Author: Lisa Hunter, Art Psychotherapist

Traumatic experiences are hard to think about, talk about and process. Art psychotherapy uses artmaking as an additional tool to communicate and process difficult thoughts and feelings by allowing us to consider ourselves from an ‘outside-looking-in’ perspective.

As an Art Psychotherapist working with people who have experienced trauma, a particular interest of mine is the disconnect I have observed between the mind and body as a result of traumatic experiences. The mind no longer feels safe to interpret signals from the body and the body no longer understands signals from the mind. This miscommunication can mean regulating emotions promoting a sense of happiness and calm are no longer seen as safe and feelings of overwhelm, hypervigilance, dissociation and panic are promoted. I view art psychotherapy as a bridge in trauma work. A bridge between mind and body, past and present, verbal and non-verbal communication and between therapist and client.

Art psychotherapy moves between a ‘top down’ and ‘bottom-up’ approach. The top-down approach considers how we make sense of what has happened to us, with the bottom-up considering the signals our body is sending to our mind and how connected and safe we feel within our body. Using artmaking in therapy provides a space to make sense of what might appear from either approach. Importantly, it also promotes a sense of safety in that the pace can only be set by the client, who will some days cross the bridge many times and others choose not to cross the bridge at all. The materials used in session themselves walk the bridge with collage, pencils and pens more easily controlled, more brain-led and painting and clay work less predictable and more body-led… somatic.

So, what can happen on this bridge space created?

Keeping the body grounded in the present while recalling difficult experiences

Keeping the body moving at a pace set by the client during recall sends positive and ‘safe’ feedback signals to the brain. Using artmaking in this way helps regulate the body and mind meaning distressing subjects can feel easier to talk about.

Finding our voice and telling our story

Sometimes people who have experienced traumatic childhoods and events struggle to talk about what has happened to them verbally. Sometimes there is simply too much. Through artmaking we can express what we may find difficult to explain in words. While many people do not depict events themselves in imagery (nor would ever be asked to) working on visualising emotions or expressions of how we view ourselves can help us tell our story. Some people do find narrative work to be extremely helpful. There are many ways to tell our story visually.

Helping to make sense of emotions and fragmented memories

By projecting our thoughts and feelings into a physical form we have the ability to consider them from an external perspective and rebuild lost narrative. Clients can find it helpful to reflect and think about their present and past using the artwork itself as a bridge between the conscious and subconscious mind.

Introducing somatic artmaking

Learning to slow and soothe our nervous system. Mindfulness, visualisation and breathwork are a natural result of the artmaking process. Somatic artmaking pushes this further to incorporate texture and rhythmic drawing, stimulating the brain through the body to release emotions stored in the body.

Boosting healthy mind-body connections

For some people it can be important to focus on boosting healthy mind-body connections over exploring trauma itself. At least for now. Many people find they are unable to engage in healthy activities that would boost these connections. Especially if they are experiencing a ‘live’ trauma or have recently experienced a traumatic event. Sometimes the act of artmaking itself in a facilitated therapeutic environment can be enough to start the process of healing.

Overview

Most trauma specialists agree trauma affects both the mind and body and that therapies utilising a dual approach can have beneficial outcomes.^1,2,3 This is due, in part, to theories around our nervous system and its impact on our emotional regulation including the Polyvagal Theory by Psychologist and Neuroscientist Stephen Porges, who places an emphasis on the vagal nerve, our longest nerve connecting our body to our brain.⁴

There is still much to do in researching the benefits of art psychotherapy and trauma work. It’s a difficult form of therapy to measure. Sessions are completely personalised around the goal of the client and change is measured within this space. Saying that, there are many key themes of working with trauma across the discipline. Some of which I have shared above as having observed in my own practice. It’s an interesting and ongoing conversation I’m very happy to be part of.

References:

1. Herman, Judith. (2022). Trauma and Recovery (4^th ed.). New York, NY: Basic Books.
2. Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books.
3. Van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. UK. Penguin Books.
4. Porges, S.W. (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. W. W. Norton & Company.

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It’s great that we live in an age where coming to couples therapy is much more accepted and accessible than ever before. But with so many therapists out there advertising therapy of all shapes and sizes, you’ll be forgiven for feeling that finding the right one can feel a bit overwhelming. In this guide, we’re going to help you find the right couples therapist for you and your partner.

Why is Finding the ‘Right’ Therapist Important?

