Attending a Terry Real seminar on relationship therapy proved to be a profoundly eye-opening and transformative experience. Real, a pioneering family therapist and founder of the Relational Life Institute (RLI), delivers a rigorous, commonsense approach that challenges conventional wisdom.

It offers practical pathways to deeper intimacy and personal fulfilment. His methodology emphasises moving beyond individual pathology toward genuine relational health, confronting both shame and grandiosity, and equipping people with the skills for authentic connection and “full-throttle marriage.”

Understanding the Foundations of Relational Life Therapy

Terry Real, LICSW, is an internationally recognised family therapist, speaker, and author with over 25 years of experience. He founded the Relational Life Institute, which offers workshops for couples, individuals, and parents, as well as professional training programmes. A senior faculty member of the Family Institute of Cambridge and a retired clinical fellow of the Meadows Institute, Real has worked with thousands of clients. He has authored several bestsellers, including I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression (1997), How Can I Get Through to You? Reconnecting Men and Women (2001), The New Rules of Marriage: What You Need to Make Love Work (2007), and Us: Getting Past You and Me to Build a More Loving Relationship (2022).

His integrative work draws from psychotherapy, family systems, feminist perspectives, trauma recovery, addiction insights, neurobiology, and ecological/spiritual awareness. It has featured on major media platforms and received praise from notable figures such as Robert Bly. Real’s perspective challenges the toxic pillars of modern discontent—individualism and patriarchy—and promotes relational consciousness that aligns with ecological wisdom.

Relational Life Therapy Core Concepts

Real frequently references interpersonal neurobiology, including Dan Siegel’s contributions. Interpersonal experiences shape brain development, particularly the limbic system and prefrontal cortex. Thanks to neuroplasticity, meaningful change remains accessible to everyone. Relationships function as essential nutrients for the brain, which operates as a profoundly social organ through constant co-regulation.

He presents a clear contrast between traditional therapeutic models and his approach. Traditional methods typically centre on shame, prioritise impartiality and early alliance-building, treat character as a relatively fixed structure, position the therapist as an expert who heals primarily through nurturing, and remain largely non-directive. In comparison, this model addresses both shame and grandiosity. It strategically takes sides to empower healthier aspects of the self, establishes an alliance after creating leverage for change, views character as internalised relationships open to dramatic transformation, positions the therapist as a coach and fellow traveller, and heals through explicit education in relational skills.

A vital distinction lies between shame (a painful judgement about who one is, often paralysing) and guilt or remorse (concern about specific actions, which can motivate repair). Grandiosity—one-up entitlement and diminished empathy—proves equally destructive as one-down inferiority. Healthy intimacy demands a “same-as” relational democracy rather than power imbalances.

Remedial empathy serves as a practical tool, particularly for those leaning toward grandiose stances. Before speaking or acting, one pauses to consider: “What will the action make the other person feel?” This cultivates respect and connection instead of harm.

Real often shares a sentiment attributed to Goethe or similar wisdom: “If you treat someone as they are, they stay who they are. If you treat them as they ought to be, they become who they ought to be.” This optimistic relational stance underpins much of the work.

He also connects personal dynamics to larger systems, advocating a shift from power-over models (dominance and patriarchal hierarchies) to power-with approaches (collaboration and mutual respect) across couples, families, society, and ecology. Relational awareness proves synonymous with ecological consciousness. The myth of the isolated self, combined with patterns of dominion, breeds disconnection from others and the natural world. The work fosters “Us” consciousness—we exist together within a living system.

The Three Phases of Relational Life Therapy

This approach organises the therapeutic journey into three distinct phases. These guide individuals and couples from initial awareness through deep healing to sustained skill-building and practice.

Phase 1: Waking Up in Relational Life Therapy

(Joining Through the Truth)

This initial stage involves direct yet compassionate confrontation of patterns that damage the relationship. Practitioners gather relevant data, such as clients’ core desires from one another (often referred to as the “MQ or Marriage Questionnaire”), apply structured lenses for understanding, establish a clear therapeutic contract, and interrupt denial or repetitive cycles. “Loving confrontation” builds necessary leverage for change. Here, mutual childhood triggers frequently emerge, revealing the unconscious “dance” between partners’ adaptive and wounded child parts.

Participants learn to identify which aspect of the self is currently active: the Wise Adult (mature, present, connected, and operating from second consciousness), the Adaptive Child (overfunctioning and reactive “kid in grown-up clothing” from first consciousness, requiring firm but loving limits), or the Wounded Child (the most vulnerable and fragile part needing nurturing and protection).

It is a practical tool used to wake up. The therapist asks each partner direct questions, such as:

• “What do you want from your partner?”
• “What do you want from me (the therapist)?”
• “What would a successful outcome of therapy look like for you?”

The purpose is to quickly gather clear data, cut through vagueness, establish a concrete therapeutic contract, and understand each person’s explicit needs and expectations. It helps shift the conversation from complaints to actionable desires and sets the stage for “joining through the truth.”

This direct approach is characteristic of Real’s more confrontational and structured style compared to gentler buy-in approaches, like Motivational Interviewing.

Phase 2: Inner Child Healing and Re-Parenting in Relational Life Therapy

Once patterns become visible, the focus shifts to relational trauma. This phase traces current stances back to their adaptive child origins (“Where does this come from?”). Clients give experiential voice to their inner children (“I’m here now; you are not alone”), repair early wounds, and gradually demote these younger parts so the Wise Adult can assume leadership. Partners often witness and support this process, which builds empathy and interrupts intergenerational transmission of pain.

Phase 3: Skill-Building and Relational Practice in Relational Life Therapy

The final phase emphasises practical learning and consistent application. Clients master essential skills such as shifting from criticism to clear requests, effective transmission and reception of feedback, offering encouragement rather than discouragement, and handling setbacks with compassion. Slips become normalised as part of genuine progress. This stage equips people for ongoing relational living, including tools like relational jujitsu and maintaining “Us” consciousness amid new challenges. Repeated practice harnesses neuroplasticity to form healthier habits.

Throughout all phases, relationships are understood as living ecosystems. Reactivity introduced into the system eventually returns to its source. Skill-building balances assertive self-expression with genuine cherishing of the partner—embracing loving power instead of dominance or collapse.

Personal Reflections: Comparing Approaches

Having attended a Motivational Interviewing seminar only the week before, I was particularly struck by how much more directive and confrontational Terry Real’s style feels. Where Motivational Interviewing gently guides clients through their own ambivalence with a collaborative, non-confrontational spirit, Real is far more upfront. He provides information directly, takes clear sides when needed, and challenges unhelpful patterns head-on through “joining through the truth.”

I personally preferred the gentler, more client-led approach of Motivational Interviewing. However, I found Terry Real’s method very interesting and refreshing to observe. His directness and structured three-phase framework offer a powerful contrast that can create rapid breakthroughs, especially with couples stuck in destructive cycles. It highlighted for me how different therapeutic philosophies can both be effective, depending on the client, the context, and the therapist’s personality. Both approaches are goal-directed by using different therapy skills.

Why This Approach Resonates Broadly

The seminar illustrated how these principles extend far beyond couple dynamics. They support personal growth, conscious parenting, and wider societal transformation. By questioning individualism and patriarchal structures, the work advances social justice and ecological awareness. Attendees typically depart with renewed hope: change emerges through awareness, targeted healing, and deliberate repetition. New relational experiences can literally reshape neural pathways.

