Counselling and Psychotherapy

Professional support and mental health care. 1140 Vienna, near U3 Johnstraße.

Life is not what it’s supposed to be. It’s what it is. The way you cope with it is what makes the difference.
Virgina Satir

How and when can Counselling and Psychotherapy help?

Counselling and psychotherapy can help not just with mental health issues but also in times of crisis and when significant relationships come under pressure. There is a good body of scientific evidence to back up the claim that counselling and psychotherapy are effective in dealing with such issues and in helping to improve quality of life.
Room in my practice for counselling and psychotherapy in 1140 Vienna
The question is sometimes asked as of which point in time it becomes advisable to seek out support from a counsellor or psychotherapist. I personally think that if you are asking this question then it is time. Another answer to this question would be to think about it as follows: normally our psyches are well equipped to deal with crises and difficulties. We find ways of dealing with our problems and after a while we even forget that we even had them. There are times however when neither our own attempts to solve our problems nor the comfort and support of family members, partners and friends seem to work. We start to mull the same things over again and again, we may even not feel understood and we can start to feel frustrated, depressed or angry. In times like this it is difficult to find an inner balance again. If you find that this description partially of fully applies to you then you would be well advised to seek help from a counsellor or psychotherapist.
If you are thinking about taking your own life or harming yourself or other people then you should seek out help from a psychiatrist and/or psychotherapist as soon as possible. Where eating disorders, traumatic experiences (e.g. experiences involving sexual and physical abuse, catastrophes and accidents etc.) and more serious mental health issues are concerned it is also recommended that you seek help from a psychotherapist.

What is Counselling and Psychotherapy?

Counselling and psychotherapy are umbrella terms that refer to a range of services that aim to reduce psychological distress, enhance wellbeing and improve the quality of life. Clients/patients are generally supported with a mixture of conversational techniques, exercises (relaxation, imagination, visualization etc.) and psychoeducation. Counselling and psychotherapy professionals can be expected to work with scientifically proven methods for which an evidence base exists that they can help with mental health issues and interpersonal problems.

Psychotherapie hilft bei Krisen und schwierigen LebenslagenThe distinction between a counsellor and a psychotherapist is a blurred one as they both work in a similar fashion to help their clients. In Austria the difference can be noted by the job description (licence) and education of the person providing the service. A counsellor (referred to as a Lebens- und Sozialberater) will generally have completed training lasting around 2,5 years (750 hours theory and practice) in order to obtain their licence whereas the training which a psychotherapist undergoes lasts a minimum of 5-7 years (3000 hours of theory and practice). The focus and scope of the training also differs in that counsellors are not required/allowed to work with people with mental health conditions. If you suspect your symptoms are acute or serious then you should seek help from a psychotherapist rather than a counsellor as you have the guarantee that they are appropriately trained and legally licenced to deal with your issues. It is also worth checking to see if the psychotherapist has expertise and/or further qualifications in dealing with your symptoms/problem area.

Psychotherapists and counsellors are also trained in terms of the theoretical models and techniques they employ in many different ways. If you take a look out there at the sorts of psychotherapy and counselling on offer you will find a large (and maybe even confusing) variety of terms. Practitioners claim to offer psychoanalysis, behavioural therapy (of which CBT is perhaps the most well-known variant), client-centred therapy, hypnotherapy, systemic therapy, transactional analysis, and the list goes on and on! Some psychotherapists and counsellors, like myself, even work with a number of methods. I work for instance with methods and techniques from systemic family therapy, hypnotherapy/clinical hypnosis, trauma therapy and NLP.

This diversity is understandably confusing for the consumer and I am frequently asked by friends and acquaintances which school of therapy/counselling is good for what. The fact of the matter is that psychotherapy research consistently shows that the relationship between psychotherapist/counsellor and client is one of the most significant factors. Indeed studies claim that the relationship contributes to 40% of the therapy/counselling outcome. Moreover technical factors such as which methods the theoretical models are employed by the psychotherapist/counsellor are said to account for only 10% of the therapy/counselling outcome.

In summary your best bet as a layman is to choose a psychotherapist or counsellor on the basis of how likeable, trustworthy, reliable and competent they appear to you and not on the basis of trying to match your needs to a specific technical approach or theoretical school of thought.