Finding the right therapist is like finding the right pair of shoes; style, age and gender will always be important factors that shape your preference, but fundamentally it all comes down to fit! Research (Hubble et al, 1999) tells us that the relationship we build with our therapists is the most important part of therapy. That means that it doesn’t matter how much of a smarty pants your therapist is, if you don’t form a good ‘therapeutic relationship’, then therapy is unlikely to be effective.

The reason for this is that when we go to therapy were entering a process of self-discovery, growth and ultimately, change. It requires us to open up and become a bit vulnerable and if we don’t feel the person facilitating our journey is trustworthy, empathic, safe, compassionate or caring, if we don’t get ‘good vibes’ from them, then we probably won’t want to open up in a way that might be important to do. I feel strongly that there is no point in going to therapy for weeks or months with someone who doesn’t ‘feel’ right. It is a waste of your time and money.

This doesn’t mean that the ‘right’ therapist won’t challenge you, good therapy should be challenging, but it will mean that your therapist does it in a way that feels safe enough and as something that is done with you, rather than to you. We’ll talk about finding the right fit further down and what to do if you’re not ‘feeling it’.

Where to Look for a Couples Therapist?

As a starting point, it is good to understand what type of services you might be out there in your search for a therapist who specialises in working with couples. Different services may have different price points to suit what you’re happy to spend. We’ll look at each in turn:

Public Sector (NHS or Local Authority Services)

It is worth checking on your local NHS and Local Authority website to see whether there are any couples therapy services provided in the public sector. Your GP may also be able to signpost you to any services they are aware of in your local area. It is likely there will be a wait to see a professional and the level of expertise and availability of therapists/services will vary from area to area, but it might be a viable option to paying for your couples therapy.

Charity Sector

There are certain charities that specifically target support for couples, the most well-established one in the UK is Relate. The benefit of going through a charity is that they are likely to be more affordable than private therapy services, whilst still having the infrastructure and a model for working with couples. The practitioners you encounter may not be as highly qualified as those in the public sector or private services as this is often how charities can afford to operate at significantly lower costs.

It is possible that these therapists have been trained in a specific model developed by the charity, which may be useful, but may not have as significant an evidence base as more established, researched and widely practice forms of couples/relationship therapy. Therapists may also be influenced predominately by the charity’s own ethos, for example, some Christian charities may provide therapeutic approaches based on Christian values, which may shape the types of conversations you’re able to have within couples therapy.

Furthermore, it’s likely that the professionals you will see are counsellors, rather than psychotherapists or psychologists (but this can vary between organisations), the latter of which typically involve higher levels of study and practice experience than the former. This may not be an issue and it might be that for the struggles you and your partner are encountering, this level of couples work is sufficient to help you move forwards. It is about deciding (as best as you can) if this sounds like the right approach for you and the right level of help.

Private therapists

Private therapists may work independently or be attached to a private therapy service. This will be the most expensive option of those presented which can be an understandable barrier for many people. Therapists working with couples will be priced differently and hopefully this will mean there is someone who fits within your budget. Typically, therapists with higher levels of qualification and greater levels of experience will charge more than those that do not. However, as outlined below, it is always worth checking with your therapist about their credentials before you seek to work with them.

A benefit of opting for private therapy is that you will have more choice in the type of therapist/therapy you would like and have more say about the regularity of appointments, times, and location. Going private means you can be choosey in what you are looking for and seek a therapist that is qualified to work with couples and experienced in working with couples and the issues you are wanting to bring.

For those of you who have private health insurance, it is worth checking out what your insurers will cover and whether they require you to use their recommended list of providers. If the therapist you want costs more than your premium will cover, many therapists will often let you top-up the difference, so your therapy is part funded through you and part through insurance. Again, it is worth checking with your insurer that they accept this arrangement.

Which Couples Therapist?

Many therapists who offer couples therapy have only trained in working with individuals because many psychotherapy training courses and psychology doctorates focus on the individual as the primary client. This can mean that, although well-experienced and well-intentioned, therapists may lack the skills to work specifically with your relationship and instead end up working with you as two individuals. Whilst this may not sound a great deal different, when it comes to working with couples, it’s important that your relationship is the primary client. In the immortal words of Systemic Family Therapist, Virginia Satir, “there are three parts to any relationship; you, me and us”.