For practising clinicians, it provides an explicit, educational, and appropriately directive framework that moves beyond strict neutrality when relational imbalances cause harm. For couples and individuals alike, it maps a clear route from chronic disconnection to vibrant mutual intimacy.

Attending the seminar reinforced that relationships serve as the primary crucible for human transformation. The blend of straight-talking honesty, deep compassion, and immediately applicable tools renders sophisticated concepts both accessible and genuinely life-changing. Whether one identifies as a therapist, partner, parent, or simply someone seeking richer connections, these insights offer an alternative to longstanding unhelpful patterns.

References

Real, T. (1997). I don’t want to talk about it: Overcoming the secret legacy of male depression. Scribner.

Real, T. (2001). How can I get through to you? Reconnecting men and women. Scribner.

Real, T. (2007). The new rules of marriage: What you need to make love work. Ballantine Books.

Real, T. (2022). Us: Getting past you and me to build a more loving relationship. Rodale Books.

Additional insights drawn from Relational Life Institute workshops and resources.

Contact Anna Here:

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Important Note: This article is for educational purposes only and is not a substitute for professional mental health advice. CPT should only be delivered by properly trained clinicians. If you are experiencing trauma-related symptoms, please consult a qualified psychologist or trauma-informed therapist.

Introduction

Trauma can profoundly disrupt a person’s sense of safety, trust, and self-worth. For many survivors, emotional pain continues long after the event because of the meaning they assign to what happened. Cognitive Processing Therapy (CPT) is a highly effective, evidence-based treatment specifically developed to help people work through trauma by addressing these unhelpful beliefs, often called “stuck points” (Resick et al., 2017).

Developed in the late 1980s by Dr. Patricia Resick and colleagues, CPT is a structured form of cognitive-behavioral therapy and has become one of the gold-standard treatments for post-traumatic stress disorder (PTSD). It is an offshoot of Cognitive Behavioural Therapy. It is recommended as a first-line intervention by major organisations including the American Psychological Association (APA, 2017).

What makes CPT particularly powerful is its balanced focus on cognition rather than requiring repeated detailed exposure to the traumatic memory.

The Theoretical Foundation of Cognitive Processing Therapy

Cognitive Processing Therapy is grounded in cognitive theory and information-processing models of PTSD (Resick et al., 2017). The central premise is that PTSD symptoms often persist not just because of the trauma itself, but because of how the event has been interpreted and integrated into a person’s belief system.When a traumatic event occurs, it can clash with existing beliefs (schemas) about the self, others, and the world. People may assimilate the trauma incorrectly, over-accommodate in unhelpful ways, or remain in emotional conflict. CPT helps clients achieve healthier accommodation — updating their beliefs in a realistic and balanced way (Resick et al., 2017).

Key concepts in CPT include:

• Stuck Points — rigid, unhelpful beliefs linked to the trauma
• The ABC Worksheet (Activating event → Belief → Consequence)
• Five core theme areas: Safety, Trust, Power/Control, Esteem, and Intimacy

Who Can Benefit from Cognitive Processing Therapy?

Cognitive Processing Therapy has strong evidence for adults with PTSD from various traumas, including sexual assault, combat, childhood abuse, accidents, and natural disasters. It is also effective for related issues such as depression, guilt, shame, and anxiety (Asmundson et al., 2019). Both the full protocol and cognitive-only versions show good outcomes.

Structure of CPT

Standard Cognitive Processing Therapy typically consists of 12 sessions (Resick et al., 2017).

Sessions are usually 50–60 minutes and can be delivered individually, in groups, or via telehealth.

Phase 1: Psychoeducation and Impact Statement (Sessions 1–2)

Clients learn about PTSD and the cognitive model. They write an Impact Statement describing their beliefs about why the traumatic event happened and what it means about themselves, others, and the world.

Phase 2: Processing the Trauma (Sessions 3–5)

Clients may write a detailed account of the worst traumatic event (optional in some versions). The therapist and client identify key stuck points and begin challenging them.

Phase 3: Cognitive Restructuring and Thematic Work (Sessions 6–11)

This is the core of Cognitive Processing Therapy. Clients work systematically through the five domains using targeted worksheets and Socratic questioning.

Phase 4: Final Integration (Session 12)

Clients write a final Impact Statement to observe changes in their thinking. They review gains and plan for the future.Homework (worksheets and practice) is a vital component of CPT.

The Role of Worksheets in Cognitive Processing Therapy

Cognitive Processing Therapy is highly structured and practical. Clients use worksheets such as Challenging Questions, Evidence For and Against, and Challenging Beliefs Worksheets (one for each theme). These tools make cognitive restructuring concrete and provide lifelong skills.

Evidence Base for Cognitive Processing Therapy

Cognitive Processing Therapy is one of the most well-researched trauma treatments. Meta-analyses show large effect sizes for PTSD symptom reduction, with benefits maintained at follow-up (Asmundson et al., 2019). It performs comparably to Prolonged Exposure therapy, and many clients prefer CPT because it feels less overwhelming.

CPT vs. Other Approaches

• Vs. Prolonged Exposure (PE): PE emphasises repeated exposure; CPT focuses more on changing beliefs.
• Vs. EMDR: Both are effective; CPT is more worksheet-driven.
• Vs. General CBT: CPT is a specialised trauma-focused protocol.

What to Expect as a Client in Cognitive Processing Therapy

Cognitive Processing Therapy is collaborative, respectful, and empowering. Clients learn why trauma symptoms persist and gain practical tools to change unhelpful thinking patterns. Many describe it as life-changing because it restores a sense of meaning, self-worth, and hope.

Conclusion: The Power of CPT

CPT stands out as an incredible, structured, and compassionate approach to trauma recovery. By helping people examine and modify painful conclusions drawn from their experiences, CPT enables survivors to reclaim their lives with greater peace, trust, and self-compassion.

Recovery from trauma is possible. If you are struggling, reach out to a trained Cognitive Processing Therapy provider.

References

American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline

Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., Smits, J. A. J., & Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive Behaviour Therapy, 48(1), 1–14. https://doi.org/10.1080/16506073.2018.1522371

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. The Guilford Press.

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Hello, and welcome to my online practice page. In this article, I will tell you a bit about my practice, provide some examples of cases I have worked with and talk you through my training and practice. I specialise in supporting couples facing challenges and providing compassionate therapy for individuals. I accept that clients are the experts in their lives. I deliver my work with authentic warmth and respect. I am a BPS-registered psychologist and psychotherapist, and I combine evidence-based approaches to suit the individual or couple where they are. I always work from a place of curious enquiry to understand your situation. Feel free to read my bio here.

Working with couples

Most couples come to therapy when communication is broken down, arguments seem endless, emotional intimacy has disappeared or following major betrayals such as infidelity. I try to create a safe, neutral and non-judgmental space so both partners can be heard and respected. I don’t take sides.

Anna Keyter’s Online Practice: Integrative Psychotherapy For Couples:

1. I often use the Gottman Method – Building Love Maps, increasing fondness and admiration, turning toward each other, managing conflict well, and repairing after arguments.
2. Relational Life Therapy (Terry Real) – Joining Through the Truth, Inner Child Healing, Re-Parenting, practical skill building.
3. Internal Family Systems (IFS) – Help each person to understand their different “parts” (protective, wounded, critical, etc).
4. DBT and CBT tools – DEAR MAN for assertive communication, emotional regulation for anger, perspective-taking and healthy timeouts (and more).

