Meet the Therapist: Nicole Scott
Nicole Scott is a psychoanalytic psychotherapist in North West London
What attracted you to become a therapist?
There are so many ways of answering this question. The first thing that comes to mind is that I can’t fully distinguish my original wish to train as a therapist from an earlier wish to be a patient. But I have to say that my first experience with therapy wasn’t helpful and I found myself in the difficult position of having spent many years training as an integrative psychotherapist and then wanting and needing to push it much, much further.
This led me in the direction of psychoanalysis and I can say with certainty that the attraction to being a psychoanalytic therapist is a consequence of having felt deeply helped by my own psychoanalysis. But this is also an over-simplification, because long before I made the decision to train as a therapist or as a psychoanalyst, psychoanalysis had been ticking away in the background intellectually speaking, and I think I must have come to it in practice when I had more capacity to really use what it was offering.
My formation as a therapist, which included many years of learning from other modalities, really set me up to receive what psychoanalysis had to offer. The experience as a patient on the couch is also the thing that pulls me to working as I do with my own patients, because I know from the inside how powerful it can be whilst somehow being able to hold onto its fallibilities. So the attraction to doing this work with patients is that, despite the difficulty of it – and it can be extremely painful at times – I see how it can really help a person live their life, or get their life back, or find a way of living which includes building a future in which much more is possible and a much broader range of thoughts and feelings is tolerated. A project in the service of greater aliveness is definitely the attraction.
Where did you train?
I first got into the world of therapy through the world of somatic, or body-based therapies, which included years of practicing yoga, mind-body centring, meditation, Feldenkrais Method and then doing modules in body psychotherapy at The Chiron Centre, a centre for body psychotherapy in London that no longer exists. Then training as a yoga teacher with a Scaravelli teacher named Catherine Annis, who completely transformed my idea of what yoga could be, seeing it as much more internal, much deeper.
I then trained as an integrative psychotherapist at The Minster Centre, where I was introduced both to the ambitions and limitations of integrative and relational work and then a Masters in the same modality.
After that, I reoriented towards psychoanalysis and ended up doing a year-long entry-to-psychoanalysis course at CMPS in New York and then several preliminary courses at The Institute of Psychoanalysis in London. Along the way, seminars at IPTAR in New York and CFAR or Site in London were also a feature of my formation and still are.
I have moved a lot between therapeutic institutions and orientations, arguing with myself about what I believe in and what I think is clinically helpful. My commitment to psychoanalysis, particularly the British Independent Tradition, is pretty unwavering now, even if the theoretical questions persist.
My formation as a psychoanalyst continues at The Institute for Psychoanalysis in London. Ultimately I would also like to affiliate myself with The Paris Institute of Psychosomatics, as I think they are doing rigorous and exciting work that addresses the increasingly urgent social question of psychosomatic illness and the relation between illness and the mind. Asking what/where is a mind?, that kind of thing.
Can you tell us about the type of therapy you practise?
I practice psychoanalytic therapy, which means I see people face-to-face or on the couch for multiple sessions a week. The question of whether you should lie on the couch can become preoccupying and I would say that for many people lying down is helpful and can really progress the work because it collapses the normal social conventions of a face-to-face interaction and can free up associations and reduce self-consciousness. Some people also prefer to do their sessions face-to-face, which is fine too, although a different experience.
The only instruction, what Freud called 'the fundamental rule', is for people to come to their session and say whatever comes to mind. This turns out to be almost impossible, so a patient may encounter the difficulty of speaking or of finding out what they want to say which may be different from what they habitually say.
This struggle may be informed by their ideas about what I, the listener, can’t tolerate them thinking. This is one of the things that makes psychoanalytic work different to other modalities, that the therapist creates an environment in which the person of the therapist comes to represent all kinds of things and people and experiences in the patient’s history – and that this process plays a central part of how we understand what is going on internally at a deeper level.
Hopefully, this kind of work opens up not just thoughts about the preceding week or the intervening days since the last session, which are important too, but also memories, dreams, fantasies, feelings and fears, not just for their own sake, but because those aspects of unconscious life are the material we work with, and work through, not only to build new understanding, but also new experience over time.
How does psychoanalytic therapy help?
A sense of trust built over time is the basis of any therapeutic work, so it is obviously important to feel like there is a good rapport with a therapist. Nor can building this trust be rushed or even taken for granted. I would also say that psychoanalytic therapy is different from the other therapies I have trained in because it creates a particular frame in which aspects of unconscious life are opened up in order to elucidate symptoms and understand them in a new way. This is the process by which a symptom can be brought to life in the context of the therapeutic relation and also be transformed through it. It is also a process that wants to avoid coming to quick conclusions about the nature of the problem, which patients often bring. People often come with preconceived ideas about themselves and the nature of their problem. In this kind of dynamic, the therapist tries to help create the space for a new thought to emerge, something outside the internal loop, or that sense of absolute knowing which can sometimes really limit a person.