Counselling/Psychotherapy Topics

I think it can be said that counselling and psychotherapy can (theoretically) help with any issue which affects mental well-being and in turn quality of life. It is therefore not possible to identify and list every topic here which counsellors/psychotherapists work with. The following is a list of those topics which are of particular interest to me and/or with which clients come to me most frequently. Clicking on the respective topic reveals more information.

Conflict, relationship problems and communication difficulties
Conflict and communication difficulties can create tension and feelings of helpless. Bullying, intimidation, anger and aggression can impact our sense self-worth and we may even feel victimised and disempowered. Sometimes we also struggle to control our own anger and aggression and treat others in a fashion we do not feel proud of. Counselling and psychotherapy can help you to learn to regulate your emotions, become more assertive and recognise underlying interactional patterns which you have unconsciously become a part of.
Trauma and post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) can result after experiencing an event which is so disturbing that the world does not seem the same again afterwards. Examples of such events are war, serious accidents, sudden and significant loss, sexual or physical abuse, assault, catastrophe etc. Commonly occuring symptoms are so-called flashbacks (vivid recollections) of the traumatic event, being flooded with emotion, irritability, panic, anxiety and depression. A wide variety of psychsomatic symptoms can also develop from headaches and gastrointestinal disorders through to dissociative disorders such as losing feeling in body parts or even having “out of body” experiences. If you are suffering from PTSD then it is highly recommended that you seek help from a psychotherapist trained in trauma therapy.
Dealing with heartache und difficulties living single life
Almost everyone experiences at some point in their lives the stress of an emotional break-up and the difficulties in readjusting to being alone. Some people have a perpetual problem or even fear of being and living alone and/or a sense of feeling unable to cope without a partner. Counselling and therapy can be useful here to learn to come to terms with loss, to learn to enjoy life as a single person and to reflect on choice of partners in order to increase the chancee of having a healthy and satisfying relationship.
Addiction problems
People can become not only addicted to substances such as alcohol, recreational and prescription drugs, nicotine and sugar etc. but also to activities such as shopping gambling, looking at pronography and sex etc. The reasons for this are varied and usually there is more than one behind any addictive behaviour. Opportunity and possibility to participate in the activity/consumption, stress factors, family and societal attitudes, personal tendancies towards dependancy in relationships and traumatic experiences in the past can all contribute to the addiction cycle. Psychotherapy can help you to recognise the driving factors behind your addiction, to learn to break the addiction cycle and to develop alternatives to acting out.
Grief and bereavement
In the event of the death or loss of an important person it is normal to experience intense feelings as a result. Such feelings can also be experienced in the event of the loss of a home(land), job, spouse or partner in the event of a breakup. When grief or other feelings related to this loss threaten to overwhelm you or if you start to doubt whether you will ever get over the loss, then grief and bereavement counselling can help you. In counselling you will learn to differentiate between the normal feelings of loss and other mental health issues such as depression. Grief and bereavement counselling can also help you to learn to dose the pain of loss, to find sense and meaning in life and hope for the future again.
Depression
Depression is Usually indicated where one or more of the following symptoms are present: a reduced sense of self-worth, self-doubt and feelings of insufficiency, existential fears/doubts, unhappiness and lack of hope, feelings that current problems are insurmountable, listlessness and lack of energy, difficulties in concentrating, nightmares and sleeping problems. Psychotherapy can help to relieve these symptoms by building up interpersonal and mental ressources and providing insights into the mechanisms behing the depression.
Burnout treatment and prevention
A burnout cycle is usually characterised by the presence of multiple of the following symptoms: feelings of being overwehlmed by stress/pressure/tension, emotional/mental exhaustion, disillusionment, anxiety and panic, irritabilty and anger during or after phases of chronic stress, sleeping difficulties, difficulties relaxing and switching off, turning to alcohol/drugs in order to relax, withdrawal from leisure activities, social and family life. Counselling and psychotherapy can help to interrupt and stop the process of burnout causing further damage and provide assistance for people already severely affected. Importance is placed on learning to deal with stress, pressure and conflict and developing a lifestyle which includes time for leisure, relaxation and physical and mental regeneration.