I do inner child work, too, because the patterns that keep repeating in relationships are often from childhood experiences.

I often ask couples a question:
“Are you speaking to your best friend the way you’re speaking to your partner right now?

This simple question can often be a powerful moment of awareness. Many people realise that they are much kinder and more patient with friends than with the person they proclaim to love most. This realisation is often a turning point.

Important note: Couples therapy is most effective when both partners are willing to learn, grow and take responsibility. If one person is only there to get the other “fixed”, then progress is limited. Real healing comes from mutual effort and a desire to rebuild the relationship.

I offer 50-minute or 80-minute couples sessions, depending on the depth of work that is needed.

Anna Keyter’s Online Practice: Welcome Video

Real Life Examples – Couples Therapy

These examples are not isolated incidents but reflect a common pattern seen across many couples I’ve worked with. Accordingly, each case study is a composite created from several real couples with very similar experiences.

1. One couple was exhausted from constant high-conflict arguments. The man had difficulty with anger outbursts, and the woman felt criticised and unsafe all the time (as if she were walking on eggshells). They became adept at de-escalating, identifying each other’s triggers, and communicating without attacking through Gottman conflict management, DBT emotional regulation skills, IFS parts work, and perspective-taking exercises. They said they fought a lot less after 14 sessions and gradually rebuilt trust and affection.
2. Another couple needed help working through infidelity. The pain, the rage, and the sadness were so deep. The unfaithful partner took full responsibility, working through Relational Life Therapy, Gottman trust-building techniques and inner child work (particularly around abandonment wounds), while the hurt partner worked through profound pain. They worked through 12 committed sessions and rebuilt trust, creating new, healthier relationship agreements. Later, they said they felt stronger together than before the crisis.
3. A couple was on the brink of a breakup over housework, made more complicated by ADHD. Constant criticism eroded their connection. We employed practical ADHD-friendly tactics (breaking tasks into small steps, using timers, body doubling), Gottman appreciation exercises, and fair compromise. The resentment fell away, and they were working as a team, not against each other.
4. A long-term married couple who felt like roommates with little affection or intimacy. Using Gottman Love Maps, fondness and admiration exercises and Relational Life Therapy, they reconnected emotionally and physically. By session 11, they were dating each other on purpose again and said they fell back in love.
5. Not all couples remain together after couples therapy. Some couples come to the realisation that they are at the end of their journey together and decide to end the relationship. In couples therapy, the couple will decide how to end the relationship amicably.

Example of a perspective-taking handout:

Working with Individuals

I also provide individual therapy (generally 50-minute sessions) with a wide range of challenges. I work from a variety of therapeutic approaches to best meet the needs of each client. Common frameworks include Cognitive Behavioural Therapy (CBT), Cognitive Processing Therapy (CPT), Acceptance and Commitment Therapy (ACT), trauma-informed work and Internal Family Systems (IFS). You can find a full list of therapies we offer here, or view a list of our services here.

Shame and Guilt

So many clients come in weighed down with shame and guilt. Guilt is “I did something bad” (other-focused). Shame is “I am a bad person” (me-focused). I support clients in separating the two, reducing toxic self-blame, and developing self-compassion. For trauma survivors and those who grew up in critical environments, this work is particularly powerful.

Fear, worry, and anxiety

Many people live in constant fear and worry. We use the CBT triangle of thoughts-feelings-behaviours to work through anxious thoughts, dial down catastrophic thinking and build practical coping skills. Clients are taught to experience their emotions without being controlled by them.

Stress and Burnout

Chronic stress and burnout are extremely prevalent, especially in high-achieving people. Individuals show up often worn out, emotionally spent, and barely hanging on. We work on regulating the nervous system, boundary-setting, perfectionism and rebuilding energy and motivation. Burnout recovery requires practical changes and deeper healing of beliefs that drive over-functioning.

Perimenopause & Menopause

Women going through perimenopause and menopause have many physical symptoms, but also intense emotional swings, anxiety, low mood, irritability and identity challenges. Hormonal fluctuations amplify past trauma, loss, or issues of self-esteem. I provide compassionate support for women to navigate this transition, lessen shame around symptoms and come out empowered in this new stage of life.

Anna Keyter’s Online Practice: Therapy Examples

These examples are not isolated one-offs — they reflect recurring patterns I’ve seen in many individuals. Accordingly, each case study is a composite based on several real individuals with very similar experiences.

1. A woman who had been raped came into therapy with unbearable shame and self-blame. She was out of touch with her own body and had difficulty being intimate. We worked through the trauma safely and gently using Cognitive Processing Therapy (CPT). After 10-12 sessions, she was able to stop blaming herself, clearly put the responsibility on the perpetrator, and gradually feel safer and more at peace in her body.
2. One of my male clients had long-term depression and anxiety and felt trapped in negative thought loops and hopeless. Through CBT (working deeply with the thoughts-feelings-behaviours) and Acceptance and Commitment Therapy (ACT), he learned to challenge harsh self-criticism and take small, meaningful steps. His spirits lifted, and he felt agency and hope returning.
3. One woman in perimenopause felt extreme anxiety, mood swings and grief over ageing. She felt she was losing herself. We worked through these changes using a mix of CBT, ACT and inner child work. She learned to be kind to herself through hormonal shifts and found strength and purpose in this new chapter of her life.
4. A man who suffered childhood trauma had trouble with trust, people pleasing, and explosive anger. Through IFS, trauma-informed therapy, and inner child healing, he found ways to soothe his younger wounded parts and establish healthier boundaries. He said he finally felt lighter and more genuine in his relationships.
5. Several clients came in mourning the loss of significant relationships. By working through the stages of grief, Denial (shock and disbelief), Anger (frustration and unfairness), Bargaining (seeking control and “what if” scenarios), Depression (intense sadness), and Acceptance (learning to adapt and move forward), they came to an acceptance. They honoured their loss, worked through complex emotions, and slowly rebuilt identity and hope for the future through 5-10 sessions of gentle grief work.

An example of a grief handout.

Understanding Grief

These examples are just a small part of what I do. Everyone’s story is different, and I tailor my approach to each person.

A Message to Prospective Clients:

Therapy is not a magic pill. It is a courageous journey of learning more about yourself, healing old wounds, learning new skills, and creating the life and relationships you truly want. Whether you are a couple feeling stuck or in pain, or an individual carrying shame, fear, burnout, grief, or the challenges of menopause, you can work together to make the changes.

I provide a warm, compassionate, and professional space where you will feel seen and supported. If you feel ready to take the next step, I would be honoured to work with you.

Ready to take the next step?

I’d love to support you on your journey. Choose the option that works best for you:

I’m here if you need to talk.

Keeping My Practice Safe

1. I do 30 hours CPD (Continuing Professional Development) every year, minimum, to keep up and improve my clinical skills.
2. I also have formal clinical supervision with a registered clinical psychologist every 3 weeks. Clinical supervision is a formal, confidential supervisory relationship where the supervisor provides guidance, oversight, case review, risk management and support for ethical decision making and reflective practice.
3. I also take part in peer supervision on a 3-week cycle, a collaborative, non-hierarchical forum with colleagues to discuss cases, give mutual feedback, problem-solve and share learning.
4. I meet with like-minded professionals monthly for networking, provide clinical supervision to others and engage in regular formal training to ensure that my practice is safe, current and evidence-informed.
5. I do not disclose any client identifiable information in any supervision or meetings – client confidentiality is strictly maintained, and all information is stored and handled securely. You are welcome to read my full terms and conditions for more information on confidentiality and data protection.

