Title: FAQ: Trauma, EMDR, Fees and Online Sessions | Renée Shearing Source: https://reneeshearing.com/faq Last updated: 2026-10-18 Summary: Why understanding your trauma may not stop the triggers, therapy beyond talking, EMDR and TRE®, the first session, fees, and working with her online from abroad. # Frequently Asked Questions ## Understanding Therapy and Change ### Why do I understand my trauma but still get triggered? Because understanding something consciously doesn’t always change the automatic responses we’ve developed. You may know exactly why something affects you and still find your body reacting before you’ve had time to think. Some of these responses have developed over many years and involve emotional and physiological processes that aren’t entirely under our conscious control. Much of my work involves exploring what’s happening beneath conscious awareness, rather than relying only on understanding things intellectually. ### I’ve done years of therapy. Why am I still struggling? There can be several reasons. Sometimes therapy has helped you understand yourself, but particular emotional responses, relationship patterns or physical symptoms haven’t changed in the way you’d hoped. Sometimes new experiences or life circumstances bring difficulties to the surface again. It doesn’t necessarily mean your previous therapy was unsuccessful. You may already have a very good understanding of your childhood, your attachment style, your triggers and the ways you’ve learned to cope. We can build on that understanding rather than assuming you need to start all over again. ### What if I’m tired of talking about myself? I understand that. You might know your story very well by now. You understand your patterns, your childhood experiences and the reasons you respond in certain ways. You might simply be tired of talking about yourself, tired of telling your story and tired of understanding why you are the way you are. You just want something to change. We don’t necessarily have to spend months going over what you already know. There are other ways of working, including EMDR and body-based approaches, that may help us engage with experiences and responses that aren’t always accessible through talking alone. ### What kind of therapy works beyond just talking? Different approaches engage with different aspects of our experience. My work draws on EMDR, TRE®, somatic approaches, Family Constellations, EFT, Compassionate Inquiry and other methods alongside conversation and reflection. I’m interested in the emotional, psychological and physiological responses that may continue operating even when we understand them consciously. I don’t believe one method is right for everyone. My clinical experience, training and intuition inform how I work, and I respond to what’s happening for you as the therapeutic process unfolds. ### Can therapy change automatic emotional responses? Sometimes, yes. Some changes happen gradually as we develop new ways of thinking and responding. But sometimes, when we’re able to shift something at a deeper, less conscious level, change can happen quite spontaneously. Something that previously required enormous effort can suddenly feel natural. You might find yourself responding differently in a situation that previously overwhelmed you, setting a boundary without having to rehearse it or simply noticing that something doesn’t have the same hold over you anymore. There’s no guarantee that a particular response will disappear, but greater flexibility and freedom in how you respond are things we can work towards. ### Why do I keep people-pleasing when I know it isn’t good for me? Because people-pleasing is often more than a conscious choice. It may have become a way of maintaining relationships, avoiding conflict, feeling accepted or keeping yourself emotionally safe. You may know perfectly well that you need to set boundaries, but knowing that doesn’t necessarily make setting them feel comfortable. I’m interested in understanding what’s happening underneath that response and what makes putting yourself first feel difficult. When some of those underlying patterns begin to shift, you may find that saying no or prioritising yourself becomes easier and more natural. ### Can therapy help me feel different rather than just understand myself better? That’s certainly one of the things I’m interested in. Understanding yourself can be valuable, but I also want the work to make a difference to how you actually experience your life. Are you feeling less anxious? Are relationships becoming easier? Are you finding yourself responding differently? Are you more comfortable in your own skin? Sometimes change is gradual. Sometimes people experience more fundamental shifts in how they feel and respond. For me, the point isn’t simply to understand yourself better. It’s to have more freedom in how you live. ## My Approach and Experience ### What kind of therapist are you? I’m a South African-registered Occupational Therapist with nearly 30 years of experience working in mental health and psychological