The Diary of a Psychotherapist

Long term therapy becomes something else

Thomas Smithson — Fri, 28 Aug 2026 06:30:35 GMT

I have been working as a therapist for almost 8 years qualified and working with clients 2 further years during training. So next month I will reach my first decade of working with clients. And with that it has become my normal to work with many clients long term.

The longer I do this job and the longer I work with individuals in long term therapy, the more I see how much the therapy changes, it becomes something else, something beautiful.

In the first few months of working with a client, despite the want for us to be two equals, the client often sees the therapist as the professional who is providing the service, and the therapist, I believe, at least in private work wants to do a good job and provide that service. This in itself is acceptable, if the client gets what they need and the therapists offer that, fabulous. Relationships take time to develop so in a few months of therapy, although there can be a therapeutic relationship, it is still a young seedling reaching for the light.

But as we move into six months to one year mark of therapy the therapeutic relationship foundations are usually quite solid. We become equal (enough). The therapist knows so much more about their client, the people they have in their life, their history, what they are working towards. Within a year a therapist has seen how a client deals with their birthday, or birthdays in general, they will witness how they are during key events like religious holidays and have been there with the client during important anniversaries. Therapist and client become part of one another’s life on a weekly basis. It isn’t unusual that a therapist learns more about their clients than they know about some of their closest friends. It can still feel quite “professional” though, we are “doing therapy” while also trying to be authentic.

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If the work continues further than a year, into the two year mark we have even more of a therapeutic relationship, we are friendly, but not friends (as that would be unethical). All going well we are fully equals, DESPITE the therapist / client dynamic. Not only does the therapist know a lot about the client but the client might know much more now about the therapist, just from observing the therapists life changing as theirs has too. For example many of my clients have seen me move house, they have seen different locations, seen different hairstyles and changes in how I look, some even witnessed the time I horrifically tried a beard! Many of my long term clients have seen me become a parent as we navigated my time off during my adoption leave.

On top of that we can expect at this point many more light self disclosures that naturally come up with long term work. For example it’s not just “I’ve been on holiday” it’s “I was away in Spain with my family and the weather was lovely”.

A beautiful thing at this stage, and perhaps a little earlier depending on the clients, is the therapist has a lot more say. What I mean by that is the therapist has seen patterns play out over and over. We can say “remember to …” or “Really? This guy can treat you that way?”. We can remind clients of their successes and the reasons why they want to better themselves and their lives. We have so much more therapeutic safety to challenge unhealthy behaviours and having a solid understanding of what our clients want we can push a little more…. did you apply for that job? No? Let’s speak about that then yeah?

By years three, four and plus the therapeutic relationship has become so strong that clients become part of a therapists life. We wonder how they are, we are emotionally invested in their relationships, much more than earlier years. We care, we grieve, we feel.

Long term therapy means that we work with our clients through their changing lives.

We watch them fall in and out of love.

We watch them get new jobs and leave others.

We watch them make and lose friends.

We are with them (metaphorically) when they get married.

We support them through divorce.

We hold them when people die.

We celebrate with them when they have babies, and grieve the losses that might come with that.

We watch them with their pets old and new.

We watch as they travel the world and find themselves.

We support them through crisis.

We watch them change careers and change their lives.

We watch and help and support them become more authentic year by year.

We get to gossip with them and chat about TV, favourite foods and recent books, all this and so much more.

And there is something so magical about this. It isn’t just therapy. It is relational therapy. It is a relationship.

As I write this I am aware of how long this long term therapy all seems, like to get there you have to wait AGES and it takes YEARS. And most of the time yes it does (although with some clients it can be a lot quicker or a lot slower). But trust me, it never feels like this. With my long term clients it feels like we have blinked and we’ve travelled years in minutes. So if you want all this, get started, the time will fly.

I am so grateful for all the clients that I work with, but I must admit when we pass a year something exciting and beautiful usually starts to occur. The long term therapy becomes something else.

Thank you for reading today’s essay, happy Friday.

If you are regularly moved or interested by my posts, please consider upgrading your subscription if you can.

Tom

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I'm allowed to show up online as a therapist

Thomas Smithson — Fri, 21 Aug 2026 06:30:39 GMT

If you didn’t already know, I’m a therapist.

And if you didn’t already know “boundaries” in therapy are like gold. We have to manage boundaries all the time with our clients. Not only does this help the work, but it helps to model to our to clients how powerful and empowering healthy boundaries can be.

One “boundary” I have always struggled with is the “argument” about whether or not therapists can show up online because … “what if a client reads that”.

I totally get the importance of this argument, but the reality is there isn’t actually a rule in place that prevents a therapist from showing up online. On top of that, these expectations that I, and other therapists have been taught, were created in a time where social media and the ability to freely express ourselves wasn’t as available.

I really dislike the idea of being silenced - silenced - because “what if a client saw this” - well, If my grandmother had wheels, she’d be a bike. My responsibility to my clients safety is important. But my responsibility to expressing myself is also important - and valuable.

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The truth is, I silenced myself for years - hid my true self - and I simply can’t do it anymore.

