Questions worth asking

Both matter, but the research is unambiguous: the quality of the relationship between therapist and client accounts for more of the outcome than any specific technique. A brilliantly delivered EMDR protocol with a therapist you don’t trust will do less than an imperfect conversation with someone you feel genuinely seen by. This doesn’t mean technique is irrelevant — it matters enormously, particularly for trauma. But technique without relationship is a tool without a hand to hold it. What I look for early in any therapeutic relationship is less “which model fits?” and more “is there enough honesty and safety here for real work to happen?” If there isn’t, nothing else will.

Most people arrive at therapy when something has broken. But some of the most significant work I’ve done has been with people who were, by any reasonable measure, functioning well — and who came because they sensed something wasn’t quite right, or that there was more available to them than they were living. Therapy as a tool for growth rather than rescue is underused and undervalued. The capacity to look clearly at your own patterns, to understand what drives you, to relate to your emotions with more skill and less fear — these aren’t luxuries. They are the conditions for a genuinely good life.

The short answer: if it’s causing you persistent distress or limiting what you’re able to do or feel, it’s worth taking seriously. There is no threshold of suffering you need to cross before therapy becomes legitimate. The idea that you have to be unwell enough to deserve help is one of the more unhelpful myths in mental health. That said, I’d push back gently on the framing of “serious enough.” Therapy isn’t a hospital. You don’t need to be an emergency. You need to be curious, willing to look honestly at your experience, and ready to do some uncomfortable work. Those things matter far more than how bad things are.

Trauma-informed practice means understanding that many of the patterns people bring to therapy — the numbness, the reactivity, the difficulty trusting, the ways of thinking that seem irrational until you know their history — are not character flaws. They are adaptations. Responses that made sense once, that may have kept someone safe, and that have simply outlasted their usefulness. A trauma-informed approach doesn’t require trauma to be the explicit focus of every session. It means holding the possibility that what looks like resistance, avoidance, or dysfunction might be intelligence — a system that learned to protect itself in the only way it knew how. That reframe changes everything about how you work with someone.

Confidentiality is a professional and ethical obligation, not a courtesy. As a UKCP registered psychotherapist, I’m bound by a clear code: what is said in therapy stays there. There are limited exceptions — specifically, situations involving serious risk of harm to the person themselves or to someone else. These exceptions exist because the duty to protect life occasionally overrides the duty to keep confidence. But these are rare, and any therapist worth working with will be transparent about them from the outset. Confidentiality isn’t just a procedural safeguard. It’s the condition that makes honesty possible — and honesty is what makes therapy work.

The terms are often used interchangeably, and the boundary is genuinely blurry. As a rough distinction: counselling tends to focus on a specific difficulty over a shorter period of time, while psychotherapy tends to work with longer-standing patterns — the ways of thinking, feeling, and relating that have formed over years and don’t shift quickly. Psychotherapy is also more likely to draw on a range of theoretical models and to work at greater depth. In practice, the quality of the therapist and the fit between you matters far more than which label they use. What I’d look for isn’t the title — it’s whether they have the training, supervision, and ethical registration to work safely.

EMDR stands for Eye Movement Desensitisation and Reprocessing. It’s an evidence-based therapy originally developed for trauma and PTSD, and it works differently from most talking therapies. Rather than focusing on analysing or narrating a difficult experience, EMDR uses bilateral stimulation — typically guided eye movements — to help the brain reprocess distressing memories. The theory is that traumatic memories get “stuck” in a way that keeps them feeling present and threatening, even years later. EMDR helps the brain do what it would naturally do if it could: process the experience, integrate it, and file it as something that happened rather than something still happening. It’s particularly effective for single-incident trauma, but is increasingly used for complex, developmental trauma too.