 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast, with Bob Cook and Jackie Jones. Welcome to this next episode of The Therapy Show with Bob Cook and Jackie Jones and we're going to look behind closed doors and what happens in the therapy room. And in this episode, we thought we would look a little bit about how to find a therapist. Whether there's a good therapist or a not good therapist, the different types of therapy, what's it all about? Over to you Bob. So one of the things that I often talk about is the therapeutic relationship to me is up at the top of the list. I don't know what your thoughts are on that. Well it is up at the top of the list. I agree with you. Good. I agree with you on that. I'm not disagreeing with you on that. And for people who want to come to therapy, I'm not sure if they think about that. I think people come to therapy because they're driven by the discomfort in life. Yeah. And I'm not sure they think, well I must go to the therapist and have a good relationship with them. I'm not sure about that one, but I do know they're usually driven by the discomfort in their own lives. Sometimes they're told to go, which is I don't think is a particularly good way to go. Sometimes somebody might say, well you need therapy like somebody came along and said that to me and I went, obediently went to therapy, but it was driven by my own discomfort. And I think that's what takes people into the whole world of looking for a therapist and a counsellor because their life is so painful or discomforted to them. They wanted to change that. I'm not sure, Jackie, if they actually think, well, you know, the method is going to be, you know, like what you've just said, we must seek somebody who's got a very good relationship. You see, I think that's more in the world of the therapist or the counsellor themselves because they've been trained that way or yeah, usually it's because of that. I don't think there's so much about that from the client's perspective. See, the reason why I asked that question is because I hear a lot of people saying, I've been to therapy before, I've had counselling before and it didn't work. And, you know, for whatever reason, and it kind of boils down to the fact I didn't like the therapist. They poo poo the whole of therapy because they didn't like that person. Jackie, that's a different question. That's right. If someone's been before the counselling of therapy and they don't get on with the therapist or counsellor and therefore it doesn't work, I can easily imagine them saying that to you. And of course, they've said that to me many times. That's a different. However, if you talk about the first time somebody ever goes to therapy at counselling, then I think it's a different story. Yeah. And so following on from what you said then, what's your thoughts around people waiting for a crisis before they go to therapy or the idea that we should all have a therapist? And my fantasy is in America, everybody has a therapist of some description that they go to. It's a matter of course. But in this country, often we wait for a crisis before we access. Well, there's two questions there. I'm going to take the first assumption, which I don't think is true. So I'm going to, sorry, I've going to blow your fantasy about Mocha. I actually believe if you go down to many, many of the deprived places in America, whether it be from the lower ghettos, whether it be in the Bronx of New York or whatever, they have no more, they might, they might wish to have somebody talked to, but they have not got the money to be able to afford a therapist. They're so poor, they're not able to even think about the, the ability of therapy. And they may look at this sort of rich affluent New Yorkers or the liberal right or left wingers in California. And I don't know, but they haven't got the money for therapy. In fact, if you look at, and this is a political way we could go down it, but look at Obama Barrack's idea of extending healthcare into all areas of the American culture and look at where Trump took that and how much he denigrated that whole process because of the how much it costs went into another whole political story. But I do know there's many, many, many, many, many swathes of people that America could no longer afford therapy in the counseling and fly. So your fantasy about, I think, is quite centered on the people who can afford therapy. Yeah, quite possibly. And then it's openly disgust. And that's a different story. Yes. I think, I think, you know, the idea that all, all actors have got money and people in the liberal right or left wing in different parts of America who have got that type of money, that I think your fantasies holds water a lot more. So I think, again, America's the have and have nots. So the have people, therapy is much more popular, it's much more accessible. It's talked about as a way of dealing with mental health problems in a much more accessible way than the United Kingdom. Yes, but I did mention America then, but I would imagine the listeners will be thinking that that happens over here as well, that there is a have and the have nots, you know, and often therapy is seen as a privilege or an expensive thing to do. Same problem, isn't it? I think it's more acute in America, so differentials are much bigger, a much bigger country of 500 million