Meet the Therapist: Dr Ana Costa
Dr Ana Costa is an online Clinical Psychologist
What attracted you to become a therapist?
I love science and I love helping people. Being a Clinical Psychologist combines the two: I use evidence-based psychological therapies to help people improve their lives. And because, as individuals, we are so complex and idiosyncratic, there are never two people who are the same. So that enables me to tailor-made my interventions to each and every client I see.
It’s also a real privilege to get to know people at their deepest level: their hopes, fears, insecurities, but also their strengths and resilience.
Where did you train?
I trained as a Clinical Psychologist at the Institute of Psychiatry, King’s College London. I was very fortunate to train there, as the teaching was done by the research psychologists who have themselves developed the psychological models we/psychologists use now (at least in CBT). The learning environment was thriving and I had very competent and kind supervisors who helped me develop my clinical skills.
Can you tell us about the type of therapy you practise?
I practise cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT), both of which are under the umbrella of the so called “behavioural therapies”. What this means is that there is an emphasis on change and on learning skills to manage our difficult thoughts and feelings. This emphasis on change is, however, balanced with fostering a sense of acceptance of the client and where s/he is at.
I chose these therapies, firstly, because they are the most evidence-based therapies, i.e. there is a huge amount of research showing their effectiveness in improving a range of mental health issues. Secondly, because I find it extremely empowering when clients learn to manage their own difficult issues. Thirdly, there is a sense of “team work” whereby I bring my knowledge and expertise in psychological research and psychological models, and the client brings their knowledge on what it is to be them. We then work together with a view to meeting the client’s needs and goals. It’s all very collaborative.
How does CBT help with symptoms of anxiety?
I have seen many clients suffering from anxiety and low mood. CBT focuses on understanding how anxiety was developed over time and, most importantly, what factors have (inadvertently) maintained it.
For example, the client might engage in behaviours to manage the anxiety in the moment, but those same behaviours may be making things worse in the long-term. Understanding the “vicious cycle” that keeps the symptoms going is a crucial first step. From there, we can then implement changes that will have a positive impact and, ultimately, will create a more “virtuous cycle”.
With ACT, clients learn to be more present, more in touch with their values, and they learn skills to manage their anxiety (and other feelings) that are part of life, whilst engaging fully in what is important to them.
What sort of people do you usually see?
I have worked mainly with adults (18-65 years of age). When I did my training (over 13 years ago), I also saw children and adolescents, and older adults, but my clinical experience since then has been with adults.
Currently, in my private practice, I tend to see a lot of clients suffering from anxiety, stress, burnout, in the context of other life events that can be very stressful, e.g. pressures at work, breakdown of relationships and divorce, a sense of low self-confidence and low self-esteem (even when, by any standards, the person is “successful”), grief, disordered eating, over-drinking, etc.
I previously worked in the NHS and I saw many clients who experienced trauma (physical, emotional or sexual), and suffered from PTSD.
Have you noticed any recent mental health trends or wider changes in attitude?
I think that, fortunately, it is much more common and acceptable to talk about mental health. This gives people a sort of permission to acknowledge to themselves and to others when/if they do need to seek professional help, without stigma or fear of being judged. This is definitely a very positive change!
On the other hand, we live in a society where it’s far more challenging to be healthy (physically and emotionally) than ever before, as it can be so tempting to over-engage in behaviours that can be detrimental to our health, whether it’s scrolling our phones endlessly (and not letting our brains take a rest), grabbing convenience food (that doesn’t really nourish us), not moving our bodies, not sleeping or resting enough… you need to be very mindful to make small decisions in your everyday life that support your emotional and physical health, in regards to the information you consume, the foods you eat, the time you go to bed, the moments of connection you allocate to have with others, etc. It’s almost as if society is structured to make you unhealthy and, unless you have good awareness of your behavioural patterns and are willing to create good habits, you’re likely to become unwell at some point.
What do you like about being a therapist?
I like to help others, but I like to do so using a science-driven approach. It’s very rewarding and a real privilege helping people to help themselves, and being a facilitator of that positive change.
Contribution and connection are two of my key values, and I am fortunate to use them by working as a Clinical Psychologist. Other values that are important to me and that tap into my role as a Clinical Psychologist are authenticity, compassion for others, and living in the present, all of which I try to incorporate in my clinical practice.
What is less pleasant?
It can be emotionally draining dealing with people’s mental health issues or just life issues, particularly if you overdo it. However, I have learnt not to over-book clients, so I can be fully present with each client. It’s also important to have sources of support in your own life (a supervisor, good friends, a loving partner), so that any stresses regarding your professional life can be dissipated.