well-being. My professional background includes work in psychiatric hospitals and rehabilitation settings in South Africa, the UK and Australia, as well as private practice in South Africa. Over the years, I’ve trained in a range of approaches including EMDR, TRE®, EFT, Family Constellations, Compassionate Inquiry and shamanic and energetic approaches through the Four Winds. My work is integrative, which means I consider the whole person and draw on different approaches according to what’s appropriate. ### Do you only work with trauma? No. I’ve worked with people experiencing a wide range of psychological, emotional, relational and life difficulties. These include anxiety, panic attacks, eating disorders, addictive patterns, relationship difficulties, emotional exhaustion, low self-worth, the effects of trauma, health concerns and challenges associated with loss or significant life changes. Sometimes people come with a very specific difficulty. Sometimes they simply know that something isn’t working in their lives anymore. I’m interested in understanding the whole picture, not just the immediate problem. ### What is integrative therapy? For me, integrative therapy means working with the whole person rather than approaching every difficulty through a single method. Our experiences affect us emotionally, psychologically, physically and relationally. Our beliefs, nervous systems, learned responses and, for those who relate to it, our spiritual experiences all form part of how we experience life. I draw on my clinical experience and different therapeutic approaches to respond to what’s happening for you. We’re working with a dynamic human being, and the therapeutic process needs to be responsive to that. ### Do you use EMDR in every session? No. EMDR is one of the approaches I use, but it isn’t appropriate or necessary for every person or every session. Some modalities, including EMDR, have specific protocols, which I follow. My approach is flexible, and we may use different methods at different stages of the therapeutic process. ### Do you offer TRE®? Yes. TRE® is one of the body-based approaches in which I’ve trained. It can be incorporated into our therapeutic work where appropriate, depending on what you’re experiencing and what we’re working towards. ### How is EMDR different from somatic therapy? Both are ways of working with trauma beyond cognitive understanding and traditional talk therapy, but they are not the same kind of work. EMDR follows specific protocols, beginning with history-taking and preparation, and the processing itself does not rely on repeatedly talking about or recounting the traumatic experience. Somatic approaches, such as TRE®, work through the body, with the patterns of tension, protection and automatic response it can hold, rather than through verbal processing of traumatic events. Which of them we use, and when, depends on what you are experiencing and what we are working towards. ### How do you decide which therapeutic approach to use? I draw on my clinical experience, training and intuition, while responding to what’s happening for you in the moment. I’m listening to what you’re sharing, observing how you’re responding physically and emotionally, noticing the state of your nervous system and paying attention to what’s happening between us. The therapeutic process is dynamic. Some approaches have specific protocols that I follow, but there’s also flexibility in how I work with different methods. They can complement one another, and I may draw on more than one approach as the work unfolds. I don’t see therapy as choosing one method at the beginning and applying it regardless of what’s happening. ### Is your work spiritual or clinical? My professional background and experience in mental health form the clinical foundation of my practice. I’ve also trained in shamanic and energetic approaches through the Four Winds, and that training has expanded the way I understand and work with human experience. I see us as whole human beings, and for some people, the spiritual or energetic dimensions of their experience are meaningful parts of that picture. Not everybody relates to those dimensions, and that’s perfectly fine. I don’t assume that everyone shares my perspective, and we work in ways that are appropriate for you. ### Can we work with all your different therapeutic approaches online? Yes. I work with my different therapeutic approaches both in-person and online. There are aspects of the work that are easier when we’re physically in the same room, particularly when we’re working with the body and nervous system. But I’ve developed ways of adapting the different approaches for online sessions. That includes EMDR, somatic work and other aspects of my integrative practice, with appropriate adjustments to how we work together. Not every method is suitable for every person or circumstance, and some work may require more preparation or a different approach online. I consider this as part of our therapeutic process rather than assuming that working online means we’re limited to