I met Emma while studying at Örebro University where she was one of few friends who regularly listened to my student radio programme Black Rooster. She’s always been a good listener, which is why I wasn’t surprised to learn that she chose to become a therapist. Emma is warm, friendly and softly spoken, but also filled with deep convictions, and what I interpret as an unusually strong internal compass.
In February 2019, Emma launched her cognitive behavioural therapy (CBT) practice following a number of years working as a counsellor at Stockholm County Council. She works with people who have different mental health issues as well with coaching.
“I always wanted to start my own practice, so last year when I took some time off work to do a masters in social work I thought I could open my own practice at the same time. I dropped my studies after about six months to focus solely on my practice.”
Since it isn’t an accredited practice, Emma explains that anyone who wants to can call themselves a cognitive behavioural therapist in Sweden. With that said, Emma is both a licensed counsellor and has completed a foundational course in psychotherapy, which gives her the right to practice psychotherapy as well. Following the launch, she has spent two days a week on her practice and one day a week as a school counsellor. With Covid-19 impacting session demand, she’s spent less time on the practice during the spring, but when we speak in early July she is looking forward to ramping things up once again.
So what kind of problems do people come to her with?
“It’s for a variety of reasons; it can be anxiety related, some feel down or depressed, others have health related issues, or because of relationship issues. Some people find it difficult to manage everyday life and are looking for coping strategies that can help them handle work or study commitments.”
With such a wide remit, I'm curious to understand if it was a conscious decision to not specialise on a certain area of work?
“I did consider specialising, but at the same time the help people are looking for might not necessarily be what the sessions will eventually focus on. A lot of what I do is relevant for lots of different issues; it’s about managing thoughts and feelings in order to develop a better relationship with oneself.”
Some might picture the world of therapy as something centred around Freud’s idea of uncovering the childhood’s impact on adult life with regular session spanning several years. And while CBT can deal with the past, it’s much more focused on the present.
“Some criticise it for being a shallower approach, like putting a band aid on a cut instead of treating the cause, but it doesn't have to be. But if someone has a phobia, for example, you might only need a few sessions to work through the issue. Other times people have been carrying things for a long time, which requires time to really understand the root of the problem and start changing patterns of thought and behaviour. Then we work deeper.”
Emma’s CBT sessions are based on cognitive psychology and psychology of learning and focus on the connection between our thoughts, feelings and behaviours. It’s a goal oriented and more practical form of therapy, where people often get actionable homework between sessions.
“It’s about practicing new approaches in real life situations.”
Covid-19 is impacting people in a variety of ways, for some it’s been a relief to work from home; a retreat from social demands in the workplace.
“A lot of ‘musts’ have disappeared, you don’t have to go to the gym, you don’t need to make appointments. Life becomes calmer. Then you have those who are concerned about the uncertainty and that so much is out of our control at the moment. But some people in Sweden seem to be looking ahead as if it never happened, even though it’s still here, while other people have been furloughed, or have lost their jobs.”
The building where Emma currently sees her patients.
While many countries have seen long periods of significant restrictions when it comes to everyday life (I did this interview during week 12 of working from home in London), Sweden has famously taken a more lenient approach. The jury is still out whether this was right or wrong, but some are wondering if it might end up having a positive effect on overall mental health. Emma admits that in some cases you wouldn’t realise we’re in the middle of a global pandemic.
“At the school where I work everything continued as normal. It was a strange feeling since I was very conscious of the virus in all other aspects of my life and did all I could to socially distance. But then you go to the school and it’s an environment where it’s impossible to do.”
Mental health has been a hot topic in Sweden during the past few years and Emma believes the stigma is starting to dissipate. Going to therapy is no longer seen as a shameful or self-indulgent, which means that people also start seeking help before it turns into a crisis and symptoms take over someone's whole life. The demand certainly seems to be there, as Emma mentions a recent news story where the Swedish suicide hotline said that they are only able to answer 7% of the calls they get.
Even though the stigma might be gone, some people still hesitate to talk to someone about their issues. Emma admits that it can feel like a big step to take.
“Some might not believe in the method; others might think they can solve their problems on their own. I suggest that people who think they could benefit give it a try; it’s ok to just test it out, you don’t need to commit to anything more. Sometimes you need a few times to figure out if it feels right. It also comes down to personal chemistry and whether you feel comfortable opening up to your therapist. People shouldn't feel like they need to say everything during the first session, it’s perfectly fine to take it slow and only talk about what feels right at the time. I also think some people are worried about not having anything to say, but since I tend to start the session by asking some questions that’s rarely a problem. At the same time, it’s also ok to be quiet. It’s a space where silence is ok.”
Since personal chemistry is so important, I’m curious to understand if Emma has any tricks for how to prepare for a session? Does she do a power pose in the bathroom before meeting a client? Unsurprisingly her answer is no.
“The most important thing is to be present, listen and adapt to each individual. I don’t tend to start with a big presentation, I like to start by listening to the other person and take things as they come. If they are nervous they might not remember anything I say at the start anyway. People tend to ask me if I think I can help them with their issue, while others fear their issues are not important enough to talk about, that it’s nothing compared to those who really suffer. But you can’t compare suffering, there is always someone who is in a worse position than you, but that doesn’t minimise your suffering. If you feel you have issues that take a lot of energy in your day to day life, that you know you could feel better than you do, then it’s definitely worth dealing with.”
So how does her therapy room actually look like? Some might picture the classic film setting where the psychiatrist sits in a comfortable armchair and the patient is half laying on a daybed. That, however, is not how today’s session rooms look like. At least not in Sweden.
“It’s nice and clean with two classic treatment chairs,” Emma explains, which leads me to ask what a classic treatment chair looks like. The day after she sends me a photo of a very egalitarian looking chair that both she and her patients use; a symbolically level playing field.
The "classic treatment chair", something I became interested in following this episode of Curb Your Enthusiasm.
The CBT field is constantly evolving and has its roots in the inception of behavioural therapy in the 1950s, with its focus on Pavlov's dogs and how people react to various signals. In the 70s cognitive psychology started to develop, which focused on the impact of thoughts, memories and perceptions. In the 80s the combination of these theories created the starting point for what is today’s CBT field. It further developed in the 90s when concepts from eastern philosophy, such as mindfulness and acceptance, were incorporated.
“It has moved on from being focused solely on changing our thoughts, feelings and experiences to also accepting what we cannot change and that life includes pain and suffering and ups and downs that we cannot remove. CBT is a unifying concept that includes several strands, one of the most popular ones is acceptance and commitment therapy, which looks at an individual’s values and goals, and recognising that we sometime need to accept short term pain as long as we feel that we are heading in the right direction.”
And with those worlds we end our conversation, with Emma sitting on a rock by a lake outside Stockholm as another summer day comes to an end, and I in my London flat looking up at a despondent evening clouds. I remind myself that I need to accept this short-term pain.