6 things a sex therapist wishes you knew

22 05 2018

Here’s an article I did for Prima magazine a couple of years ago, but omitted to post on here at the time:

6 Things A Sex Therapist Wishes You Knew

My 6 tips were as follows:

1. It’s good to talk about sex!
Lots of clients still feel like opening up about their sex lives is a real taboo, and that sexual thoughts should be kept private and hidden away. But the truth is that sex is a huge part of who we are – it plays a vital role in determining our identities, and in shaping the relationships we choose throughout our lives – so it’s good to talk about it, and there’s nothing shameful or degrading about doing so.

You might not think that your sexual thoughts are relevant to certain other issues in your life, but sometimes sharing these inner desires can really shine a light on something else that’s seemingly unconnected.

sex

2. …but don’t JUST talk about sex
Sex is often the symptom, not the cause. Lots of people come to therapy looking to resolve a sexual issue, and often there’s a temptation to focus on that issue and not talk about anything else. But as you explore around the problem, you tend to find that what’s being played out in the bedroom is often related to other thoughts and feelings.

Even something as innocuous as moving house or changing job can have an unexpected impact on libido, as attention and energy levels are focused elsewhere. So it’s really important to get the full picture of what’s going on.

3. There’s nothing you could say that would surprise your therapist
People go to therapy for all kinds of sexual issues. This might be a question of their own orientation, making sense of a certain fetish, or exploring some kind of dysfunction, which they feel is preventing them from having the sex life they truly desire.

No matter how embarrassed you might feel about a certain sex-related issue, your therapist won’t judge you for it, and will remain calm and impartial as you explore the problem. Sexual issues are very common reasons for people to seek therapy, so your therapist has most likely heard it all before; and however filthy or unusual you might think your kink is, someone else has probably already shared it.

4. The biggest sexual organ is the brain
People spend so much time focusing on genitals, but often forget about the brain. Sex is a deeply psychological process, and one person’s turn ons can be another’s turn offs. This is because we all get aroused by different sensory stimuli, and have a different set of positive and negative associations for all kinds of situations and events; often relating back to previous experiences.

You can have a lot of fun with your body, but truly great sex needs to involve the brain as well. After all, it’s the brain that gets flooded with a magical cocktail of chemicals – dopamine, serotonin, oxytocin and endorphins – at the point of orgasm, to produce an almost trance-like experience.

sexybrain

5. Sex means different things to different people, at different times
There’s no single definition of a good sex life. Sexuality is fluid, and needs and desires can change drastically from person to person, and even day to day. For example, at the start of a relationship sex is usually about pleasure and passion, but over time it can become more about intimacy and connection, and then if a couple decide to have children it can suddenly become quite outcome-focused.

Sometimes people struggle to cope with these transitions, or may find that their own needs don’t match with their partners’, and this is why talking about sex is so important in relationships.

6. Don’t put it off
If you do have a sex-related worry or concern, it’s best to talk about it as soon as possible. If you don’t feel comfortable discussing it with a family member or a friend or partner, then seek out a good therapist to explore the issue with you. The longer you wait, the more it becomes likely that you build the issue up in your head, or start to complicate it even further.

It’s always best to tackle issues, rather than to let them fester or be ignored. More than ever, people are talking openly about their sexual orientations and desires, so there’s no need to deal with your worries alone. Everyone deserves to feel sexually fulfilled, and that includes you.

I specialise in sex and relationship issues, so if you would like to discuss any of these in a safe and secure environment, either individually or as part of a couple of family, then please contact me and I will schedule a session for you.

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Wishing everyone a restful end to the year.

20 12 2014

As we’re coming to the end of the year I just want to wish everyone a restful time over the next few weeks. It’s often a time where families get to come together, but that doesn’t mean it’s any less manic or stressful than the rest of the year; in fact it can often be a time of conflict and anxiety.

