Dr Guy Van de Walle, Psychotherapist & Psychologist
Chelmsford (Essex) - Face to face & online - English & French

“What is psychotherapy?”

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​As the word indicates, psycho-therapy is a therapy of the psyche, a Greek word usually translated as “soul” and which refers to the human self. The existence of a variety of theoretical approaches and methods in psychotherapy reflects the existence of various conceptions of the self, its nature, its structure, its ways of being, its needs, as well as the type of issues and challenges which it encounters and how these can best be overcome or dealt with. ​In the context of psychotherapy, “therapy” should be understood in the broad sense of the word: providing a “treatment” means taking care.

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Often misunderstood, the relationship between psychotherapy and medicine deserves to be clarified. One frequently reads that psychotherapy is primarily concerned with treating so-called “mental pathologies”. However, the widespread notion of psychotherapy as a discipline which involves the “diagnosis” and “treatment of psychological disorders” or “illnesses” is incorrect. This amounts to confusing psychotherapy with psychiatry, which belongs to the medical world. The current use of the notion of “mental health” in psychotherapy does little to bring clarity. As with the notion of “therapy”, one needs to refer to the broad sense of this notion (the same with “healing”), as mentioned in the above paragraph.

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“What is the difference between psychotherapy and counselling?”

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Therapists talk about counselling and psychotherapy. This difference in terminology may suggest to the unfamiliar public that we are dealing with two different professions. This is not the case, although distinguishing between the two terms makes sense for a number of reasons. Let me explain.

Historically, the term “psychotherapy” has appeared at the end of the 19th century, first in French (psychothérapie), then in English, to designate the art of curing mental illness. The term ‘counselling’ has emerged much later, not for scientific but for institutional and ideological reasons. In the United States of America, the term ‘psychotherapy’ used to be the reserve of psychiatrists alone. It implied medical training and qualifications. Also, when the psychologist Carl Rogers created the person-centred approach to psychotherapy in the 1950s, the psychiatrists objected to his use of the term ‘psychotherapy’. Rogers then stamped the term ‘counselling’, which allowed him to continue practicing psychotherapy without provoking disapprobation.

Nowadays, in practice, the terms ‘counselling’ and ‘psychotherapy’ are frequently used interchangeably by professionals. However, because of its origins, the term ‘counselling’ remains more closely associated with Carl Rogers’ school of thought within psychotherapy. For this reason, many therapists refuse to treat the terms ‘counselling’ and ‘psychotherapy’ as strictly synonymous. This is often the case for psychodynamic therapists, who trace their tradition back to Freudian psychoanalysis.

I personally have a preference for the term ‘psychotherapy’. I believe that it best describes what I do professionally, which involves offering therapy (care) for the self. ​

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“What is the difference between life coaching and psychotherapy?”

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All those who engage in psychotherapy share a common denominator. They all need to better understand themselves and their lives, to gain a new sense of direction and to change how they think, how they do things and possibly how they live. They need to develop and grow as human beings, and not just heal. Therefore, in every case, the role of the therapist is to provide their clients with the necessary logistical and emotional support which is required to undertake the necessary mental and practical changes. For this reason, without being reducible to life coaching, psychotherapy has something in common with it. Some psychotherapists, like myself, are more versed in this type of work, as reflected by some of my clients’ Testimonials.

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When approached as different professions rather than activities, psychotherapy and life coaching differ greatly because of their ideology, their knowledge base, their skills base and their ethos. Life coaches generally promote a self-management ideology (in which personal development is approached in terms of management, with specific practical goals and ideals to reach) while psychotherapists promote a self-development ideology (in which you are the goal). Both use ad-hoc techniques which are aligned with their ideology (e.g., brainstorming and conscious processing in life coaching, processing of feelings and reconfiguration of the self structure in psychotherapy). Importantly, the self-development ideology which constitutes the backbone of psychotherapy is supported by an elaborate theoretical framework and a sophisticated approach to client work which is rarely found in life coaching stricto sensu. The brief but suggestive comments made in Psychology Today (online) under the title “The Difference Between Coaching and Therapy is Greatly Overstated” usefully complement these views.

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“How do psychotherapists differ from psychologists and psychiatrists?”

Psychiatrists are medical doctors who specialise in so-called "mental health" issues. Their main modes of intervention involve the use of drugs, electroconvulsive therapy (ECT, which used to be called ‘electroshocks’) and, in some cases, psychotherapy.

The word ‘psychology’ is based on the Greek terms psyche (soul) and logos (science, discourse). Historically and in principle, a psychologist is someone who studies the psyche, what we would nowadays call the 'self'. However, as materialism has come to dominate in psychology, the focus has shifted from the psyche to the ‘mind’, leaving the theorisation of the self to the sole psychotherapists. Most psychologists are academics and have qualified with a PhD, as is my case. They usually specialise in one particular area, of which clinical psychology, which overlaps with psychotherapy, is only one (psychologists who specialise in mental health issues are  called ‘clinical psychologists’). In my case, I have been researching the psychological processes involved in human learning and socialisation.

