All of us feel worried or depressed now and again and most of us have known times when we feel like saying “I can’t cope any more” or “I don’t know which way to turn”. When we look back on these periods it’s easy to see that they are a part of life and that it’s quite normal to feel this way at some time or other. But at the time we may feel sad, hurt or frightened and ill at ease. It’s at difficult, painful times like these, facing personal problems or periods of crisis, that many of us would welcome the chance to talk things over in a confidence with an understanding and objective outsider.
Friends, of course, can be wonderful but we may feel we don’t want to, or else can't, burden them with our problems, or they may simply not be there when we need them. A counsellor or psychotherapist is trained to listen actively whilst you talk through your personal problems, to support you through your bad patch and to help you find your own answers to your troubles. They can help you see the overall picture. And you don’t have to worry about overburdening them – their job is to offer this kind of help and give you the concentrated time and objectivity that friends often can’t give.
Hundreds of thousands of people seek help from a counsellor or psychotherapist at some time in their lives. They may be suffering the death of a loved one, or not getting on with their partner, they may have lost their job or be worrying about coping with a new one, they may be finding the strain of work or exams too much, they may be at the end of their tether, anxious about the children, their parents or themselves, or simply down in the dumps. Many people also seek guidance when they come to points in their lives when nothing seems to be seriously wrong but they just don’t know which way to go next. They may just have retired, their children have left home or they may feel suddenly, for no apparent reason, that life seems to lack a purpose for them.
Here are some of the most frequently asked questions about counselling and psychotherapy to help you guide your choice.
Answers to the questions above are as follows:
Counselling is a supportive process which is useful in exploring, coming to terms with and resolving specific personal problems, difficulties, anxieties and stresses in our lives. It involves the helping skills of listening, caring and reflecting, is non directive and is based on establishing a trusting, confidential relationship between the client and the counsellor that focuses empathy, respect and positive regard.
One of the main aims of counselling is to guide us from feeling victims of circumstances to a point where we can explore our difficulties, enabling us to make sense of our unhappiness, and eventually help us to recognise, understand and accept that we have some control over our lives. Counselling allows us to reassess our coping skills and strategies - how we deal with anxieties, challenges, relationships, work problems etc - and helps us develop new insights and resources within ourselves that enable us to approach these issues in a fresh and more effective way. It also involves looking at how we communicate, guiding us to become clear and direct in saying what we mean and asking for what we want.
By getting to know ourselves better, we can come to understand the reasons for our feelings, thoughts, motives and behavioural responses which can help reduce tension, anxiety, misunderstanding and ease how we are experiencing ourselves and our circumstances.
Counselling is not the same as the advice giving service of say the CAB. Individual one to one sessions with a trained counsellor offer a more concentrated kind of help. Counselling is also rather different from self-help groups where people with the same problems talk together to try to help each other. Self-help groups can be very supportive and often go well with Counselling.
Sessions usually last 50-60 minutes, once a week for a period for 6-8 weeks or longer, depending on the need and how the counsellor works. Setting some sort of goal together with the counsellor is often part of the counselling.
In practice Counselling and Psychotherapy overlap. Both can help us deal with our problems in a fresh way and enrich our lives generally. But where Counselling tends to focus on a specific current problem, Psychotherapy, while including all of the above, tends to look at more deep seated issues. We are encouraged to look closely at the past, at our childhood and our relationship with our parents, at patterns, habits and behaviours that are lodged in the part of ourselves which is subconscious and of which we may only be dimly aware. This can be, but is not necessarily, a long process involving sessions arranged over many weeks, months or even years depending on the individual clients and the therapist.
Psychotherapy may bring about quite profound changes in how we see ourselves, or how we treat our children for example. But it also focuses on drawing out our potential and uncovering the buried creative side of ourselves, so the process can expand our capacity to fully experience the joys of life as well as dealing with the pain.
All Psychotherapists will have been a client in therapy to deepen their understanding of themselves and others; not all counsellors will have been, though many will have done so.
Psychoanalysis, created by Freud at the turn of the 20th century, is the ‘grandfather’ of all Psychotherapy. Analysis is very intense, typically hourly sessions 4 days a week for years. However the ‘popular’ image of the analysts couch and anonymous analyst you never see is a bit outdated now. Nowadays it is considered as one form of therapy on offer.
You can still go for traditional analysis, but most analysts have incorporated newer, person-centred techniques into their working method. Depending on their training, a Psychotherapist may use a whole range of techniques including, for example, guided imagery work, drama techniques, role playing, formative psychology, drawing and play.
Many of the people who seek psychotherapy are not going through a crisis but are looking for a way to get to know themselves better, to understand and improve their relationships or to get more out of life. This can be an exciting and rewarding adventure.