Anna Keyter’s Online Practice References:

Gottman, J. M., & Gottman, J. S. (2015). Gottman couple therapy. In A. S. Gurman et al. (Eds.), Clinical handbook of couple therapy.

Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.

Schwartz, R. C., & Sweezy, M. (2019). Internal family systems therapy (2nd ed.). Guilford Press.

Real, T. (various works on Relational Life Therapy).

Do you want to learn more about Anna Keyter’s Online Practice? Complete the form below.

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When in crisis, please call 999

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Introducing Online Therapy for ADHD Burnout

As an online psychologist, I see many bright, capable adults struggling with a particularly exhausting form of burnout. After attending the Global Burnout Summit 2026, I gained valuable insights into why online therapy for ADHD burnout is becoming increasingly important.ADHD burnout is different from regular burnout. It often feels more intense, confusing, and shame-inducing. This article explores why it happens and how online therapy for ADHD burnout can support real, sustainable recovery.

Understanding ADHD Burnout in the Age of Overload

We live in an era of constant input — notifications, algorithms, short-form videos, and information overload. For people with ADHD, this environment is especially draining. At the Global Burnout Summit 2026, experts explained that ADHD brains often have lower baseline dopamine, which affects motivation, focus, planning, and emotional regulation.

Many people with ADHD end up relying on stress as fuel — using cortisol and adrenaline to power through tasks at the last minute. While this can work short-term, it is toxic fuel. Over time, it leads to nervous system dysregulation and burnout.

A common pattern is the “I’m broken” cycle: difficulty with executive function → procrastination → last-minute panic → temporary success through stress → exhaustion and shame → repeat.

Online therapy for ADHD burnout helps break this shame cycle by providing understanding, practical strategies, and nervous system support.

Why “Trying Harder” Usually Makes ADHD Burnout Worse

For many neurodivergent people, trying harder increases burnout. When someone with ADHD feels shame or external pressure, they often push themselves more, which activates fight-or-flight. This further depletes dopamine and exhausts the nervous system.

Key challenges include sensory overload, difficulty filtering stimuli, and the brain comparing itself to neurotypical people. Low dopamine affects motivation and executive function, making “simple” tasks feel impossible.

How to Function Optimally While Burnt Out with ADHD

Recovery from ADHD burnout is not about forcing yourself back into high performance. It’s about working with your brain. Here are practical strategies:

Dopamine Regulation Strategies:

• Use body doubling (working alongside someone, even virtually)
• Gamification and interest-based motivation (tie tasks to something you care about)
• Movement breaks and physical activity to naturally boost dopamine
• Protein-rich meals and stable blood sugar (blood sugar crashes worsen ADHD symptoms)
• Short, timed work sessions (Pomodoro-style, but flexible)
• Celebration of small wins to create natural dopamine hits

Executive Function Challenges & Support:

• Reduce decision fatigue by creating routines and systems
• Break tasks into tiny, specific steps (e.g., “open laptop” instead of “start project”)
• Use external tools: timers, visual planners, voice notes, apps
• Accept that executive function fluctuates — plan around your best times of day
• Lower the bar dramatically during burnout phases. If you only have 40% capacity, 40% is your 100%

Daily Practices That Help:

• Mindful walking in nature (especially effective for ADHD brains)
• Short grounding exercises (5-4-3-2-1 technique)
• Accepting numbness and fatigue as valid states instead of fighting them
• Building in recovery time without guilt
• Creating a supportive environment with reduced sensory input when needed

Online therapy for ADHD burnout is especially useful for creating personalised systems that match how your brain actually works, rather than forcing neurotypical strategies.

The Role of Community and Self-Compassion

Feeling “I’m the only one” is very common. The summit highlighted the power of community support. Being honest with trusted people and asking for help reduces shame dramatically.

The most important shift is moving from self-criticism to self-compassion: “My brain works differently, not wrongly.”

Online Therapy for ADHD Burnout: Taking the First Step

If you have ADHD and feel burnt out, exhausted, or stuck in cycles of shame and over-effort, know that you are not broken and you are not alone. Your brain works differently — and it needs different support.

Online therapy for ADHD burnout offers a compassionate, flexible approach tailored to how your brain actually functions. Recovery is possible through understanding, self-compassion, pacing, and the right strategies.

References

Brignoli, P. (2026). Human performance and sustainable ambition. Presentation at the Global Burnout Summit 2026, Virtual.

Ruppert, P. (2026). The power of community in anxiety and burnout recovery. Presentation at the Global Burnout Summit 2026, Virtual.

World Health Organization. (2019). Burn-out an “occupational phenomenon”. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

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Feel free to get in touch if you want to learn more about online therapy for ADHD burnout:

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Introduction

Attending a two-day training with Professor Stephen Rollnick, co-founder of Motivational Interviewing, alongside the highly experienced Orla Adams, felt like a genuine gift to my professional development. What made it even more special was that the entire 8-hour seminar was offered free of charge — an act of generosity that underscored their commitment to sharing this life-changing approach. Both presenters delivered the material with warmth, humility, and deep expertise. I walked away not only refreshed but genuinely transformed in how I understand and apply advanced motivational interviewing skills in practice.

This comprehensive article combines reflections from both days into one detailed narrative. It is written as a personal journey through the training, blending storytelling with practical insights, video examples, role-play learnings, and advanced techniques. Whether you are a therapist, counsellor, psychologist, dietitian, or any helping professional in the UK, these advanced motivational interviewing skills can reignite your confidence and protect you from burnout while creating real change in clients.

Day One: Foundations of Advanced Motivational Interviewing Skills

The first day gently reconnected us with the heart of advanced motivational interviewing skills. Stephen Rollnick shared his remarkable personal journey — growing up in Cape Town during apartheid, moving to Cardiff, his early collaboration with William R. Miller, and the evolution of the approach from addiction work to health care, criminal justice, education, and now elite sports (Miller & Rollnick, 2023).

Orla Adams spoke movingly about her own turning point as a dietitian. Faced with clients saying “I don’t want to do this anymore — there’s too much going on,” she felt ineffective and burned out. A single day on Motivational Interviewing changed her trajectory. She has since trained extensively with Rollnick and now passionately trains others.

Motivational Interviewing Skills:

Advanced motivational interviewing skills build on a collaborative, person-centred method that strengthens a person’s own motivation for change. It is directional yet not directive — a guiding style that honours the client’s autonomy while helping them move forward (Miller & Rollnick, 2013, 2023).

1. The MI Spirit — partnership, acceptance, compassion, and empowerment — forms the foundation of advanced motivational interviewing skills. This spirit transforms not only clients but also practitioners. Affirmations build self-efficacy by focusing on strengths. These skills are like putting on special glasses that help you see the resilience and wisdom already present in every person.
2. The four processes — Engaging, Focusing, Evoking, and Planning — provide a flexible roadmap for advanced motivational interviewing skills.
3. We explored OARS (Open questions, Affirmations, Reflections, Summaries) in depth. Listening with curiosity, being fully present, and seeking to understand rather than fix became recurring themes.
4. A powerful takeaway was the fixing reflex — that natural urge to jump in with solutions. While well-intentioned, it often leads to sustain talk, disengagement, and practitioner burnout. Advanced motivational interviewing skills help contain empathy and channel energy more sustainably.
5. We also examined change talk versus sustain talk, ambivalence as a normal part of change, and the shift from “rolling with resistance” to addressing discord. Videos and role-plays illustrated these concepts vividly and laid the groundwork for deeper advanced motivational interviewing skills on Day Two.