Sleeping problems and disorders
Sleeping problems and disorders come in various forms: difficulties in falling asleep and/or getting a good (refreshing) night’s sleep, suffering from frequent or disturbing nightmares and feeling constantly tired or exhausted are examples of ways in which sleeping problems manifest themselves. These difficulties frequently occur as a result of psychological stress. Sometimes people aware of this, such as when they lie awake at night ruminating about things and sometimes it is not so evident. That which we have done are best to ignore but is bothering us nonetheless can emerge within our dreams while we sleep. Psychotherapy and counselling can help you to reflect and work through issues which are the source of stress. They can also equip you with better strategies for having a good nights sleep, such as unwinding, relaxing and preparing well for sleep and learning to switch off whilst relaxing and when you are in bed.
Panic attacks, phobias and anxiety
Panic attacks can have a significant impact on a person’s quality of life. Sufferers of panic and anxiety episodes will typically experience symptoms such as palpitations (the heart is experienced as beating quickly, which some people then construe as a sign that they are having a heart attack), shortness of breath and difficulty in breathing, sweating, fear of losing control of oneself etc. Anxiety and panic can occur suddenly and unexpectedly or be related to specific stimuli (e.g. subways, water, escalators, hospitals) and situations (e.g. social situations, exams, being alone, work). Psychotherapy can help to gain an understanding of the mechanisms at work here, to learn new coping strategies for dealing with stress, pressure and anxiety and to help to neutralise the fear attached to specific stimuli.
Obsessive behaviour and compulsions
Urges and impulses to perform specific rituals or acts can have a debilitating effect. They prevent sufferers from acting freely and without anxiety. Instead they create a reliance on performing certain acts (e.g. hand washing, walking down the street on a certain side) and creating certain structures in order to alleviate anxiety and maintain a sense of well-being and calm. Suffers experience a sense of inner compulsion to perform these activities and have little or no sense of being able to resist this inner pressure. There is not always (this is frequently so in fact) a logical link between the ritual or action to be performed and the underlying concerns and anxieties. Psychotherapy can help to find alternative ways to deals with anxiety and concerns, they can strengthen individuals to resist inner urges and assist sufferers in understanding the underlying mechanisms behind the compulsion.
Psychosomatic and somatoform disorders
The term psychosomatic is used to refer to symptoms which are physical and medically-measurable and which are aggravated by psychological factors. These symptoms are real and are not just “all in the mind”. Coronary heart disease, gastritis and back problems are all examples of psychosomatic symptoms. Stress has a well documented influence on psychsomatic disorders. Stress results in body tension, weakens the immune system and can disturb important self-care routines like eating and sleeping. There are also instances in which symptoms cannot be verified by medical means. Such symptoms are called somatoform disorders. Examples of somatoform disorders are the feeling of losing control of a body part, a subjective feeling of pain for which there no medical evidence, constant worry about health or body parts. There can be a number of reasons for a somatoform disorder. Supressed feelings, a heightened sensitivity to physical sensations, a pronounced sense of vulnerabilty or the conviction that one’s health is fragile can all contribute to the origin and perpetuation of the somatoform disorder. Psychotherapy can help you to identify sources of stress, concern and conflict behind psychsomatic and somatoform conditions, to explore ways of finding relief and to develop alternate strategies in delaing with pressure, tension and anxiety.
Eating disorders
Eating disorders such as bulemia, anorexia and adiposity can have a debilitating affect on the lives and self-esteem of sufferers. They are also the cause of considerable concern for relatives and partners. Eating disorders often occur as a result of relationship difficulties in the present and/or in the past. Psychotherapy can help to identify possible sources of relationship tension, to find closure for past issues and ways of handling current conflicts as well providing assistance in discovering alternatives to solutions involving food and (not) eating as a source of self-esteem, comfort and solace.