I work with a lot of my clients to raise awareness of their feelings at times of conflict or anxiety, and then to manage them using techniques such as mindfulness. I see mindfulness as a means of remaining focused on the here and now, and being completely in touch with the present moment; thus removing ourselves from the constant ‘noise’ of past-oriented or future-focused thoughts buzzing around our brain. Imagine your mind as one of those Christmas snowglobes, shaken up and swirling all over the place; and mindfulness helping all the snowflakes become settled and calm, so that the globe is clear again.

mind-full

Scientific evidence has shown the effectiveness of regular mindfulness, and you can read the recent experiences of the American news anchor Anderson Cooper here, as he describes how mindful practice has changed his life; enabling him to be more calm, present, and efficient.

However you spend the next few weeks, why not try out some mindfulness techniques to simply catch your breath and gather your thoughts? For example, you might want to just focus on your breathing for a couple of minutes, or try some progressive muscle relaxation, or sit through a brief guided imagery exercise. These techniques should help you feel far less stressed and anxious, and much less overwhelmed.

_

I would also like to briefly thank everyone at the ACPNL, as they kindly invited me to present a workshop for them last Sunday. I have to admit I didn’t expect many people to be present – considering it was a cold and frosty Sunday morning at the end of the year – so I was delighted to have almost 50 people in attendance. I presented for 3 hours, on the topic of Social Emotion Regulation, and talked about the difference between attachment and attunement, how to create lasting and secure connections in therapy, and the basics of Emotionally Focused Therapy (as a reminder, EFT is an evidence based modality with a proven ‘total recovery’ rate of 75%, and 90% of clients showing improvements; no other modality even comes close!). The workshop was such a success that the ACPNL have requested that I go back and do another one, so I will keep you posted once dates are confirmed.

Once again, I would like to wish you all a happy and healthy end to the year, and all the best for 2015.





Association of Counsellors and Psychotherapists in North London (ACPNL)

23 10 2014

I’m really honoured to have been invited to be a guest speaker by the Association Of Counsellors and Psychotherapists in North London (ACPNL). I will be presenting there on Sunday December 14th, from 10am to 1pm, and you can find full details on their events calendar.

acpnl

The title of my presentation will be “Social Emotion Regulation: Bringing The ‘Other’ Into Therapy”, and a brief description is as follows:

“Often in therapy we focus on the internal struggles our clients face, exploring intrapsychic variables such as troubling narratives, conflicting beliefs, or self- defeating messages. We discuss our clients’ emotion regulation strategies, and give them the tools to develop new ones, such as meditation, mindfulness, exercise, awareness of automatic thought patterns, and so on. However, these are all relatively isolated activities, and the social circumstances of our clients’ lives are often left unexplored. In this workshop, Stefan Walters explores the importance of social emotional regulation, and how a sense of being part of a supportive and enriching social network is absolutely vital to good mental health. Stefan looks at the links between self-worth and other-worth, and discusses how we can bring the ‘other’ into therapy, to assist our clients with their issues.”

Tickets are £30 for non-members of the ACPNL, or £20 for members, and can be purchased on the website. I hope to see you there!





Boys Do Cry

15 10 2014

I just wanted to post a quick link to a a couple of excellent articles.

The first was published by Vice last week, titled “A Stiff Upper Lip Is Killing British Men“. You can read it here and I think the facts speak for themselves:

stiffupperlip

“Even accounting for reproductive health, in any given year men are half as likely as women to visit their doctor in England, which doesn’t make a lot of sense. I’m pretty certain women don’t get ill twice as often as men. In the UK, the rate of premature deaths (under 50) is one and a half times higher among men than women, primarily due to cardiovascular disease, accidents, suicide, and cancer—the latter cause offering perhaps the strongest evidence of men’s reluctance to seek help. While affecting men and women equally, skin cancer kills four times as many men in the UK because we avoid addressing the issue until it’s too late… The disparity in suicide rates is another eye-opener. In spite of depression being more common in women, men are three times more likely to take their own lives in the UK. A 2012 Samaritans report concluded that the social constructs of masculinity were a major cause of this imbalance, noting that “the way men are taught, through childhood, to be ‘manly’ does not emphasize social and emotional skills,” and that, in contrast to women, “the ‘healthy’ ways men cope are using music or exercise to manage stress or worry, rather than ‘talking.’ Alcoholism is also significantly more prevalent in men, linked largely to self-medicating mental illness… Communication is the key to a successful relationship, as any happily married person will tell you. The worst part is that we know this. It’s been drilled into us by every book and TV show and film that deals with these kind of issues, but still we ignore it, forging ahead under the misconception that those rules only apply to others.”