Day Two: Mastering Advanced Motivational Interviewing Skills Through Practice.

The second day focused on intensive practice and refinement of motivational interviewing skills. Without breakout rooms, participants engaged actively through chat responses, creating a dynamic, collective learning environment. Stephen and Orla shared rich personal and clinical experiences, interweaving more demonstration videos that brought the skills to life.

A major focus was on reflections — one of the most powerful elements within advanced motivational interviewing skills. Orla Adams provided clear distinctions that elevated our practice:

1. Paraphrase (Simple Reflection): Moves well beyond the client’s words and presents information in a new light.
2. Amplified Reflection: Amplifies or exaggerates what has been said, sometimes to the point where the client may disagree and correct you.
3. Double-sided Reflection: Captures both sides of ambivalence.
4. Affective Reflection: Addresses the emotion, whether expressed or implied.

On double-sided reflections, Orla gave crucial guidance for motivational interviewing skills: avoid using “but” as it can disqualify the first part and feel like a push toward change. Replace it with “and”.

Example of framing advanced advice:

“You find smoking helps you cope and it also comes at a real cost to your health.”Ending on the sustain talk side can pull more sustain talk, so careful framing matters. When stuck for a reflection, a simple “Tell me more?” often serves as a safe, non-fixing response that keeps the conversation open and reduces the urge to advise prematurely. This small but powerful technique is a cornerstone of effective motivational interviewing skills.

The Art of Skilful Advice in Advanced Motivational Interviewing Skills

One of the richest sections of Day Two centred on skilful advice-giving — an area where many practitioners seek advanced MI skills. Psychologists and psychotherapists are often trained to avoid direct advice, yet clients frequently need guidance. Advanced MI skills offer a professional, collaborative way to integrate advice without triggering resistance.

Advice is a widespread human response, often given with good intentions, but unskilled delivery leads to defensiveness. Stephen Rollnick described it as a common trap: the more chaotic the situation, the more unsolicited advice appears. He humorously called overwhelming uninvited feedback “UFO — Uninvited Feedback Overload.”

Common traps in advanced motivational interviewing skills training include:

1. The Expert Trap (data download)
2. Blaming and labelling
3. Persuasion and confrontation
4. Judgement without acknowledging strengths

Advanced motivational interviewing skills transform this through the Ask-Offer-Ask framework.

1. Ask permission and what the person already knows.
2. Offer information or suggestions gently, in small chunks, as one possibility among options.
3. Ask what they make of it, how it fits for them, or what they want to do next.

This keeps the client in the driver’s seat and maintains collaboration. Advice becomes guiding rather than dumping — part of a dance that remains person-centred.

The continuum of advice ranges from unskilful/uncaring to skilful/caring. Skilful advice within advanced motivational interviewing skills is offered thoughtfully, calmly, with deep listening, and always followed by checking the client’s response. It champions the client’s learning, allows mistakes, and provides scaffolding without solving problems for them.

Rollnick shared five key principles for good advice in advanced motivational interviewing skills:

Ditch the deficit detective and regulate the fixing reflex.

1. Offer advice up (don’t dump it down).
2. Rediscover the superstyle of guiding.
3. Listen like you mean it and roll with discord.
4. Look for strengths — praise less, affirm more.

Praise is “I-focused”; affirmations are “you-focused” and highlight the client’s efforts and qualities. Building a habit of genuine affirmations takes more skill but yields far better results and is central to advanced motivational interviewing skills.

Personal Stories, Cultural Connections and the Magic of Advanced Motivational Interviewing Skills

A highlight was Stephen Rollnick’s openness about his life in Cape Town — fond memories of his mother, landscapes, food, smells, and paving stones. It felt deeply human and reminded me of Māori pepeha. Orla’s skilled listening during this exchange demonstrated how quality advanced MI skills create safety for vulnerability. The natural flow of paraphrasing and curious questions allowed beautiful sharing and connection.

This reinforced that in complex cases, the quality of the therapeutic relationship and deep listening — core to advanced motivational interviewing skills — can itself be profoundly healing.

Cross-Cultural Relevance and Practitioner Wellbeing with Advanced Motivational Interviewing Skills

Advanced motivational interviewing skills travel well across cultures because they honour the wisdom in the room and treat people as experts in their own lives. Safety remains paramount. In most cases, asking “Can I share a concern?” opens dialogue compassionately.

The training repeatedly returned to practitioner wellbeing. The fixing reflex drains energy. By evoking clients’ own reasons for change through advanced MI skills, we reduce the sense of “hitting our head against a wall” and lower burnout risk.

Links to Broader Ideas and Limitations of Advanced Motivational Interviewing Skills

Advanced motivational interviewing skills build on Carl Rogers’ person-centred foundations while adding purposeful direction. Adam Grant’s Think Again (2021) complements them perfectly.

Advanced motivational interviewing skills are not a panacea. They have limits in acute crisis or severe trauma. They work best as part of a strong alliance and within ethical boundaries. Never manipulate. Regularly check in with clients. Use straight, natural language.

Final Reflections: Gratitude for Advanced Motivational Interviewing Skills

I am deeply grateful to Stephen Rollnick and Orla Adams for offering this high-quality two-day seminar. Their generosity, combined with masterful teaching through stories, videos, chat engagement, and live demonstrations, made advanced MI skills accessible and inspiring.

My greatest learning was in the nuance of advanced reflections, double-sided framing with “and,” and the transformative power of Ask-Offer-Ask. These advanced motivational interviewing skills have already shifted how I show up in sessions — more curious, less fixing, more collaborative.

For any UK-based practitioner seeking to deepen their practice, reduce burnout, and help clients thrive, investing time in advanced MI skills training with experts like Rollnick and Adams is one of the best decisions you can make.

Motivational Interviewing continues to evolve, but its core remains profoundly human: honouring people’s wisdom, evoking their own motivations, and walking alongside them with compassion and skill.

References

Grant, A. (2021). Think again: The power of knowing what you don’t know. Viking.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press.

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Introduction

As an online psychologist, I regularly support high-achieving women who suddenly feel overwhelmed and exhausted. After attending the Global Burnout Summit 2026, I gained valuable insights into online therapy for menopause burnout and why this condition is so common yet often misunderstood.

Many women search for menopause burnout because they feel caught in a perfect storm of hormonal changes and overwhelming life demands. This article explores the reasons perimenopause hits high-achieving women so hard and how online therapy for menopause burnout can support meaningful recovery.

Why Perimenopause Significantly Increases Burnout Risk

Perimenopause brings major hormonal fluctuations, particularly declining estrogen and progesterone. These changes affect sleep, mood, energy, cognitive function, and stress resilience. At the Global Burnout Summit 2026, experts highlighted that perimenopause remains heavily stigmatised. Many women wonder whether their symptoms are “just burnout” or something more.

High-achieving women are especially vulnerable. They often manage demanding careers, childcare, household responsibilities, and emotional labour while their bodies undergo significant changes. This combination creates a double burden. Online therapy for menopause burnout is particularly helpful because it addresses both the hormonal and psychological sides of this experience.

