or back away and abandon when attacked.

Lastly, this is not to say that as psychotherapists we should accept or ‘put up with’ attacks from patients. On the contrary, the boundaries are there to protect us too, and if a patient verbally attacks and cannot return to think alongside their therapist, then they may simply be unsuitable for the work, which is also a boundaried position to hold.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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What is the difference between a counsellor and a psychotherapist?

The terms counselling and psychotherapy are often used interchangeably and many mental health practitioners use both terms to describe themselves. In this article I explore whether there is a difference between counselling and psychotherapy, what that difference may be and why may matter.

In very simple terms, counsellors work at a more immediate level generally focusing on a current issue that is affecting the client. The work is therefore often considered of more limited duration although this is not exclusively the case.

Psychotherapists both think and work at a deeper process level considering how the structure of the client’s personality is affecting their experience of relationships and being in the world. This is reflected in the training depth, duration and intensity of each discipline. Let’s go deeper into this:

Defining counselling and psychotherapy: a brief history

Counselling and psychotherapy are two practices that are closely related that both fall under the category of ‘Talk Therapy’. All talk therapy hails back to the last century and Sigmund Freud, broadly seen as the ‘father’ of modern applied psychology.

Many people know that Freud ‘invented’ psychoanalysis – the practice of patients lying on a couch out of view of their analyst and sharing whatever comes into their mind – free associating – with their analyst who, as he or she is out of view, gets ‘projected’ onto by the patient. The analyst is therefore not related to as a whole person as the analysand (the person being analysed) knows very little about the life of the analysts and cannot see them due to the seating arrangement.

Psychoanalysis changed the way we thought about the both the actual human mind and its lexicon – repression, ego, libido, to name a few – all of which have become ubiquitous in everyday language. Far from being redundant, psychoanalysis has continued to evolve over the years with a strong British school emerging during the mid-20^th century that has shaped how we think about infant and child development, as well as our relationship to self and others.

From Freud to modern therapy: the evolution of talking therapies

Classical psychoanalysis led to an explosion in us wanting to understand mental health with many trained analysts in the 1960’s, in particular, pivoting away from traditional analysis towards other more ‘relational’ therapeutic approaches. Many of these new approaches continue to exist to this day and have evolved as evidence-based practices in treating mental health problems. It is the practice of these approaches that sits within the categories of counselling and psychotherapy.

Where psychoanalysis would require patients to attend analysis at least three, and often five times per week (and still does), counselling and psychotherapy typically require patients or clients to attend one, or possibly a couple of sessions per week.

An analysis is also a very long-term affair, frequently taking many years or even a decade. And it was and is also not uncommon for patients to undergo a second analysis later in their lives.

For many, psychoanalysis is simply too expensive and too much of a time commitment, however, this does not suggest that analysis does not have its place and can often be the only appropriate treatment for some patients. Indeed, some patients will be prescribed ‘psychotherapy’ before entering into analysis and some clients are may be too unwell for weekly psychotherapy where they are too regressed and psychoanalysis may be more appropriate and holding.

Counselling vs psychotherapy: structure, depth, and duration

We have established that all modern talking therapies hail from psychoanalysis and that psychoanalysis remains an extremely important and in-depth treatment for certain patient groups. So, are the terms counselling and psychotherapy interchangeable? No.

An anecdote I believe sheds some light on the overlap and difference is that I have met many counsellors who call themselves psychotherapists, but no psychotherapists who call themselves counsellors.

Unlike analysis, counselling and psychotherapy do look, at least to the layperson, rather similar: two people sitting in a room talking. They meet for a therapy hour (usually) and tend to meet on the same day at the same time, weekly (again, usually). However, what looks the same on the surface belies a profound difference in depth of thought, application and clinical process.

One of the fundamental differences between counselling and psychotherapy is that psychotherapists are trained to formulate – to diagnose – according to their therapeutic approach. This is critical when dealing with issues that are deep-rooted and impact on the patient/client’s relationship to self and others. Counsellors do not have this training.

Formulation drives the treatment plan for psychotherapists – knowing what one is treating and why.

In order to learn to formulate, psychotherapists undertake rigorous training which generally extends over a period of four to five years at post-graduate level. During this training period, they learn to conceptualise in one or more approaches and to become proficient in working with psychological process at depth. The training includes their own process of personal therapy over the duration of their training, a mental health placement and a minimum of 450 training hours of clinical work.

Working at depth with the psychological process – what is happening beneath the content of what the patient is bringing and what is manifesting between the patient and psychotherapist in the relationship – is a complex and core element of psychotherapy. A useful synopsis of this process is that psychotherapists are constantly asking themselves ‘what is it that the patient wants me to know about them?’ irrespective of the content of the session. This can then be brought to light and explored in the therapeutic relationship.

What psychotherapists are trained to do that counsellors are not

In the UK, counselling and psychotherapy are not regulated by the government. This is unlike clinical psychology, which is, and it is therefore illegal for someone who is not a clinical psychologist to claim to be one.