In summary: it’s good to talk. And the stigma that men should be strong just deal with things by themselves is outdated, unnatural, and unhealthy.

The second is a lovely article by Robert Webb for The New Statesman which touches on topics such as going from boyhood to manhood, grieving a lost parent, and forgiveness. You can find it here.





Guardian Interview about sex for the over 60s

25 08 2014

A while ago I did a short interview with The Guardian, to discuss sexual health and relationships for the over 60s. It was recently published on their website, and you can read it here.

older couple

Unexpectedly, the story seems to have been picked up by a number of other international sites as well, including this American news site and some blog posts. It’s nice to see the story spreading around, and hopefully this will encourage further healthy discussion around the topic.

I think sometimes there’s a stigma that you “can’t teach your grandmother to suck eggs”; that after a certain age we just get stuck in our ways and refuse to change. So the misconception follows that therapy is reserved for younger people; from teenagers facing problems in puberty, up to married couples in their 50s facing divorce.

But the truth is that it’s always good to talk; no matter what age you are. I see many elderly couples who find it transformative to discuss their relationships and sex lives in therapy, and it’s always rewarding to see the progress they make together. It’s never too late to make a change!





Lost Highway

4 03 2012

I’ve been a fan of Lost Highway, by David Lynch for many years. I remember seeing it in the cinema when it first came out and being mesmerised by what I had just seen, although not fully understanding it.

Since then I have watched the film many more times, and last month’s David Lynch retrospective at the BFI recently inspired me to revisit it again.

I’d like to think that I have a pretty good grasp of what the film is about, now, and I get frustrated by all the reviews saying that it is ‘meaningless’ or ‘pure surrealism’, so I thought I’d share my interpretation here. Before I start, I should point out that you should not read ahead if you haven’t seen the film yet – I discuss the full plot of the film here, and my review contains many spoilers.

Right, now that’s out of the way…

In summary, I think it is a film about infidelity and unrequited love, and how they can lead to literal madness. I think it’s a wonderful study of mental anguish, and of dissociation, and personality disorders.

When watching the film, it’s also important to remember that David Lynch is primarily an artist, not a film-maker. He often mixes fantasy and reality, and uses a lot of surreal imagery in his films. Many of his films are wonderful studies of consciousness, dreams, identity, and mindfulness (in fact Lynch runs his own center for transcendental meditation), as well as the primary emotions, including desire, shame, fear, and anger.

Here’s my summary of Lost Highway:

Lost Highway film poster

[At the start of the film a buzzer goes off. A man answers it, and he hears a voice say “Dick Laurent is dead”. Then we hear police sirens in the distance, and the scene fades out.]

We meet our two main characters: Fred Madison and his wife, Renee. They live in a minimalistic, modern house in the Hollywood Hills. Fred is a professional musician and Renee (as we later discover) used to be an actress in the sex industry. Right from the outset, we see that there is a lot of tension in their relationship. They barely speak to each other, and most of the scenes are silent and awkward. One night Fred is preparing to go and play a gig, and Renee says that she’s not going to attend. Fred seems suspicious and asks what she’ll do instead, and the following dialogue occurs:

Renee: “You don’t mind that I’m not coming tonight?”
Fred: “What are you going to do?”
Renee: “Stay home, read.”
Fred: “Read? Read what, Renee?”
Renee laughs.
Fred: “It’s nice to know I can still make you laugh.”
Renee: “I like to laugh, Fred.”
Fred: “That’s why I married you.”

The tension is palpable, and the distrust between them is obvious. Fred is clearly suspicious of Renee. After he comes off stage, Fred calls the house, but nobody answers. We see the phones ringing throughout the house, but nobody is there to pick them up. When Fred gets home later that night, he finds Renee asleep in bed, and seems relieved; momentarily, at least.