It is worth ensuring that your therapist is qualified in working with relationships. One way to ensure this is to ensure that your therapist’s psychotherapy qualification is in a specific model of therapy for working with couples and family relationships. In the UK the most well-established and evidenced-based therapeutic model for working with couple and family relationships is Systemic Family Therapy, with therapists having to complete 4 years of post-graduate university training and study and are qualified at a masters level. These courses should be accredited by the fields Association of Family Therapy and Systemic Practice (AFT) and therapists should be registered with the UK Council of Psychotherapy (UKCP), which governs the practice.

In lieu of this, your therapist may have a primary counselling, psychotherapy or psychology (clinical or counselling) qualification from a university and have then gone on to complete further certificates or diplomas in ‘couples therapy’, ‘relationship therapy’ and/or ‘psychosexual therapy’. Alternatively, it might be that your therapist has completed further training in a specific model of therapy that works with couples e.g. Narrative Therapy, Dialogical Therapy, Emotion Focused Therapy, Gottman Method Couples Therapy, etc. These qualifications tend to be accredited by founding organisations rather than a university, though not always, so it is worth asking where they completed this study.

In any instance, it is important to ensure that the therapist you see is registered with an appropriate governing body. In the UK, Clinical/Counselling Psychologists are required to be registered with the Health Care Practitioners Council (HCPC) and Psychotherapists and Counsellors with the UKCP and/or the British Association of Counselling and Psychotherapy (BACP). Having a therapist who is registered with a governing body is important as it means that they have:

1. completed a psychology, counselling or psychotherapy qualification that is accredited at a standard that enables them to work therapeutically with the public;
2. that they have completed sufficient clinical practice hours to be able to safely work independently with people;
3. that their practice is kept up to date through required levels of clinical practice and evidencing of continued professional development;
4. that their practice is governed by an organisational body that can receive complaints from the public about misconduct or malpractice, and who can audit the therapist to ensure that they are up-to-date with their practice/development.

Essentially, it creates a safety net for you as a client and some assurance that this therapist is legitimate. Please keep in mind though that registry with any of the above organisations does not indicate that a therapist has expertise in working with couples or family relationships specifically. Remember to look at your therapists’ qualifications, their accrediting body and additional training that they have undertaken to develop their knowledge and skills in working with couples.

Most therapists will have a CV for clients and be happy to share this on request. I like the transparency that sharing a CV can bring, but do be cautious of only focusing on the qualifications rather than the person. An exceptionally qualified therapist who you can’t open up with is less effective than a suitably qualified therapist who you feel comfortable with.

It is also worth asking how much of their caseload is dedicated to working with couples, as this will give you a sense of how practised they are in this area.

Now you have an idea of how to find a legit couples therapist, let’s think about how you actually do it.

How do We Find the Right Couples Therapist for Both of Us?

When looking for a couples therapist you have an extra challenge, finding someone you both like. Now, when people are thinking of coming to couples therapy it can often mean that their relationship is at a point of stress and struggle, and the question ‘which therapist?’ can become another point of argument. Let’s take the stress out of this with some simple steps:

1. Set yourself a deadline to find a therapist.

It’s easy for the task of finding a therapist to drift. It’s normal to feel apprehensive and anxieties about going to see a therapist are completely normal. You likely have a busy schedule and plenty of other demands occupying your time. Setting a deadline helps you both be accountable to getting some help and the act of creating the deadline in itself can feel like an achievement, a commitment to taking some action in helping repair your relationship.

2. Decide what kind of couples therapist you want to see.

There are lots of therapists out there and lots who offer work with couples. Not all therapists are the same and finding the right one for the two of you will require you both to think about, and talk together about, what you want out of your couples therapy:

• Is there a specific problem (arguments, intimacy, communication, sex, compromise, etc.) that you want to work on?
• Are you wanting a couples therapist who can help you stay together at all costs or one who can help you separate well if needed?
• Are there specific details about your relationship that you want your therapist to be experienced in working with (e.g. LGTBQIA+ relationships, race/diversity, ability/disability, health conditions, kinks/BDSM, gender identity/expression, non-monogamy, etc.)
• Is online or in-person working preferable for you and your partner?
• Is there a specific area that you need your therapist to be located in or not located in?
• What is the price range your therapist needs to be in for you to have several sessions of therapy?
• Are there specific days of the week and times of the day that you might need your therapist to be able to see you in?

