Understanding Therapy

What is therapy?

Therapy is a structured space to explore your thoughts, feelings, and patterns of relating. It can be understood as means of relieving mental stress by exploring the emotions and associations surrounding the cause(s) of this stress. At ECPT, sessions are grounded in psychodynamic therapy, often combined with existential perspectives. This means we look at how your past relationships and unconscious processes shape your present, while also considering the big questions of existence—freedom, isolation, death, and meaning. You can read more in our blog post on how to know if existential–psychodynamic therapy is for you.

Do I need therapy?

If you’re feeling stuck, overwhelmed, anxious, or disconnected—or if you keep repeating unhelpful patterns in relationships—therapy may be able to help. Many people seek therapy not only in times of crisis but also to deepen self-understanding and increase their self-awareness.

Does therapy work?

Research consistently shows that therapy can be effective, especially when there is a good match between client and therapist. At ECPT, the first four sessions are treated as a “prolonged assessment” to see if the fit feels right before you commit longer term.

Substantial research supports psychodynamic and existential approaches. For example, a major meta-analysis found psychodynamic therapy to be as effective as other established treatments like CBT, using rigorous methods and equivalence testing. It is also effective for common mental disorders, including depression and anxiety—which have been shown to respond well to psychodynamic therapy compared to both active and inactive controls. A meta-analysis of existential therapies demonstrated large positive effects on finding meaning, and moderate reductions in symptoms like anxiety and depression in physically ill populations.

How long are therapy sessions?

Each session lasts 50 minutes and takes place weekly at the same time and day.

How many sessions will I need?

Therapy at ECPT is open-ended but designed for longer-term work. We ask clients to initially commit to a minimum of 6 months to a year, but sessions can go on longer than that depending on therapist’s availability. Every 20 sessions, you will review progress together with your therapist and check in on how therapy is going. For online therapy, we offer a maximum of 20 sessions.

How long does it take to notice changes in psychodynamic therapy?

Psychodynamic therapy is designed as a deeper, longer-term process. While some people experience relief within the first weeks or months, research shows that significant, lasting improvements often become noticeable after about a year of weekly therapy.

• Studies of long-term psychodynamic psychotherapy (LTPP) — typically one year or more of sessions — found clear benefits over shorter treatments, with recovery rates increasing steadily across the first and second year of work (Leichsenring & Rabung, 2011).

• One inpatient study showed meaningful symptom improvement within 4 weeks, but the strongest and most stable gains were maintained at one-year follow-up (Leichsenring et al., 2006).

It’s also worth noting that clients may often expect to initially feel worse for a while before feeling better. This is due to getting in touch with difficult feelings that have long been dissociated out of our conscious awareness, and in psychodynamic therapy, we try to make contact with these feelings and help clients process them so they don’t continue to affect them in direct or indirect ways.

Cost & Logistics

How much does therapy cost?

At ECPT, we charge a fixed monthly fee of £135, which covers a weekly 50-minute session (equivalent to £36 per session). This structure reflects the psychodynamic principle of reserving the same weekly time slot for you throughout your therapy, set aside exclusively for you each week and with the therapist holding you in mind, whether or not you attend.

• First month: if you begin mid-month, sessions are charged individually at £36 until the new calendar month begins, at which point the fixed monthly fee applies.

• Assessment period: during the first four “assessment” sessions, you can pay per session (£36 each) before deciding whether to commit longer-term.

• Annual adjustment: fees are reviewed once a year and may be adjusted for inflation.

• How it’s calculated: the monthly fee is based on 45 weeks of therapy across the year, allowing for up to 7 weeks when your therapist may take planned leave. Any additional cancellations or missed sessions on the client’s side are not reimbursed, so clients pay the same monthly fee regardless of how many sessions they have in a given month.

Why is therapy so expensive?

Private therapy often reflects the training, experience, and running costs of practitioners, and prices are typically raised each year in line with inflation, such that typical fees in Edinburgh are now between £50 and £95 per session. At ECPT, improving access to existential psychodynamic therapy is central to our mission so we endeavour to reduce costs where possible and are hence proud to be one of the few providers of affordable long-term therapy in Edinburgh. We are able to do so thanks to our trainee therapists on placement who are heavily supervised and work according to robust ethical standards.

Is therapy available online?

Yes, we offer online therapy via Microsoft Teams. Online sessions are limited to a maximum of 20 sessions, but clients are then welcome to continue in-person beyond the 20 sessions.

Do you offer couple therapy?

No, our service is currently for individuals only.

Where do sessions take place?

In-person sessions are held at 2nd floor, 86–92 Causewayside, Edinburgh, or online via Teams.