Common Symptoms and the Overlap

Symptoms of perimenopause and burnout frequently overlap:

• Extreme fatigue
• Brain fog and difficulty concentrating
• Sleep problems
• Irritability, anxiety, and mood swings
• Loss of motivation and joy

When these two conditions occur together, symptoms often feel more intense. Many women experience grief over losing their previous energy and sense of self. Online therapy for menopause burnout offers a safe space to process these feelings and understand what is happening in both body and mind.HRT – Benefits and Risks

Hormone Replacement Therapy (HRT) was discussed at the summit as one potential option.

Benefits of HRT can include:

• Reduction in hot flushes and night sweats
• Improved sleep quality
• Better mood stability
• Increased energy and mental clarity

Risks and considerations vary by individual and should be discussed with a knowledgeable doctor. These may include a slightly increased risk of breast cancer with certain types of HRT, and blood clot risks with oral forms. Not all women are suitable candidates for HRT.

Online therapy for menopause burnout works especially well when combined with appropriate medical support for those who choose it.

The Emotional and Identity Impact

Perimenopause often triggers a significant identity crisis. High-achieving women may grieve the loss of their former energy, sharpness, and sense of control. The summit emphasised that this grief is valid and needs space.

Through online therapy, women can:

• Process identity changes and grief
• Rebuild self-worth beyond productivity
• Develop self-compassion during this major life transition

Online Therapy for Menopause Burnout: Practical Recovery Strategies

Recovery from menopause burnout involves multiple layers. Key approaches discussed at the summit include:

• Nervous system regulation through nature connection and mindful walking
• Learning to pace rather than chase
• Making small micro-shifts in daily life
• Practising self-compassion and speaking kindly to mind and body
• Accepting all feelings, including numbness

Online therapy can help clients implement these strategies in a personalised, sustainable way.

How Online Therapy for Menopause Burnout Can Help

Online therapy provides flexibility, privacy, and accessibility for busy women. In sessions, we work on:

• Understanding the overlap between hormonal changes and burnout
• Unpacking mental load and perfectionism
• Rebuilding self-worth and healthier boundaries
• Developing personalised recovery plans

Many women find that online therapy for menopause burnout gives them the space and support they need during this challenging transition.

Taking the First Step

If you are a high-achieving woman struggling with perimenopause or menopause-related burnout, know that you are not alone and that recovery is possible. Online therapy can offer a compassionate, flexible path toward renewed energy, clarity, and self-understanding.

Online Therapy for Menopause Burnout References:

Brignoli, P. (2026). Human performance and sustainable ambition. Presentation at the Global Burnout Summit 2026.

Lazarus, N. (2026). Behind the smile: The untold stories of burnout in high-functioning women. Presentation at the Global Burnout Summit 2026.

National Institute for Health and Care Excellence. (2024). Menopause: diagnosis and management (NICE guideline NG23). https://www.nice.org.uk/guidance/ng23

World Health Organization. (2022). Menopause. https://www.who.int/news-room/fact-sheets/detail/menopause

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In my practice as an online psychologist, I regularly work with capable, driven women who appear to have it all together — until they don’t. After attending the Global Burnout Summit 2026, I gained powerful new insights into why so many high-achieving women experience burnout. The summit reinforced what I see in my work every day: many women are carrying an enormous invisible load while continuing to function at a high level.

This article shares key insights from the Global Burnout Summit 2026 and explores how online therapy for burnout among women can provide meaningful support and promote recovery.

The Hidden Reality of Burnout in High-Functioning Women

High-functioning burnout in women is rarely obvious from the outside. These women continue to show up, deliver results, and hold everything together — often at great personal cost. At the Global Burnout Summit 2026, speakers highlighted how women are expected to excel simultaneously in career, motherhood, household management, emotional labour, and often caring for ageing parents. This creates a massive mental load — multiple “open tabs” that continue draining energy even when not actively being worked on.

Online therapy for burnout in women is increasingly sought after because this invisible load often goes unrecognised by others. Women are frequently praised for being “so strong” and “having it all together,” while privately feeling depleted.

Online Therapy for Burnout in Women: The Superwoman Trap and Unpaid Labour

A major theme at the summit was the Superwoman Trap. Society still expects women to be the strong ones — the perfect mother, the dependable colleague, the fabulous friend — while managing most of the invisible, unpaid labour. This includes mental planning, emotional support, childcare logistics, and household organisation.

Many women shared the painful realisation: “I don’t want to be a superwoman anymore.” Yet letting go of this identity feels incredibly difficult due to deep internalised beliefs and external expectations.

Online therapy for burnout in women helps clients gently unpack these patterns, release the need to do it all, and rebuild healthier boundaries.

Perimenopause, Hormonal Changes and Burnout

Perimenopause and menopause emerged as significant but still-taboo contributors to burnout. Hormonal fluctuations can dramatically worsen fatigue, brain fog, irritability, and anxiety. Many women expressed huge relief when they realised some of their symptoms were hormonal rather than purely stress-related or personal failure.

The combination of chronic stress and hormonal shifts creates a double burden. Online therapy for burnout in women provides a safe space to explore this intersection and develop strategies that address both the psychological and physiological aspects.

The Mask, Self-Worth and Emotional Exhaustion

High-functioning women often become experts at wearing masks. They show up, perform, and hold everything together for everyone else. Behind the mask, however, there is frequently nothing left — no energy, and sometimes a deep sense of emptiness.

Discussions at the Global Burnout Summit 2026 showed that only about 29% of women feel safe to share what they are going through fully. However, approximately 75% feel immediate relief simply by saying out loud, “I’m not okay.” Many women struggle with self-worth when it comes to self-care, often viewing therapy or rest as selfish.

Online therapy for burnout in women offers a consistent, compassionate space to drop the mask, process difficult emotions, and rebuild self-worth without guilt.

The Healing Power of Permission, Nature and Community

One of the most powerful messages from the summit was the importance of permission just to be — permission to rest, to feel, to not be productive, and to prioritise personal needs.

Nature was repeatedly described as powerful medicine. Mindful walking in nature, seeking moments of awe, lying on the grass, and sensory connection help regulate the nervous system and process emotions. Many women reported feeling significantly restored after spending intentional time outdoors.

Community and safe sharing were also highlighted as vital. When women realise they are not alone, shame decreases dramatically. Online therapy for burnout in women provides this consistent, confidential support alongside encouragement to build real-life safe connections.

Moving from Exhaustion to Sustainable Living

Recovery from burnout in women is rarely about doing more — it is about doing less, more wisely. It involves learning to pace rather than chase, speaking kindly to mind and body, and making small micro-shifts in daily life.

Online therapy for burnout in women supports this process by helping clients:

• Understand their unique mental load and triggers
• Develop self-compassion and healthier inner narratives
• Set boundaries and practise saying “No”
• Reconnect with their body and nature
• Build sustainable ambition aligned with their values

Taking the First Step Towards Online Therapy for Burnout in Women

If you are a high-functioning woman who has been doing it all but feeling increasingly exhausted and empty, know that you are not alone — and that support is available. Burnout is not a personal failure. It is the result of carrying too much for too long while pretending everything is fine.

Online therapy for burnout in women offers a flexible, compassionate, and effective path toward genuine recovery and reconnection with yourself.