talking. ## Beginning Therapy ### What happens in the first session? We begin by talking about what has brought you to therapy, what you’re experiencing and what you’d like help with. I’m interested in understanding the wider picture, including relevant aspects of your history, relationships, health and current circumstances. It’s also an opportunity for us to get to know each other, to begin exploring how we might work together and whether we’re a good fit. ### Do I need to know exactly what’s wrong before making an appointment? No. Sometimes people come with a very specific difficulty. Other times they simply know they’re not feeling the way they’d like to feel. Perhaps you’re feeling overwhelmed, disconnected, anxious or unhappy, and you’re not entirely sure why. We can begin there. ### Do you work with adolescents? Yes. I have extensive experience working with adolescents, and I really enjoy this work when there’s a good fit. I recognise that adolescents don’t always arrive at therapy particularly enthusiastic about being there, and that’s perfectly understandable. I’m often able to establish a connection and help young people feel comfortable enough to engage, even when they’re initially reluctant. But I’ve also learned that not every adolescent is the right fit for the kind of work I do. I don’t expect an adolescent to arrive motivated or knowing exactly what they want from therapy. I’m very comfortable working with some initial hesitation or resistance. What matters is that there’s a willingness, or at least an openness, to engage as we get to know each other. I don’t generally take on adolescents who have no interest in participating in therapy and are attending solely because somebody else wants them to. I usually begin with a conversation with a parent to understand the circumstances, or an initial session with the adolescent, to establish whether we’re likely to be a good fit. Ultimately, I want the young people I work with to feel that therapy is something we’re doing together, rather than something being done to them. ### How long will I need therapy? That depends on what you’re experiencing, what you’re hoping to change and how the process develops. Some people come for focused work around a particular issue. Others need or prefer a longer therapeutic process. We can review this together as we work. ### What if I’m not sure we’re a good fit? That’s completely understandable. Choosing a therapist is personal, and I think it’s important that you feel comfortable with the person you’re working with. You’re welcome to make an enquiry and tell me a little about what you’re looking for. We can consider whether my approach is appropriate for your needs. ## Online and International Consultations ### Do you work with people internationally and online? Yes, I do. I regularly work with clients internationally, and online sessions are an established part of my practice. There are a few things we need to consider when working together remotely, including time zones, availability, the nature of the work and your individual circumstances and needs. I consider each enquiry individually to establish whether online work is appropriate and whether we’re a good fit. You’re very welcome to get in touch, tell me a little about what you’re looking for, and we can take it from there. [Professional Registration and International Online Sessions](https://reneeshearing.com/working-with-me-online#registration) ### What are your fees? My standard international fee is US$250 per 50-minute session. For clients in South Africa and elsewhere in Africa, my local fee is R2,000 per 50-minute session. ### How do I arrange an appointment? You’re welcome to contact me and tell me a little about what you’re experiencing and what you’re looking for. We can establish whether my approach is appropriate for your needs, discuss availability and consider how we might work together. ## More questions ### What benefits can I expect from therapy? The benefits depend on what we are working with, but the aim is not simply to understand yourself better. It is to feel and live differently. You may begin to notice: - feeling less triggered and less emotionally reactive - feeling safer in yourself and in the world around you - less guilt and shame - less pressure to hold everything together - feeling less responsible for other people’s emotions, choices or wellbeing - greater freedom to choose yourself and prioritise what matters to you - clearer boundaries with less fear or guilt - more confidence in your decisions - greater clarity about what you want and need - more capacity to tolerate uncertainty, change and difficult emotions - less repetition of familiar relationship and behavioural dynamics - more ease and freedom in relationships - a stronger sense of who you are - more courage to make changes that previously felt too difficult - greater willingness to take healthy risks - more confidence to pursue experiences or opportunities that once felt out of reach - a wider, more spacious perspective on your life - greater ability to see