What actually happens in a first session
Nobody tells you this beforehand, so most people arrive braced for something that isn't going to happen.
Read this →An honest question
Do you need therapy, or something else?
Therapy isn't the answer to everything, and anyone who tells you otherwise is selling you something.
Sometimes the problem is the situation
A meaningful amount of what gets treated as anxiety is an accurate response to circumstances that would make anyone anxious. A job that takes more than it returns. A relationship where you're not safe to disagree. Money that doesn't stretch. Caring for someone with no relief in sight.
Therapy can help you see the situation clearly, decide what you're willing to tolerate, and find the nerve to change it. What it cannot do is make an unliveable situation liveable, and a counsellor who helps you cope indefinitely with something that needs to change is doing you a quiet disservice.
Sometimes it's physical
Thyroid problems, anaemia, sleep apnoea, perimenopause, chronic pain, a medication side effect, long COVID. All of them can present as low mood, brain fog or anxiety, and all of them are routinely missed. If your difficulty arrived fairly suddenly, or came with physical symptoms, see your doctor before or alongside anything else.
This isn't a reason to delay counselling. It's a reason to do both.
Sometimes you need more than we offer
Some difficulties need a level of care beyond weekly conversation: active suicidal planning, an eating disorder that's affecting your physical health, addiction that has taken over, psychosis, or a crisis needing same-day response. These aren't failures of willpower and they aren't beyond help. They need the right kind of help, which in these cases is usually medical or a specialist programme.
We'll tell you plainly at the first conversation if we think that's your situation, and we'll help you find where to go. Being told the truth about fit is part of the care rather than a rejection.
Sometimes it really is therapy
The clearest signal is a pattern. Something that keeps happening across different jobs, different relationships, different cities. Or a reaction that's consistently out of proportion to what triggered it. Or a version of yourself you can see clearly and can't seem to stop being.
Patterns are what therapy is genuinely good at. They were usually formed for good reasons, they're maintained by something, and they can be worked with.
This is general writing, not advice about you. It can't account for your history or your circumstances, and it isn't a substitute for talking to someone. If any of it lands close to home, that's usually worth taking seriously rather than filing away.
Worth Knowing
Something to read while you decide
A letter every so often on the things people actually struggle with. No course to buy at the end of it, and one click to stop.
We never share your address, and we don't email often.
More reading
You might also find this useful
How to choose a counsellor — and when to change one
The thing that predicts whether this works isn't the method. It's whether you can be honest in the room.
Read this →Awakening, or crisis? How to tell the difference
Both can look identical from the outside. The distinction matters enormously, and getting it wrong is dangerous.
Read this →
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If you'd rather talk it through.
Fifteen minutes, free, and nothing to fill in first. Or if you already know you want to start, book a session whenever suits you.