You don’t have to figure this out alone. If you’re ready to take that first step, I would be honoured to support you.

References Online Therapy for Burnout in Women

Brignoli, P. (2026). Human performance and sustainable ambition. Presentation at the Global Burnout Summit 2026, Virtual.

Lazarus, N. (2026). Behind the smile: The untold stories of burnout in high-functioning women. Presentation at the Global Burnout Summit 2026, Virtual.

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311

World Health Organization. (2019). Burn-out an “occupational phenomenon”: International Classification of Diseases. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

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Important Disclaimer For Depression Self-Tests:

This article is for informational and educational purposes only. It is not a diagnostic tool and cannot replace a professional assessment. This depression self-test is designed to help you understand common symptoms, but self-tests are not substitutes for clinical evaluation. If you are experiencing symptoms of depression, please consult a qualified psychologist, psychiatrist, or your GP.

If you have thoughts of suicide or self-harm, or feel you are in crisis, seek immediate help:

United Kingdom

• 999 — Emergency services (if in immediate danger)
• 111 (select mental health option) — NHS urgent mental health support, available 24/7
• 116 123 — Samaritans (24/7 emotional support)

United States

• 988 — Suicide & Crisis Lifeline (24/7)
• 911 — Emergency services

Europe & Other Countries

• 112 — Common EU emergency number
• Visit findahelpline.com or befrienders.org for local support.

What Is Depression?

Depression is a common but serious mood disorder that affects how you feel, think, and function every day. This depression self-test can help you recognise whether your symptoms may indicate something more than temporary sadness.

DSM-5 Criteria for Major Depressive Episode

According to the DSM-5, a Major Depressive Episode requires five or more symptoms present during the same 2-week period, with at least one being depressed mood or loss of interest or pleasure.

Depression Self-Test (PHQ-9 Style Scoring)

This depression self-test is based on the widely used PHQ-9 screening questions. Over the last 2 weeks, how often have you been bothered by any of the following problems?

How to Score the Depression Self-Test:

Add your scores for questions 1–9 to get your total (out of 27).

Score Interpretation:

• 0–4: Minimal or no depression
• 5–9: Mild depression
• 10–14: Moderate depression
• 15–19: Moderately severe depression
• 20–27: Severe depression

A score of 10 or above on this depression self-test usually means it’s worth speaking to a professional.

If your score is 10 or higher, or you feel ready for support, you can book an online consultation here.

Different Types / Phases of Depression

• Clinical Depression (Major Depressive Disorder – MDD): Discrete episodes lasting at least 2 weeks with a significant impact on daily life.
• Chronic Depression (Persistent Depressive Disorder / Dysthymia): Milder but long-lasting symptoms for at least 2 years.
• Severe / “Can’t Function” Depression: Marked impairment where basic daily tasks become extremely difficult.

Many people use a depression self-test like this one as a helpful first step before starting therapy.

When to Seek Professional Help

Consider reaching out if your depression self-test score is 10 or higher, symptoms last more than two weeks, or daily functioning becomes difficult. As a BPS-registered psychologist specialising in psychotherapy, I provide evidence-based online depression therapy.

Learn more about my approach here or explore my online mood disorder services.

Ready to Take the Next Step?

If you would like confidential support with depression, anxiety, grief, or other difficulties, I offer flexible online therapy sessions.

• Book an online appointment
• Contact me directly
• View online mood disorder services
• View individual counselling services
• View grief & loss services

References for a depression self-test

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

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Our specialised trauma services provide evidence-based support to help you process difficult experiences, reduce distressing symptoms, and regain a sense of safety and control in your life.

What is Trauma and PTSD?

Trauma can be defined as an emotional and psychological response to stressful or overwhelming events that impair an individual’s ability to cope (American Psychiatric Association, 2022). These events can include natural disasters, wars, major accidents, physical or sexual abuse, and more.

Understanding Post-Traumatic Stress Disorder (PTSD)

According to the American Psychiatric Association (2022), Post-Traumatic Stress Disorder (PTSD) is a clinical condition that can develop after exposure to actual or threatened death, serious injury, or sexual violence. The DSM-5-TR outlines four main symptom clusters:

• Intrusion symptoms: Recurrent, involuntary distressing memories, flashbacks, nightmares, or intense emotional or physical reactions to reminders of the trauma.
• Avoidance: Persistent avoidance of trauma-related thoughts, feelings, people, places, or activities.
• Negative alterations in cognitions and mood: Inability to experience positive emotions, distorted beliefs about oneself or the world, persistent negative emotional state, detachment from others, and diminished interest in activities.
• Alterations in arousal and reactivity: Hypervigilance, exaggerated startle response, irritability or angry outbursts, problems with concentration, and sleep disturbance.

Online therapy for PTSD has proven to be highly effective in addressing these symptoms, especially for people who prefer the privacy and convenience of receiving support from home.

There is also Complex PTSD (C-PTSD), which typically results from prolonged or repeated trauma, such as ongoing childhood abuse or domestic violence (Herman, 1992). C-PTSD often includes additional difficulties with emotional regulation, self-perception, and forming stable relationships.

How Online Therapy for PTSD Can Help

Online therapy for PTSD allows you to work with a qualified therapist without the added stress of travel or leaving your safe environment. Many clients find this format particularly helpful because they can attend sessions in a space where they already feel more secure.

In my practice, clients with PTSD frequently describe struggling to control their emotions, having a negative view of themselves, difficulty maintaining relationships, detachment, emptiness, and hopelessness. Physical symptoms are also very common. As van der Kolk (2014) powerfully explains in The Body Keeps the Score, trauma lives not only in the mind but also in the body. Common manifestations include a racing heart, headaches, muscle tension, and feeling constantly on edge.

Practical Steps During Difficult Moments

During flashbacks or intense distress, here are some grounding techniques many of my clients find helpful:

• Focus on the present moment and remind yourself you are safe right now.
• Use your senses — touch something nearby, sip water, or wash your hands.
• Breathe slowly and deeply.
• Move your body.
• Reach out to someone you trust.

These strategies can provide immediate relief, but they work best alongside consistent online therapy for PTSD.

Our Approach to Online Therapy for PTSD

In online therapy for PTSD, we primarily use evidence-based treatments including Cognitive Processing Therapy (CPT), trauma-informed Cognitive Behavioural Therapy (CBT), somatic approaches, and Internal Family Systems. These methods help process traumatic memories, challenge unhelpful beliefs (often called “stuck points”), and reduce the intensity of symptoms such as flashbacks, nightmares, and hypervigilance (Resick et al., 2017).

Who Seeks Online Therapy for PTSD?

Anyone can benefit from online therapy for PTSD. Some people start because they have agoraphobia or find it difficult to leave home. Others have experienced direct trauma or vicarious trauma. If you or someone you know is struggling, please feel free to reach out.

Our BPS Registered Psychologists have specialist training in trauma and PTSD.

In emergencies, always call 999.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Herman, J. L. (1992). Trauma and recovery. Basic Books.

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. The Guilford Press.

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

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As an online therapist, providing depth-oriented work through telehealth opens powerful opportunities for meaningful client change. Online Psychodynamic Psychotherapy combines the rich theoretical foundation of psychodynamic thinking with the accessibility and flexibility of virtual delivery. Online Psychodynamic Psychotherapy explores how unconscious patterns, early relational experiences, and unresolved conflicts influence current emotional difficulties and relationships. Delivered via secure video platforms, it helps clients gain insight, work through transference, and achieve lasting personality-level change (Lindegaard et al., 2020; Maroti, 2025).

