 It wouldn't be about, for example, with aggressive psychotherapy. No. And it wouldn't be about looking at how the past affects the present, even though you might do, I don't know, some, some educative therapy in those, say, 12 sessions, which might look at how the past affects the present in different coping mechanisms. It'd be much more specifically focused on one or two particular aspects of change. Yeah. We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-created conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 67 of The Therapy Show with myself, Jackie Jones and the wonderful Bob Cook. In this episode, we're going to be looking at short-term versus long-term therapy. Yes, that's a good one. This is what you think is short-term therapy. What a great podcast then, because, you know, I do all the assessments and still do at the institute, even though I've sort of semi-retired. I do all those sessions. I always say, if I had to do a percentage of, say, out of 10, I would say probably at least seven or eight, that's quite a high percentage, isn't it? Of them will ask the question, how long do you think it will take? Yeah. And I always say, you know, well, how long is a piece of string? So it's a good podcast we're going to have about the advantages and disadvantages of short-term psychotherapy and I think we're going to have a good discussion. Yeah, me too. Me too. It's one of those things that I always contract right at the very beginning that they'll come for at least four weeks, for at least a month, and then we'll reassess where we are after that first month. And the only time I've ever done short term was when I was training and they kind of come in for a designated period. So it's contracted that I will see them for X amount of weeks. But other than that, they've, there's a few exceptions, but the majority have been long term. That's interesting, isn't it? I mean, in the NHS and the United Kingdom anyway. So the therapy, if you want to call the therapy and some people might not is CBT. Yeah. And if you kind of get CBT thefts in the NHS and with all the cuts, it's not so easy people go on lists. I think the average time given will be trial sessions. Yeah. Yeah, which is for short term. Yeah. And a lot of the insurance companies will designate maybe six to eight sessions. So it's very important for people listening to this to look at their insurances by the health insurances, by the way. So lots of insurance companies don't pay for that. And that's short term again. So a lot of therapy which is designated to different health providers and NHS, of course, the biggest is short term therapy. Yeah. Which is a completely different ballgame completely different ballgame to the idea of long term therapy. And then the other question is what, you know, what constitutes long term psychotherapy as opposed to short term psychotherapy, which is a really interesting question. And according to, I think the therapist you asked that question to will be determining the answer. So if you asked it to me, which because when I when I say when I'm a long term relational integrative psychotherapist, and the person says what do you mean by long term. I will say, at least a minimum of 12 months, more likely a minimum of two years, nearly always answer that way. And before I retired, if you looked at my practice of a probably about 15 to 20 clients, the average will probably be four to five years. Yeah. So I'm very much term myself as a long term psychotherapist. And if we say in for this podcast, minimum one year. Yeah, because it's the psychotherapy bit for me. If it's coaching, it's even counseling, then that's more likely to be short term in my eyes, whereas when you're talking about psychotherapy. I always think of it as long term. It's an interesting one isn't it because especially in today's economic markets. Yeah. And what I haven't said, of course, is that it's weekly therapy. So it's been one year. Weekly. And most qualified therapists are going to charge a maximum of 60 pounds probably. Minimum 60 pounds probably if they're qualified and been around a bit. And so I'm like myself and I kept the prices down because my belief systems are going up a lot more in price. Yeah. So in today's economic world, unfortunately, it may take a lot of people out of the equation. Yeah. I did have sliding scales and I did try to accommodate economic situations. Still it's, it's, it's important to bear in mind. However, for some people who have been so personally traumatized. It becomes priceless. Yes, definitely. Yeah. And it easy. It's how much you're willing to invest in yourself. Yeah. So I'm just finishing off interviewing people for the four year training psychotherapy and, you know, the institute and we've been quite in a dated this year for you want to retrain in that career. And so UK CP training. So in other words, we're an institution accrediting training organization the UK CP rewarded by the UK CP, they put down criterias that we have to follow and which I agree with that while I'm going to talk about now. And it's a four year psychotherapy training program. The UK CP say that there has to be at least 160 hours of personal psychotherapy. And that's 40 hours a year. Yeah, Christmas take away Easter winter once a week. Yeah, if you're going to retrain as a psychotherapist. The UK CP the major regulating body in this country for psychotherapy are saying that you have to do four years. Which of course is expensive itself. But behind that you have to know yourself so you don't merge with the clients. So it's imperative not only for yourself personally I think professionally