Slow Therapy: Have We Forgotten About the Person?

I've become increasingly interested in the idea of slow therapy. It takes some of its inspiration from the wider Slow Movement, which began with slow food and has since influenced the way people think about travel, education, fashion, medicine and other areas of life. Slow food has nothing to do with taking a long time to eat your dinner. It is a reaction to fast food and everything that came with it: speed, standardisation, convenience and the gradual loss of something more individual, local and meaningful.

That wider idea interests me when I think about therapy. Slow doesn't necessarily mean taking longer. It can mean questioning what we lose when speed and efficiency become goals in themselves, particularly when we are working with something as individual and complicated as another human being.

I'm certainly not arguing that therapy needs to be slow for the sake of it. There are areas where focused, relatively rapid work can be extremely effective. Smoking cessation is an obvious example. A client may have reached a very distinct point where they have decided they are going to stop smoking, and there can be enormous value in seizing that motivation while it is strong. A specific phobia can sometimes be similarly clear. Somebody is frightened of flying, dogs or injections, they don't want to be frightened anymore, and there are established approaches that can sometimes produce considerable change surprisingly quickly.

I've seen enough rapid change in my own clinical work to know that it happens. If somebody can stop smoking after one session, or make a significant change to a phobia in a short period of time, I don't see any virtue in stretching that work out unnecessarily. Sometimes the problem is relatively well defined, the client's desired outcome is clear and their motivation to change is strong. Focused therapeutic work makes sense.

But much of what brings people to therapy isn't remotely that black and white.

A client who has spent decades feeling that they aren't good enough, who repeatedly finds themselves in difficult relationships, who grew up adapting to an unpredictable parent, or who has experienced years of trauma isn't necessarily bringing us a clearly defined problem with an equally clear endpoint. They may not know exactly what they want to change. They may want two apparently contradictory things at the same time. A behaviour that is causing problems now may also have protected them for years, and understanding that behaviour may involve understanding a person whose experiences, relationships and ways of coping have developed over decades.

Human beings are complicated, and much of therapy is complicated because of that.

In my own practice, I usually have some idea of where the first few sessions might take us. I think clients benefit from knowing that there is thought and direction behind the therapy, and many of the approaches I teach include protocols or suggested structures, which is important to clients who are financially and time-aware, and are often not looking for open-ended therapy. But I am very clear that a protocol is a guideline. It isn't a set of instructions that has to be completed regardless of what is happening with the person in front of me.

The client may need longer somewhere. We may move more quickly than expected. Something may emerge which changes the direction of the work completely. Occasionally something I had thought would be central turns out not to matter very much at all. Having a structure gives us somewhere to begin; it shouldn't prevent us from responding to the individual.

This is where my interest in slow therapy comes from. It isn't an argument against brief therapy, rapid change, protocols or effective techniques. It is a question about what happens when the expectation of rapid change, which may be entirely appropriate in one area of therapy, starts being applied to difficulties that are far less straightforward.

Alongside that, I've found myself wondering something else. What happened to working with the client?

Not the client's nervous system, their amygdala, their subconscious mind or their trauma response, but the person who has developed within a particular family, history, culture, body and set of relationships, and who has usually found ways of coping that make considerably more sense once we understand where they came from.

For me, slow therapy is partly about bringing our attention back to that person.

Why are we suddenly talking so much about the nervous system?

There has been an enormous increase in interest in the neuroscience of therapy, and much of that is welcome. We know considerably more about stress, memory, emotional learning, neuroplasticity and the ways in which previous experiences can affect future responses. Trauma research in particular has encouraged therapists to think beyond a purely verbal account of what happened to somebody and to consider physiological responses, sensory experiences, attention, learning and the way danger can continue to be anticipated long after the original circumstances have changed.

I use this knowledge myself, and it is central to much of the training I teach. Understanding why a client can know intellectually that they are safe while continuing to experience a powerful physical response can be enormously helpful. Understanding memory, learning and the effects of prolonged stress can change the way we conceptualise a client's difficulties.

But an increased understanding of what might be happening in the brain doesn't mean that we now have a simple biological explanation for everything that happens in therapy. If anything, the more we learn about the brain, the more apparent its complexity becomes.

Somewhere between the research paper, the therapy training and the social-media post, however, that complexity can disappear. A complicated account of threat detection and learned physiological responses becomes "your nervous system thinks you're unsafe." Research into memory and PTSD becomes "trauma is stored in the body." Neuroplasticity becomes "rewire your brain." A discussion about autonomic responses becomes a promise to "reset your nervous system."