I have also found yoga an extremely important practice in my life, that has helped me to wind down both physically and emotionally. The benefits that I’ve experienced have been so profound, that I got to read the research (on yoga and mental health), and have started suggesting it to clients.
How long have you been with Welldoing and what you think of us?
I joined the Welldoing community a couple of months ago. It’s a thriving community and I am happy to be part of it.
What books have been important to you in terms of your professional and personal development? Do you ever recommend books to clients?
Professionally, I still go back to ACT Made Simple by Russ Harris, which details the basis of acceptance and commitment therapy and has loads of exercises that I have used with clients.
Personally, I really enjoyed The Course of Love by Alain de Botton, which describes a love story in a humorous way, intertwined with really insightful reflections of what true love really is and how to survive a modern relationship.
I’m a big fan of bibliotherapy and certainly recommend books to clients, either as complementary to therapy or instead of it. There’s a wonderful series of self-help books called Overcoming (overcoming.co.uk) that have a wide variety of topics. These are based on cognitive behavioural therapy principles, and have plenty of exercises for clients to practise. If clients are unable to engage in therapy or, conversely, if therapy has come to an end but it’d still be helpful to have a book companion to consolidate things, this would be a great option.
Here are some in the series:
Overcoming Anxiety by Helen Kennerley
Overcoming Low Self-Esteem by Melanie Fennell
Overcoming Worry and Generalised Anxiety Disorder by Mark Freeston and Kevin Meares
Overcoming Shyness and Social Anxiety by Gillian Butler
Overcoming Depression by Paul Gilbert
Overcoming Anger and Irritability by William Davies
What do you do for your own mental health?
As mentioned above, practising yoga has been paramount in my life. I always feel grounded and centred after my yoga practice, no matter what’s going on in my life. Many times, I don’t feel like going to the mat, but I have never regretted doing so. There is a sense of freedom created in the body and a quietness in the mind, both of each I cherish. Even a 15 minute yoga class will have a positive impact on how I feel.
You are an online psychologist. What can you share with us about seeing clients in this way?
I used to see clients in central London (in Liverpool Street), but with the pandemic that came to an end and I haven’t gone back to it. So at the moment, I only do remote work via video call. There are pros and cons in this approach, and I’m always careful that clients make an informed decision about working in this way.
One of the pros refers to the ease of access, as there is no time or money spent on travelling to and from appointments. Moreover, clients are seen in a more naturalistic setting (their home or office), which opens up possibilities for therapeutic intervention, particularly in regards to exposure tasks that are difficult to replicate in the therapy room.
The cons refer to losing some of the depth of connection that comes with “in person” therapy and the less visual feedback client and therapist get from each other. Online therapy seems to really suit some clients who value flexibility and time efficiency, but it’s ultimately an individual decision.
What do you wish people knew about therapy?
That it is a process where you identify and work towards your goals with the help, support and expertise of your therapist. Therefore, as I jokingly often say, it should be the only non-reciprocal relationship in your life! You and your therapist work as a team, but you (as the client) don’t need to think or worry about your therapist.
That the more you engage in therapy, the better the outcomes. By engaging, I don’t mean just showing up for the sessions, but actively practising any exercises, skills, ways of doing things differently outside the sessions.
That you don’t need to have a mental health diagnosis or to be very unwell to engage in psychological therapy. Having a space in your life where you can be yourself, say what you really think without any fears of judgement and without the need to put any “masks”, and allow yourself to feel what unfolds can be very helpful in itself.
In addition, you’ll also learn about yourself and, if willing, learn new ways to relate to yourself. For example, I see many clients who are very harsh on themselves and ever so kind to others, in which case they may want to learn to treat themselves as they treat other people.
What did you learn about yourself in therapy?
I engaged in therapy on a couple of occasions where I was going through some life transitions. I didn’t want to engage in the same type of therapy that I do (CBT and ACT), as I worried that I’d be taking a supervisory role towards the therapist, instead of just being the client. So I did couples psychodynamic psychotherapy on one occasion, and individual counselling on another occasion.
In the couples psychotherapy, I learnt a lot about my relationship with my partner, my ways of responding, which in turn impacted on his ways of responding (a figure of eight). I’d recommend couples therapy well before a relationship goes through major issues.
In the individual counselling, it was all about me and reflecting on the decisions I wanted to make. On both occasions, it felt good to be “on the other side”.