people, where there's 67 million people in the United Kingdom. But at a macro level, the same problem. Yeah, the underclass of the UK can't afford it. I, you know, I run, or the Manchester Institute runs a low cost clinic where we subsidise people to be able to come 15 pounds, those people under 14,000 pounds. And there's such a large outcry of it, but in general, people haven't got the money. But let's, let's go to your second question, which is much more around, you know, well, we could send the first question, let's go to the same question, which I think is therapy is much more popular nowadays. You know, when I first went for therapy in 1983, it was not as popular as it is now in the United Kingdom. It wasn't as accessible it was now in the United Kingdom. And it was much more of a taboo, wasn't discussed. 2021, we have a different situation, but it's still for the middle class, I believe, unfortunately. Yeah. So going on from that, the other question that I said was what's your thoughts around, I know what you were saying, what brings people to the therapy room. But would you say that most people come because of a crisis? Because my thoughts around this are that when people are in crisis, you're dealing with an awful lot of emotion and, you know, everything's quite traumatic. So for them to, to fully engage and to hear and to connect can be quite difficult if they've been through a trauma, if there's a sudden death or, you know, whatever it is. What are your thoughts on if people went to therapy, when things were okay? I think it would be marvellous. Me too. I'm glad we agree on that one. It's not the case. No. I think I've said to my trainees, I've said to many people, look, you know, the best time to come to therapy is when there's not a crisis in your life. And then you're going to be coming far more from the here and now to be able to deal with some of these processes. And your defence systems may not be so entrenched. However, very rarely does that work. Bob with you, there's always a however. I remember that from my training, however. It doesn't really work out that way. Most people I know wait for a crisis. Yeah. So very rarely, very, very rarely do I have somebody who comes in and says, well, actually, you know, I feel I'm in good state now. So I feel able to talk about therapy. Occasionally that happens. And I say, Bravo. Usually people wait for a crisis or a stage in their life, which they find so excruciating, painful that they turn for help. Yeah. But you're right. If people could come from a different place where they can say, oh, right now, I'm feeling okay. I think it's a good time to look at the trauma in my life that I've had or, but usually people say, and I think it is most unfortunate, Jackie. Most people say, or a lot of people say, oh, I'm feeling okay now. So we'll just carry on in life as it is. Yeah. And I can remember, I'm not sure whether I've said it to you before, when I was doing my training, I actually said, go, this is really depressing. Can we not have some good news? Is there nothing good in any of these books? And you quite rightly said to me, people don't go to therapy when everything's going okay, we can spend a full weekend if you want to, Jackie, on all the good stuff, but it won't be any help to you when you're seeing clients. And unfortunately, people will come to therapy in the main when there's a crisis. And we can go on from there. So we've kind of covered a little bit about what brings people to therapy. I'm very, you know, protective of transactional analysis because I do like it. It fits well with me. I like, as we've discussed before, I like diagrams, I like structure and it fits really well with that. But there are a zillion different types of therapy out there. And as a therapist, I'm confused by them. So, you know, for somebody that's scrolling through Google looking for a therapist, how would you advise them to pick? Well, let's just start at the beginning. You're right. Most people come to therapy, I think it was a crisis. And most people want to get healthy as quick as possible. Yeah. So they don't want to spend endless time in psychotherapy or endless time in psych analysis five or six times a week, whether they're spending 300, 400 pounds a week or whatever it is. They want to get cured. If you like the word cure, which I'm not sure I do. I saw a certain healthy as quick as possible. Yes. Within one session, please. If not before. And unfortunately, from fastest to do with psychological and emotional problems and not like, oh, I'll go to the doctor's got earache, I get some tablets or I get some optimize or whatever it is. And I put it in two times a week. And my ear or the infection in my ear gets treated pretty quickly in two or three days and everything's hunky-dory. That's not how it is with emotional psychological problems. Otherwise, people will never come to therapy. So that's where I think most people come from. They want to be cured as quick as possible. The truth is that's not possible particularly. So what have you got in the UK? We have what is put forward by the government as a panacea for all illnesses and believe it or not, very, very quickly. And that's cognitive behavioral therapy. Now, usually if you're very fortunate, you might get up to about 12 sessions of what we call CBT and as is sold on the packet by the