It becomes clear that Fred suspects that Renee is cheating on him, and that this is literally driving him crazy. His fear of losing her is so great that it begins to cause him to ‘dissociate’; to split off different aspects of his identity as a means of coping with the trauma, as is common in cases of dissociative identity disorder (DID). During these dissociative episodes he imagines that he is ‘outside of himself’ and is completely unaware of his own actions; almost as if he has blacked out. It is only afterwards that he can remember what happened, by imagining that someone else had videotaped him during that time. Lynch brings these videotapes into the movie as if it they were real objects, but they are metaphorical, and they represent those dissociated parts of Fred’s consciousness; the parts that contain his deepest fears, and which are starting to enter into his daily life as he can no longer push them aside any more.

One night Fred and Renee have sex. It is a frenzied scene, and we see the conflicting emotions in Fred’s eyes as he orgasms, and the emptiness in Renee’s. Fred comes quickly, and as Renee attempts to reassure him, he recounts a dream where he couldn’t find her in the house – he says he saw someone that looked like her, lying in bed, but it wasn’t her. At that moment, the image of a spooky white face suddenly flashes across Renee’s face. This terrifying image represents Fred’s inner demon. The dream suggests that, for Fred, Renee is slowly beginning to represent his inner demon; the source of his deepest fear and rage.

The videotapes start to appear more and more regularly, as Fred is no longer able to prevent these dissociated parts of his consciousness from coming to the surface and entering his daily life. Renee is spooked by them, and they call the police.

Two detectives visit the house, and the following conversation occurs:

Detective: “Do you own a video camera?”
Renee: “Fred hates them.”
Fred: “I like to remember things my own way.”
Detective: “What do you mean by that?”
Fred: “How I remember them… Not necessarily the way they happened.”

This explains why videotapes are such a dangerous metaphor for Fred’s darkest thoughts (and video cameras will later appear as incredibly threatening objects); and why he is struggling so hard to create a coherent narrative for himself. He wants to construct a story that makes sense to him; but which may not necessarily be true.

In one scene we see Fred remembering the night he was on stage at a gig. We see him noticing Renee at the back of the room, and then he sees her leaving through the exit, with a sleazy looking man. He suspects that they might be having an affair.

A couple of scenes later, we see Fred and Renee at a showbiz party at someone else’s house. The camera pans back and suddenly we see the sleazy looking man from the club scene. We learn that his name is Andy, and that he is a ‘friend’ of Renee’s. Renee is drunk and very flirtatious with Andy. They are all over each other. Renee asks Fred to go and get them some drinks. This seems to be the snapping point, which pushes Fred over the edge. He cannot stand it any more. He goes to the bar, and drinks two drinks himself, and then suddenly his inner demon (the spooky white face we saw earlier) appears at the door; his nemesis. The demon approaches, and they talk. This is the first time Fred’s inner demon has ever entered into his waking life. The demon knowingly says “We’ve met before, haven’t we?” and when Fred asks where, he says “At your house” (in a sense, he is saying “I am inside you”). The demon proves his existence via a trick on Fred’s phone, and then leaves.

Fred is understandably distressed by this encounter, and asks Andy who the demon was. Andy says he is a “friend of Dick Laurent’”, which reminds Fred of the very first scene in the film. He looks confused, and the following dialogue takes place:

Fred: “But Dick Laurent is dead, isn’t he?”
Andy, looking angry and threatened: “He is? I didn’t think you knew Dick. How do you know he’s dead?” (The use of the name ‘Dick’ here, and the reminder that ‘Dick is dead’ may also be a reference to Fred’s sexual performance, and his shame from the other night).

Fred is confused and upset and angry, and pulls Renee away from the party. On the way home, he asks her how she met Andy. She says “We met at a place called Moke’s. We became friends. He told me about a job.”. When Fred asks what job it was, Renee simply says she can’t remember; but by this point it’s already too late. Fred is filled with jealousy and rage, and he is convinced that Renee is cheating on him. He can no longer dissociate, or keep it under control. As they approach the house, we see shadows moving indoors. Fred enters the house, and asks Renee to wait outside. He goes into the house and we see him moving amongst the shadows; starting to merge with his dissociative alter-ego.

Renee enters the house, and we later see her calling for him in the darkness. This is the last time we will see her. Later that night (as we will discover through footage from Fred’s ‘videotape memories’) Fred murders her in their bed.

