In this short video, I explain what I do first when someone joins me by video in the middle of a crisis, and why you do not need to have the words ready before we start.
You can also send me an email
Acute online psychotherapy gives you quick, focused support by video when loss, conflict, shock or sudden change has made ordinary life hard to manage. We meet one to one, in English, in 1-hour sessions with 50 minutes of therapy, usually within days, at a time that fits your time zone.
I help you slow the situation down, understand what is driving it and make decisions from steadier ground. This is the crisis branch of my online psychotherapy. If you live far from home, acute psychotherapy, living abroad adds that context. If autism or ADHD is part of the picture, acute online neurodiverse psychotherapy is built for it.
You can book a free 30-minute call, take the first open session, read my client policy or write to me directly.
Acute online psychotherapy is for English-speaking adults, anywhere in the world, whose life has just been shaken and who cannot wait weeks for a first appointment. A break-up, a bereavement, a diagnosis, a dismissal or a frightening event has knocked out your usual ways of coping. You want help this week to steady yourself and decide what comes next.
Acute work is for the first days and weeks after a shock. If one of these sounds more like you, the linked page will serve you better.
You can also send me an email
These reviews describe clients’ experiences of working with me. They come from my wider practice and do not all relate to online sessions. Each person’s experience is their own, and a review does not promise a particular outcome.
“Of all the people who find me online, the ones who are in acute crisis are often the ones who apologise most for taking up my time, and I think that apology is part of the problem. They have spent years being the capable one. In the first session I hear the frightened question underneath, ‘Is anyone going to stay with me through this?’, and right next to it, ‘I just need to get a grip and sort it out alone.’ Often the same person says both within a minute: ‘Please help me’ and ‘Do not come too close’. None of that is weakness. It is what shock does to a careful person. My job is to bring enough steadiness that you can think again.”
Mark Colclough, MA, psychotherapist and EFT couples therapist
I am Mark Colclough, MA. I have practised since 2004 and offer online psychotherapy and couples therapy in English.
My training brings together your emotions, your thoughts and your relationships. My deep passion is the moment when what happens between you finally makes sense, to each of you and to each other. I have lived and worked in nine countries, so I know something of life across languages, cultures and borders.
Read about my background, or explore online psychotherapy and online couples therapy.
I meet regularly with experienced psychotherapists to reflect on my work, question my understanding and develop my skills. Supervision is part of the professional care I bring to individual and couples work, including online sessions.
My focus is thoughtful practice, integrity and responsibility.
You are welcome to ask about the kind of support you need.
Tell me where you are based and your time zone. We can then consider whether online sessions together are suitable.
Greta is 47, Dutch, and has lived in Lisbon for 9 years. On Monday her company closed its Portuguese office and her job went with it. On Wednesday her brother rang to say their father had been taken to hospital in Rotterdam. Since then she has slept 3 or 4 hours a night, snapped at her teenage son and spent hours comparing flight prices without booking one. She tells friends she is fine, because she has always been the one who manages.
In our first video session I would help Greta separate what must be decided this week, such as whether to fly to her father, from what can wait, such as what the redundancy means for her future. She would probably notice that the hardest part is not the events themselves but being the one who needs help.
I have presented this clinical example as a compound of 22 years of clinical practice.
Something has become too heavy to carry in your usual way, however hard you have tried to hold it together.
There is no perfect reason or correct moment to ask for help in a crisis. If your sleep, your thinking or your relationships have suddenly stopped working, or you sense that something is badly wrong, take that seriously. You do not need a diagnosis, a referral or a clear explanation first. In 22 years of practice I have watched many people try to think their way out of a crisis on their own, and the weight usually grows.
In acute sessions I will help you name what is happening, decide what needs attention first and create enough stability to move forward. These 6 questions describe the situations I meet most often.
If so, act now rather than waiting for it to pass. You lie awake replaying the event, forget what you went into a room for and push food around the plate. You may still be working, but every task takes 3 times as long.
I would look at what changed, when, and how far it has spread into your days. That tells us whether this is a sharp but passing reaction or something that needs closer support. If this is you, book a session with me and we will start with the most urgent part.
Both urges can live side by side, because they protect different things. One part of you wants someone to hold the situation with you. Another wants to close the door until you have it under control. You draft a message to a friend and delete it, or call your sister and then cut her off.
I do not treat either side as wrong. I help you see what each one is protecting, so you can choose who to let in, and how much, without feeling exposed or abandoned.
In a crisis, silence can feel like danger. A partner who has gone quiet, a doctor who has not called back or an employer who has not decided can keep your mind circling. You check your phone every few minutes, reread old messages and struggle to settle until you hear something.
Your need for clarity is real, and I will not make light of it. I help you calm the alarm enough to get through the waiting, separate what you know from what fear predicts, and say what you need to the people involved.
Yes, this often happens after a shock. You beg someone not to leave, then tell them to go. You ask for company, then cannot bear to be touched. It frightens you, and it confuses the people trying to help.
I help you slow the swings down so we can see what tips you from one side to the other. Usually there is a trigger, such as feeling pitied or feeling left. I have compassion for these protective moves, and I will also help you take responsibility for the ones that cause damage.