government, that should do the trick. Now, in my business, we get many, many, many, many, many people who have CBT and actually it hasn't worked or they haven't got better because it doesn't deal with the past. And it doesn't deal with the emotional world of the past. And it doesn't deal with trauma. And it doesn't deal with depression. It deals basically with invasive thoughts and behaviours which you might be able to change from the distorted thinking. OCD is not too bad with. But for most of us, we need a therapy that deals with the traumas of the past, I believe. Yeah. I always say that it's kind of solution focused. This is a problem and I want to move forward. Okay, so this is how we do it. But often with clients that have come to me, they just move that into a different area of the life. So it's kind of like if I'm straddling in work or whatever, you sort the work stuff out. But then that same issue will move into a different area because of all the background stuff. That's often what drives our behaviour. Absolutely. So to answer your question, I think it's going to be very hard to cure somebody in six sessions, 10 sessions, 12 sessions. You might be able to help somebody deal with different coping mechanisms. Yeah. And you might be able to help people with different behaviours. But whether those behaviours stick as another story, even if they are the right healthy behaviours. And if we are going to help people get different coping mechanisms, whether we can do that in 10 to 12 sessions, I'm not so sure. Unfortunately, again, NHS, if a lot of people turn to, will only give you about if you're lucky, six to 12 sessions, and you might have to wait a year for that. Yeah. So hence why people turn privately. One, because I believe they want more than CBT offers. Secondly, they want to get cured quicker, but they want to deal with the emotional past. And thirdly, often CBT hasn't worked. Yeah. And, you know, I don't want to slate CBT because I think it has its place. It's a good start. Do you know what I mean? And there are some people I would imagine that that works fine. My issue with it, if I do have an issue, is that people who go through the NHS and use CBT and it doesn't work, have then got, you know, a belief that therapy doesn't work. It doesn't work. It won't work for me. It's rubbish. And it's about finding a different type or a different person. There's so many nuances to getting a good fit with this. And I always say to be, if it doesn't work first time, move, go to another one. You know, don't stop therapy altogether. It just means that that bit didn't work for you. Don't give up on it. Couldn't agree with more. So you're right in the, there is about, I think in the latest Wendy Dryden book, looking, compared to therapies in the United Kingdom, there's about 700 different types of therapy, but you can put them honestly. Yeah. You can put them to different camps though. You can look at the therapies that deal exclusively with behavioral change. You can look at the therapies that deal exclusively with cognitive change. You can look at the therapies that deal exclusively with spiritual change. You can look at the therapies that deal exclusively with physiological change and you can look at the therapies that deal exclusively with emotional change. So you can start splitting them up into different camps. Now I think that actually integration is probably the best process where we're looking at integration or change and also I think looking at how the past affects the present is what a lot of lots of people in my clinical practice want. Yeah, yeah, replaying the same behaviours and kind of bringing all that stuff with them, yeah. Of course, there's some counselling or therapy people might turn to a bit more specifically, so if they've had, you know, someone die or bereavement where they got stuck on the bereavement cycle, they can't handle life or their own function very well, they'll turn to somebody specifically for bereavement counselling, for example. If they've got eating disorder issues, they might turn to a specialist for eating disorder counselling, you know, so there are specific specialists you can turn to. But if you're talking about generally looking at trauma and how the past affects the present and developing new coping mechanisms and making new decisions to take charge of your own life, I think it's more around psychotherapy which looks at how the past is played out in the present and then going from there. So moving on, again, I think it's quite relevant in where we are at the moment. How do you rate face-to-face versus online or telephone therapy? I've even heard that you can have therapy via text message now. Yeah, you can have therapy via text message and it's actually quite popular or get more popular and also email therapy and Zoom therapy and Skype therapy. You can even get specific therapy for people who lose their phones, for example, over email. I shouldn't laugh at that. No, no, no, you know. So social media has taken over a lot of the way we communicate and, you know, in life generally you've got LinkedIn, Facebook, all sorts of things, Instagram and goodness knows what. So it makes sense that of course psychotherapy or some of the healing mechanisms, especially in a pandemic like this, Zoom was better than nothing. I also believe some of these other