How I work
From the first call to the last session, set out plainly — including how children’s work differs, what I do not do, and where confidentiality ends.
The free 30-minute call
Everything starts here, and it costs nothing. You tell me what has been happening and I tell you honestly whether this is work I do. If it is not — if NHS Talking Therapies, a psychiatrist or a different specialism would serve you better — I will say so and point you somewhere sensible.
It is not therapy and it is not an assessment: half an hour is not enough to draw conclusions about anything. It is not a sales conversation either — turning people away kindly is a normal part of my week. And there is nothing to prepare. No forms, no reports, no rehearsed version of events. Start wherever you like and we will sort out the order together.
The 90-minute initial assessment
If we both think it is worth going ahead, the next appointment is a full assessment. It runs 90 minutes rather than the usual hour, because rushing it costs more time later than it saves.
We go through the problem in detail: what happens, when it started, what sets it off, and critically what you do to make the feeling stop — the checking, the reassurance, the avoidance. I ask about sleep, mood, alcohol, school or work, physical health and previous treatment, and about risk, directly.
I use standardised measures as part of this: short, well-established questionnaires that put a number on something otherwise described only in adjectives. Their value is the comparison later. They are how we find out whether treatment is working rather than whether it feels like it is working, which is not the same thing.
The formulation, and why it matters
A formulation is a working explanation of what is keeping the problem going now. Not the label, and not entirely the cause — what maintains it today. Two people with the same diagnosis often need different treatment, because the mechanism is different, and treating the label rather than the mechanism is the most common reason therapy fails.
So at the end of the assessment I draw it out with you, in plain English, and you tell me where I have got it wrong. Then you leave with a plan: the treatment I am recommending, what the first few sessions consist of, and an honest estimate of how long it is likely to take. If I think you should be seen by someone else, or that medication should be on the table, you hear it at this appointment rather than three months in.
Treatment
The therapy I do is CBT and, for OCD and most anxiety disorders, Exposure and Response Prevention. It is active, structured and time-limited by design, not open-ended weekly talking. Every session has an agenda we set together in the first few minutes: we review last week’s practice, do the work of the session, and agree the next step before you leave.
That between-session practice is where most of the change happens. An hour a week with me is not what loosens anxiety’s grip; the rest of the week is, in real situations, without the safety behaviours. My job is largely to make those steps small enough to be possible and hard enough to be useful, and to make sure nothing is sprung on you.
We repeat the measures periodically and review progress out loud. If it is not moving we do not quietly carry on. Usually the formulation has missed something and we change the approach; sometimes something else — sleep, alcohol, an untreated co-occurring problem — needs dealing with first. Occasionally it means I am not the right clinician, in which case I will say so and help you find someone who is. Continuing to book sessions that are not working is the one outcome I am not willing to have.
Endings
Endings are planned, not drifted into. As progress becomes solid we space sessions out — fortnightly, then monthly — so you can test the gains with more room around them. The last few go on relapse prevention: a written summary of what you learned, your early warning signs, and exactly what to do if things slip. Setbacks are normal, and the difference between a wobble and a relapse is usually what happens in the fortnight after it starts.
Throughout, I am working towards you not needing me. If something flares up a year later, people come back for a top-up of two or three sessions, which is a good outcome rather than a sign the first course failed.
How working with children differs
The framework is the same and the delivery is not. Parents are in and out of the room by design: with younger children I usually see parents first, then the child, then everyone together, and much of the treatment is delivered by you at home. With teenagers the balance shifts towards the young person setting their own targets and parents deliberately stepping back. We agree explicitly who the client is, because it changes how the work runs. Sometimes it is the child, with parents as co-therapists; sometimes it is the parents, as in SPACE, where the child does not need to attend at all.
With teenagers I set out confidentiality in the first session, with the young person and the parents both present. They get a private space and I do not relay sessions back line by line, because treatment does not work without that. What I do share is anything concerning their safety, and everybody hears that rule before we begin.
