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In celebration of private practice and bespoke treatment

One of the great pleasures of working in private practice is being free to make therapeutic interventions according to the needs and preferences of the person you are working with and, let’s be honest, according to your own preferences too. Individualised therapy starts with an individual case formulation, taking account of the client’s personality, and of any co-morbid conditions. If it goes well, it finishes with a satisfied client, who feels respected and understood, who is not only symptom free but has a positive sense of psychological well-being.

Whilst the therapist providing individualised treatment may know the territory to be traversed, the route will only become clear as the therapeutic journey proceeds. The therapist must be well attuned to the client, ready to respond to any feedback available, sensitive to the slightest hesitation, and wary when things are going too well. If it’s all going swimmingly, you are probably in danger of drowning in your own complacency! Delivering bespoke therapy involves working harder, and being more creative than your protocol-adherent colleagues. On the other hand, the process has the potential to be much more rewarding for you and your client. Both of you must put yourselves on the line. Both of you must be fully engaged in the enterprise.

More than two hundred years after starting the industrialised production of household goods such as pottery, and cotton fabric, we now have the industrialisation of psychotherapy. True enough there are advantages, but many of these benefit big agency providers, like the NHS or private healthcare insurers not individual practitioners or clients. Standardised treatment is cheaper to deliver because it treats therapists as interchangeable, but is that how you want to be treated? And does it work that well for clients, especially those with co-morbid conditions and idiosyncratic presentations? Not all unhappiness can be reduced to a symptom checklist.

Individualised treatment does not necessarily involve therapeutic drift or a loss of fidelity to the therapeutic modality. It is easier to ensure protocol-driven treatments don’t deviate from the  evidence or theory base, but a reflective and proficient therapist delivering tailored treatment should be able to justify whatever they are doing with reference to research and theory every bit as much as their algorithmically adherent colleague.

“Bring me the raw materials of your life: your thoughts and feelings; your history; your dreams and your nightmares”, a wise old therapist used to say to his clients, “and I will show you how to make a beautiful coat that you will feel comfortable wearing, and proud to show off”.

We started off trying to make computers that could think like humans, but we seem to have ended up trying to make humans think like computers. I’m hoping 2019 might be the year of the individual, the oddball, and the independent therapist who delivers bespoke therapy loudly and proudly. See you on the barricades!

Adam May is a CBT psychotherapist with a thriving independent practice on Anglesey. He runs CBT Psychotherapist Briefings in partnership with Sophie Wood. If you are interested in finding out more about their webinars for independent CBT practitioners, please “like” their page on Facebook.

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