online therapies were better than nothing. Now, once we come out of the pandemic, do I believe that face-to-face therapy is better? Well, I'm not sure what you mean by better, but in my view it's more authentic and more holistic and brings different dimensions. So I'm somebody first face-to-face, though I understand Zoom might be useful for people who find therapy inaccessible. In other words, they live a long way away from the therapist or there's geographical things to be taken in consideration or people who find it less shameful or they find Zoom easier to handle for lots of different reasons, less anxiety, less stress. Do I email therapy? I don't mind all these therapies to people, you know, have them as a first port of call to reach out to, like Samaritans, for example, which a lot of people would, but as a long-term ongoing therapy, I think that there's nothing more potent or powerful than face-to-face therapy. Yeah. I like face-to-face. But like you said, it's quite restricted in a way, you know, and for a therapist or a psychotherapist who lives in a little village, you know, it's quite difficult. And the other thing that I think is worth mentioning from our point of view, there's an awful lot of, you know, rules and regulations that we need to adhere to as psychotherapists that... Yes, that's true. You know, word amount is a wonderful advertisement, but often that doesn't work for us because, you know, if we're seeing one client, then is it appropriate and ethical for us to see other members of that family or somebody in their friend's circle? So it can and narrows down. Yeah. And do you remember I said that there's at least 700 different types of therapies? So therapies, I mean, so Zoom, email, counselling, all these different types of social media, counselling, stroke therapies might be more applicable. For example, people who want to deal with cognitive change or people want to deal with behavioural change. I think the more problem comes if the people want to deal with emotional changes. And I think personally, again, they need to have an authentic relationship where they can get some actual reparative healing that isn't so easy on social media outlets. Yeah. See, again, touching on that, I know this is probably going and I'm going to write it down as I speak, because I think the next episode of the podcast, we're going to look at assessments. But do you think people know what it is that they want help with when they come to therapy or is that unpicked? I don't want to be patronising to the viewer, the reader here or the listener at all when I'm going to say this. Most people think they do and actually don't. But that was when you were saying it's whether they want to change emotionally or whatever my instant thought was. They probably don't even know what they want to change. They know they're in pain. Yes. They may feel depressed or to the level where they just feel as a black hole and they don't know how to function. Do they know what's wrong? Probably not. So then it's up to the therapist to be able to look and help the person beneath the actual layers so they can actually get some peace, harmony and healing. Is that better face-to-face? I believe it is. However, I understand all the necessities for social media in terms of therapies. But once again, I think for cognitive therapies, even behavioral therapies, some spiritual therapies, I was thinking of meditation and yoga and all these sorts of things. Soon we could argue it's pretty fine. But if we're then going to talk about emotional change and healing from trauma, I do think talking to somebody in front of you is more positive. And I am sure we will come back to this topic throughout. It will weave in and out of the next few episodes and beyond, no doubt. So I'm going to bring this one to a close. The next one is going to be around assessment and what happens behind closed doors in the therapy room. Yeah, and just to sort of end, you see, we're very nice. I'm in a Zoom in Didsbury and your Zoom and I can't quite remember where you're there. But it's very nice if when we end this, we're both going to have a cup of tea in the real world face-to-face because there's an emotional connection. 100%. Yeah, so I come down on the side though, I understand the use of social media for other outlets. As you said that, Bob, something happened in me and I'm not sure what that is. Maybe I need to take it to therapy. But I think the difference between me and you is because I've been in a room with you, sat next to you and I've touched you and felt you. I've automatically got a connection with you. You've got that memory. Yeah, yeah, and you're my constant object. I've brought you into the 2021 with me. I understand all that. It's a wonderfully interesting discussion we're having here. So I've got to come to a close. But the next one is on assessment and how we choose a therapist in terms of that whole process. So that will be interesting again. 100%. Because it's unique to all of us, just like we're all unique individuals. We're unique psychotherapists and courtes and all that malarkey. Right, so I shall see you on the next episode, Bob. You will all look forward to that. Thank you. I resume from our different rooms. Bye. Bye bye. You've been listening to The Therapy Show, behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.