With your consent I will speak to school, which is often where avoidance and compulsions are most visible and most accommodated. One conversation with the right person there can be worth several sessions of anything else.
What I do not do
- I am a psychologist and I do not prescribe. Where medication may be relevant I work alongside GPs and psychiatrists, and will say plainly if I think it should be considered.
- I do not carry out ADHD or autism assessment or diagnosis. I treat anxiety and OCD in autistic people and people with ADHD, and adapt the treatment accordingly, but the diagnostic assessment needs a service set up for it.
- I do not treat anorexia nervosa, bulimia nervosa or binge eating disorder. These need a specialist eating disorder service with medical monitoring. ARFID is different and is something I do treat.
- I do not treat tic disorders or Tourette’s as a service, though I regularly work with tics that co-occur alongside OCD.
- I do not provide crisis, emergency or out-of-hours care. This is a planned outpatient service running weekdays, 9am to 9pm.
Confidentiality, and where it ends
What you tell me stays between us, and records are kept securely to HCPC standards. I will not contact your GP, your school or anyone else without your consent.
The limits are the standard ones. If I believe a child or vulnerable adult is at risk of significant harm, or that there is a serious and immediate risk to someone’s life, I have a duty to act, which usually means contacting a GP or the appropriate service. In rare cases a court can require disclosure. If you claim through insurance, your insurer receives limited information such as dates and a broad treatment category.
In practice this arises far less often than people fear, and when it does it is a conversation I have with you rather than something that happens behind your back.
Practical details
I work online across the UK and in person near Ravenshead, Nottingham and Mansfield, weekdays 9am to 9pm. Sessions are £120 and the assessment £180; see fees and insurance and the common questions. No GP referral needed. The next step is small: ask for a free 30-minute call.
Common questions
What do I need to prepare for the free call?
Nothing at all. You do not need dates, reports, a diagnosis or a tidy version of the story. Most people start somewhere in the middle and we sort the order out together. If you happen to have a letter from a GP, a school or a previous therapist, it is useful, but it is not a requirement and its absence will not slow anything down.
How long will treatment take?
You will get an honest estimate at the end of the assessment, before you commit to anything. Specific phobias often take a handful of sessions. Panic and health anxiety commonly run somewhere in the region of eight to sixteen. OCD, in adults or children, usually takes longer. Parent-based work tends to run around ten to fourteen. These are estimates rather than promises, and I would rather revise one openly partway through than let treatment drift.
What happens if the therapy is not working?
We will know reasonably early, because we measure. If the numbers and your own account are both flat by around session six or eight, that is a signal, not a failure. Usually it means the formulation has missed something and we change the approach. Occasionally it means I am not the right person, or that something else needs attention first. In that case I will say so and help you find a better route rather than continuing to book sessions.
Do you tell my child what I have said, or tell me what my child has said?
With younger children, parents are fully in the loop because parents deliver most of the treatment. With teenagers I agree the rules at the start, in front of everyone. The young person gets a private space, I do not report the content of sessions back line by line, and I do tell parents about anything that concerns their safety. Everyone knows the rule before we begin, so nobody is caught out by it.
Can I come back later if things flare up again?
Yes, and quite a few people do. Anxiety and OCD can resurface at points of change such as exams, a new job, a house move or a new baby. A short top-up of two or three sessions to reapply what you already know is usually enough, and it is a much smaller undertaking than starting over. You do not need to go back to the beginning to get back on track.
Do you offer support between sessions or in a crisis?
I reply to practical messages between sessions, but this is a planned outpatient service and not a crisis service. I do not provide out-of-hours or emergency cover. If you or your child are in immediate danger, the right route is 999, NHS 111 option 2, or your local crisis team, and I will always say so plainly rather than stretch my service to cover something it cannot cover safely.
Related pages
Not sure whether this is the right fit?
Start with a free 30-minute call. We will talk through what is going on, I will tell you honestly whether I think I can help, and if I cannot I will try to point you to someone who can. There is no obligation and no charge.