Once out of his dissociative state, Fred has no memory of this afterwards; in fact when the police accuse him of being a murderer, he begs for them to “Tell me I didn’t kill her”. He is sentenced to jail, and execution in the electric chair. In his cell, Fred struggles to make sense of what has happened. He can’t sleep, and suffers from constant headaches. He has short glimpses of memory where he sees what he did to Renee, but still cannot resolve everything in his mind. He needs closure somehow; he needs another chance to make his relationship work, or to understand what went wrong. He has to figure out what happened, and why. He has to know who caused it, and he has to get revenge on those people that corrupted Renee and helped her cheat on him. There is only one way he can do this: by creating an ‘alternate reality’ for himself and entering into a fugue state.

So this is exactly what he does, and from here on everything we see is taking place within Fred’s consciousness, as he attempts to battle his inner demons and make sense of what has happened. Fred imagines himself to be a young man named Pete, and from this point on, we see the movie from this alter-ego’s perspective.

Pete is a young, attractive ladies’ man, who works as a mechanic, and dates a girl named Sheila. Pete ‘appears’ in Fred’s cell, and is set free; with detectives following his movements from a distance. Pete decides to go to work, and here we meet a terrifying character named ‘Mr Eddy’. ‘Mr Eddy’ takes Pete for a ride to fix his car, but whilst they’re out driving someone overtakes them, and ‘Mr Eddy’ rams his car off the road, beats him up, and threatens to kill him. Clearly, ‘Mr Eddy’ is not somebody you should mess with. As they get back to the workshop, the detectives spot them, and identify ‘Mr Eddy’ as Dick Laurent; the man we heard about earlier. Clearly, this man represents the corrupt, dangerous, nasty side of life.

Mr Eddy

The next day, ‘Mr Eddy’ returns with a different car, but this time there’s a woman in it: it’s Renee. Except she has blonde hair, and her name is now ‘Alice’. This is Fred’s way of bringing her back to life; to incorporate her into his fantasy world as some kind of identical twin.

Alice

Pete instantly falls in lust with her, and she seems to feels the same way. Time slows down, and they glance at each other as music plays. Later that night she returns, and asks Pete to accompany her to dinner. Pete hesitates, as he recognises the danger of getting involved with ‘Mr Eddy’s’ girl, but he cannot resist. They go to a motel and have sex. They swap numbers, and start a sexual relationship. They regularly meet in motels and sleep together, and seem to be developing feelings for each other.

Notably, as Pete starts to develop feelings for Alice, reminders of reality start to creep into the fantasy word Fred has constructed in his mind: Pete starts to have headaches, and to become confused about ‘what happened to him’, and there is an occasion where we hear Fred’s sax solo on the radio at the workshop, and Pete quickly has to change it.

One day, Alice tells Pete that they are in danger, and that ‘Mr Eddy’ knows about them. Pete asks what they should do, and she comes up with a plan. She says that she knows a man who “pays girls to party with him” and has a lot of cash. They could kill him and steal the money and run away together. Fred asks Alice how she met this man, and she explains that he works with ‘Mr Eddy’. She reluctantly confesses that she made adult films for them in the past, and explains that their very first meeting was “at a place called Moke’s”. Suddenly it becomes clear that she is talking about Andy. Finally, through Pete, Fred is able to understand the full story of what happened. Pete agrees to Alice’s plan; to kill Andy and run away with her.

But when Pete gets home that night, Sheila is there. She is distraught, and says she knows he is cheating on her. She urges Pete’s parents to tell him something, but they refuse. Finally, she bids him farewell, and says she will never see him again. It’s clear Pete’s time is running short and that his fantasy can’t last forever. Fred needs resolution.

Pete goes into the house and his parents pass him the phone. It’s ‘Mr Eddy’, and he is with Fred’s inner demon; working in cahoots. At this point, the demon still represents Fred’s nemesis, and the source of his darkest fears and deepest anger. Pete talks to the demon, and has the same conversation that Fred has with him at the party. Finally the demon tells him a story:

Demon: “In the East, the far East, when a person is sentenced to death, they’re sent to a place where they can’t escape, never knowing when an executioner may step up behind them and fire a bullet into the back of their head.”

This is of course a thinly-veiled threat against Fred; who already has been sentenced to death, but still awaits the execution itself.

