Psychological Change Management

Most people first come to counselling with a specific issue in mind, often something like not feeling able to manage work as well as they used to, a problem with relationships, or stress. It’s possible to do solid work which results in a helpful goal becoming more clear and therefore more achievable in around 6 weeks. Very often, that’s how coaches approach their work and, in repeating that cycle with the same client and a different goal a number of times, they can get real insight into the client’s life which allows them to speed up the goal-identifying and achieving process.

Counselling has been moved into a goal identifying and achieving role over the last decade or so and for some people that’s fine. It’s called ‘solution focussed counselling’, usually 6 or so sessions long and you’ll access it through most Employee Assistance Programmes (EAP’s) your GP and some counselling agencies. It seems an obvious choice when you compare it to what Hannah Booth writes about - a decade of more or less weekly meetings all of which must be paid for in money, time and emotional investment. 

Life is not always easy, there are things we all have to do that we would rather not do, things outside of our control change our lives in ways we can’t predict, events that we plan for knowing that they will cause disruption, even chaos, suddenly veer out of our hands. Coaching and solution-based counselling can help bring structure to managing these events. 

Longer term counselling offers a more reflective space, somewhere to think about how what’s happening may be affecting how you’re feeling about an event, and about your life leading to this point. The point of this approach is to give you some support during a difficult time, allow you to catch your breath and to discern truly sustainable ways forward, including addressing decision making processes: why did you chose this way? Why not that way? And so on.

Some counselling agencies and some EAP’s offer 6, 12, sometimes up to 20 sessions, the NHS offers various tiers of more or fewer sessions. The constraint around limited sessions is, simply, money. EAP’s are a kind of employer insurance for which the employer pays. The NHS and counselling agencies are endlessly financially constrained.

I’ve yet to hear a counsellor say “I love seeing clients for 6 weeks, solving their problems and sending them out into the world full of vim and vigour.” We are trained to work for the long term because that’s what is effective.

There are very few problems that are genuinely solvable within 6 weeks, the 6, 12 or 18 session model is not based on how well problems are solved but on a cost/benefit analysis: is the client more or less likely to be able to function more efficiently in employment for a certain financial investment? You can appreciate that rationale from an employers point of view, and it’s been unspoken in healthcare for decades coming out into the open around 2015 when ‘Employment is a health outcome’ became US and UK government policy.


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Look at the state of mental ill health in the UK: if we could ‘mend’ people in 6, 12 or 20 sessions, either all NHS, EAP, agency and private therapists are dreadful or there’s something else going on.

So why would anyone spend years in counselling? Are they indulgent? Self-absorbed? Weak? Broken?

In my experience and in the experience of my peers and my profession the overwhelming majority of people who come to long term therapy are fully functional. They have families, can maintain healthy enough relationships, have at least a reasonable standard of living, the huge majority are employed - it’s one of the reasons they can afford counselling in the first place. 

My experience is that they’ve put aside the desperate search for relief and are engaged with the process of carefully changing the direction of their lives. 

It's taken decades before you get to therapy so it’s reasonable to assume it’s going to take more than 5 or 10 hours to address issues in a manner that will lead to long term change. 

First you’ve got to catch your breath. Then you’ve got to see if you like the counsellor. Then you need to discern if you can trust them. That’s 5 weeks or so. Then you’ll want to know the boundaries of that trust. If and when there’s a rupture in the therapeutic relationship you both have to work harder to understand what’s happening and work through it. (Why? Because although you’re paying for this work you’re so much more than just a customer, and because genuinely repaired ruptures can be some of the most enlightening parts of the therapeutic relationship.) That’s before you start talking about your real and realistic hopes for your future, or how the lives your parents didn’t live might be manifesting through you, or any of the myriad possibilities for human experience. Somewhere along the line you’ll experience a plateau where nothing much seems to be happening, then you discover you were preparing to explore something particularly illuminating.

It takes time to trust that your therapist isn’t making you dependent on them, something every client will wonder about from time to time and which should be spoken about with absolute transparency, by both of you, every time it passes though your mind.

It takes time to know how you got to where you are. It can take a lot more time to allow knowledge to move to understanding, then to really getting it. It takes time for the conditions to be in place for you to offer yourself sufficient compassion so that the parts of you that you didn’t know were running your life can stand down, take their proper, quieter position and let you move forwards. 

Because that’s what therapy is for: genuine, sustainable, lifetime change.