Writing is healing for me, it’s expressive for me, it’s fun for me - and as you know, I would like it to pay part of my wage for the next 30 working years. So yet another reason to show up online and hone my craft.

Theoretically we, I have been taught that therapists need to remain a “blank slate” inside the therapy room. Sometimes I am, more often I am not, especially considering I work so much with acceptance and authenticity. But I want to point out two important things.

Firstly, the people who made these “rules” were in no way blank slates. Freuds offices were full of his knick knacks from various hobbies and his clients had their sessions in his family home. They walked past rooms filled with his possessions, children, wife and sister in law just to get to his office at the back of the house in Vienna.

And don’t even get me started on all the others, the theorists I follow the most; Freud, Jung, Rogers, Clarkson, Frankl, Yalom, Berne - they were incapable of being blank slates, unknown entities when they were relatively famous (especially in the therapy world). Their clients could easily look them up and get the inside scoop if they wanted to.

Secondly, these expectations, are old. Psychotherapy, or at least today’s version of it is almost 130 years old. And as I wrote on Instagram a while ago we have to ask ourselves “Is this therapeutically out of date?”. In this changing world, in this therapy world where intersectionality and authenticity are so important - perhaps we should be showing up online.

Now don’t get me wrong, there are things I personally won’t put online - my kids, my family, my partner, however this is down to preference not necessarily because I think it is “bad”.

I do make sure I ask myself what it would be like for a client if they were to see a post or essay, but all I can ask them to do is let me know if anything they read or see impacts them, by brining it to the session - if they don’t - really, that’s on them.

And some clients have done this, they have mentioned to me seeing one of my posts on Instagram, or reading one of my substacks. Every time we’ve had a very productive conversation about it.

How do I manage the fact that clients might see me online? Well first I’m explicit in my therapy agreement with clients by saying: “I currently have an online presence on Instagram and Substack …. Please note, on these platforms I share more of myself than I would in the therapy room. Seeing more of your therapist online can have a positive, negative or mixed impact on the therapeutic relationship. If anything comes up for you from my presence online, please do bring this to therapy”.

Other than that statement, when it comes down to exploring what a client might find out about me and that “coming into the room” I just do what therapists do best. I communicate and roll with whatever comes up, in the now.

What do you think? Let me know in the comments.

Thank you for reading today’s essay, happy Friday.

If you are regularly moved or interested by my posts, please consider upgrading your subscription if you can.

Tom

✺ Support The Diary of a Psychotherapist...

The Diary of a Psychotherapist is an eclectic selection of writing from the inner workings of my mind 🧠. Each new post is crafted with thought, care and free for two weeks before going behind a paywall. If you would like full access to the archive and to help support my writing, please consider a paid subscription for £5.00 a month.

If you want to support my writing as a one off, you can buy me a coffee! Me and my caffeinated words will be forever grateful. Click here

Want to work with me? Click here

The Diary of a Psychotherapist is 100% Human Made

Fear the Lion

Thomas Smithson — Fri, 14 Aug 2026 06:30:39 GMT

I had a version of this newsletter in my drafts since I started using substack. I’ve had a version of this newsletter in my head for years, in pieces scattered around my journal and in countless therapy sessions. Now a version has been published for over a year, and I want to give it some fresh air during my “hot girl summer” because to this day, I cons…

The Fruit Trees

Thomas Smithson — Fri, 07 Aug 2026 06:30:07 GMT

Arthur was sat in his usual seat in the usual carriage of the Great Western train. The firm seat, dark blue in colour was beginning to be uncomfortable. It was sunny outside, with white clouds peppered in the sky. He was on his way, as he was most days, to the facility where they are building more lines, more trains for the company.

The news says war is…

My hot girl summer

Thomas Smithson — Fri, 31 Jul 2026 06:30:23 GMT

“Hot girl summer is about just being you, just having fun. It’s turning up, driving the boat and not giving a damn about what nobody’s saying.” - Urban Dictionary.

Here we are folks, 27 months, 117 weeks since I started this Substack. I’ve consistently brought you something to read on your Friday mornings. Sometimes twice a week. During this time, the l…

Here's to the Café

Thomas Smithson — Fri, 17 Jul 2026 06:33:52 GMT

Here’s to the Café that gets me out the house.

Here’s to the couple sharing coffee and cake.

Here’s to the men chatting like old friends.

Here’s to the guy reading the paper, whisking me back to analog life.

Here’s to the man behind me, chatting to a loved one on the phone, while sorting paper work that he “can’t complain about”.

Here’s to the lady at t…

I'm okay with the end of the world?

Thomas Smithson — Fri, 17 Jul 2026 06:31:21 GMT

For those of you unaware, Europe has had record breaking heat waves recently. And they keep coming.

It has meant many people continue to be quite anxious about the climate crisis.

I have the anxiety myself too. Part of me enjoyed the heat sure, hey I’m a summer baby. But the other part of me thought; is this the end? I honestly wonder how my kids and I …

The struggle of being the preferred parent.

Thomas Smithson — Fri, 10 Jul 2026 06:30:50 GMT

As you start reading, please know, I do love my children - obviously - but hear me out.