These phrases can sometimes be useful ways of communicating an idea, and I use simplified explanations myself when they help a client understand something. The problem comes when a metaphor or shorthand explanation gradually acquires the status of biological fact and then begins to determine the therapy. As far as I'm concerned, therapeutic practice is often overly-informed by pop psychology, over-exagerated and unsubstantiated claims.

All of which means we can find ourselves doing something rather strange. We have acquired all this knowledge in order to understand people better, but end up reducing the person to a brain or nervous system that needs to be altered, regulated, rewired or reset.

Are we treating people or regulating nervous systems?

Clients don't generally experience themselves as nervous systems requiring regulation. They experience themselves as people who can't sleep, keep finding themselves in relationships that make them unhappy, panic when somebody is angry with them, drink more than they want to, feel unable to say no, become overwhelmed at work or find themselves reacting in ways they don't understand.

Of course their nervous system is involved. Their brain is involved too. It would be rather surprising if either weren't.

But describing what is happening neurologically or physiologically isn't necessarily the same as understanding the person experiencing it.

Someone may become extremely alert when their partner's tone changes because they grew up with an unpredictable parent. We could describe that in terms of threat detection, autonomic activation and learned associations, and those concepts may add something genuinely useful. We could also become interested in what it was like to grow up never knowing which version of a parent was coming through the door, what the person learned to do to get through that environment, and what happens now when somebody they love sounds slightly irritated.

Those aren't competing explanations. We need to be able to hold both. What concerns me is when the language of the nervous system begins to replace the person's story rather than helping us understand it.

Why this particularly matters in trauma therapy

Trauma is one of the areas where I think this shift has become particularly apparent. There are good reasons why trauma therapy has become increasingly structured, and we now have established approaches for PTSD which can be extremely effective, including approaches that involve working directly with traumatic memories.

The difficulty comes when the presence of trauma begins to determine the therapy before we have properly understood what the client is experiencing now.

A client may tell us about a highly traumatic childhood but have come because they are struggling in their current relationship. Someone else may have experienced abuse but want help with alcohol. Another person may be exhausted by constantly monitoring other people's moods without initially making any connection between that behaviour and the environment they grew up in.

Their past may become extremely relevant to the work, but that doesn't automatically tell us what to do with it.

One of the changes in my own thinking over many years of clinical work has been becoming less interested in assuming that we need to find the trauma and more interested in understanding what remains from it. Sometimes that is an intrusive memory which the client desperately wants help with. Sometimes it is a physical response, a belief, an expectation or a way of behaving that made complete sense in the environment in which it developed.

Those are quite different therapeutic situations, even though we might describe all of these clients as having experienced trauma.

Trauma doesn't always arrive in the therapy room as a memory

Many clients don't arrive saying that they need to process something that happened twenty years ago. Some rarely think about what happened at all.

Instead, the past may be showing itself in what happens now. A client may find it almost impossible to say no, become intensely uncomfortable when somebody is unhappy with them, feel physically overwhelmed by conflict or remain alert to tiny changes in another person's voice. They may understand intellectually that their current situation is safe while finding that their emotional or physical response doesn't seem to have received the same information.

We can acknowledge the relevance of trauma without immediately turning therapy into a search for traumatic memories. We can become interested in what the person learned from their experiences, what their mind and body came to expect and whether those expectations still fit their life now.

Sometimes that eventually takes us back to a particular memory. Sometimes useful change happens without needing to go there.

Slow therapy doesn't mean avoiding difficult work

I don't want slow therapy to become another reason for therapists to be overly cautious around trauma. Being thoughtful about readiness is important, but it is also possible to become so concerned about destabilising somebody that useful work is repeatedly postponed.

A client with PTSD who wants help with a traumatic memory shouldn't necessarily have to spend months preparing for it simply because the therapist believes trauma work must proceed slowly. Slow therapy isn't a rule that everything has to happen gradually.

The pace should come from what is happening in the work. For one client, that may mean spending several sessions before approaching a memory. Another may want to work directly with it quite quickly. Even then, we can allow space within the work rather than pushing somebody through a predetermined sequence simply because the protocol says that is what comes next.

Respecting pace includes respecting somebody's readiness to move forward as much as their need to take more time.

Some therapeutic change needs time to become experience

Clients can understand something long before it feels true.

Someone who grew up in an unpredictable home may understand perfectly well that they no longer need to monitor everybody else's mood, but they have spent years becoming extremely good at doing exactly that. A person who learned that saying no led to anger or rejection may know intellectually that they are now entitled to have boundaries while still experiencing considerable discomfort when they try to set one.

Telling somebody that they are safe now or that they have choices they didn't have in the past can be useful, but understanding something intellectually doesn't automatically change a well-established response.