I personally wear the two hats of psychologist and psychotherapist, in addition to the hats of social scientist and historian of ideas.

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“Which therapeutic modality is the best?”

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Psychotherapists often introduce themselves to the public in terms of a particular modality or approach to human psychology and psychotherapy which refers back to a particular theory and its originator(s). To find out what I think about this practice and its limitations, read the page What to Expect.

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“What determines the success of psychotherapy?”

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​This question is vast and complex, as it concerns the entire process of psychotherapy and the nature of this process, but I will keep my answer short and simple by focusing on key points.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For theory to make a significant contribution to the success of therapy, two conditions need to be met. Firstly, instead of relying on the passive learning of existing theories and treating them as doctrines, therapists need to become active theory builders and assessors, namely researchers. Secondly, they would need to be good at it, as research is extremely demanding and challenging, which is why there are so many contradictory theories. Therefore, as confirmed by my experience and client feedback, theory plays an essential role in the success of therapy where the following conditions are met:

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• The therapist needs to be a researcher rather than a passive learner

• The theory needs to be valid and relevant

• The theory needs to be used appropriately and skilfully by the therapist, who also needs to be pragmatic (to work with client’s levels of awareness and potential resistance)

• Clients need to make use of the therapist in ways which trigger the use of theory and, where appropriate, either directly or indirectly, the communication of relevant and carefully selected theoretical components to meet cognitive and practical requirements

Based on the above, my answer to the question “What determines the success of psychotherapy?” includes both the relational and the theoretical aspects of therapy. The importance of the relational aspect is obvious and undeniable. The quality and characteristics of the relationship are in themselves healing and educational. However, the relationship between client and therapist is (or should be) also a working partnership. As a therapist, one of my core objectives is to support my clients’ personal development. This entails fostering greater knowledge and understanding of psychological themes, so that clients eventually develop a more effective map of the existential configuration which they are trying to navigate. To support this work, theory is vital.

As a final remark, it is not possible to discuss the conditions of successful therapy without highlighting the role of the client, whose responsibility is to engage as fully and deeply as possible in the working relationship which is offered by the therapist, and remain committed to this engagement over a period of time, with regular attendance. See the above section entitled “Can I be helped?” for my discussion on client passivity and resistance.​

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“How will I know that my therapy is working?”

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I have listed here some of the most important markers of therapeutic success. This list does not pretend to be exhaustive.
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• The therapy has felt challenging and thought provoking;

• One has unlearned false knowledge and assumptions, and learned new things. New horizons have opened;

• One’s thinking has gained in concreteness and practicality. In other terms, one has become more able to connect one’s thinking with one’s lived experiences and overall reality;

• One has developed a new vocabulary to talk about and describe their psychological life and their experiences;

• One has become more aware of one’s feelings, more inclined to talk about them and more fluent when doing so;

• One has developed a greater ability to make use of one’s feelings, both as a source of information and understanding, and for the management of one’s life;

• One may have also developed a greater ability to make use of their intuition, allowing them to get closer to reality (one’s gut feeling is rarely wrong);

• Correspondingly, one may have lightened their reliance on the intellect, which is too often responsible for building or maintaining poorly grounded and biased mental constructs (the powers of the intellect are overrated in our societies);

• Where applicable, one is feeling better, less depressed, less anxious, less stressed;

• Generally, one feels freer and empowered, and experiences greater agency;

• One will often feel more congruent, in tune with who they really are. They may have also gained a much better idea of what this means, and even journeyed towards being their true self;

• One has become less judgmental and more accepting of oneself as well as of various aspects of one’s reality, generally more at ease and better disposed to face life challenges;

• One will have learned some techniques and principles which one can use as guidelines or rules to apply to one’s thinking and actions. This may concern the management of boundaries, human communication and self-care, amongst many other things.​

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“How long is therapy?”

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Clients sometimes wonder why therapy takes time, why they have to attend weekly therapy sessions over several weeks or even months, sometimes years, why psychological change is not quicker. Surely, once the therapist has helped identify all the underlying issues, they should be able to advise a suitable course of action and ensure that everything gets resolved in a timely fashion. This would be the case if human beings were mere dysfunctional minds which need to be fixed. But, contrary to what some strands of psychology tell us, human beings are not minds and brains, but persons, therefore living entities which are equipped with complex personalities. These complex personality configurations require time to reconfigure and, where relevant, heal. Discovering or rediscovering this basic truth actually frequently becomes a part of the therapy.

