3 types of therapy for people exploring conversational options

Therapy is a very particular type of conversation, and those who are looking to access this ‘territory’ can be left in a lot of confusion. My experience as a supervisor, counsellor – and client – is that therapy has its own language; we have rituals, environments, our own schedules and culture, which can be off-putting even to the bravest or most desperate of people.

What follows is not a comprehensive attempt to solve the challenges within the language of therapy*, but a sketch that will hopefully help those ‘looking in’ choose a way forward that is more useful for them.  

With a very broad brush, I’m going to outline three types of therapy: 

1. maintenance  
2. trauma 
3. crisis 

Anyway, onto the types or ‘focus’ of therapy...

Maintenance

Life is hard and sometimes there are conversations you want or need to have which don't (or can't emerge) in the everyday conversational system you find yourself in (friends, neighbours, colleagues etc)*. So, therapy can be a conversation to vent, to reflect, to have your feelings validated… to talk about the blood, piss and sick (elements of life, that left unprocessed feel heavy but are difficult to speak about in everyday life).

There is a power in conversation, from the dopamine (happy hormone) released in face-to-face conversation, via learning how to talk about things emerging in your lives, to knowing that you can protect those dear to you from the hard edges. Sometimes a person needs to hear the words out loud to know what’s next, how to carry on or to know that they are not alone. Even if it's for 50 mins on a wet Thursday evening in South Birmingham, you know that you're connected to someone, who will offer a safe, confidential space. It has been framed elsewhere that this type of therapy could be considered a type of self-help or gym work for your emotional world.

The suppression of such experiences can invite a sense of isolation, maybe even a sense of desperation. Lived experiences have weight and without anywhere to pour out the on-going reality of the days you live in means you may carry greater and greater weight, which will inevitably cost and will be paid one way or another. The little cuts can often be brushed over, but they are both leeching energy and, when infected, can do extreme damage.  

Which brings us (kinda dramatically) to the second type of therapy...

The conversation of the overwhelmed seeking recovery

This is where the focus of the work is on the wounded areas of a person's life; a vast scope that can range from pre-birth contexts, through historic abuse, and neglect, to relationship breakdowns or other traumatic occurrences. As a conversation, it is often intense, structured, and long-term. It can lead to changes in relationships, lifestyle, well-being and even society and culture. As a conversation, it can bring into question every aspect of how a person functions and is often very, very challenging.

My experience as a practitioner is that it is often done in phases, healing occurs, change happens, the wider system adjusts (not always in the most supportive ways) and then a person moves on to the next level of recovery. This process is not always done with the same therapist over the same period, and there may even be times when a person goes through a period of maintenance therapy to consolidate their recovery.

For instance, I have worked on medical trauma with EMDR; which highlighted relational issues with a primary caregiver, which in turn led to healing around a part of myself. This work took around six years. The process may have been quicker, but in those six years I also have lived through: flooding, selling a house, moving in with my folks after 20 years, buying a house in another country and having two children. I can say it would not have been compassionate, or at some points possible, to be recovering and re-wiring my perception when there were simply no resources available as they were employed elsewhere. 

Crisis and trauma  

It is what it says on the tin – everything is falling or has fallen, apart. This type of therapy is often life and death, requiring a team, medical and psychological intervention, and aftercare plans. As a circumstance, it is unpleasant because the reasons are critical; the system has reached a level of dysfunction which means there are few other options available to everyone involved. It is also often misunderstood and underrepresented in the conversations around therapy, but the clinical staff, primary and community mental health teams and the CPNs do, for many, a brilliant and lifesaving job.

The nature of my practice over the years has been after the mental health teams have helped a person into a place where they can have the conversations that keep them from visiting those places again. I would argue the heavier end of this type of therapy is often the consequences of a person not having access to other types of therapy or social constructions that would maintain ill health and then remove crisis/trauma.  

Though it must also be said that there is a spectrum here with regards to how one defines crisis: death, inappropriate advances from another human, affairs, redundancy, these are forms of crisis as well, and often need a conversation beyond the realm of family and friends. Not to compare the two, but to invite one to consider the vast nature of crisis in a multi-contextual way. Crisis without care will often either become a recurring trauma incident (PTSD) or life-ending. 

Final thoughts

*I think there is a fine line between making therapy ‘easy access’ and surrounding it in such a ‘sacred’ language that no one can enter. Therapy, and its types, are not everyday conversation; it is not wise or useful for a person to try and conduct some of the incredibly vulnerable and painful conversations (that are conducted in the confidential and safe environment of therapy), in the pub. That’s not to say honest, compassionate conversations can’t be had, it's just that presenting therapy as a ‘normal’ everyday conversation is creating a limiting expectation – for the ‘client’ and the therapist.

For the sake of a person’s recovery, I have asked questions that have highlighted people's pain and challenged their preconceived notions. Conversations are hard, questions splutter and sometimes fall lifeless on the floor of the conversation, confusion often abounds and understanding for any party can seem distant.  

* I would also put forward that therapists and supervisors almost certainly should be in some kind of ‘maintenance’ type therapy conversation, if not engaging in between maintenance and trauma work. 10 sessions to pass training is not enough to process the ongoing realities of being in emotionally challenging conversations, of often thinking more about the other person than yourself, of challenging generations of systemic narrative trauma, etc. and this is not even factoring in how isolating being a therapist can be. Assuming you honour your confidentiality (expect a complaint if you don’t) then you can’t have conversations with your friends or family. It's often hard to explain, what you do and even if you have a well-rehearsed sentence, there are invitations to boundary issues or just outright cultural dismissal. 

Yes, there is a space in supervision for restorative processing, but there are often contracted limitations and supervision at its heart is about supporting the counsellor to support their clients. I recognise that you being well as a therapist is supporting the client, but in my opinion, it is not fair to you, your supervisor or your clients to skip on a conversation with a fellow therapist because you think it will be more ‘cost-effective’ to take it to supervision. (Maybe I will release a post on this later). 

*Research suggests that the quality of the relationship between the therapist and the client is the greatest indicator of how useful the therapy will be for the client.