challenges in context rather than feeling consumed by them - less sense that life is simply happening to you - more agency in shaping your life - more curiosity about difficult experiences and what they may be showing you - greater ability to move through challenges without remaining stuck for as long - more vitality, spaciousness and enjoyment of life Sometimes the most meaningful changes are surprisingly simple. Something that used to trigger you no longer has the same hold. You say no without the usual guilt. You stop carrying something that was never yours. You take a step you have wanted to take for years and notice that it suddenly feels possible. For me, that is meaningful change. **Not just understanding yourself differently, but having more freedom, agency and capacity to live differently.** ### What if I’ve already done a lot of therapy and understand my history? That is often exactly where my work begins. Many people I work with already understand a great deal about themselves. They know their history and can see the dynamics. And still, something does not shift. My interest is not only in understanding the story cognitively, but in what is still operating underneath it: in the nervous system, body, learned adaptations, family dynamics, trauma responses and deeper ways of relating to yourself and the world. Insight matters. But sometimes we need to work at the level where the response is actually being generated. ### What if I don’t want to tell my whole story all over again? You don’t have to. I understand that many people have told their history repeatedly and are tired of starting again with every new therapist. I need enough context to understand what has brought you to me, what you are experiencing now and what you would like to change. We can gather the rest as it becomes relevant. ### How is your work different from traditional talk therapy? We talk, of course. Language, insight and understanding matter. But I don’t assume they are the only levels at which change happens. I also pay attention to what your body and nervous system are doing, your emotional responses, learned adaptations, family and relational dynamics, trauma and the deeper systems that may still be shaping your experience. I sometimes describe this as working with the **operating system** underneath the conscious mind. The aim is not only to understand why you respond as you do, but to create the possibility that the response itself begins to shift. ### Do all the methods you use have the same evidence behind them? No, and I would rather say so plainly. Some of what I do is clinical practice, some draws on broader therapeutic frameworks, and some, such as shamanic and energetic work, is exploratory. I explain the difference when I suggest a way of working, and you decide what you are comfortable with. [How the ways I work differ](https://reneeshearing.com/my-treatments#differences) ### Do I need to have experienced trauma to work with you? No. Trauma is an important part of my clinical experience, but you do not need to identify as traumatised to work with me. You may feel stuck, exhausted, disconnected, burnt out, confused about a relationship, dissatisfied with the life you have created or aware that the way you are functioning no longer feels sustainable. You may be facing a major transition or asking bigger questions about meaning, identity and what you want from your life. Sometimes nothing is dramatically wrong. You simply know something needs to change. ### I’m successful and functioning well. Is therapy still relevant for me? Absolutely. Many people I work with are highly capable. They function well, carry significant responsibility and have created successful lives. That does not mean those lives always feel good from the inside. You may be functioning exceptionally well while feeling exhausted, emotionally flat, over responsible, unable to switch off or wondering why the things you worked so hard for no longer feel as satisfying as you expected. Therapy does not have to begin with something being terribly wrong. Sometimes it begins with recognising that you want more freedom, vitality, meaning or enjoyment from the life you already have. ### What if nothing is obviously wrong, but I don’t feel happy or fulfilled? That is enough. You don’t need to arrive with a diagnosis or crisis. Sometimes people come because they feel disconnected from themselves, bored with their own responses, uncertain about what they want next or aware that their lives are working but no longer feel particularly alive. We can begin there. ### I have a good life. Why am I feeling like this? I cannot tell you why without knowing you, and there may be more than one reason. It may be that the way you learned to function, to cope and to succeed is costing you more than it used to. How a life looks from the outside and how it feels from the inside are not always the same. [Therapy for high-functioning adults](https://reneeshearing.com/therapy-for-high-functioning-adults) ### Why am I anxious when everything appears to be fine? Anxiety