After more than 25 years working across mental health, psychotherapy, coaching and service development, there is something I have become increasingly clear about:

People don’t all arrive needing the same thing.

Some people know exactly what they want help with.

Others arrive with five different things happening at once and have no idea which one we should start with.

Some have done therapy before and understand themselves extremely well but can’t work out how to translate that understanding into change.

Some are in the middle of a crisis.

Some aren’t in crisis at all. Life is functioning reasonably well, but something doesn’t feel right.

And some have spent so much of their lives responding to everybody else’s needs that asking:

“What would actually work for you?”

is surprisingly difficult.

That is one of the reasons I created three different ways of working.

I don’t want to decide in advance how much therapy you need

Traditionally, therapy is often organised around weekly sessions.

You start.

You continue.

At some point, you decide whether you’re ready to stop.

There is nothing inherently wrong with that model and, for some people, open-ended therapy is exactly what is useful.

But it isn’t the only way we can work.

Over the years I’ve become increasingly interested in matching the structure of the support to the person and the situation in front of me.

Before deciding what we need to change, I want us to understand what is actually happening.

What brought you here now?

What is going well?

What isn’t?

What pressures are you carrying?

What have you already tried?

What helps?

What keeps repeating?

What resources and support do you already have?

Is there anything I’m hearing that makes me concerned about your mental health or safety?

And importantly:

What would you like to be different?

We may not know all the answers immediately.

That’s okay.

Formulation develops as we get to know each other.

But we can still decide what seems like the most useful place to begin.

Option One: The Two-Hour Deep Dive

Sometimes somebody doesn’t necessarily want therapy.

They want space to think properly.

Perhaps several things have happened at once.

Work is changing.

A relationship feels uncertain.

They’re exhausted.

Money is worrying them.

They’ve reached a crossroads.

Or they’ve spent months going around the same questions in their head.

A standard hour can sometimes feel as though we’ve only just opened everything before it’s time to stop.

So I created the two-hour Deep Dive.

It gives us enough time to slow things down and look at the wider picture.

We can explore what’s happening, what appears most important, what is already working, what might be getting in the way and what options are realistically available.

Sometimes the outcome is surprisingly practical.

We identify two or three priorities.

Something can wait.

Something needs attention.

Something isn’t actually theirs to solve.

Sometimes a deeper pattern becomes visible.

And sometimes the most useful outcome is simply:

“I understand what’s happening now.”

From there, you decide what you want to do.

You might take what we’ve discovered and work with it yourself.

You might decide you would benefit from several sessions.

You might realise another kind of support is more appropriate.

 

The Deep Dive doesn’t automatically commit you to therapy with me.

That matters to me.

 

Option Two: Six Sessions

For some people, one conversation isn’t enough, but they don’t want to begin an indefinite therapeutic relationship.

 

Six sessions gives us a piece of time to work with.

We can agree an initial focus.

Try things.

 

Notice what happens between sessions.

Explore patterns as they emerge.

Review what is changing.

And adjust the work if our original understanding turns out to be incomplete.

Because it sometimes will.

A client may arrive believing their problem is procrastination.

 

As we work together, we discover they’re exhausted.

Another person thinks they need more confidence and gradually realises they’re carrying responsibilities that don’t belong to them.

Someone comes because of a relationship and discovers the transition happening in the rest of their life matters just as much.

Therapy shouldn’t become a process of deciding what somebody’s problem is in session one and then spending the remaining sessions proving ourselves right.

We stay curious.

 

At the end of the six sessions we can ask:

Where are you now?

What’s changed?

What hasn’t?

What have you learned about yourself?

What can you continue doing without me?

Is there something we still need to work on?

And then you have another decision.

 

Option Three: Open-Ended Work

Sometimes there is more to do.

A person’s situation may be complex.

Things may continue unfolding while we’re working together.

They may be navigating significant changes in relationships, work, identity, health, family or the way they want to live.

Or they may simply find that having a consistent therapeutic relationship gives them somewhere valuable to think, process and develop.

In those circumstances, we can work more openly.

I usually prefer us to have done the Deep Dive first because it gives us a shared starting point.

But open-ended doesn’t mean directionless.

We still review.

We still ask what we’re doing.

We still notice when the work changes.

And eventually we should also be able to ask:

Do you still need me?

 

For me, that is an important therapeutic question.

Why choice matters so much to me

There is another reason I’ve structured my work this way.

Many people who come to therapy have spent significant periods of their lives without feeling that they had much choice.

Perhaps somebody else made most of the decisions.

Perhaps they grew up learning to keep everybody happy.

Perhaps they were in a controlling relationship.

Perhaps work consumed their life.

Perhaps caring responsibilities always came first.

Perhaps money limited their choices.

Perhaps they became extremely good at adapting to whatever everybody else needed.

Then they arrive in therapy and we start talking about boundaries, confidence, autonomy, self-esteem and agency.

It would seem strange to me if I then created another relationship in which I decided what they needed and how long they should stay.

I can make recommendations.

I can tell you if I’m concerned.

I can challenge you.

I can tell you when I think something deserves more attention.

And sometimes my professional responsibility means recommending specialist or additional support.

But wherever it is safe and feasible to do so, I want you involved in deciding what happens next.

Because making decisions is sometimes part of the work.

Self-care can be harder than it sounds

People sometimes hesitate to seek support because they don’t think their problem is serious enough.

Other people have it worse.

I should be able to sort this out.

I’ve coped before.

I don’t want to waste anyone’s time.

Maybe I just need to pull myself together.

Sometimes those thoughts are worth examining too.

If you’ve spent years prioritising everybody else, spending money, time or attention on your own wellbeing can feel strangely difficult.

Support doesn’t have to be reserved for the point at which everything has fallen apart.

Sometimes getting help earlier means spending less time circling the same problem in your head.

That mental circling has a cost.

It follows us into work.

Into sleep.

Into conversations.

Into parenting.

Into relationships.

Into the decisions we’re trying to make.

Having somewhere to put it down, examine it properly and decide what to do with it can free up some of that attention for ordinary life again.

Therapy should increase your agency, not replace it

 

I don’t believe my role is to become the person who knows your life better than you do.

I bring professional experience.

I listen for patterns.

I ask questions.

I assess.

I formulate.

I draw on psychotherapy, psychology, coaching and many years of working with people and mental-health systems.

Sometimes I will see something you haven’t seen yet.

And sometimes you’ll tell me my hypothesis doesn’t fit.

Good.

Then we look again.

Because ultimately the aim isn’t for you to become better at asking:

“Mel, what should I do?”

It’s for you to become increasingly able to ask:

“What do I think? What do I need? What are my options? What are the consequences? What matters to me? And what feels like the right next step?”

For somebody who has rarely been able to ask those questions, that can be significant work in itself.

So where do we start?

You don’t need to arrive knowing whether you need therapy, coaching, deeper exploration or simply somewhere to make sense of what’s happening.

Working that out can be part of the work.

You may need two hours.

You may want six sessions.

You may discover that longer-term work would be useful.

Or you may have one substantial conversation with me, leave with a clearer map and decide to take it from there yourself.

I am comfortable with all of those outcomes.

Because the goal isn’t to keep you in therapy.

The goal is to help you understand where you are, what you need and what might help you take the next step — with as much choice, autonomy and agency as possible.