The lack of legislative regulation brings with its certain benefits and disadvantages. A benefit is that counselling and psychotherapy offer a broad range of approaches in working with the human mind – arguably broader and deeper that clinical psychology (and clinical psychologists are under no obligation to undergo their own personal therapy!) . However, one of the disadvantages is that it can be difficult for prospective patients to ascertain whether a clinician is really as proficient as they say they are.

Regulation of counselling and psychotherapy in the UK

There are two main professional bodies for general counselling and psychotherapy in the UK: the BACP and UKCP. The BACP is the main register for counsellors and encompasses the name ‘psychotherapy’ in its title subscribing to the perspective that the two terms are interchangeable. If a clinician is a BACP member and not a UKCP member, then it is a fair assumption that they are a counsellor.

The UKCP is the main professional body for psychotherapy in the UK. Members must evidence meeting rigorous training and practice standards. Full UKCP members are psychotherapists.

There is a consultation in process between the BACP, the UKCP and other bodies to differentiate between counsellors and psychotherapists in a way that will be meaningful to the lay person, but as of re-visiting this article in June 2023, this process is far from concluded.

Do you need a counsellor or a psychotherapist?

It can be difficult to work out whether counselling or psychotherapy is right for you. If you are considering the question, then it may be that you are in a period of crisis, such as a life change, divorce, bereavement or are struggling with stress, anxiety or depression, for example.

If you believe that your issue requires a more present-based intervention – meaning that it is an isolated experience and not something that relates to the past or is a repeating pattern in your life, then a period of counselling may be sufficient for you.

If, however, you are concerned about how your past experience affects your present life, you want to address the deeper roots of unhealthy ways of thinking and behaving, and look at how you relate to self and others, then psychotherapy would most likely be better suited to you.

And if you have a history of mental health problems, or a diagnosis, then psychotherapy would be the advisable route to take.

“The unexamined life is not worth living”

The above statement is a quote attributed to Socrates of ancient Greece and is based on his premise that in the face of mortality – certain death – it is incumbent on us all to find meaning and purpose in our lives. This, it can be argued, is the greatest value of psychotherapy.

Freud stated that it was not until a crisis had been resolved that psycho(analysis)therapy begins. Perhaps this is the greatest value that an ongoing process of psychotherapy can offer us all – it is a deep, intimate, ongoing relationship where, through relating with a separate other who is there to hold us in mind, we can in turn establish a calmer and more ordinary relationship with ourselves. A relationship wherein the important questions about being human can be examined. Some see this as a luxury, preferring to be distracted by the mania of modern life; I would argue that with such our limited lives it is essential and it is questionable whether anything could, in fact, be more important.

How to choose the right psychotherapist

When choosing a counsellor or psychotherapist it is important to not only consider how they present themselves, but also evaluate whether they are truly able to work to the standard that the say they are. Most clinicians offer an initial consultation, and this is a time and place for you to ask appropriate questions to enable you to make an informed decision about whether to embark on this important relationship.

All psychotherapists should be members of an appropriate profession body as discussed above. All psychotherapists should be in clinical supervision with at least one supervisor, who overseas their clinical work and ensures that the therapist is working ethically and constructively with each client.

And, whilst not mandatory, ethical clinicians who take their profession seriously will be in their own ongoing psychotherapy so that they too can be emotionally and psychologically supported in their work and lives.

Lastly, it is essential that you ‘feel’ whether you can work with the counsellor or psychotherapist sat in front of you. A therapeutic relationship should ‘feel safe, but not too safe’. What does this mean? You need to feel that you are working with someone who can remain separate to you; who can hold onto their own thinking mind even when you struggle to do so. Otherwise they can end up colluding with you and change becomes impossible. Your psychotherapist is not there to be your friend nor to ‘validate’ the way you live your life. They are there to help you understand yourself and how you operate in relationships with others.

Finding a reputable psychotherapist or clinic

There are many directory websites on the internet that provide lists of counsellors and psychotherapists based on your location. However, whilst these websites may rank well, this in itself provides no guarantee of the calibre of clinician on offer.

Both the BACP and UKCP provide their own lists of qualified counsellors and psychotherapists enabling patients to search with the assurance that a clinician in in fact registered with the appropriate professional body.

You may also wish to consider whether you psychotherapist of choice is part of a clinic like Brighton and Hove Psychotherapy – a ‘bricks and mortar’ organisation who hold clinic meetings, is populated by clinicians working with different client groups and who can cross-refer to each other. There are many directories of clinicians on the web who purport to be ‘practices’; few actually are, so do your research and ask questions!

Lastly, the field of mental health has been identified by ‘big tech’ as a goldmine and increasingly us bona fide clinicians working in physical collegial settings are facing stiff completion from websites purporting to be able to ‘hook you up’ with the most suitable clinician based on your needs. Aside from this being no measure of whether someone is well-trained, ethical and able to clinically work with you, there have been numerous privacy scandals where patient data has been sold or used by other third parties. One of the most basic tenets of psychotherapy is that confidentiality is sacrosanct and this is being violated by these platforms at the expense of vulnerable people.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.

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