A patient may come to therapy with anxiety as the primary symptom, or it could be insomnia, migraines, or feelings of rage. They will probably have some ideas about their symptom, what it’s about and conclusions they have come to after a long period of thinking about it. In addition, usually they will have tried, with more or less success, to control their external or internal environment to limit the symptom. However, these adaptations can often create other problems: overwork or externalizing anxieties onto family members, creating friction through attempts to control or feel safety and certainty.
As a therapist, you cannot just suddenly deprive someone of ways of operating that have developed for good reason over time. Rather, you have to work to bring to light the psychic experiences that have led us to where we are and to begin to think around these ways of being, not to judge them or even to change them, but to live with them, to shed light on them, and to build something new from the inside. This cannot happen without first feeling, at least in some place in your mind, safe. Over time, a person would not only gain insight into the feelings underlying the pattern, they would also have an experience of being able to have the underlying feelings or complaints and to work with them. This might include being able to tolerate difficult feelings without acting on them, or knowing when and what kind of action might be helpful.
Over the years of practice I have become especially interested in the psychosomatic aspect of psychological work and have invested a lot into thinking about the very complex question of how physical symptoms can, to put it very simply, take the place of internal life. I work with many people who are experiencing distress in their bodies and who perhaps have realised that continuing to address only the physical symptoms, without also considering the psychic environment, will only take them so far.
What sort of people do you usually see?
A real variety. I see a lot of people of all ages who are struggling in relationships and frustrated by the repetitions that emerge in them. Often they come in in their early thirties after another breakup in which they recognise something may have been repeated.
I also see many people who are living with chronic illness or symptoms in the body, including eating disorders, that can be a complex response to very early relational experiences. Such patients can benefit from high intensity work on the couch as it gives them the space and time they need, often to unravel, to undo something in themselves in order to find a new experience and a new place from which to emerge.
Also people who have been diagnosed with personality disorders, depression or anxiety. I suppose these last three things sound a bit diagnostic, but I put it like this because these words have become a contemporary shorthand that describes a series of symptoms which can be a very understandable response to the world we live in.
I also work with teenagers and young adults, which I love, partly because if a young person takes to this work it can really change things for them quite quickly.
Have you noticed any recent mental health trends or wider changes in attitude?
Very much so. I am aware of how social media has contributed to changes in the way people think and talk about themselves and their interior lives. A kind of generalised mental health language is much more available thanks to these platforms, and there is an increased awareness of different forms of psychological distress, which I think, broadly speaking, is a good thing.
The flip-side of this is that what gets broadly disseminated online is often reductive, or overly diagnostic, or emptied of meaning. There is a sort of ready-made language for psychological distress that can feel at once like a relief and the beginnings of a way out of confusion, but also can end up being a source of despair and alienation because it is can feel platitudinous and empty. Like with everything on social media, it can lead to over-identifications or comparisons which leave people feeling further and further away from themselves and their actual experience.
So whilst I notice a greater willingness to talk about mental health, particularly among Gen Z, I think there is also a tendency to think about psychological pain as an aberration, or a diagnosable illness, rather than an inevitable part of life. This tendency, which can be amplified by an apparent ease with diagnostic language, perhaps reveals a wish to dismiss the metaphysical aspects of being alive and to dispense with the whole troublesome notion of subjectivity in all its complexity and contradiction. Why do we need to do so? This is an extremely interesting question.
What do you like about being a therapist?
There are lots of things I like. I really enjoy seeing my patients and the experience of solidarity that comes from listening to them talk about what really matters to them. It’s a huge privilege to be addressed in this way. A huge responsibility too. I also like the challenge of trying to find a way of saying something that the patient can use, finding the right angle, language, timing.
One of the things that can feel exciting about being a therapist is that people bring all the problems of the historical moment – all the social, economic and cultural maladies and mess that we see around us – right into the consulting room. Part of my job is to think about the way that the world we live in both builds our psyches and our unconscious lives and vice-versa, without losing sight of the personal experiences and histories at play. So being a therapist can feel like being at a nexus of many urgent and crucial questions: the psychoanalytic idea of an old family drama that needs to come to light and be worked through, or unconscious conflicts and old disappointments, or trauma, but also the idea that there is something still happening, that there is a world still being built – both internally and externally – that we can intervene in.
I guess the idea that something new can be found, both internally and in the world at large, is what psychoanalytic work represents to me and what makes it exciting. I realise that what I have just said sounds like a description of hope; that psychoanalytic work can produce hope in the possibility of something new coming into being. This is no small thing.
What is less pleasant?
The question makes me think of Freud’s description of psychoanalysis as the impossible profession! There are a few things about this work that I find difficult, not least that I am sitting down all day, which can be challenging on the most basic physical level.
It can also be lonely. I have fantastic colleagues and supervisors, but I don’t see them every day and sometimes I miss not having colleagues to chat to between sessions.