This article offers practical guidance for online therapists delivering online Psychodynamic Psychotherapy, including core principles, session structure, evidence base, benefits, challenges, and clinical tips specific to telehealth practice.

The Origins and Theoretical Foundations of Psychodynamic Psychotherapy

Psychodynamic psychotherapy evolved from Sigmund Freud’s psychoanalysis in the early 20th century. Over decades, it has been refined into more contemporary, time-limited, and relationally focused forms while retaining core ideas: the influence of the unconscious, the centrality of early attachment experiences, defence mechanisms, and the therapeutic relationship itself as a vehicle for change (Shedler, 2010).

Modern psychodynamic approaches emphasise insight, emotional processing, and repairing relational patterns. For online therapists, these principles remain highly relevant and adaptable to video-based work.

Core Concepts in Online Psychodynamic Psychotherapy

Key elements that guide online Psychodynamic Psychotherapy include:

• Unconscious Processes: Helping clients bring hidden thoughts, feelings, and motivations into awareness.
• Transference and Countertransference: Exploring how clients relate to the therapist as a reflection of past relationships — readily observable even in video sessions.
• Defence Mechanisms: Identifying ways clients unconsciously protect themselves from anxiety or painful emotions.
• Attachment and Object Relations: Understanding internal working models formed in early life and how they manifest in present relationships.
• Free Association and Reflection: Encouraging open expression of thoughts and feelings.

In telehealth, the therapeutic frame (consistency, boundaries, and presence) remains essential, though it requires thoughtful adaptation (Maroti, 2025).

How Online Therapists Deliver Psychodynamic Psychotherapy

As an online therapist, you can structure online Psychodynamic Psychotherapy flexibly — from short-term (12–20 sessions) to longer-term work, depending on client needs and goals.

Typical Session Flow (45–50 minutes):

1. Opening/Check-in — Observe emotional tone, body language (even on video), and emerging themes.
2. Exploration — Invite free association or follow the client’s material wherever it leads.
3. Interpretation and Insight — Gently offer links between past and present, patterns, or transference.
4. Working with Transference — Comment on the here-and-now relationship as it appears on screen.
5. Closing — Summarise key insights and assign reflective “homework” (e.g., journaling or noticing patterns between sessions).

Delivery occurs primarily through secure video platforms. Many therapists supplement with secure messaging for reflections between sessions while maintaining clear boundaries.

Evidence Base for Online Psychodynamic Psychotherapy

Research increasingly supports online Psychodynamic Psychotherapy. A systematic review and meta-analysis by Lindegaard et al. (2020) examined internet-delivered psychodynamic therapy (IPDT) across seven RCTs (N = 1,080). Results showed small-to-moderate effects compared to controls for overall symptoms (g = 0.44), depression (g = 0.46), and quality of life (g = 0.40). Gains were maintained or increased at follow-up.

Broader evidence on telehealth psychotherapy indicates that video-based delivery is generally as effective as in-person therapy across modalities, including psychodynamic approaches (Fernandez et al., 2021; Giovanetti et al., 2022). Recent studies also support its use for depression, anxiety, somatic symptoms, and relational difficulties in virtual formats (Maroti, 2025).

While more large-scale studies are needed, current evidence positions online Psychodynamic Psychotherapy as a promising, effective option — particularly when therapists adapt techniques thoughtfully to the online environment.

Benefits for Online Therapists and Clients

Online Psychodynamic Psychotherapy offers distinct advantages in telehealth:

• Accessibility — Reach clients in remote areas, those with mobility issues, or those with busy schedules.
• Reduced Barriers — Lower no-show rates and greater comfort disclosing sensitive material from home.
• Rich Observational Data — Video allows close attention to facial expressions, tone, and home environment as relational clues.
• Flexibility — Easier integration of reflective work between sessions.
• Depth with Convenience — Clients can engage in meaningful insight-oriented work without travel.

Many clients report strong therapeutic alliances via video, comparable to in-person work.

Potential Limitations and Clinical Considerations

Challenges specific to online Psychodynamic Psychotherapy include:

• Potential attenuation of non-verbal cues or emotional intensity.
• Technical disruptions affecting the therapeutic frame.
• Difficulties with severe pathology, high suicide risk, or certain personality dynamics (may require hybrid or in-person referral).
• Maintaining confidentiality and managing the home environment.

Skilled online therapists mitigate these through strong alliance-building, clear contracts, and proactive discussion of the medium’s impact on the work.

Practical Guide: Implementing Online Psychodynamic Psychotherapy

Best Practices for Online Therapists:

• Establish a consistent virtual “frame” (same time, background, reliable technology).
• Use screen sharing for occasional visual aids or joint reflection.
• Pay close attention to micro-expressions and shifts in client presence.
• Actively monitor and discuss transference as it appears (e.g., “I notice you seem hesitant to share today — does that connect with anything from the past?”).
• Encourage clients to notice relational patterns outside sessions and bring them in.
• Use validated outcome measures periodically to track progress.

Start with a thorough assessment and collaborative goal-setting. Be transparent about how the online format may influence the therapy.

Who Can Benefit and Integration with Other Approaches

Online Psychodynamic Psychotherapy is particularly helpful for clients with depression, anxiety, relationship difficulties, personality issues, trauma, and those seeking deeper self-understanding. It integrates well with other modalities (e.g., combining with mindfulness, CBT techniques for symptom relief, or attachment-informed approaches).

It serves as both a standalone depth therapy and part of a stepped-care model.

Future Directions

As telehealth evolves, online Psychodynamic Psychotherapy will likely benefit from hybrid models, enhanced training in virtual relational work, and further research on specific populations. AI-assisted reflection tools and improved platforms may further support the work.

Conclusion

Online Psychodynamic Psychotherapy allows online therapists to deliver rich, insight-oriented therapy that fosters lasting change. By working with unconscious patterns, relational dynamics, and emotional depth through secure video connections, you can help clients achieve meaningful transformation regardless of physical distance (Lindegaard et al., 2020).

Mastering this approach strengthens your telehealth practice while honouring the core values of psychodynamic work. As you adapt the frame to the online space, the therapeutic relationship remains the most powerful agent of change.

Feel free to integrate these ideas into your own style and client work. Continue prioritising ethical practice, supervision, and ongoing professional development in telehealth psychodynamic therapy.

References

Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B., & Aboujaoude, E. (2021). Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to session frequency and duration. Clinical Psychology & Psychotherapy, 28(6), 1535–1549. https://doi.org/10.1002/cpp.2594

Giovanetti, A. K., Punzo, J. F., & Muroff, J. (2022). Teletherapy versus in-person psychotherapy for depression: A meta-analysis of randomized controlled trials. Telemedicine and e-Health, 28(8), 1071–1080. https://doi.org/10.1089/tmj.2021.0294

Lindegaard, T., Berg, M., & Andersson, G. (2020). Efficacy of internet-delivered psychodynamic therapy: Systematic review and meta-analysis. Psychodynamic Psychiatry, 48(4), 437–454. https://doi.org/10.1521/pdps.2020.48.4.437

Maroti, D. (2025). Psychodynamic teletherapy: The past, the present and the future. Current Psychiatry Reports. https://link.springer.com/article/10.1007/s10879-025-09688-4

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378

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