does not always follow the facts of your present life. Your body and nervous system may still be responding to something learned earlier, even when you know you are safe. If the anxiety is new, severe or comes with physical symptoms, please see your doctor first. [Anxiety, panic and persistent fear](https://reneeshearing.com/anxiety-and-panic) ### Why can’t I relax or switch off? For some people, staying alert, busy or useful once felt necessary, and the body has not yet learned that it can stop. It may also be a sign of prolonged stress or burnout. [Burnout and over-responsibility](https://reneeshearing.com/burnout-and-over-responsibility) ### Why does everybody think I’m so capable when internally I feel as though I’m falling apart? I hear this often from people whom others depend on. When you appear to be managing well, the people around you may not notice that you need support too. If you feel unable to cope right now, the page Feeling Unable to Cope says who to call. [The one everyone relies on](https://reneeshearing.com/the-one-everyone-relies-on) [Feeling unable to cope](https://reneeshearing.com/feeling-unable-to-cope) ### Can stress start to affect me physically? Our psychological and physical systems are not separate, and prolonged stress can affect the body and nervous system. That does not mean physical symptoms are “all in your head” or should automatically be assumed to have a psychological cause. Physical symptoms may require appropriate medical assessment and treatment. Therapy is not a substitute for medical care. At the same time, our bodies, our soma, can sometimes express the load we are carrying. People may experience tension, disturbed sleep, fatigue, digestive changes, headaches or other physical symptoms alongside periods of significant stress or nervous system activation. In my own clinical experience I have also seen people notice an easing of some physical symptoms as they process difficult experiences, work with their nervous systems and change some of the ways they are responding to stress. I therefore remain curious about the body as part of the whole system while appropriate medical care continues where necessary. ### Why am I experiencing physical symptoms when I don’t understand what is causing them? Please see your doctor first, because physical symptoms need a proper medical assessment. I do not diagnose physical conditions, and therapy does not replace medical care. If your doctor has found no medical cause, or thinks stress may be contributing, it may be worth looking at what your body and nervous system have been carrying. [Stress and the body](https://reneeshearing.com/stress-and-the-body) ### What do you mean by working with the nervous system or the body? Our bodies often respond before our conscious minds have made sense of what is happening. You may know rationally that you are safe and still feel activated. You may understand that a current situation is not the same as something from your past and still experience a powerful physical or emotional response. I pay attention to those responses as part of the work. That may mean noticing changes in tension, breathing, activation, shutdown, emotion or bodily sensation. The body can give us information that cognition alone sometimes cannot. ### What do you mean by the “operating system”? I use the term **operating system** to describe the deeper processes that influence how we respond to life before we have consciously decided what to do. It can include your nervous system, early experiences, family conditioning, trauma, learned adaptations, personality, beliefs, relationships and the ways you learned to stay safe, connected or functional. You can understand something intellectually and still have an operating system generating the old response. My interest is in working with that deeper system so that change does not rely entirely on forcing yourself to think or behave differently. ### Why do I continue behaving in ways I know are not good for me? Knowing that something is unhelpful and being able to stop are different things. Much of what we do is shaped beneath conscious intention, by earlier experience and by what once kept us safe or connected. [When understanding isn’t enough](https://reneeshearing.com/when-understanding-isnt-enough) ### Do I have to be spiritual to work with you? Not at all. My work is grounded, psychological, somatic and clinically informed. I also have training and experience in energetic and shamanic approaches, and for some people intuitive or spiritual dimensions become meaningful parts of the work. For others, they don’t. I won’t impose a spiritual framework on you. We work with what is relevant, useful and meaningful to you. ### How do I know whether I need therapy or coaching? There can be overlap. Coaching can be very useful when the focus is primarily on goals, strategy, performance, decision making or accountability. Therapy may be more appropriate when you recognise that something deeper is affecting your ability to move forward: recurring relationship dynamics, trauma, nervous