What Happens During a Counselling/Psychotherapy Process?

The Initial Consultation

The initial consultation lasts 50 minutes as a rule and is charged at my standard rate. More information about my fees and other terms and conditions such as the cancellation agreement can be found here).

I use the initial consultation to get to know you, your motivation for seeking out my services and any sources of difficulties which you are experiencing. The initial consultation is also there for you to get to know me as a professional person and to become acquainted with my style of working. It is clearly essential that we both believe that I can help you and that the atmosphere is one within which you feel safe and able to open up in.

The initial consultation is conducted as a structured conversation and usually touches on the topics listed below. Having said that I do not stick rigidly to this structure and allow for individual needs, particularly the need to have enough space to expand on specific concerns or wishes.
 

Defining the problem in concrete terms
It is important to identify and clearly define the main topics. Focus is important here in order to achieve change in a directed fashion. It is therefore also important to decide what should not be focussed on in counselling/psychotherapy and also what should not be changed. This is also an important consideration from the perspective that change sometimes brings with it (unwanted) side effects and you should be sure that you are prepared to live with the consequences, e.g. not everyone you come in to contact with will be happy about any personal changes you make, particularly if it means that things get more uncomfortable for them as a result!
Exploring your motivation for change
Motivation is essential to driving change. Without motivation change becomes a chance event or something that is enforced upon us by external circumstances. I therefore spend time on exploring the benefits of (not) changing with you and also the price which change or resisting change will exact from you (even if this is only in terms of time and energy). It is also worth investigating what you are prepared to do to contribute to change compared with what you are hoping other people will do to support you or fulfil you in your wishes.
An initial formulation of your goals
Often goals are formulated as a wish to get rid of something. Anxiety, anger, conflict etc. should be disposed of. This is understandable and at the same time it is important to know what should take their place and what freed up energy should be channelled into. A positively formulated goal that is attainable and measurable is also essential for measuring the success of counselling, coaching and psychotherapy processes.
Understanding your expectations
Closely linked to the goals of psychotherapy and counselling are your expectations for our work together. It is important that we discuss here your hopes and wishes as well as any ideas of how you would like us to work together. You may have prior experience of counselling and psychotherapy and it is useful for me to know what was helpful to you in the past as well as what you did not find so useful and should be avoided in our work together.
Exploration of resources, strengths and talents
Everyone has strengths, talents, skills and external sources of support that can be harnessed to find and implement new approaches to problems. Often when we find ourselves in a tight situation we lose sight of these resources and focus on the things which do not work, what we do not have and what we do not want. I place great value on exploring what does work, what is available, what is desirable and what hopes there are for the future. It is my experience that when we develop a resource and competence-oriented perspective of ourselves and our situations then solutions to problems start to present themselves as a natural response to this inner state.
At the end of the initial consultation we should both be in a position to start to evaluate whether further work together can provide a constructive outcome and contribute towards solving your issues. At this point I will give you a feedback on what I think I can do to do to help you and what the next steps might be here in terms of the process or treatment. It is then up to you to decide if you want to arrange a next appointment or not.

Follow-up Sessions and the Psychotherapy/Counselling Process

Every person and every problem is unique. It therefore follows that the psychotherapy/counselling process will run its unique course for each and every individual. My style of working is nevertheless a structured one. In order to structure sessions and the psychotherapy/counselling process I make use of the following techniques and methodical building blocks:

Evaluation of changes and progress.
Evaluation of therapy/counselling goals. These quite often change over time and it is important to adjust them accordingly. At the beginning of every session I will also discuss with you what you would like to use the session for and what would like to leave with at the end of it.
Exploration of the next steps to be taken in order to reach the desired change.
Identification of strengths, resources, talents, current difficulties and obstacles which can help or hinder change.
Developing and practising new skills.

To support our work with these structural elements I see techniques from systemic therapy, hypnotherapy and NLP. For example:

Conversational and questioning techniques
Visualisation and imaginative techniques
Sculptures. Here small wooden figures are used on a wooden board called a “system board” to depict family and work situations
Hypnosis, trance and relaxation techniques
Educative explanations and models
Role play and rehearsal techniques
At the end of a follow-up session I frequently give clients either a task or something to reflect on between sessions. This has the effect of enabling the transfer of new skills and learning between sessions. I arrange follow-up sessions in a frequency which depends on your current life and work situation and how acute your needs are. Generally speaking though it makes sense to have a session every one to two weeks although in some cases a longer gap is possible. In order to ensure the quality of our work together it is also important to attend sessions regularly.

Ending the Psychotherapy/Counselling Process

A frequently asked question is how long psychotherapy or counselling will take. This question can of course only be answered on an individual basis and much of it depends on you. The nature of your issues, your expectations, how motivated you are and what obstacles you are facing all have an impact on the course and length of the psychotherapy/counselling process. That being said, I aim to work as efficiently as possible and will treat your time and financial resources with utmost respect. It is also my objective to help you to experience the first signs of change and progress within the first few sessions.

Psychotherapy and counselling processes come to a conclusion when it can be established that you have reached the goals which we laid out for the psychotherapy/counselling process or when it becomes evident that the goals are not attainable. In the case of the latter this usually means that some readjustment of your goals is necessary. In some rare cases it could also be more meaningful to abort the therapy/counselling process and to try something else.

The final consultation is an important part of the psychotherapy/counselling process. Research indicates that this final meeting has a significant positive impact on the sustainability and longevity of progress and changes made during the process.

Next Steps