Presenting Past Psychotherapy is Paolo Imbalzano’s independent practice. I offer individual and couple psychotherapy, neurofeedback and clinical supervision. Psychotherapy and supervision are available in person in Shinfield, Reading, and online; neurofeedback is available in person only.

Despite the name, much of therapy happens in the here and now—in what you notice, feel, do, expect and experience in your body and relationships. Earlier experiences can help us understand how present patterns developed, but detailed recollection of the past is not always necessary. The past becomes relevant where it continues to shape present-day responses, relationships or ways of protecting yourself. New and present experience can also create change.

Change does not usually come from one technique or follow a simple sequence. It may begin with understanding a pattern, noticing a reaction earlier, recovering more readily after stress, staying present with difficult feelings or responding differently in a relationship.

The work may include reflection and meaning-making, attention to the therapeutic relationship, bodily and nervous-system responses, stabilisation, deeper emotional or trauma-focused work, and integration. What becomes relevant depends on the shared formulation, your aims and what remains manageable. Not every person needs every kind of work.

We review the process together, including what seems to be changing, what remains difficult and whether the direction and pace still make sense. Progress does not require every difficulty to disappear; it may mean that familiar reactions have less power, recovery is easier or more choice becomes available.

Read more about how I work ›

How do I know if therapy is right for me?

There is no single test. People often consider therapy when anxiety, overwhelm, disconnection, low mood, self-criticism or relationship patterns remain difficult, or when understanding a problem has helped only so far.

A free 20-minute consultation allows us to talk briefly about what is happening and whether this way of working may be appropriate. It is an initial conversation, not a full assessment, and there is no pressure to continue.

Do I need a referral?

No. You are welcome to contact me directly. I also receive referrals from GPs, psychiatrists, health insurers, case management organisations, counsellors, psychotherapists and other professionals, but a referral is not required.

Who do you offer individual therapy to?

I offer individual therapy to people aged 16 and over. Suitability depends on what support is needed, the level of risk, whether regular psychotherapy in this setting is appropriate and whether my experience fits what you are looking for.

What happens in the first session?

The first session gives us more time to understand what has brought you to therapy, what feels most difficult and what you hope may change. I may ask about your present situation, relevant history, current support and any safety or health considerations.

You do not need to explain everything perfectly or disclose painful material before you are ready. The early sessions also help us both consider whether working together feels like an appropriate fit.

What if I am not sure what I want from therapy?

That is a common starting point. You may know that something feels stuck, overwhelming or difficult to shift without yet knowing what you need. We can begin by developing a shared understanding rather than requiring a fixed goal in advance.

Can I try a few sessions before committing?

Yes. There is no requirement to commit to a fixed course of psychotherapy at the outset. We can review how the work feels, what focus is emerging and whether continuing appears useful. Booked appointments remain subject to the agreed cancellation terms.

What if I need urgent or crisis support?

This is not an emergency or crisis service. Weekly psychotherapy may not be the right level of support if you are in acute crisis, cannot keep yourself or someone else safe, or need urgent medical, psychiatric or intensive support.

If there is immediate danger, call 999 or go to A&E. For urgent mental health support where there is no immediate danger, call NHS 111 and select the mental health option. Please use these services rather than waiting for a reply from the practice.

Useful helplines and websites ›

What is the difference between counselling and psychotherapy?

In practice, the boundary is not always clear. Psychotherapy often allows sustained exploration of recurring patterns, relationships, emotional and bodily experience, and how earlier adaptations may continue in the present.

My work is psychotherapeutic in nature, but the depth, pace and duration depend on what is clinically appropriate and useful for you.

What does trauma-informed mean in practice?

It means the work is informed by how trauma, chronic stress and relational experience may affect emotions, relationships, the body and nervous system. In practice, this includes attention to consent, choice, pacing, present capacity and the possibility of activation, shutdown or dissociation.

Trauma-informed practice does not mean assuming that every difficulty is caused by trauma, or that everyone needs trauma processing.

Do I need to identify as having experienced trauma?

No. Anxiety, low mood, self-criticism, relationship difficulties, shutdown, overwhelm or a persistent sense that something is not right can all be reasons to seek therapy. We consider your experience without requiring a particular label.

How is your approach different from CBT?