How long have you been with Welldoing and what you think of us?
I had a period with Welldoing when they first started back in 2016 and then have rejoined recently. One of the things that appeals to me about the site is the plurality of therapeutic voices and the way it gives people the chance to read about different therapeutic approaches in the therapist’s own words.
To say something obvious, every therapy is different, and the choice of therapist can be overwhelming and confusing, so prioritising the therapist’s personal voice can be a helpful way for people to find someone who speaks to their personal needs and preferences.
What books have been important to you in terms of your professional and personal development? Do you ever recommend books to clients?
Perhaps the book that stands out in terms of my professional development is Donald Winnicott’s Playing and Reality. It’s a deceptively simple book that opens up crucial questions about psychoanalytic theory and technique: What is it for; what might we be aiming at; why do we create the environment we do; what’s play got to do with psychoanalysis? Perhaps what makes the book exciting, but also slippery and difficult, is that he has a way of offering ideas – many implicit or seemingly incomplete or throwaway – that leave space for the reader to question and elaborate what they have just read. I re-read it recently with the psychoanalyst and Winnicott scholar Lesley Caldwell and a group of really experienced New York Freudians. This time I couldn’t get away with my previous reading, which I now see as somewhat simplistic. Reading it again in this context I had more of a sense of how radical his ideas were, particularly in the American context of the 1950s and 60s, the extent to which he was pushing back against classical theory and helping to create a new way of working and thinking about the therapeutic relationship and analytic technique.
I love Adam Phillips’ books and see him as a kind of natural companion to Winnicott because his writing is the kind you can play with and use for your own imaginative purposes. I recently read his short book On Giving Up, which is lovely because it liberates the idea of giving up from notions of failure. I also adore his his earlier book Going Sane, which makes space for thoughts about sanity in a world and in a profession that finds it much easier to think about, or even fetishise, madness.
Lastly there are two French writers have been consistently important to me. When I first read André Green’s essay ‘The Dead Mother’ it hit me in an uncanny way. Like a good psychoanalytic interpretation, it was well timed and helped identify something I felt I had always known but never been aware of.
On a very different note, I am drawn to the work of Marie Darrieussecq, a French novelist and Lacanian psychoanalyst whose weirdness and imagination I really like. She writes across genres but her latest book about insomnia is both a memoir and an attempt to find her way around a long-standing experience outside of her control. I suppose both Darrieussecq and Green also speak to a very French sensibility and to the importance of French psychoanalytic thinking in my formation.
Although not strictly French, I would also like to mention here the deep value I have found in Julia Kristeva’s work, particularly her astonishing book Black Sun in which she offers one psychoanalytic perspective on sadness.
I don’t usually recommend books unless an association emerges in a session that is very specific to the person or the moment, but even then it’s very rare for me to do so. I suppose I would want to encourage a person’s own reading-idiom rather than risk imposing my own preferences.
Having said that, and risking contradiction, I would encourage anyone considering starting psychoanalysis or psychotherapy to read Marion Milner’s book A Life of One’s Own. I first read it before entering psychoanalysis and found it a moving description of a young woman’s attempt to find out who she is and to develop her own method for doing so.
What you do for your own mental health?
I see my analyst. This work is the main resource for my own work with patients and part of the texture of my daily life, so it has become something I do, not quite like brushing my teeth – much more useful that that – but almost.
There are many other more prosaic things too. I just got back from a swim with a friend in the ladies’ pond on Hampstead Heath, a magical place that somehow presses pause on demands of daily life. Also I think most of my relationships, which I see as an ongoing conversation, are a part of my feeling well in the world. Perhaps what I am talking about is the importance of feeling familiar to the people I love, or, to the extent that anyone ever can be, of feeling known.
You are a therapist in North London. What can you share with us about seeing clients in this area?
Most psychoanalytic work takes place in cities, and practising in this context is interesting because people inevitably come to their sessions and bring the outside in with them, which in a city like London often includes a sense of things needing to happen at pace. But I think psychoanalytic work, or some versions of it, can produce a change in internal pace, which can also be a change in depth, and that can be a relief.
Many of my patients don’t live in the immediate environs of my office and their journey to and from the sessions can come to feel like part of the whole experience of the therapy.
What’s your consultation room like?
It’s in a studio in a courtyard garden so it can be both very peaceful and open to the ambient sounds of city life going on around. I have worked in more corporate spaces, and in the NHS, and I like that this feels more personal.
What do you wish people knew about therapy?
That you can’t really know anything about it until you do it, until you take a risk and find out what it might be for you. Also, that it might take time to find the right therapist.
What did you learn about yourself in therapy?
It’s very difficult to condense years of learning into a few sentences without it sounding glib. But maybe I can say that psychoanalysis helped me feel less frightened of the scope my internal life. It allowed me to feel real and to build a life in which much more possible.