if you're going to choose that career. Yeah. So they recognize that's what I'm saying the UK CP importance of long term psychotherapy. And as I say I try and make allowances for economic situations, but it will cut out economically a lot of people. Unfortunately, because as I said, if there's been heavy trauma, then long term psychotherapy is really a must and is priceless. Yeah. Which is probably you know when you're looking at the cost of training. You know, that potentially could be the reason why people choose counseling rather than psychotherapy. Well, now you're taking me down a real rose here on me, because I don't know if that correct or not but people who go down the road of counseling for whatever reasons there's to be a lot of different types of reasons. One of them is of course, and I don't know if it is a reason why people choose counseling, but you don't, you aren't designated by the major regulated body in this country which is which is association counseling with psychotherapy. They don't ask for any personal hours at all. Most counseling courses of this, you know, with their salt anyway, will probably require them to have some, but usually it's often only over four years. I don't do four year courses, probably three year courses. Yeah, it's only usually 20 hours. Yeah. And, you know, I know what I think about that I certainly don't think it's enough. No. And, you know, when I know we're going down a different route now this is long term versus short term the topic of this. But when you look at the cost of training as a psychotherapist, you know, the difference in, and I was counseling or coaching or psychotherapy reflects the training that you've had to do over four years and the cost of that. And the ongoing, you know, continuous professional development that the majority of psychotherapies throughout the career. Yeah, so you're right, it's not really off the road because clients will come in and I say I say they've had a lot of trauma, deep trauma. And for us to work healthily and really get to a place where a person can function here and now in a healthy way, you need at least a year or two years of psychotherapy once a week. Now, you know, first again, for most people with that type of specialism, we're talking about quite a lot of money monthly. So we are in the area of people who perhaps what are they left with so they go, you know, perhaps they can go the NHS or, and then it's just really specialized in CBT, they might do what is called dialogical behavioral therapy but that's a pretty long wait on this. So it's a whole area of discussion where economics plays a really, unfortunately Jackie plays a really big part to play. Yeah. So how would you go about doing short term therapy then? Is it structured different to long term? Yeah, very different. So there's a book by Keith Tudor, I mean, we're, you know, we're transaction analysts, I mean, I've gone on to training relational integrative psychotherapy because my basic training is in transaction analysis. There's a book by Keith Tudor, which I quite like, which came out about 10 years ago, which I think it's called brief, I think it's called grief psychotherapy by Keith Tudor and TUDOR. And there's a lot of chapters in that book from well known TA Therbys actually talking about how they would do TA in a brief way. And actually I haven't read it for about four years, but what I do want to say about that is that they all would state, I'll have to go back to read the book but I'm sure they would. One of the really important prerequisites about brief psychotherapy is the contract. And secondly, that is very specific. Yeah, that's what I was thinking then that it needs to be specific and have an end goal and a definite route to that as opposed to being, you know, adaptable and free to move around and yeah an open ended contract definitely. So, it wouldn't be about, for example, aggressive psychotherapy. It wouldn't be about looking at how the past affects the present, even though you might do, I don't know, some, some educative therapy in those, say 12 sessions, which might look at how the past effects present a different coping mechanism. It'd be much more specifically focused on one or two particular aspects of change. Yeah. In the here and now. Yeah, and solution focused rather than explorating, explorating exploring. Yeah, very much so very much so so you know how to stop smoking, for example. Yeah, much more specific. Like you've just said solution focused. Yeah, and specific outcomes to it. Yeah, which are measurable that's why the the NHS usually uses CBT because they say it's measurable you answer a questionnaire when you first go and you've answer on when you're finished and then they can measure whether it's working or not. And then you've got all these different diagnostic methods like core nine ICD nine DSM for whatever way you want to look at it with core nine or is it core 10 or even core 11 now, where they, they, they do what you've just said, and put the answers to the questionnaires on the computer. And they, after every session you fill in a computer process, you know, hold. So at the end of the 12 sessions, whatever it is, you can match how you've gone along behaviorally, the seeding outcomes so there's a whole structure around it. So that's very, very different animal to long term psychotherapy with a relational integrative psychotherapist for example or perhaps even from another desk discipline. It's very much developmentally into a person's past and looks for where the, you know, the deficits are there and where the trauma is and looks at the healing from a past