All sorts of people. Counselling and psychotherapy are not just for the rich or those who are seriously disturbed, and going for counselling/psychotherapy does not mean you are self-indulgent or have gone mad! It is a very natural and healthy response to seek help when we can’t sort out things on our own. In the old days we may have gone to the local priest or family doctor, to a ‘wise woman’ or favourite aunt when we needed to talk over our feelings or get help in an emotional crisis. Nowadays, with families and communities split up and everyone leading busier lives, for most of us these characters have faded from the scene and in many ways Counsellors and Psychotherapists have filled the gap. Men and women of all ages and from every kind of background go to Counsellors and Psychotherapists with problems ranging from depression or anxiety to addictions, phobias, stress at work and trouble at home or in a relationship.
How long it takes depends on you, the counsellor/psychotherapist and the problem. While deep rooted problems will need longer, say one hour a week for several months, short term counselling for a specific problem may only take a few weekly sessions. Some people begin this way and then decide to make deep changed to their lives and enter therapy for a year or more. Initially you might expect to go for an hour a week, but the question of how many sessions, how frequently and the length of each session should be discussed with the counsellor/therapist you choose.
Within the NHS counselling/psychotherapy (if available) is normally free although these days sometimes a nominal charge is made. Otherwise the average range of fees is £50-£75 per hour for a newly qualified therapist and £100+ for an experienced person who works in private practice.
Most counselling/psychotherapy centres and individuals try to offer a sliding scale of fees which takes ability to pay into account. Also most training institutes offer low cost sessions with trainees. There is some therapy available through the NHS (increasingly focussed on Cognitive Behavioural Therapy in its approach), but the waiting list at GP practices and hospitals tends to be lengthy. The wait to see a Counsellor working at a GP practice can be shorter but at the moment not all practices offer this service to their patients. Ask your GP (or Family Practitioner Committee) for further details if you are interested.
The final judge of whether a counsellor/psychotherapist is ‘right’ for you can only be yourself, and in the end you must trust your own instinct and how you feel about them. Ask yourself if you would feel comfortable telling this person intimate details of your life; do you feel safe with them?; do you like their manner towards you and their attitude to your questions?; do you trust them and feel able to be completely open with them? The more open you can be the more you will gain from the therapy.
Word of mouth from someone you respect is one of the best recommendations, but you may also prefer just to choose someone from one of the many directories that list professional Counsellors and Psychotherapists in the UK. The entries for individual therapists summarise their qualifications and training. Length of experience is an obvious thing to think about. Supervision is considered equally important. This means that the Counsellor/Psychotherapist meets regularly with a more experienced colleague to talk over their work for support and discussion of any issues that arise from their work with clients. Many people consider that personal therapy is the most important ‘qualification’. This means that the counsellor/psychotherapist has been a client in their own therapy, which helps them to understand themselves and others better. These two factors are often an indication of high standards.
Finally all professional Counsellors and Psychotherapists should be members of either the British Association for Counselling and Psychotherapy (BACP), the Institute of Psychosexual Medicine or a member organisation of the United Kingdom Council for Psychotherapy. These organisations all have a code of ethics and practice to which their members are expected to subscribe. BACP is the main national membership body for counselling and psychotherapy and their code of ethics and practice is an example of the principles a code should contain. Some training Institutes and some organisations offering counselling services have their own codes of practice too.
Membership of the BACP, UKCP or other organisations (e.g. ASMT, WMIP, BABP) is not to be regarded as a qualification. The BACP and UKCP has an accreditation scheme for members wishing to apply and criteria for accreditation. Other organisations (such as RELATE, Spectrum, Metanoia, Westminster Pastoral Foundation) also have accreditation schemes or different categories of membership dependent on the level of training and/or experience of the therapist (e.g. IPC/WPF; LCIP).
However you make your choice, ‘shop around’. See 2-3 Counsellors/Psychotherapists for a first interview before deciding and don’t be afraid to ask questions such as: "How does the therapy work?" "What will a session involve?" "What sort of supervision does the therapist/counsellor have?" "How much of their own therapy have they done?" "What is their professional qualification?" "What kind of training did they do?" etc.
If your problem is very specific (e.g. sexual, addictions, marriage), you may want to see a specialist in your particular area of difficulty, although most therapists will deal with a wide range of concerns.
If you have never been in therapy before, then it is normal for you to feel unsure about what will happen and to be uncomfortable. Remember that you can take some time with your therapist to focus on the reasons that you are uneasy before getting into the reason you came for therapy. This will help you feel more comfortable. Another way to help this situation is to tell your therapist what you expect will happen in therapy. Ask them how their way of working differs from your ideas. They will probably ask you what brings you to therapy and won't think any the worse of you if you are not sure. It is their job to listen attentively. If you feel as though you are being heard by them you may start to feel more comfortable. The more open and honest you are the more you will gain from being in therapy. Feel free to ask questions and to make suggestions that might make you feel more comfortable.