The next day, Pete goes to the address Alice told him about, and murders Andy, as planned. However, what he didn’t expect was to actually have to witness seeing Alice in her adult films. They’re projected onto a wall in the living room, and he cannot avoid them. This is too much for Fred’s psyche to handle, and Pete starts to convulse and bleed. Fred’s fragile alternate reality is falling apart, and suddenly we see a picture, of both Alice and Renee, standing with Andy and ‘Mr Eddy’. Pete asks Alice if they are both her, and she points only at Alice and says “That’s me”; temporarily keeping the narrative of the alternate reality alive. Pete goes upstairs to clean himself up, and when he comes back down there is a short exchange with Alice where she points the gun at him and we once again question whether or not she can be trusted. Finally she hands it to him and suggestively tells him to stick it in his pants.

Alice tells Pete that they must drive out to the desert, to a cabin, so they do. The cabin represents the very heart of Fred’s consciousness.

When they get there, there’s nobody there yet, so they have to wait. Alice seduces Pete, saying: “You still want me, don’t you, Pete”.
“More than ever,” Pete replies, “I want you, I want you.”
Time slows down and they have sex one last time and roll around in the sand. As they finish, Alice towers above Pete, and leans down to whisper into his ear: “You’ll never have me.” Then she gets up and leaves.

Fred’s alternate reality has fallen apart. Even in this fantasy, he couldn’t convince himself that his wife loved him.

There is no need for the alter-ego any more, so Pete has turned back into Fred, and this is who we see stand up, in the middle of the desert. Pete is gone.

Fred walks to the cabin and his inner demon is there, waiting with a video camera; the window into his soul. Fred asks where Alice went and the demon makes it brutally clear: “Alice who? Her name is Renee. If she told you her name is Alice, she’s lying.”

Demon with video camera

Everything is lost. All that is left is for Fred to be executed; but he can still commit one final act of revenge, by joining forces with his inner demon and killing ‘Mr Eddy’. So this is what he decides to do.

He finds ‘Mr Eddy’ in bed with his wife, at the Lost Highway Motel (the ‘Lost Highway’ of the desert represents the journey down deep into his consciousness). He kidnaps ‘Mr Eddy’ and bundles him into the car boot. He drives him out to the desert, and then opens the boot. Suddenly ‘Mr Eddy’ leaps out, and for a moment it seems like Fred will lose the battle, but suddenly someone hands him a knife, and he cuts ‘Mr Eddy’s throat. The camera pans out, and we see that his accomplice is now his inner demon. They have joined forces, and Fred has embraced his innermost fears and rage. ‘Mr Eddy’ dies; one final token act of revenge, and closure for Fred.

We cut to a scene back at Andy’s house, and the detectives are cleaning up the mess. They notice the picture we saw earlier, but this time only Renee is in it. “That’s Fred Madison’s wife with Dick Laurent.” The fantasy world has collapsed.

Finally, all that is left for Fred to do is to run. But he has one last idea; perhaps if he can somehow go back in time, and reassure himself that the evil Dick Laurent has already been dealt with, then maybe he can find happiness with his wife after all? So this is what he does – he flees from the police, and goes right back to the start of the movie; setting a Möbius strip into motion, like a black hole in time.

In the fantasy world, Fred is suddenly submerged by flashing blue lights, and his body starts to shake violently. He screams out. In reality, he is in the electric chair, being electrocuted. These are his final moments.

And that’s the end of the film.

Film stills

Of course, I’m aware that I could be wrong, and that it could all mean something completely different, or even a million different things. But, to me, that’s what makes it such a brilliant piece of art.





Private Practice Made Simple

4 02 2012

My review of “Private Practice Made Simple” by Randy J. Paterson, PhD:

Private Practice Made Simple front cover

There are plenty of books and websites out there offering advice to mental health professionals who want to know how to establish their own private practice. With this new release Randy J. Paterson, PhD offers his own comprehensive take on this popular topic, promising to provide “everything you need to know to set up and manage a successful mental health practice,” from “getting client referrals and creating a positive and comfortable office atmosphere to building a strong and thriving therapy practice that can serve both you and your clients.”