developmental position, while they're staying in the here and there and looking for behavioral outcomes. And that word relational as well, you know, when you're in therapy long term is, you know, the relationship the therapeutic relationship plays a big part in it, which I would imagine if it's short term and solution focused and structured. There's not really enough room to build that relationship. Yeah, and there's not a focus on it. No, yeah. Yeah. There will not be much of focus on what in psychodynamic or long term but you know processes. Transplants or counter transplants there won't be a focus on our on this short term cycle therapy. Yeah, it's much more focus on, you know, change of, you know, behavioral focuses. Yeah, in the here and now. So, if I took you to a short term CBT therapist, you'd be doing mood diaries. Yeah. You know, how things have changed week to week in terms of thought patterns or things which are very solution focused. Yeah, unhelpful thinking styles is one of the ways that we think about things. And they're not useful. They're just, it's a very different structure as I used earlier on a different structure, a different focus and the two therapies. Yeah. And, you know, I, I sound like I'm very skewed towards the long term but that's because that's what I, you know, I was changing and that's what I do. But for some people, short term therapy is enough and it's what they want, you know, if they're leading busy lives and they can schedule it in once a week for eight or 12 weeks and that's it. And it is solution focused and it's moving in the right direction. That's, that's brilliant. And money comes into it. Yeah. Yeah. And also change can happen, I think. Yeah. 12 sessions. Yeah. If you never talk to anybody at all about some of your unhealthy patterns or things which are causing you real difficulties in life in terms of mental health, talking to somebody for three months in itself. Yeah. Yeah. Because, you know, I've had one client quite a few years ago that came for four weeks and totally transformed her life. Yeah. That's the one that sticks out for me. You know, it wasn't the intention. She didn't come for short term therapy. But after four weeks, she had literally taken on board everything and got so much from it and completely turned things around. And they developed, I suspect, different coping mechanisms. Yeah. Yeah. And also on the same level, short term therapy, and I'll put that in inverted commons here, can often be the bridge to long term therapy. Yeah. So I, somebody came in for assessment, I think about four weeks ago, and she said, I said, have you had any therapy or counseling said yes 20 years ago. I said wow, she said it was the most wonderful thing I ever did. And I said how many sessions did you have. She had six sessions. But she said it changed her life because she never talked about these things, which had hurt her so much. And she never experienced a kind person before. And that stuck in her mind and gave her the impetus to come back after all these years to take this further. Now 20 years might seem a long time and certainly isn't one level, but another level, psychological time and real time isn't the same thing. No, no, definitely. Yeah. Sometimes I think I'm still living 20 years ago when I realized it's 2022 it's like wow, what it does 20 years ago. So yeah, I can I can imagine. And it is if it's a good experience if somebody leaves after four or six weeks with a good experience it just stay with them. Oh, absolutely. Well, I've just told you there's happened many times, maybe not 20 years ago, but they say, you know, five years ago I managed to talk to somebody and they were very kind to me. And I've always remembered what and that's been the motivation to come back at this particular time when things are in this phase of my life are particularly difficult. And that's the other thing, you know, having short term therapy life throws as a curveball. So what you went for originally for the therapy isn't necessarily what you would go for again because you know marriage divorce death it's always out there and sometimes people just need that safe space to talk to somebody. So I think 100% that is really so true that people have different phases in their lives they have different curveball, you know as you say curveballs in your life. And also, as they've got older the discomfort gets higher because the defenses get more weaker in terms of funerability. There's no place in their life where they because more of a survival level, and also people say to me, you know, I'm now 40 or 50 I've got more money different phase in my life, and I would like to take it further. Yeah. So I think short term therapy can be a very useful and can be a bridge to, you know, if it goes right. Yeah. Of course, if it goes wrong, we've got another story. Yeah. Yeah. And that that to me is where the relational part of long term therapy comes into it because you would, you know, talk about that in the therapy room. Whereas, you know, we've we I don't know with short term therapy I've got it in my head that there's no space for the relationship because it's it's fast paced. You know, you've you've got a plan I would imagine in every, every session that you're doing this is what we need to cover this is where we're going. I think you're right. In terms of the relationship is not the focus. Yeah. But when I think of the people say to me, you know what I remembered about those four sessions, all those 10 sessions is the kindness. Yeah. You know, it can also remember the relational aspect, even though it was short term, and it might not have been