In practice, clients usually only make a decision concerning the length of their therapy as they go along. The important thing to remember is that clients are under no obligation to be in therapy for any longer than they wish to be. They are at all times in control of their therapy and can end it whenever they see fit. In some cases, clients choose to give their therapy a pause and resume it at a later date.

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“Can I attend one session and reflect before I commit?”

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Yes, you can. However, there are many reasons why assessing a therapist, especially one like myself, in only one session makes little sense and why one needs to give it plenty of time.

Here, one has to forget the adage according to which first impressions count. In therapy, they do not, or should not. Therapy is a journey, and this includes your appraisal of the therapist and your relationship with them, which are likely to evolve a great deal as you progress through your therapy. The same way that you will progressively view yourself and others differently as a result of therapy, you will also view your therapist and your relationship with them differently.

Also, the therapist’s personality and ways of working can be deep and complex, as is my case. My personality and ways of working are also different from the mainstream. It would therefore be unrealistic to expect that one can give them a fair assessment in only one or even few sessions. To use an image, trying to get a feel for what psychotherapy with me entails in just one session is a bit like trying to get a sense of what swimming and diving in the ocean for several months feels like by merely having a quick bath along the beach.

There are other reasons why a quick assessment is difficult to achieve. Contrary to what some clients expect, therapy is not something that the therapist does to their clients, it is something which they do together, inside a partnership and division of work. The job of the therapist is to accompany their clients on their developmental and healing journey through facilitation. The job of the client is to actively engage in therapy, a complex and multifaceted endeavour indeed. Because of this collaborative set up, while clients are assessing me and how good or suitable I am as a therapist, I am also constantly assessing them as clients,  monitoring my client’s readiness and affordances for therapy. While clients may be waiting for me to do something, I am actually waiting for them to actively engage in their therapy, so that I can play my role of facilitator. How much I am able, indeed allowed to play this role will largely depend on the client’s own characteristics and attitude.

Without going as far as proposing the notion of “good client” to oppose it to that of “good therapist”, I would suggest that the final assessment concerns the development of a “good working relationship” between client and therapist. However, the development of a good working relationship takes time. Not only it is a process, but the relationship may be tentative in the first stages. It is not infrequent for the working relationship between client and therapist to only find itself after a while, maybe after the client has - consciously or unconsciously - readied themselves for their therapy, as some resistances or other psychological hurdles have been overcome.

Finally, clients need to bear in mind that no therapist is a machine. The expressions of the therapist’s personality and their ways of working may be temporarily impacted by their life circumstances, even if they take great care in trying to make sure that their clients are not impacted negatively as a result. A first encounter which happens at the “wrong” time will give a false sense of what the therapist offers on a more regular basis.

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“Why are the sessions weekly? Could I attend less frequently?”

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Significant psychological change relies on continuous processing which can only be sustained through attending weekly sessions. For this reason, I do not usually offer fortnightly sessions to clients who are in the first stages of their therapy, unless a timetable or financial motive justify it. In practical terms, the availability of fortnightly sessions is subjected to the possibility for two clients to alternate.

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“What do you think of CBT?”

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The general public is often misinformed about psychotherapy. This applies also to Cognitive-Behavioural Therapy, or CBT. The decision by the NHS to make CBT its therapy of choice has contributed to its misrepresentation. Nowadays, CBT is frequently seen as the panacea. In reality, its institutional recognition primarily rests on its cost-effectiveness (6 weeks treatments done by quickly trained and low paid CBT practitioners) and its ability to fit within the main paradigm of modern western medicine, which mostly focuses on symptoms rather than the causes or roots of a problem. From this point of view, the use of the term “Cognitive-Behavioural Therapy” is misleading. CBT is not a therapy, as frequently acknowledged by CBT practitioners themselves.

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CBT is not a “talking therapy” and, as such, does not belong to the realm of psychotherapeutic  approaches, although it is often placed amongst these, wrongly in my view. Indeed, it does not entail facilitating the expression and exploration of the individual’s verbalised thoughts and feelings with a view to gain a better understanding of their existential issues. While CBT allows in some cases to reinforce the individual’s superficial coping mechanisms, which explains why some people find it helpful, it does not allow them to deal with what causes them to seek therapy in the first place.
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Some aspects of my work may be reminiscent of CBT. This is because highlighting and overcoming false assumptions and other cognitive biases constitutes an important feature of my practice of psychotherapy. Equally, one of my aims is to promote a more realistic approach to life. However, there is a major difference. The process of education or re-education involved in psychotherapy, at least as I practice it, extends well beyond the cognitive aspect, which I see as constituting only a part of a broader experiential framework. In other words, the focus is not just on reforming how one thinks, but more broadly on revising and opening up how one experiences oneself, others and the world at large.

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