3. Get looking!

A Google search of “couples therapy [your area]” can throw up some instant ideas of local therapists and the maps feature of Google can give you a good sense of how near/far they are from you. If the world of Google feels too daunting then platforms like Psychology Today, Find a Therapist or The Counselling Directory can be excellent, it helps you filter out therapists by specialism and location, making your search much easier. If you know that there’s a certain approach to couples therapy you’re after (e.g. Emotion Focused Therapy, Systemic Family Therapy, Gottman’s couples therapy, etc.) then it might be worth using Google to see if anyone in your area offers this.

Although it may sound daunting, it can be worth asking friends and other couples you know if they are able to recommend a couples therapist. You’ll probably be surprised to find how many of your friends and colleagues have been in a similar situation and sought similar help and it’s often helpful to have a therapist recommended by someone we trust.

4. Make the decision together.

Both you and your partner may have different ideas of the type of therapist you want to see or approach you’re after. This might mean that neither of you ends up with your first-choice therapist and I would suggest that finding a way to comprise at this point will be helpful. It’s important that you both feel the therapist is the right fit for you as you’ll both need to feel able to open up in therapy. Don’t let the decision of “which couples therapist?” become another reason to fall out!

5. Make contact

I’ve dedicated a whole step to ‘making contact’ as it can often be the point where we get stuck when looking for a therapist. It’s where our desire to make changes must involve someone else. It can be daunting because it’s often the first time we have to acknowledge out loud, with someone else, a stranger, that we are struggling. It’s perfectly normal to sit on the edge of this step and feel uncertain whether this is the right choice. We can also feel frightened of making the wrong decision; “is this therapist the right therapist after all?” Whilst this feeling of apprehension is normal it certainly isn’t useful in helping us move forwards.

The best way to get through this is to simply pull the trigger and send the email or make the call. Whilst this might feel like unknown territory to you the therapist you’re contacting is likely well-seasoned when it comes to this conversation. They will be aware of how nerve-wracking this can feel and they will be there to guide you through the next steps. There’s no wrong way to ask for help and your potential therapist will be able to ask further questions to gain any details they need to best support you and your partner.

If there are a few different therapists that you and your partner like, then it might be wise to contact each of them. There’s no reason you can’t shop around for the right therapist and it might be that their availability or the way they handle this beginning bit might influence your decision. As long as you can tell when you’re shopping around to find the right therapist rather than to avoid making a decision then it’s something I’d recommend. We’re looking for the right therapist after all, the ‘perfect’ therapist may be an unhelpful idea.

Some therapists offer a free consultation and this can help you hear a bit about their practice and whether they can help you and your partner with the problem you’re encountering. It’s well worth taking this time at the start to have these initial conversations as they can give you a sense of what you’re therapist is like and whether they’re right for you two.

6. You’re free to stop at any time

Just because you’ve met a therapist for a session or two, it does not mean that you’re committed to working with them forever. Good therapists should give you and your partner space to explore whether this process feels right for you and whether this feels like the right fit. My sense is that it takes 2 or 3 sessions to feel out whether the therapist you have seems like one who can be helpful to you, to understand a bit about their approach and the kinds of questions they ask.

If at any point the therapy doesn’t feel like it’s doing what you need to you should take this back to your therapist. They may be able to take a slightly different approach or work with a slightly different focus that helps the therapy feel most useful. Therapy is a collaborative process after all, and it’s important that you and your partner have a voice in the work you’re undertaking.

If it feels that the work just isn’t working for you both, even after trying to make tweaks with your therapist, then it’s okay to say “goodbye” to them.

Good Luck!

Reaching out for help with your relationship can be daunting and leave you feeling unsure of who to approach and what is right for your relationship. Hopefully, the steps above can help guide you in the first part of this journey and give you confidence in navigating these initial conversations with your couples therapist.

What we know at Kaleidoscope is that couples who take these steps to address the emerging or established problems in their relationship, can bring about significant changes in their relationship and get it working in the way they both want it to.

We offer a free 30-minute telephone consultation to anyone who is looking for therapeutic input for their relationship, just get in touch via our contact page by clicking here and take those first steps today.

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Through working with relationships we can help people move past their struggles and start to see and hear each other differently. When we relate to each other (and ourselves) differently we create enough space for change. Relational working is something I hold a deep passion for and seeing the changes people can make in this type of work keeps me returning to these ideas and philosophies.

Click on the link below to see the full article, which was published in Context, issue 177, October 2022, pp16-20. Thanks again to the Association of Family Therapy for providing a space for me to share some of my thoughts and ideas with the wider systemic family therapy community.

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