Psychotherapy & Counselling: All You Need to Know

Seeing a Psychotherapist or Counsellor can feel very daunting. There are a series of steps people take before they find themselves in front of a professional, and sometimes those steps have been taken over and over again before someone feels supported in the right way.

            When I see a new client for the first time, I consider what they might have gone through before sitting down with me for an initial meeting, and this is usually something we explore within that first conversation. Often, people struggle for some time on their own before coming to terms with the idea there is a problem to be addressed, followed by thinking of asking for help, asking for that help, and then requesting an appointment. That’s a lot of steps before having a first appointment!

My experience as an Administrator and Service Co-Ordinator in mental health organisations, as well as a Psychotherapist, means I am fully aware of the nuances of accessing support for mental health and wellbeing at each stage of the process. Here is some information which I hope will make it easier for you to get the help you’re looking for.

What is the difference between a Counsellor and Psychotherapist?

Counselling and psychotherapy are types of talking therapy for mental health problems, so there are a lot of similarities between Counsellors and Psychotherapists.

Counselling tends to focus more on the ‘here and now’ (especially if you’re doing short-term work), whereas psychotherapy almost always focuses on the link between your past and present. However, counselling can include looking at your past too.

Counsellors and Psychotherapists aren’t medically trained so they aren’t able to offer a diagnosis, nor are they able to recommend or prescribe medication. These would fall under the responsibility of a Psychiatrist, or a GP.

What kind of counselling/psychotherapy should I have?

I consider that this can be one of the most confusing aspects of searching for the right person to work with, as there are so many types of counselling and psychotherapy out there. It’s worth thinking about what you’re looking for in a professional and the work you’ll be doing, as this can guide you to the type of approach that you’ll make use of the best.

For example: if you’re looking for structured work that’s more directive then cognitive behavioural therapy could be helpful. Exploratory, non-directive work may mean that a person-centred practitioner could be what you’re looking for. An eclectic or integrative approach suits those who may need more than one approach at any given point in the work, too.

However, there is research* to show that the relationship between the client and practitioner is the most influential factor on how effective the work is – rather than what kind of counselling/psychotherapy is being delivered. This speaks to how important it is to feel comfortable, safe and listened to during what can be a difficult process.

It’s vital to work with someone who is registered and/or accredited with a regulatory body such as the United Kingdom Council for Psychotherapy (UKCP) or British Association for Counselling and Psychotherapy (BACP). This gives you assurance that the Counsellor/Psychotherapist has a certain level of experience, and abides by a professional and ethical framework.

* Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357-361.

What happens in an appointment?

Usually the first appointment is an assessment or an initial meeting to better understand your specific circumstances and difficulties. This can be nerve-wracking or feel like a test but you should be made to feel as comfortable as possible throughout as it’s totally normal to have worries about what to expect, and meeting someone new for the first time.

The ultimate aim is to make sure that the practitioner or service can meet your needs as well as for you to decide whether this is the right type of support for you. Therefore, they are likely to have set questions to ask you as well as allowing for you to bring whatever you feel is important to say.

My approach is to offer semi-structured appointments, and be an active participant throughout the work so that you feel fully supported and responded to. I understand how silence and space can be helpful, and this is a unique part of having a private appointment to explore your thoughts and feelings.

How many sessions will I need?

Generally, the more sessions you have the more opportunity you have to work at depth, and the more topics you can focus on. This doesn’t mean that short-term work isn’t helpful as it definitely is! It just means that you’re more likely to work on one or two areas, and focus more on the ‘here and now’ rather than the past.

It’s useful to confirm at the beginning of the process what you want to change, and this can influence how many sessions you’ll need. My clients tell me that this is really helpful, as is reviewing our work every few weeks to make sure we’re on track.

Can you fix me?

I firmly believe that psychotherapy and counselling is not a process that means a person is ‘done to’, as this dynamic is so often part of the cause of mental distress and ill-health. It also goes against the principles of empowerment, autonomy and respect that I believe are vital to enabling someone to improve their mental health within and beyond our work.

However, it’s important for Counsellors and Psychotherapists to make full use of their skills and experience as that’s why people come to see them. One way to achieve this is to work collaboratively, and pay attention to the working relationship as well as what’s going on in the work. Counselling and psychotherapy is a shared process, facilitated by the practitioner, so together you can get to where you need to be.

I feel nervous about telling my story to someone new. Is this normal?

This is extremely common, and completely understandable. Whilst there can be relief in being able to speak to someone (especially if you’ve waited a long time for an appointment), there are worries about being able to communicate what’s important to you and be understood as a result. Having to repeat your story to lots of professionals is also a common anxiety, which can also be frustrating.

It’s important to remember that you’re in control of this aspect of the process, so you can say as much or as little as you like. Over time you may feel more comfortable in saying a little more, which is of course totally normal as we need to feel safe to open up.

Before you refer yourself to a service or an individual professional, it can be helpful to think about what you need to feel comfortable. For example, would you working with a male/female/non-binary practitioner suit you best? Would seeing someone close or further away from home give you the space you need around appointments? Do you need assurance that someone has specialist skills in the area you’re struggling with? All of these are worth considering to make it as easy as possible to get the help you need.

Still unsure?

I hope these have been helpful for you. If you have any other questions about counselling and psychotherapy, or the services I offer, please get in touch.

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