CBT is a broad family of approaches, but it often works explicitly with links between thoughts, feelings and behaviour and may use structured exercises within a defined focus. My approach is relational, formulation-led and body-aware. It may include cognitive understanding while also attending to emotional experience, bodily responses, protective patterns and what happens within relationships.

I do not offer a standard manualised CBT programme. For some people, a structured or time-limited CBT service may be a better fit, and I will say so if that appears likely.

How do you decide which approach to use?

I do not ask you to choose a method from a menu. The work is guided by a developing formulation of your difficulties, aims, history, resources and present capacity.

For some people, early work may emphasise stability, sleep, regulation or the therapeutic relationship. Others may be able to approach deeper emotional or trauma-related material sooner. Any method is used within the wider relational process and reviewed according to how you respond.

Approaches I integrate in therapy ›

How long does therapy take?

This varies. Some people find a focused period useful; others choose longer-term work because the difficulties are longstanding, layered or relational. I do not prescribe a fixed number of psychotherapy sessions. We review the focus, pace and usefulness of the work as it develops.

Do I have to talk about my past?

Not in a pressured or exhaustive way. Earlier experience can be relevant, but some people begin with what is happening now. Body-aware or trauma-informed work may sometimes proceed without a detailed verbal account of everything that happened. We consider what is clinically useful and what you can approach without becoming overwhelmed.

What if I find it hard to talk about certain things?

Difficulty finding words may reflect fear, shame, protection, overwhelm or not yet knowing how to describe an experience. It does not prevent us from beginning. We can notice the difficulty without forcing disclosure and work towards conditions in which more can become thinkable or speakable over time.

What if previous therapy did not help?

It is useful to understand what felt unhelpful, what helped only partly and what may have been missing. A different therapeutic relationship, formulation, pace or way of including bodily experience may fit differently, but no approach can guarantee a better outcome. Previous experience helps us think more carefully about suitability and what you need now.

How will I know if therapy is working?

Change may be visible in everyday life: noticing a familiar pattern sooner, having more choice before reacting, recovering more quickly after stress, sleeping or functioning better, setting clearer boundaries or remaining present with feelings that previously led to overwhelm or shutdown.

Change is not always linear. We talk periodically about what appears different, what is unchanged and whether the work remains useful. If it does not, we consider whether to adjust the focus, seek additional support or end the work.

What if I feel worse after starting therapy?

Difficult feelings can sometimes become more noticeable when therapy begins, but increased distress should not simply be treated as proof that therapy is working. Please tell me if you feel significantly or persistently worse, less able to function or less safe.

We would review what is happening, adjust the pace or focus where appropriate and consider whether other or additional support is needed. Urgent or immediate safety concerns require the crisis and emergency services described above.

Can therapy help with shutdown, numbness or feeling “offline”?

It may. Shutdown, numbness, brain fog or loss of words can sometimes function as protective responses to overwhelm or chronic strain. The work would not aim to force feeling or disclosure, but to understand the pattern and support greater steadiness, connection and choice at a manageable pace.

Where do sessions take place?

Psychotherapy and clinical supervision are available in person in Shinfield, Reading, Berkshire, and online by video. Phone appointments may sometimes be appropriate by agreement. Neurofeedback is available in person only because it requires specialist equipment and live monitoring.

The Shinfield room currently has no wheelchair access and no accessible toilet. Please tell me about access requirements before arranging an in-person appointment so that we can consider what is possible.

How often will we meet?

Individual and couple psychotherapy usually take place weekly, particularly at the beginning. Individual supervision is commonly weekly or fortnightly. Neurofeedback frequency is agreed individually and reviewed according to response.

Sessions are usually 50 minutes. Longer or alternative appointment lengths may sometimes be agreed where clinically or professionally appropriate.

Can I switch between in-person and online sessions?

Occasional changes may be possible by agreement. A reasonably consistent format can help maintain the therapeutic frame, but practical circumstances can change. Neurofeedback cannot be provided online; if an in-person neurofeedback appointment cannot take place, any alternative use of that time must be agreed and clinically appropriate.

What are your fees and cancellation terms?

Current fees, funded-work arrangements, payment information and a summary of the cancellation policy are published on the Fees page. Full terms are provided in the relevant agreement before the work begins.

Fees, format and practicalities ›

What if I need to pause or take a break?

Please raise this when it becomes relevant. A pause may be appropriate, and the wish to pause may also tell us something important about the work or your circumstances. We can consider the reason, likely impact and whether a planned ending, a break or a change of frequency makes most sense. Cancellation terms still apply to appointments already booked.

