Frequently Asked Questions

No. The first session is a full paid session. I used to offer consultation calls when I first started private practice in 2017. It was standard practice, and it seemed to work - people would have the call, feel reassured, and book their first session. But I stopped. Here's what I noticed. That anxiety you're feeling about reaching out to a stranger, about whether you'll be able to talk, about whether this will actually help - that's not something to be managed away before we start. That's exactly what we need to work with. The consultation call treats your anxiety like a barrier to therapy. But your nervousness about starting isn't the problem. It's material for the work. There's also something dishonest about the consultation call that nobody talks about. It's marketing. On that call, I'm performing - being warm, reassuring, demonstrating competence. And you're performing too, probably without realising it - presenting the acceptable version of your problems, showing me you'll be a good client. Neither of us is being real. We're both auditioning. Then when we meet for your actual first session, a dynamic has already been established. And it's not a therapeutic one. What I offer instead: You can read everything on this website to get a sense of how I work and whether my approach makes sense to you. You can email me with practical questions - fees, availability, whether I work with specific issues - and I'll answer them straightforwardly. But if you want to know whether we can work together, book a first session. Come and find out. That's the real test. The first session isn't just a consultation. It's the beginning of the work. Your hesitation about booking it, your uncertainty, your anxiety about what will happen - all of that is part of what we're there to understand, not something to be smoothed over beforehand.

Maybe you're googling therapists at 2am. Maybe you've told the same story to three different friends hoping one of them will make sense of it. Maybe you keep having the same argument with different people, or something that happened years ago still makes you leave the room. If you're asking the question seriously enough to be reading this, there's probably something worth exploring. The clearer version of this question is often "how bad does it need to be before I'm allowed to get help?" And the answer is: you don't need permission. If something's not working, that's reason enough. I've written more about this: Do I need therapy?

You talk. I listen - properly listen, not the polite nodding kind. I'll ask questions that might make you uncomfortable or point out patterns you haven't noticed. Sometimes I'll sit with your silence rather than rush to fill it. We're not solving problems or making action plans. We're working out why the same problems keep happening, why the patterns persist regardless of what you try. The difference matters more than it sounds like it should. More detail: What happens in the first session?

No. Not because advice is bad, but because it misses the point entirely. If advice were the answer, you wouldn't be here. You'd have fixed this with the wisdom of friends, family, or the internet. The question isn't what you should do - you probably already know what you "should" do. The question is why you can't do it, or why the solutions that work for everyone else don't work for you. Advice assumes the problem you can see is the actual problem. But the surface issue is rarely what needs addressing. It's just where the real problem shows up. Your relationship difficulties might actually be about how you learned to attach in childhood. Your work stress might actually be about never feeling good enough. Your inability to make decisions might actually be about terror of the wrong choice revealing something shameful about you. The real work starts when you understand there's a difference between the manifest problem and the psychological machinery that keeps creating it. Between what everyone can see and what's actually driving things. This is why your friends' advice hasn't worked, why self-help books gather dust. We're not dealing with a knowledge problem.

I work psychodynamically, which means I'm interested in patterns - particularly how the ways you learned to survive in your family show up in your relationships now. How the strategies that kept you safe as a child might be the very things making you stuck as an adult. We'll pay attention to what happens between us too, because that often mirrors what happens with other people in your life. If you're always apologising to me, you're probably apologising to everyone. If you can't disagree with me, you probably can't disagree with anyone. The room becomes a laboratory for understanding your relational patterns. This isn't CBT. We're not doing worksheets or thought challenges or coping strategies. We're trying to understand the unconscious material that drives the patterns you can't seem to break, even when you know better. More detail: What is psychodynamic therapy?

Longer than you want, shorter than you've been struggling. Some people need months, some need years. It depends what you're working with and how defended against it you are. Quick fixes are for leaking taps, not for patterns you've been running since childhood. You'll know it's working when you start noticing things differently - when you catch yourself mid-pattern and think "oh, I'm doing that thing again." When conversations go differently than they used to. When something that would have sent you into a spiral just feels manageable. It's gradual, not a lightning bolt. More like ice melting than glass breaking. More detail: How long does therapy take?

That's fine. Start with what's happening now - the fight you had this morning, the email you can't answer, why you're nervous about being here. The important stuff always finds its way out eventually. "I don't know what to say" is actually saying quite a lot. It might mean you're overwhelmed, or defended, or testing whether I'll fill the silence for you. The silence won't kill you, and I'm not going to rescue you from it with therapeutic small talk.

Possibly. Sometimes things get messier before they get clearer. You might feel worse before you feel different - not because therapy is harming you, but because you're finally feeling things you've been working hard not to feel. I'm not going to promise you'll feel better immediately. That's what self-help books are for, and they haven't worked, have they? But falling apart in a contained environment with someone trained to help you put the pieces back together differently? That's often exactly what needs to happen. The goal isn't to never fall apart. It's to learn you can survive it and come back changed.

Yes. Same work, different medium. Some people prefer the distance a screen provides - it feels safer, less exposing. Some people need to be in the room where they can't just close the laptop when things get difficult. Both are valid. We can work out what feels right for you. The therapy itself doesn't change. We're still doing the real work, just through pixels instead of air.

There are many reasons previous therapy might not have helped. Maybe it wasn't the right time. Maybe you weren't ready to stop performing the good client who makes appropriate progress. Maybe it was the wrong approach - if you tried CBT and it felt too surface-level, psychodynamic work might make more sense. Maybe the therapist couldn't hold what you needed to bring. Not all therapy is the same. This isn't about positive thinking or coping strategies. It's about understanding what you're defending against and why. Sometimes people need to try therapy more than once before they find what actually helps.

Not in the cliché way you're imagining - lying on a couch blaming your mother for everything. But yes, we'll probably end up there eventually. Not to blame your parents or to excuse your current behaviour, but to understand what you learned about survival. The rules that kept you safe at eight but are suffocating you now. How you adapted to the environment you had, and why those adaptations aren't serving you anymore. Your childhood isn't an excuse, but it is an explanation. And understanding the origins of a pattern often makes it possible to change it.

Then you cry. The tissues are there for a reason. What's more interesting is if you never cry, even when talking about devastating things. Or if you cry but can't actually feel it - you're performing sadness but staying disconnected from it. Or if you apologise every time you have a feeling, like emotions are something you're doing to me. That tells us something worth exploring.

If we're just starting and it feels wrong, we can stop. Not every therapeutic relationship works, and that's fine. But if we've been working together for a while and you suddenly hate everything about it, that's usually worth exploring before we call it quits. The urge to run often happens right when we're getting close to something important. When therapy has stopped being comfortable and started being real. There's a month's notice for established clients - partly practical (so you don't vanish and leave things unfinished), partly because the impulse to leave is often exactly what we need to understand together.

Email me at hello@talktoluke.com or use the booking system if you'd rather skip the back-and-forth. Don't overthink it. You don't need to explain your entire history or convince me you're worthy of help. Just say you'd like to talk about starting therapy. If you email, I'll reply and we can sort out what makes sense. If it doesn't feel like the right fit, I'll try to point you toward someone who might be better.

Nobody's truly ready. That's like waiting to feel ready to learn to swim while you're drowning. You start where you are. Defended, uncertain, convinced you're different from everyone else who's ever needed help. That's not a problem. That's exactly where we begin.