As the 2008 recipient of the Canadian Psychological Association’s Distinguished Practitioner Award, and the owner of a private multiple-provider outpatient practice in Vancouver, Paterson certainly seems to write with a wealth of personal experience in this area. Indeed, what differentiates this book from so many of the others available on the market is that personal touch, as Paterson shares his own journey into private practice, and the lessons learned along the way, explaining that:

No one really teaches you how to manage a mental health or counseling practice. As clinicians we stumble through our careers, gradually picking up shortcuts and strategies that make our lives (or those of our clients) a lot easier. Many of these useful ideas aren’t rocket science and could have been taught to us in an afternoon if anyone had thought about it. That’s what this book is for: it’s nothing more than a collection of useful basic tips … The emphasis of the book is on quick and easy strategies that can save a lot of headaches.

This light, conversational style typifies Paterson’s everyman approach to the topic, ensuring that the book is easy to read and full of accessible ideas for anyone contemplating the possibility of working in private practice.

While some other books might launch straight into the practical side of running a private practice, Paterson predicates this by starting his book with a chapter focusing on the importance of weighing up the pros and cons of running this kind of business in the first place. Paterson lists his ten most frequently-heard arguments both for and against private practice, and I can guarantee that any mental health professional will be able to relate to at least some of this debate.

The arguments in favor are listed as:

1. No Big-Organization Hassles
2. Getting Away from the Medical Model of Distress
3. Increased Accessibility for Clients
4. You Get to See Whom You Want
5. More Money
6. Supplement Your Salaried Income
7. Flexible Hours and Holidays
8. Work Fewer Hours
9. No Commute!
10. A Service Based on Your Own Vision

Whilst the arguments against are:

1. You’ll Never Get Clients
2. You’re No Good at Networking or Marketing
3. Uncertainty About Income from Month to Month
4. You Hate All the Clerical and Business Demands
5. You Don’t Know Enough to Practice Independently
6. Dealing with Fees will be a Huge Hassle
7. You’ll be Helpless in the Face of Insurers or Funders
8. No Retirement Plan or Benefits
9. You’ll Burn Out and Won’t Have a Safety Net
10. You Won’t have a Sense of Meaning in Your Work

Paterson follows this up with a considered appraisal of what is truly involved in the day-to-day running of a successful private practice, and then allows you to make up your own mind as to whether you’re really suited to this type of business. Assuming that you are, this book then serves as a comprehensive guide to everything involved in setting up and maintaining your practice, from such subtle nuances as the ‘olfactory environment’ and placement of clocks, to website design and finance tips.

As Paterson says, many of the ideas in this book aren’t rocket science, and might initially just seem like common sense, but don’t let this be a deterrent. As you make your way through the book you’ll realize there are also countless suggestions here which will leave you wondering “Why didn’t I ever think of that before?” and feeling enlightened. One such example is the section on ‘The Client’s View,’where Paterson explains the importance of the contents of the therapist’s bookcase:

Look at your own bookshelf from the client’s position. Notice where your eye naturally falls. These are the most salient shelves. Banish books that imply you are having significant problems yourself (Avoiding Burnout, The Wounded Healer), your introductory psychology textbooks, the trashy novels you secretly read at lunch, the books on handling problem clients, the self-help books you wouldn’t recommend to your worst enemy, and all the books on managing the finances of your private practice (including this book). Shift those books upward or downward, and replace them with scholarly books on your specialty areas of practice, books on diversity, a book or two on sexuality (this subtly gives clients to put such issues on the table), the self-help books you most frequently recommend, high-level books on practice and therapy, and other books that communicate your expertise, interests, and breadth of knowledge.

Once you’ve thought about it this seems so obvious, but I have seen plenty of counseling rooms where this advice had clearly been sorely missed, and where business may have suffered as a result.

It is these kinds of subtle tips which can make a huge amount of difference to the way a private practice is run, and which might distinguish an outstanding business from a mediocre one. Having all of these ideas listed in one simple book is truly invaluable, and will surely offer numerous benefits to anyone in the mental health profession. I couldn’t think of anything which Paterson had missed from this book, and he even includes a link to free downloads of practice worksheets and sample forms to help you on your way. If you’ve ever considered setting up a private practice, or you’re running one already, then this book’s for you.

3 out of 5 stars.