Crisis can be quiet. You may feel blank, organise everyone else and talk about the crisis as if it happened to someone else. It feels like control. The cost is that the shock goes underground and comes back later, often at 3 in the morning.
I take numbness as seriously as tears. I help you see what the distance is protecting you from, and let a little feeling through at a pace you can manage. You do not have to fall apart to be taken seriously.
Losing a job, a partner, a country or a person can take away the structure that told you who you were. You may feel like a stranger in your own life, ashamed of how badly you are coping, or unsure what you even want now. That shows how much has been lost, not that you are broken.
I help you sort out what has truly changed and what is still yours. I will give you direction and challenge harsh conclusions about yourself, but I will not decide who you should become. The aim is enough clarity to take the next step.
If the crisis is happening now, book the first open session, or request a call and I will tell you honestly how soon we can begin.
You can also send me an email
Tell me briefly what kind of support you are looking for.
Include your country and time zone so we can discuss whether online work together is possible and find a suitable time.
You do not need to explain your whole story in your first message.
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In a crisis the order matters: steady first, understand second, decide third.
Acute work lifts you from inside the crisis to a place where you can see its outline. I listen for the events, for what keeps the distress alive and for what has to shift first. Relief matters, but relief without understanding usually wears off.
I work warmly, directly and practically. In 22 years of practice I have found that people in crisis need a therapist who takes an active part. You will hear my view, we check together what holds up, and insight becomes steps you can take once the call ends.
Related reading: How do I deal with a feeling that feels too big? and Why is it so hard to ask for help when I’m struggling?.
A crisis is seldom the work of a single event. Usually an immediate trigger lands on top of strain, loss or conflict that has been building for longer than you realised. I help you tell the trigger from the pressure underneath it and from the meaning you have given to what happened.
Then we know where to start, and not everything in your life has to feel equally urgent. If you are ready, book a session with me and we will begin with what weighs most today.
You can learn its early signs, even in the middle of a crisis. A tight throat, a racing thought, the urge to send a message you will regret. Catching the first step gives you a few seconds to choose.
In acute sessions I help you slow that sequence down and recognise what sets it off. Seeing it is only the start. We agree on a couple of concrete things to do when it rises, so you can use them at 2 in the morning without me there.
Settling yourself is not the same as pretending the problem is small. It means becoming steady enough to see the situation clearly and answer it in a way you will not regret next month.
We lower the heat of the moment without losing sight of what actually needs to change. We find a few simple ways of settling your body that fit your days right now, from breathing and walking to what you do with your phone at night. Practise them between sessions, even when it feels pointless.
You may need to speak to a partner, a family member, an employer or a doctor while your feelings are close to the surface. Putting the talk off adds pressure, and walking in unready can backfire.
Together we work out your message, your request and your limits. We prepare words that stay honest without tipping into attack, apology or fog, and I will challenge you if you start to make yourself responsible for everyone else’s reactions.
Pressure either hurries you into a choice or pins you between options, and both reactions are understandable. Neither should decide your future unexamined. Big decisions made in shock are often the ones people most want to undo.
We pin down the actual decision, when it truly has to be made and what each path would cost. Often there is a smaller step that keeps your options open while your head clears. I will tell you what I think, but the decision stays yours.
The immediate crisis often settles within a few sessions, but it may have exposed patterns that deserve attention: how you ask for help, how you treat yourself under pressure, what you carry alone.
Once things are steadier, I give you a clear recommendation. That may mean stopping, continuing with online psychotherapy to work on what the crisis revealed, or planning a back-to-back block. Whatever you choose, you choose it deliberately.
You can also send me an email
You do not need to arrive calm, organised or sure of anything. I begin with what is hardest today.
In the first session I listen for the problem in front of you, the strain surrounding it and what you need to leave with. Say it however it comes out. You do not need to give me your history before the work becomes useful.
Acute work is the crisis strand of my online psychotherapy, structured individual work that can continue once the storm has passed. If the crisis turns out to be shared with a partner who is willing to join, online couples therapy offers long-term relational development and healing. If you already know you will need several sessions, a therapy bundle lowers the cost and gives the coming weeks a planned shape.
I ask what happened, what has changed and what you fear will happen next. I also ask directly about sleep, support, alcohol or other substances and whether you feel safe with yourself and others. I ask so that I can judge what support is wise, not to put a label on you.
Should you need a doctor, a psychiatrist or emergency care as well as therapy, I will tell you plainly and help you work out where to turn locally. Before we finish, we agree one realistic change for the days ahead. If you want to talk first, request a free 30-minute call.
Individual work fits when the crisis lives mainly in you: your shock, your grief, your fear, your decisions and the way you are coping. Even a relationship crisis can start here, especially when the other person is not willing or not safe to join.
One to one, I keep the thread between sessions and give the work direction. When the acute phase is over, online psychotherapy is where structured individual work can continue, if you want it to.
Couples therapy fits when the crisis sits in the relationship itself and both of you want to work on it: an affair has come out, one of you wants to leave, or arguments have spun out of control. A shared crisis is hard to carry in individual sessions alone.
