When Coping Stops Working

Over the years, I have thought a great deal about what brings people to therapy. My sense is that people usually come when whatever they have been doing to keep their emotions in check, even minimally, becomes harder to sustain, or can no longer be maintained at all.

Others return to therapy to keep learning about themselves, to work through a particular situation, or for what might be called maintenance. Whatever the route, the common thread is emotion: feeling too much, feeling too little, or being unable to make sense of oneself or one’s behaviour.

I work with the full range of emotional difficulties, including depression, anxiety, life transitions, low self-esteem and anger, as well as more serious conditions such as bipolar disorder, schizophrenia and eating disorders.

Being Heard

Therapy is not one-size-fits-all. Different therapists understand people in different ways, and how a therapist understands you will shape how you experience them. That is worth knowing before you begin.

Therapy is also a particular kind of relationship. For the work to be effective, it needs to feel safe and productive for both people. This is sometimes called “goodness of fit”. If either of us feels the connection isn’t there, it is better to address that early.

At its core, understanding begins with listening: to what you say, and just as importantly, to how you say it. Everyone is capable of listening. A therapist’s skill lies in the acuity of that listening, and in what they make of what they hear. Many people come to therapy precisely because they have never felt truly heard, or were not listened to at important times in their lives. Being heard and taken seriously is a vital source of wellbeing, however small it may seem.

Over time, I build a working picture of what is happening for you, drawing on my training, checking it with you and refining it as I learn more. The more accurate that picture becomes, the better I can attend to what matters most to you.

A Psychodynamic Approach

I work broadly psychodynamically. I find it the most inclusive and accurate account of how complex we are as people. My thinking draws on psychoanalytic writers, old and new, and on contemporary neuroscience, which together continue to deepen our understanding of the mind.

Psychodynamic work takes seriously the idea that our earliest experiences matter most. They lay down emotional blueprints that we tend to follow for the rest of our lives, unless something helps us notice and change them. This is not simply a theory: research in neuroscience has, by its own routes, come to strongly support the lasting importance of early life.

One body of research I keep firmly in mind is the work on Adverse Childhood Experiences, or ACEs. These are potentially traumatic events in the first eighteen years of life, such as abuse, neglect, witnessing violence, or growing up in a household affected by addiction, mental illness, separation or imprisonment. Large studies have shown that the more of these experiences a person has had, the greater their risk of difficulties later in life, both emotional and physical. ACEs are not destiny, but they help explain why patterns laid down early can be so persistent.

None of this makes therapy pointless. It does make it a challenging undertaking, because therapy usually arrives after the tracks have been laid and travelled for many years. That is why people often come when an old way of coping begins to fail: when someone recognises that the drink no longer brings the safety it once seemed to, or that a guardedness which once kept them from being hurt is now leaving them isolated.

Psychodynamic work is relational in every sense. It attends both to your relationships with others and to your relationship with yourself.

What Sessions Are Like

Most people, especially if they have never had therapy before, feel nervous in the first few sessions. That is understandable, and I expect it. Stepping into the unknown with a stranger is not easy, particularly if trust has been let down by others before. With time, people tend to settle as the therapist and their way of working become familiar. Sometimes the suffering is so great that it overrides the nerves altogether, and that is fine too: therapists are trained to receive strong emotion, just as a doctor is trained to receive physical pain. For many people, the nerves give way to relief, sometimes by the end of the first session.

Above all, therapy offers a safe, contained space, free of judgement. A therapist is not there to be your friend, or simply to be kind and reassuring. A better image is an experienced mountain guide who climbs alongside you: someone who has been on similar mountains before, in their own therapy and training, and with many others. Knowing their own experience intimately is what allows them to relate to yours in ways that matter.

How Therapy Unfolds

In the first session, we talk about what brings you to therapy, and why now, at this point in your life.

You do not need to know exactly why you are coming. Some people are in emotional pain without knowing why, or when it began, let alone what to do about it. You are just as welcome. Either way, I will soon get a sense of what is happening and begin to share my understanding with you. That starts an ongoing, back-and-forth process of understanding, aimed at relieving what brought you to therapy in the first place.

For the work to be effective, sessions are ideally weekly. At certain points, I may suggest twice weekly, but that is always decided case by case.

Therapy is not a quick process. The brain has some 86 billion neurons and many trillions of connections between them, and no therapist has a crystal ball. Therapy is a process of learning that takes time and investment. But it is one of the few approaches that can genuinely bring life back to the life of the mind.

When Medication Is Needed

Psychologists do not prescribe medication. When medication may help, I work closely with psychiatrists through a referral network in Portugal. GPs can also prescribe, but I prefer to involve a psychiatrist because of their specialist knowledge.

Sometimes a person is suffering so much that the overwhelm prevents them from taking any constructive step towards relief. To the people around them, this can be bewildering: why can’t they do what seems so obvious? But depression and other serious conditions affect the whole body and mind, and in those moments the obvious can feel impossible. Here, medication prescribed by a psychiatrist can do some of the heavy lifting, creating resources the person could not muster on their own. As it takes effect, people often notice small but important changes: being able to talk in therapy, going for a walk, returning slowly to the gym.

For some conditions, medication is an essential, long-term part of treatment. But medication works on symptoms. Talk therapy works on the root causes, the patterns that produced the suffering in the first place. That is why I see medication as a support to therapy rather than a substitute for it, and why I would not want either to take the place of the other.

Please know, too, that the decision about whether to take medication is always yours, and I will never force it on you. Where it is safe to do so, I generally prefer to begin without medication, to see whether we can reach the root causes of your distress through focused, collaborative attention to what matters most, including things that may never have been looked at before.

If you take psychiatric medication and are thinking about stopping, please speak to your prescribing doctor first. I have written more about this in Please, Whatever You Do, Don’t Just Stop Your Meds.

If You’re Unsure About Starting

It is natural to hesitate. Many of us find it hard to trust others, therapists included, and someone can want help while still having real reservations about the process. Uncertainty breeds hesitancy, and it can be sharper still when the very thing therapy relies on, a relationship with another person, is what has caused harm before.

So caution in the early stages is understandable. But therapy is meant to put you in control from the outset. If, at any stage, you feel I am not the right fit for you, you are free to stop and find another therapist. Good therapy is collaborative, and it rests on a relationship that feels safe. Those are the foundations everything else is built on.

What I Hope You Leave With

I hope people leave with three things: greater emotional freedom; greater insight, which in turn supports better judgement; and more hope.

These are how I gauge whether therapy is working. I don’t need to ask you to rate them. I listen for them in how you return to your life, compared with when you first came to see me.

Practical Details

I offer individual therapy in English, in person at my practice in Quarteira, near Vilamoura, and online. The practice is also easy to reach from Loulé, Almancil, Albufeira and Faro.

Sessions last 55 minutes and cost €65. The introductory call is free.

If you would like to explore whether we could work together, you can arrange an introductory call.

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