“Daaaaddddyyyyyyyyyy" is the soundtrack of my life right now. My five year old can say it in such a particular way that it punches through me. The D is loud, the a gets louder, the d quieter and then the y is extended for infinity until I want to bang my head against…

Let me tell you about your grand therapist.

Thomas Smithson — Fri, 03 Jul 2026 06:30:24 GMT

Grand therapist - the therapist of your therapist.

This is something I have come across recently on social media and it made me smile. Us therapists, the best of us know that to be good for our clients, we need to continue to use therapy for ourselves. And I’ve been thinking about my own therapist and how he is. And I want to tell you about him.

We have…

"This looks like it was written with AI"

Thomas Smithson — Fri, 26 Jun 2026 06:30:07 GMT

Oh the trolls. Will they ever learn that their words are fuel to my creativity? And although my husband says I should ignore them, I work on the policy that if you're going to be arsey with me I’ll be sassy with you.

You’ve got a comment to make? Cool, me too.

One of my Instagram posts the other week had the usual supportive comments. Bar one. One that …

Are the Therapists okay?

Thomas Smithson — Fri, 19 Jun 2026 06:30:26 GMT

Last week was one of those difficult weeks where I was exhausted. Ironically it was quite a quiet week, less clients than usual. However it coincided with some events that reminded me, therapists are carrying a lot. And are we asking .. am I okay?

Here in the UK there is a TV show that has just come out called Tip Toe by Rustle T Davis. It’s fantastic, …

Unapologetically Queer

Thomas Smithson — Fri, 12 Jun 2026 06:31:13 GMT

For five years, on the 1st June, I have been posting on Instagram an “Unapologetically Queer” post. Celebrating me being a gay, cis male someone happily part of the queer community, someone happy to be part of pride month.

This year though, my post was late by over a week.

Initially I didn’t understand why, I seemed to just be putting it off “I’ll get to…

A flock of Ravens

Thomas Smithson — Fri, 05 Jun 2026 06:30:40 GMT

A couple of weeks ago I experienced an unkindness. It wasn’t directed to me, it wasn’t even directly about me - but it hurt. It was a strange subtle unkindness that’s very new to me. And it came from a dreaded WhatsApp group - no worse - a school WhatsApp group, for one of my young children’s classes.

What’s this group for? Admin updates, lost property,…

Phil and his defences

Thomas Smithson — Fri, 29 May 2026 06:30:50 GMT

Phil is a powerful person, he’s tall, strong, handsome. When he walks into a room people’s heads turn. At the flick of a finger Phil can make you your life easier, and … all that much harder. “Do you need help? He would ask. “Well of course should we discuss the terms”, he’d then say.

Working with Phil is akin to working with the devil, you need to be r…

Oh just give them space!

Thomas Smithson — Fri, 22 May 2026 06:30:01 GMT

I have noticed through my work, my life and more recently at the local café I’m currently writing in, the risk of not giving people space.

The rescuers of the world, of which I used to be one can sometimes try so hard to help that it blows up in their face. Of all the roles in the Karpman Drama Triangle (persecutor, victim and rescuer) I think the rescu…

Some people have bodies buried under their shed. I have a book.

Thomas Smithson — Fri, 15 May 2026 06:31:23 GMT

Of the two options, I suppose it’s better to have a book buried under my shed. But still, I have a lot of thoughts about it.

Years ago now, I was visiting the “book town” of Hay-on-Wye. For those of you who don’t know, it’s literally a town full of book shops.

I’ve been several times and usually head to the Old Cinema, now a huge second hand book shop. T…

Here you find me nervous...

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By nature I’m a nervous person. I can usually keep it together well, but I can be an over thinker, a worrier, a ruminator. Hence my need for many - sigh - many years of therapy.

Originally, writing on substack has been a smooth ride. When I started this account, pretty much on a whim I was super chill. I didn’t plan much, I just wrote and posted.

In the…

Do you really want a "perfect" therapist?

Thomas Smithson — Fri, 01 May 2026 06:31:13 GMT

Last weeks post helped me work on the gradual lack of shame about having my own problems as a therapist. My ongoing acceptance of being messy and imperfect. And as I continue to reflect, I have come to realise, would we, I even want a therapist with their life together? One seemingly perfect?

Every therapist I’ve had hasn’t been, I have seen them forget…

Help, my clients know I'm human

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A while ago now, long enough ago to be able to reflect, I had a little breakdown. It was actually one of those dramatic ones where my husband found me crying on the floor drinking gin.

Now then, the draft for that story is currently lost in the long grass. Today I’m writing about one of the many outcomes from said breakdown.

One of the things I did to he…

Moss

Thomas Smithson — Fri, 17 Apr 2026 06:30:51 GMT

When I stand utop the hill

I see our house still.

We’ve lived their five years

Through fun, laughter and some tears.

A new build, strong and steady.

We watched for a year as they got it ready.

Brick by brick, window by window.

Up it went grow grow grow.

Our home, rising from the ground,

It’s foundations, strong, sound.

In those five years we’ve lived so well.

Our …