In couples work I help you both see the cycle between you and find safer ways to talk. Online couples therapy is long-term relational development and healing. If your partner will not join, online couples therapy alone is another way in.
At the start, usually closer together than in ordinary therapy, so the crisis does not run away from you between meetings. Some people meet twice in the first week, others once a week from the outset.
I will recommend a pace based on how much is happening and how much support you have around you. As things settle, we space sessions out. I will also tell you if the gaps are too long to be safe or useful.
A bundle makes sense once it is clear that you will need several sessions in a short time. It saves you from deciding after every hour whether you can afford the next, which is one decision fewer in a week already full of them.
It also lowers the cost per session and gives you a planned structure. I will tell you honestly whether I think one fits. See therapy discounts and bundles and the bundle cards on this page.
The acute phase is over when you are sleeping and functioning again, can think about the event without being flooded and are ready to look ahead rather than only get through the day.
I review this with you openly and will not keep you in acute sessions without a clear reason. We may stop, pause or move into regular work. If another crisis comes later, returning is not a sign the first work failed.
Not sure acute work is the right starting point? Here is how it compares with the options people in difficulty most often consider.
| Option | Choose it when | Pace |
|---|---|---|
| Acute online psychotherapy (this page) | Something has just happened and you need help this week. | Video sessions close together at first |
| Online psychotherapy | There is no single crisis, but a pattern you want to change. | Weekly or fortnightly 1-hour video sessions |
| Back-to-back online psychotherapy | You want a planned block of concentrated work over a few days. | Several video sessions in a short span |
| Acute psychotherapy, living abroad | You are in crisis far from home, family and your own language. | Prompt video sessions close together |
Acute online psychotherapy with me is short-term, focused individual psychotherapy by video, in English, for adults whose life has just been shaken by loss, conflict, shock or sudden change. It aims first to steady you, then to understand what has happened, then to decide what comes next.
I am not an emergency service, and I do not diagnose or prescribe. I offer prompt, structured therapy, usually within days. It is the crisis branch of my online psychotherapy.
If distress is disrupting your sleep, concentration, work, relationships or ability to decide, it deserves attention now. You do not need to wait until you cannot function.
People in crisis tend to play down what they carry until it has grown much harder to shift. I would rather look at it with you early than have you prove it is bad enough.
Yes. A sudden break-up is one of the most common reasons people contact me for acute help. I cannot make the pain go away or bring anyone back, and I will not pretend to. I can help you get through the first days and avoid moves you would regret.
In my clinical experience, the urge to fix it immediately, by calling, pleading or deciding never to love again, is strongest in the first week. We would focus on steadying you, on what you actually know, and on the next small step.
No. A sense that things have gone wrong, or that your normal coping has stopped working, is all it takes. There is no paperwork.
I start from your experience, not from a form. Where a doctor or psychiatrist should also be involved, I will say so and explain how our work fits beside theirs.
Both are ways of trying to feel safe when the ground has gone. Some people reach out constantly and need to hear they will not be left. Others go silent and handle it alone. Many swing between both. It is how you learned to survive fear, not a flaw in you.
I help you see which way you move under pressure, what it is trying to achieve and what it costs. Then we find steadier options: asking for specific help, and taking space without cutting yourself off.
By the end you will have my first understanding of what is happening, a clear sense of what needs attention first and one concrete step for the coming days. You will also know whether I think acute sessions are the right format.
You do not need to prepare, and you can start with whatever part is clearest. Many people begin with “I do not know where to start”. Book a first session or ask for a free 30-minute call.
A single session can restore some direction. A more complex crisis usually needs several sessions over a few weeks, and sometimes a move into regular psychotherapy once the pressure eases.
I give you a clear recommendation after the first session and review it openly as we go. We keep meeting only while it helps, never out of habit.
Yes, for most people. Video means you can be seen within days without travelling, from wherever the crisis has found you, even in a hotel room or at a parent’s home in another country.
All you need is a room with a door, headphones and decent internet. If you are not safe where you are, or cannot speak freely, tell me and we will find another way. The calendar shows times in your own time zone, and a free call can settle any doubts.
Acute sessions are booked as ordinary 1-hour online individual sessions, each with 50 minutes of therapy. See my prices page for today’s fees in US dollars.
If continued work makes sense, a therapy bundle saves you 10 per cent on each session and gives you a structured plan. The options are on therapy discounts and bundles.
Book the first available session and tell me in a line what feels most urgent, or request a free 30-minute call if you want to talk first.
If none of the times are soon enough, contact me directly. I hold some room for acute cases and will tell you honestly how quickly I can see you. If you are in immediate danger, contact the emergency services where you live.
You can also send me an email
I want therapy to help you understand your experience and make choices you can use in everyday life. We pay attention to feelings, needs and the responses that happen before you have time to think.
Our online room should offer enough trust and honesty to explore what is difficult. I bring attention and professional judgement. You bring your experience, questions and the right to say when something does not fit.
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P.S. I’ll call you in a bit!