focused on, but it stayed in the mind of the person. Yeah, which is the important thing the client is the focus of it. Yeah. And as long as they're getting what they need from it then who are we to judge what they need. No, and another aspect of this I just like to bring in is that I've heard this so many times from people. I do an assessment with somebody who talks about tremendous trauma in their history, although presenting a fairly chaotic way and obviously you can see some some earlier disturbance. And I say to them, and it's usually the question from how long do you think I've been therapy. And I say well, with your level of trauma and what happened to you and how you're presenting. This isn't going to be short term it's more likely to be a year. Quite often you know Jackie, the person says well I actually know that. Yeah. The level of trauma level of confusion, the difficulties, which they're talking about, they know that that won't be resolved in 10 sessions. Yeah. So that often the people themselves know what they want. Yeah. And there are those people you know I'm an exposter care and I know for a fact that one of the, the children that we had was very reluctant to go back and look at the things. Oh, well yes. Yeah. Some people don't want to. They know that the past is impacting and affecting their presence but it's not somewhere where they want to go back to relive or to explore or experience or anything. It's in a box and it's shut and I'm not saying at some point that won't change, but there are people that are fearful of looking at the trauma. I think there's a lot of people and then there's some people who really know for survival reasons that they have to do that. Yeah, yeah. And you can't really do that in six sessions. No, no, and sessions, and the person knows themselves. Yeah. You know, the importance of going back and doing the trauma and debriefing that, you know, and unpacking that and some people obviously don't do that but there's many people know they have to do that. And that's that style of therapy and I think there's a lot in that for helping people being particularly disturbed in life or even haven't in the sense of helping the person reflect and develop emotional literacy so they're able to, you know, look at different things in their lives and get to understand themselves although we're talking about here. Now, if you can, if you're going to try to be professional therapist, you need to do that. And then, and I don't get the this many through minus you don't must say because I suppose because there's a psychotherapy and maybe they think of therapy as more in depth and counseling but you, you know, so I don't get many of these type of people who only want 10 sessions because they've come to me, but or stroke and if I thought it only was going to take six to 10 sessions, I would say that. Yeah. And I'd pour them to a therapist with that actual contract if you like that the person's coming for 12 sessions they only want to specifically look at this. They want these behavioral changes and they don't want to have a long term therapy or are you able to take this person on board. Yeah. So that then would determine the contract. Yes, yeah. So the contract needs to be transparent and really clear. And the contract is vital because I have had clients in the past that literally just want to come once a week to offload. Yes, yeah. They're not looking to work on anything. It's just a safe space where they can talk about work family relationships whatever's happened in the seven days and literally offloads go away and are quite happy till the next week when they come back and they want to offload again. That's true. And one caveat in this is to not discount yourself. See, I think people, your answer is correct, but it needs to be to the specific person. Yes, yes. That's where relational psychotherapy comes in. Yeah. Can't just be with anyone. No, and I'm not saying that we didn't do some work in that. Yeah. I think their initial contract was just to contract the important thing. Yeah, to come in and to talk with somebody that knows nothing about their life doesn't judge doesn't have an opinion and save person. Yeah, just talk about anything for 50 minutes. Yeah. I'm not saying that I'm not saying you do this jacket at all, but know that many therapists do do well I'm going to say they discount their importance to that person in the relationship. Yeah. And they just don't necessarily talk to anyone. No, no. They talk to people they trust they talk to people that feel safe with they talk to people who can come from a place which is non judgmental. And it needs to be a good fit, whether it's short term or long term, it needs to be a good fit between the client and the therapist. Yeah. And what you said about review to see how the person's getting on as they go along and yes they may come for short term cycle therapy which was much more specific, much more solution focused, much more behavioral. And that's fine as well. But as long as the person knows what they've signed up for. Yeah. Yeah. I like, you know, the way that I do it because it was how I was trained is that, you know, you can recontract because often what the client comes for originally isn't necessarily what comes up in the sessions. And I find it, you know, really important that we recontract every so often to see whether this is still, you know, what they want to be doing. No, I certainly agree with the sort of longer term contracts like you've just said and being reviewed and a session agreements as well. Yeah, just has that level of transparency. And also, people know what