Sometimes new learning comes through experience. A client sets a small boundary and discovers what happens. They notice discomfort without immediately backing away from what they have said. They recognise that another person's disappointment is tolerable. They experience themselves making a choice and discover that the predicted consequences don't occur. Being able to share that experience with a therapist, over the course of a few weeks or months, is a fundamental aspect of how the client fully absorbs the change in their thinking and experience.

What slow therapy can look like in hypnotherapy

Hypnotherapy has a particularly interesting relationship with speed. It is frequently marketed in terms of rapid change, getting to the root of a problem quickly and achieving in a few sessions what might otherwise take much longer.

Sometimes hypnotherapy can produce surprisingly rapid changes. But I think an excessive emphasis on speed can obscure some of what hypnosis does particularly well.

Hypnosis gives us an opportunity to spend time with experience. A client can notice a sensation without immediately having to explain or change it, allow a thought or image to develop in their own way, or experience what it is like to have a little more distance, choice or control. A therapist doesn't necessarily need to fill every moment with another suggestion.

This is one of the reasons I value space and silence within hypnosis. If I offer a suggestion and immediately follow it with another, and then another, I may be giving the client very little opportunity to do anything with what I have said. Their processing isn't simply happening while I am speaking. Some of the most personally meaningful work may be happening in the spaces between my words.

Slow hypnotherapy doesn't mean reading a script in an unusually slow voice or spending half the session on a relaxation induction. It can mean doing less, allowing more space and respecting the fact that different people process language, emotions, memories and suggestions differently.

It means valuing the client's experience, allowing them to connect with their body, encouraging them to experience space, and removing the pressure to create rapid change.

There can also be value in ordinary slowness

There is another aspect of slow therapy that I think we sometimes overlook because it sounds almost too simple.

Not everything therapeutic has to involve intensive psychological work. Slowing down enough to eat something without doing three other things at the same time, taking a walk without filling the silence with a podcast, noticing the weather or spending a few minutes paying attention to physical sensations can all provide a different experience from the constant activity many people are accustomed to.

I wouldn't present these things as treatments for trauma, and I wouldn't feel the need to claim that taking a quiet walk "resets the nervous system." That is making far too much of them.

They can simply be experiences.

For somebody who is constantly scanning, anticipating, planning, achieving or responding to other people, a few minutes in which nothing is required can be surprisingly unfamiliar. What happens during that pause may tell us something about their relationship with stillness, uncertainty, control or simply being with themselves.

There is money in promising transformation

There is another part of this that we don't discuss nearly enough within the therapy and hypnotherapy professions. It would be naive to pretend that the current emphasis on rapid therapy is driven entirely by research or developments in clinical practice.

Therapy is also an industry, and therapist training is a business.

I say that as someone who sells therapist training. There is nothing wrong with creating good training, charging for it or making a living from expertise. I've been doing that for many years. But because I am part of that industry, I think it is important to acknowledge some of the incentives operating within it.

Spend any amount of time on social medica and you will see courses promising rapid transformation, deep change, breakthrough results, root-cause work, powerful techniques, nervous-system regulation, rewiring and methods which apparently work where other approaches have failed. Alongside the clinical promise there is often a financial one: learn this technique, differentiate yourself from other therapists, become a specialist, charge premium fees and make considerably more money.

Of course that is attractive.

Most therapists want to be better at what they do. They want their clients to get good results and, quite reasonably, they want to make a decent living. If somebody tells you that they have developed a new method which produces extraordinary transformation more quickly and will also allow you to charge £200, £300 or £500 for a session, that is a much easier proposition to sell than a course which says you are going to learn more about people, become better at tolerating complexity and develop your judgement about when to intervene and when not to.

It also works extremely well on social media. Dramatic before-and-after stories work. Breakthroughs work. Novelty works. Claims about changing the brain or regulating the nervous system sound modern and scientific. "I helped somebody gradually make sense of something and change the way they live over a period of time" doesn't make quite such an exciting Facebook advert.

That doesn't mean the transformations being described aren't genuine. I've had clients make extraordinary changes myself, sometimes very quickly. Nor does it mean that training is poor simply because it teaches a new approach or uses neuroscience. But I think we should be much more conscious of the way commercial incentives can shape the stories our profession tells about what good therapy looks like.

If trainers benefit financially from persuading therapists that there is a faster, deeper and more advanced way to create change, we shouldn't be surprised that faster, deeper and more advanced approaches keep appearing.

What does that pressure do to therapists?

There is another consequence of all this which concerns me just as much as what it does to clients.

Therapists can start to feel that they should be producing change quickly.