Working with ECPT

What can I expect during my first session?

At ECPT, the first one to four sessions are treated as a prolonged assessment phase. The purpose of those first few sessions is to get a sense of how your therapist works and for both of you to consider if you think you can work together. In your first session, it’s quite likely that the client will talk for most of the session, which may continue for the next few sessions when it’s more typical to be going through your history. In your second session, your therapist will go through the contract with you and discuss any questions you may have, after which you’ll be asked to sign it digitally and email it back to the office at info@ecpt.org.uk. You may end up going through a timeline of your life from that session onwards as this can be quite helpful for both the therapist and yourself, and this may take between 1-4 sessions depending on the client. After this point, you’d be expected to bring whatever’s on your mind and choose where you start each session as opposed to the therapist deciding or directing where to go.

Will everything I say be confidential?

Yes. All sessions are confidential, except in rare cases where there is risk of serious harm (e.g., risk of suicide, intent to harm others, or safeguarding concerns). Full details are in the client contract which is usually sent to clients in the initial confirmation email.

Who will be my therapist?

You will work with a trainee therapist in their 2nd or 3rd year of training in psychodynamic therapy. All therapists are closely supervised to ensure high-quality care and ethical standards. You can see the brief profiles of all our therapists in our Team page.

What if I don’t want to talk about something?

That’s your choice. Some people find that it takes time to talk openly. Your therapist will respect your pace and not force you to talk about anything you don’t wish to.

What if I miss a session?

Because your session slot is reserved for you each week, missed sessions are not reimbursed and the same monthly fee will apply, but there’s not a limit on how many sessions you’re allowed to miss, so long as you make email contact with your therapist or the office.

If you miss a session, your therapist will email you to check that you still wish them to hold your slot next week at your usual time. They will still hold your slot even if they don’t hear from you, but if you miss two sessions in a row without contact, your therapy will be paused as we’ll assume you no longer wish to proceed with therapy at that point. Clients are welcome to re-engage with the service by emailing the office when they’re ready, although they may be allocated to a different therapist and a different time slot, depending on our availability at the time.

How do I end therapy?

We recommend planning for an ending as this is an important part of psychodynamic therapy. If you’ve had fewer than 10 sessions, we suggest at least one session for an ending; if longer, 3–4 sessions are encouraged. Having a planned ending allows you to discuss how the ending of the therapeutic relationship is affecting you as endings commonly bring up our older experiences of endings. People also commonly review the work that they’ve done in therapy and the work that they may still wish to do independently or keep in mind going forward.

What if I have a complaint?

We encourage you to raise concerns directly with your therapist first. If this isn’t possible, you can contact the Director. ECPT therapists adhere to the codes of ethics of NCPS and equivalent recognised bodies.

Choosing the Right Approach

What’s the difference between counselling and psychotherapy?

Some practitioners make a distinction between counselling and therapy, though many practitioners, including ourselves, don’t make a distinction between the two and use them interchangeably. In general, what is sometimes signified in cases where a distinction is made, is that counselling often focuses on specific issues over a shorter timeframe, while psychotherapy tends to explore deeper, longer-term patterns. ECPT offers existential psychodynamic psychotherapy, which aims to uncover and work with the root causes of distress and is a more longer-term approach.

How do I choose the right therapist?

The relationship itself is key. That’s why ECPT builds in the first four sessions as a space to assess fit—for both you and the therapist. Keep in mind, sometimes what may seem like the wrong fit can in fact be a challenging transference between the client and the therapist. This can provide quite fertile grounds for the work as it may allow the client to work through some difficult relationship in their life through the here and now with the therapist. Although we endeavour to meet client preferences in terms of working with a therapist of a specific gender or otherwise, as with the previous point, sometimes it can be quite useful to work with a therapist of the opposite gender or age that we prefer as this can provide an opportunity to work through a more challenging transference within a safe therapeutic environment.

How is psychodynamic therapy different from CBT?

CBT is usually short-term (average 6-12 sessions) and problem-focused, working on thought and behaviour patterns, with agendas for each session and homeworks between sessions. Psychodynamic therapy usually lasts longer than CBT, but unlike CBT, it has no definitive timeframe with regards to how long the therapy lasts, but most psychodynamic therapists work within a long-term approach (minimum of 6 months to a year, but often longer than a year). Psychodynamic therapy isn’t structured like CBT is and it’s a non-directive approach, which means the therapist won’t control where the session goes or offer advice or solutions to the clients. Rather, it’s a relational and collaborative exploration between the client and the therapist which digs deeper into unconscious processes and past relational patterns, aiming for long-lasting change. With our existential–psychodynamic approach, we also explore how you make meaning in the face of life’s challenges.