they're signing up to. Yeah. And I think one of the accusations often thrown at long term psychotherapist is exactly we're talking about here that therapy just goes on and on and on and on. And there's no contract if you like. Yeah. And the criticism that I've heard from certain people that I've come across in my career do hypnotism and, you know, NLP and things like that is that, you know, we don't actually, I want to use the word cure people because that was what they do. You know, and it's just ongoing emptying of a bank account and not actually achieving anything and it's like well you've never had therapy then. You've not experienced the changes that take place in a therapy room. Absolutely correct. And those types of people often feel threatened by the way. Yeah. And those types of people, you know, have also have may have a good point in the terms of that the therapist hasn't may not been transparent and hasn't had contracts and isn't working towards possibly changing all things we're talking about. But it is a criticism of a phone at long term psychotherapist. So I do think it's important for long term therapist to have reviews and contracts and work within the relationship towards positive growth which is talked out between the two of you. Yeah, and not just going on. Yeah, any type of spelt out goal between the two of you. Yeah, and I like the word that you've used throughout this which is transparent, you know, it needs to be transparent. The client can talk openly about how it's going and whether they want to continue. And you know, talking about short term or long term, the ending of therapy I think is really important as well. Yeah, yeah, yeah, very much that's contracted and you know, transparent as well. Yeah. So it would not be a very good short term therapist. I don't think I was because I was trained in in long term. I don't know I've never gone down that road. So it's probably a bit discounted myself to say that, however, I'm very happy I chose the road of a long term relational psychotherapist I think it's demands that you've done a lot of psychotherapy yourself. It demands a lot of a lot of aspects and differences and say short term psychotherapy. However, I'm glad I've gone down that road. And then I've talked to many people, by the way, the CBT therapists trying to call them therapists, I think it's, I think it's an odd word because we'd have to talk about what therapy is but anyway, you know, CBT therapists or people that offer short term insurances or whatever it is, who really are pleased that they have been short term psychotherapist because they don't want to, you know, go down the road of looking at regression and counter transfers and they're happy to focus on behavioral solution focused where they can see behavioral change quicker. Yeah. So I didn't go that way but there are many people who did and I think there are advantages I said that the early part of this podcast. And, you know, people choose that route and for me that's fine. And if they then go on to look at other things that's fine as well. Yeah, 100%. And, you know, you said you'd experienced it and I certainly experienced it that, you know, some clients do come in with a view to long term and after four or six weeks they've got everything they want from it and they're quite happy to end at that point. So, you know, I always say you're not signing your life away. It's really not signing in blood and you've got to stay for two years or anything. And that's very refreshing to hear because it's very important that the therapist respects the autonomy of the person in front of them and says that's fine I'm glad you've got what you've got and if you ever want to come back, that's fine also. Yeah. And some of my clients have they've ended and then two years down the line they've got back in touch again and something else has happened and can I come back again, which is absolutely fine. Yeah. So that type of transparency, respect, sense of integrity for the autonomy of the client. It's so important in our work, whether it's short term or long term. And, you know, I think it needs to be said, I've not experienced counselling, so I can't say but, you know, there's an awful lot of therapy takes place outside of the therapy. Oh, it's not 15 minutes that, you know, we spend together. There's a kind of osmosis that happens the rest of the time. Without a doubt. Yeah. Brilliant. So we'll end it there. Yeah, I think it's a good place to end it and it's a, it's a, I could go on talking about this another half hour but it's a good place to end with the respect, I think, an autonomy of the client in front of you as a barometer for change. Yeah. Yeah, 100%. But I wouldn't change the psychotherapy that I've been trading. No, that's a path I talk and other people take other paths and they do. Fantastic job. Yeah. Job as anyone else. I know short term purpose is a fantastic job. So it's, you know, it's horses for courses and as long as we respect the autonomy of the person in front of us, then that's really the problem for our professional careers, I think. Yeah, definitely. Okay, until next time, Bob, we're going to be looking at habits that therapist needs to cultivate to enhance the therapy. Yeah, and you know something I was talking to somebody's been a therapist for 30 years about 20 minutes ago and she said what happens. You know, those things that you do every day with your clients, which enhance the relationship and build up the race. Oh, and then she listed off about 20. So I'm looking forward to discussing that. Okay, until next time, Bob. Yeah, bye-bye. Bye. That was a great episode.