Is what I say confidential?

Information shared in psychotherapy or supervision is treated as confidential, subject to important professional and legal limits. These may include serious risk, safeguarding responsibilities, legal requirements and other circumstances set out in the relevant agreement and Privacy Notice.

I may discuss aspects of my clinical and supervisory work in professional supervision. I share only what is necessary for that purpose and take care to protect privacy. Where it is safe and appropriate, I would normally aim to discuss a concern with you before sharing information, but this may not always be possible.

Full confidentiality, records and data-protection arrangements are provided before we begin.

What can couple therapy help with?

Couple therapy may be useful when you are caught in recurring conflict, distance, mistrust, communication or intimacy difficulties, or are trying to understand the future of the relationship. “Couple” means any relationship between two people.

The aim is not to decide who is right. We consider the pattern between you, each person’s experience and responsibility, and what may make greater honesty, clarity, boundaries or repair possible.

Do both partners attend the initial consultation?

Where possible, both partners attend the free 20-minute consultation so I can hear briefly from each of you. If we decide to explore working together, the assessment normally also includes a brief private conversation with each partner to consider whether joint therapy is safe, freely chosen and appropriate.

Before any individual conversation, I explain how confidentiality and information sharing operate within couple work.

When may couple therapy not be appropriate?

Joint therapy may not be the right starting point where there is ongoing domestic abuse, coercive control, intimidation, fear, threats, violence or pressure on someone to attend. It may also be inappropriate when the immediate need is crisis support, individual stabilisation, addiction treatment, safeguarding, legal advice or specialist domestic-abuse support.

If I am concerned that joint sessions could increase risk, I may recommend individual or specialist support instead.

Does couple therapy assume that the relationship should continue?

No. Therapy may support repair where that is possible, but it can also help two people make a more thoughtful decision about whether and how to remain together or separate.

Read more about couple therapy ›

What is neurofeedback?

Neurofeedback is a non-invasive learning process that gives the brain and nervous system real-time feedback about their activity. Sensors placed on the scalp read EEG activity and provide visual, auditory or sensory feedback; they do not electrically stimulate the brain.

I use infra-low frequency (ILF) and frequency-based neurofeedback. They use different training parameters and may be considered for different purposes. The approach is selected through assessment, formulation and your response to training rather than diagnosis alone.

What may neurofeedback support?

Within my practice, neurofeedback may be considered when difficulties with sleep, arousal, attention, emotional steadiness, shutdown or recovery after stress affect daily functioning or make psychotherapy harder to sustain.

It is not selected simply because someone has a diagnosis or symptom. It is not a diagnostic tool, medical treatment or stand-alone cure, and benefits are not guaranteed. The evidence base also varies by difficulty and training approach.

Can neurofeedback support trauma therapy?

For some people, it may support sleep, regulation, recovery after activation and the capacity to remain present in psychotherapy. This can sometimes help create better conditions for carefully paced trauma work, including DBR. Neurofeedback does not replace trauma psychotherapy and is not part of every trauma formulation.

Is neurofeedback safe?

Neurofeedback is non-invasive, but it should not be described as risk-free. Some people temporarily feel unusually tired, activated, headachy, foggy, emotionally stirred, unsettled or less able to sleep. Responses vary, which is why effects are monitored during and between sessions and training may be adjusted, paused or stopped.

Please report unwanted or unexpected effects promptly. Significant, persistent or medically concerning symptoms may require advice from a GP or another appropriately qualified clinician.

What if I take medication or have a medical or neurological condition?

Please tell me about relevant medication, medical or neurological conditions and other current care during assessment, and let me know about changes while training. Neurofeedback does not replace medical assessment or treatment. Medication should only be changed in consultation with the prescriber; apparent improvement during neurofeedback is not a reason to alter it independently.

Can I receive neurofeedback without psychotherapy?

I usually offer it within an ongoing psychotherapeutic process. If you already work with another psychotherapist, psychiatrist or relevant clinician, I may offer neurofeedback alongside that care where it appears clinically appropriate and roles, communication and responsibility are sufficiently clear.

Do I need a diagnosis?

No. Assessment considers the wider pattern of your difficulties, your aims, relevant history and care, and whether neurofeedback appears suitable at this stage. For some people, psychotherapy or medical assessment may be the better place to begin.