If we are continually exposed to stories of one-session transformations, rapid breakthroughs and techniques which supposedly resolve deeply rooted problems almost immediately, ordinary therapy can begin to feel inadequate. A client comes back the following week still struggling with the same relationship, still feeling anxious or still unsure what they want, and the therapist can begin to wonder what they are doing wrong.

Perhaps we need another intervention. Perhaps we haven't found the root cause. Perhaps we need to regulate something, process something, release something or get underneath the conscious mind.

The therapist's understandable desire to help can become mixed with pressure to demonstrate that something is happening. And once we feel that pressure, it becomes much harder to give the client the very things they may actually need: time, space and permission to be an individual rather than another example of how quickly a technique works.

That pressure can also pass directly to the client. A person who has spent years feeling that there is something wrong with them can find themselves in another situation where they aren't changing quickly enough. Someone whose history has involved adapting to other people's expectations may become very good at being the client who produces the response the therapist is looking for. They may sense that they are supposed to feel different at the end of an intervention and respond accordingly.

None of this means abandoning outcomes or allowing therapy to drift indefinitely. Clients are paying us to help them, and we need to keep asking whether the work is useful. Having an overall direction and reviewing progress matters.

But "Is this therapy helping this person?" is a very different question from "Have I produced a transformation yet?"

So where do we take slow therapy from here?

I don't think the answer is to create another therapeutic movement with its own certification, protocol and expensive practitioner training. That would rather miss the point.

Slow therapy can begin with something much simpler: becoming more aware of the pace we bring into the room and the assumptions we make about what progress should look like.

We can still have plans. I will continue to give clients an idea of how I think the first few sessions might look, because I think structure and transparency can be reassuring and useful. We can continue using protocols because good protocols draw together knowledge and experience and give practitioners a framework within which to work.

But the protocol remains a guideline. The plan can change.

If the client needs more time, we take more time. If they are ready to move faster, we don't artificially slow them down. If something turns out to be irrelevant, we don't keep working with it because it appears on session three of the protocol. If something unexpected matters, we make room for it.

We can still learn about the brain. We can understand the nervous system, memory, trauma, emotional learning and neuroplasticity. We can learn new techniques and become more skilled at using old ones. What we can stop doing is assuming that greater knowledge gives us permission to reduce a complicated person to whichever mechanism we currently understand best.

We can also become more comfortable with different kinds of therapeutic progress. A client recognising a pattern for the first time matters. So does setting one boundary, responding differently during one difficult conversation, noticing a physical response without immediately being overwhelmed by it, or beginning to understand why something that has always felt irrational once made perfect sense.

Some clients will make enormous changes quickly. When they do, we should welcome it. Others will change gradually and almost imperceptibly until they realise that something which once dominated their life doesn't have quite the same hold. Neither form of change is inherently more therapeutic.

And perhaps therapists can give themselves permission to do a little less. To leave a silence. To ask one question and wait properly for the answer. To resist introducing another technique because we feel anxious that the session isn't moving. To let somebody return to something several times rather than assuming it needs to be resolved today.

Ultimately, it means valuing the client's experience, returning to a holistic view of therapy and returning to the client as a whole person - not a series of brain regions.

How slow therapy fits with Beyond Trauma

This is increasingly where I see slow therapy fitting with my Beyond Trauma approach.

Beyond Trauma includes the brain and the nervous system. It includes traumatic memory, memory reconsolidation, somatic work, emotional regulation, PTSD and CPTSD. I think practitioners working with trauma should understand these things because they give us a much richer picture of what may be happening for a client.

But none of them is the client.

The danger with having increasingly sophisticated models is that we start fitting people into them. We identify dysregulation and regulate it. We find trauma and process it. We identify a memory and reconsolidate it. The intervention begins to determine what we look for.

Beyond Trauma is intended to move in the opposite direction. We can understand these processes and have a range of therapeutic approaches available while still beginning with the person. What are they struggling with? What happened to them? What did they learn? How did they adapt? What continues to cause difficulty now, and what do they actually want to be different?

Sometimes the answer will point towards direct trauma work and sometimes it won't.

Slow therapy also gives us permission to allow therapy to move backwards and forwards. Someone may work directly with something difficult and then spend time concentrating on ordinary life. They may return to it later, or they may decide they have done enough. Moving away from trauma isn't automatically avoidance, any more than repeatedly talking about trauma is necessarily evidence that it is being processed.

Slow therapy isn't about making therapy take longer. It isn't anti-science, anti-hypnosis, anti-technique or anti-change. For me, it is about protecting enough time and space for the individuality of the client to remain at the centre of the work.

We have learned an enormous amount about how to work with the brain and nervous system. Perhaps the next step is remembering that they belong to a person.