system responses, emotional patterns, family conditioning, identity, grief or ways of functioning that you understand but cannot simply think your way out of. Some people come to me because they are highly functional and don’t feel “unwell”, but want a depth of psychological and somatic work that they are not finding in conventional coaching. [More on therapy or coaching](https://reneeshearing.com/therapy-or-coaching) ### What if I keep repeating the same relationship or life experiences? That is a common reason people come to see me. We can often see what is happening cognitively long before we understand what keeps recreating it. I’m not interested in blaming you for repeating something. I want to understand what makes that response, relationship or position make sense within your system, what may once have protected you and what continues to keep it in place. When we work with what is organising the experience underneath the surface, you may begin to notice that it simply doesn’t have the same hold. Sometimes you don’t have to force yourself to make a different choice. **The choice itself begins to feel different.** ### What do I need for an online session? - A private space where you will not be interrupted or overheard. - Headphones, if anyone else is nearby. - A steady internet connection, and a computer, tablet or phone with a camera. You can have sessions from home, from work or wherever you are, in any country. [How online sessions work](https://reneeshearing.com/working-with-me-online) ### Who do you work best with? I work particularly well with people who are curious about themselves and willing to look honestly at what is happening. You don’t need to arrive with all the answers. Many of my clients are capable, thoughtful and highly functioning people who have already done considerable reflection but feel that insight alone is no longer enough. You may want to feel less triggered, less burdened by responsibility or old dynamics, more confident in your choices, or simply more alive and engaged with your life. I tend to work best with people who are open to exploring beyond cognition alone and interested in understanding themselves as complex human beings rather than as a diagnosis or collection of problems. ### What if I don’t know my goals for therapy? That is completely fine. You do not need to arrive with a perfectly formed goal or clear explanation of what needs to change. Sometimes all you know is that something feels off. You feel stuck, exhausted, disconnected or have a sense that the way you are living is no longer working for you. We can begin there. Part of the work may be discovering what you are actually wanting more of: freedom, ease, clarity, better relationships, less reactivity, more confidence, more vitality or simply a different experience of yourself and your life. Your goals may change as the work unfolds. We keep checking in together about what feels important, what is changing and where the work needs to go next. ### Do my sessions qualify for Prescribed Minimum Benefits (PMBs)? No. My sessions do not qualify for Prescribed Minimum Benefits (PMBs). Many medical aids may reimburse in full or in part for my services. Please check with your medical aid to see if they will cover out-of-hospital Occupational Therapy sessions. ### What if I need medication? I do not prescribe medication. If at any point it seems that medication may be helpful as part of your treatment, we can discuss that together and consider the most appropriate next step. If you are in Cape Town, I may be able to recommend a psychiatrist or other medical professional I know and trust. If you are elsewhere, we can discuss the referral process available in your area and what kind of professional you may need to see. The exact route depends on where you live and what services are available. My role is to help you think through whether a medication assessment may be useful and, where possible, guide you towards appropriate professional support. [Who I Work With](https://reneeshearing.com/who-i-work-with) - [Therapy for High-Functioning Adults](https://reneeshearing.com/therapy-for-high-functioning-adults) - [After Years of Therapy](https://reneeshearing.com/after-years-of-therapy) - [Burnout and Over-Responsibility](https://reneeshearing.com/burnout-and-over-responsibility) - [The One Everyone Relies On](https://reneeshearing.com/the-one-everyone-relies-on) - [Recurring Relationship Dynamics](https://reneeshearing.com/recurring-relationship-dynamics) - [Stress and the Body](https://reneeshearing.com/stress-and-the-body) - [Trauma and Hypervigilance](https://reneeshearing.com/trauma-and-hypervigilance) - [Meaning and Life Transitions](https://reneeshearing.com/meaning-and-life-transitions) - [Trauma and Its Lasting Effects](https://reneeshearing.com/trauma-therapy) - [Anxiety, Panic and Persistent Fear](https://reneeshearing.com/anxiety-and-panic) - [Feeling Unable to Cope](https://reneeshearing.com/feeling-unable-to-cope) - [Working With Me Online](https://reneeshearing.com/working-with-me-online)