How many sessions will I need?

There is no guaranteed or compulsory course. For some people, approximately 10–20 sessions provide a useful initial period in which to assess response, but the number and spacing vary according to need, sensitivity and what we observe. Suitability and progress are reviewed throughout.

Where does neurofeedback take place and how do I begin?

Neurofeedback is available in person only in Shinfield, Reading. The access limitations described above apply.

A free 20-minute consultation helps us clarify what you are hoping for and whether assessment may be worthwhile. If we proceed, assessment covers your current difficulties, relevant history, medication or medical care, what you have tried and which approach—if any—may be appropriate. Before training begins, I provide a Neurofeedback Add-on Agreement and Informed Consent alongside the main Administrative Agreement.

Read more about neurofeedback ›

Do you offer psychedelic-assisted therapy?

No. My current UK private-practice role is limited to psychotherapy and integration after psychedelic or altered-state experiences that have already occurred independently of my involvement.

I do not supply substances, advise on dosing or combinations, act as a sitter, facilitate or supervise psychedelic sessions, refer to illegal or unregulated providers, or provide preparation intended to support planned self-directed, underground or unregulated use.

What does integration psychotherapy involve?

It may involve making sense of an experience, attending to emotions or bodily responses that remain active, exploring trauma or relational material that emerged, and helping any insight find a grounded and sustainable place in everyday life.

An experience does not need to have been frightening to merit reflection. Integration may be relevant after an experience that felt meaningful, positive, confusing, destabilising or difficult to put into words. Suitability still requires assessment.

Can you help me decide whether or how to take a psychedelic in the future?

I can help you explore the psychological meaning of psychedelic experiences in your life, but I do not advise on obtaining, preparing for or undertaking future psychedelic use. This FAQ and the linked page are not medical or substance-use advice.

If you are acutely unwell, severely confused, unable to remain safe or experiencing dangerous physical or behavioural symptoms after substance use, use emergency or urgent medical services rather than waiting for a psychotherapy appointment.

Psychedelic experiences, trauma and integration ›

Who do you offer clinical supervision to?

I offer supervision to trainee and qualified counsellors and psychotherapists, as well as small groups where there is a shared professional context and clearly agreed frame. Suitability depends on your role, setting, client group, requirements and whether my experience is relevant to your work.

I am a UKCP-registered psychotherapist and a clinical supervisor. I am also a BACP-registered member and listed in BACP’s directory for supervisors.

Is your supervision only for trauma-focused work?

No. Trauma, attachment, dissociation and regulation may inform the work where relevant, but supervision can also address relational process, formulation, boundaries, ethics, safeguarding, endings, professional development and the therapist’s experience of the work.

What informs your approach to supervision?

My approach is relational, integrative, collaborative and ethically grounded. We may consider the client, you as therapist, the therapeutic relationship, and the wider professional or organisational context. Multi-layered approaches, including the Seven-Eyed Model, may inform the work where useful.

The balance of support, challenge, structure and autonomy takes account of your stage of training, experience, scope of practice and responsibilities. Supervision may include attention to emotional or bodily responses when these illuminate the clinical work, but it is not a substitute for personal therapy.

Can supervision complement an existing arrangement?

Focused case consultation or supplementary supervision may be possible by agreement. If another supervisor, training organisation, placement or employer is involved, we clarify the purpose and boundaries of the additional work, where responsibility sits and whether coordination is needed.

Will the supervision meet my training or professional-body requirements?

That depends on the current requirements of your training organisation, placement, employer, accreditation route or professional body. Please bring these to the initial conversation. We can consider whether the arrangement appears suitable, but you remain responsible for obtaining formal confirmation from the relevant organisation.

How are supervision sessions arranged?

Supervision is available online and in person in Shinfield, in English or Italian. Individual sessions are usually 50 minutes and commonly weekly or fortnightly. Small-group arrangements are agreed separately according to the group’s size, purpose, frequency and structure. Current fees are published on the Fees page.

Is urgent or between-session clinical consultation available?

I do not provide an on-call or crisis-supervision service. Any contact between scheduled sessions must be agreed within the supervisory contract. Urgent risk, safeguarding or clinical-governance concerns should be managed through the relevant organisational, safeguarding, senior-clinical or emergency procedures rather than awaiting a supervision appointment.

Read more about clinical supervision ›