You may feel this because you feel somewhat hopeless about your situation, if this is the case, tell your therapist. Asking how therapy can work for you is a good question to ask because every therapist has a different view of exactly how therapy will be helpful to you. It will depend on what your goals for the therapy are.
Your discomfort is very understandable. Therapy is a place where embarrassing and painful emotions can be worked through. One of the goals of therapy is to help you to understand how difficult feelings, thoughts, senses, imaginings, behaviours and experiences of life may be adversely affecting you and result in the conflict and pain in your life. You can always delay some discussions in order to not feel too overwhelmed until you are comfortable and able to trust your therapist.
The chances are that you may feel foolish, awkward, and even scared when you begin therapy. You probably have never opened up to a stranger and expressed your deepest feelings, desires, and fears. It is a unique experience to have someone listen to you attentively for an extended period. At the same time, as a result of taking that risk you will learn more about yourself and will eventually become more comfortable with revealing your feelings. When you have achieved that degree of trust, you will have unlocked your potential for self-discovery and growth.
Therapy is becoming more accepted by more and more people. If you are concerned about stigma you do not need to tell anyone if this makes you feel more comfortable. The fact is that everyone at some time can use a guide to help give them a clearer perspective on their life. It does not make sense not to take advantage of the self-empowerment that therapy can give you.
This is a very common concern because many people are afraid that deep down inside they are somehow different from everyone else and "nobody thinks the way I do". In fact, individuals who have lost touch with reality are not usually concerned about whether or not they are crazy. You may have developed some very creative ways of dealing with difficult situations. However, that does not mean you are crazy. Talk to your therapist about this for clarification.
Therapy may seem expensive at first, but what has more value to you that your well-being? What is more important than getting the most out of life? Therapy can provide you with immeasurable rewards in well being, greater energy, and joy for living, which will be more than adequate compensation for personal expenditure.
You have to remember that a therapist is trained to understand and empathize with emotions. You may have not felt understood trying to explain yourself to family or friends in the past, but it is likely that when you are speaking to a trained professional, that you will be better understood. If this point is a sticking point for you this may indicate that you have some fears or blocks associated with dealing with your feelings. Discuss these issues with your therapist.
Not every therapist is a perfect match with each person who comes for assistance. Evaluate what you feel in your therapist's presence about their competence and talk to them about this. Sometimes a therapist will not be the right match for you and sometimes blaming the therapist for your lack of progress or challenging their effectiveness is a way you can avoid facing up to your own problems or discomfort which is why it is very important to talk about this matter with them.
The fact that you've enquired about counselling and psychotherapy services indicates that a part of you really does want help but you are not feeling good enough about yourself to feel okay with receiving professional help. You may have learned from your family that "you should not be selfish" or that you "don't deserve anything good". Remember that you do deserve it.
If something goes wrong with your T.V., do you feel that you have to fix it yourself? Once you've checked the plug and maybe hit the side and the problem doesn't get better after several days, you will probably want to call a specialist - a technician who spends his days fixing televisions. People with their thoughts, feelings, experiences and behaviours are much more complicated than your television set! Learning how to solve human problems isn't part what we are taught at school. Fortunately, there are therapists who are trained professionals to support you in doing this effectively. Unlike the television technician though, they can only facilitate you to heal yourself, they can't do your healing for you.
It can be hard to ask for help, but it is in fact a strong-willed person who can put aside all of the personal issues discussed in these notes, set aside all of the thoughts about what other people will think, and take that scary step that leads to growth and self-understanding. It takes courage for people to turn to others, especially professionals, to help tackle a problem. It's okay to ask for help!
Therapists are not mind readers. They are good at noticing body cues and facial expressions, but they do not know what is going on inside you until you tell them. Good therapists, will not blame, ridicule, or pass judgment on you. If they do, then they are not doing their job properly. If you feel that they are being judgmental then discuss this with your therapist and if you are not satisfied with the outcome, then please feel free to seek a second opinion or find another therapist.
There is always that risk. But why start the relationship thinking that your therapist will not like you? Maybe they can identify deeply with your situation and maybe they will even fully accept you for who you are. Good therapists are very accepting and you owe it to yourself to give it a try.
Whenever you are in a situation with more than one person, every encounter will always have actions and reactions. If things are not going well with parents, spouse, or friends, and it is “their entire fault," then consider that you may be able to learn more effective ways of dealing with their reactions.
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