Counselling and psychotherapy

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Introduction

Counselling and psychotherapy are used to treat emotional problems and mental health conditions.

Counselling involves talking to a trained therapist, either one-to-one, in a group, or with your partner or family. It allows you to look deeper into your problems and worries, and deal with troublesome habits and a wide range of mental health issues, such as depression, anxiety, and schizophrenia.

Psychotherapy usually involves talking to a therapist, but sometimes other methods may be used – for example, art, music, drama and movement. It can help you discuss feelings you have about yourself and other people, particularly family and those close to you. In some cases, couples or families are offered joint therapy sessions together.

You will meet your therapist regularly, usually once a week, for several months, or sometimes even years. Individual sessions last about 50 minutes, but group sessions are often a bit longer.

Therapists

Therapists are mental health professionals who are trained to listen to a person's problems to try to find out what's causing them and help them find a solution.

As well as listening and discussing important issues with you, a therapist can suggest strategies for resolving problems and, if necessary, help you change your attitudes and behaviour.

Some therapists teach specific skills to help you tolerate painful emotions, manage relationships more effectively, or improve behaviour. You may also be encouraged to develop your own solutions. In group therapy, the members support each other with advice and encouragement.

A therapist will treat sessions as confidential. This means you can trust them with information that may be personal or embarrassing.

What are counselling and psychotherapy used to treat?

Counselling and psychotherapy can be used to treat a wide range of mental health conditions, including:

depression
anxiety disorders
borderline personality disorder (BPD)
obsessive compulsive disorder (OCD)
post-traumatic stress disorder (PTSD)
long-term illnesses
eating disorders, such as anorexia nervosa, bulimia and binge eating disorder
drug misuse

These therapies can also benefit you if you're dealing with significant emotional problems, including stress, bereavement, divorce, redundancy, or relationship problems.

Types of counselling and psychotherapy

Several different treatments are available.

psychodynamic (psychoanalytic) psychotherapy
cognitive behavioural therapy (CBT)
cognitive analytical therapy (CAT)
humanistic therapies
interpersonal psychotherapy (IPT)
family and couple (systemic) therapy

Other types of therapy may also be available in your area. The type of therapy that's most suitable for you will depend on the problem you have.

How can I get psychotherapy?

If you think you might benefit from therapy, the best place to start is with your GP. Your GP or another healthcare professional may be able to refer you to a qualified therapist for free treatment on the NHS. However, waiting lists for NHS treatment are often long.

You can choose to pay for private treatment - if you do, it's important to make sure your therapist is registered with a recognised professional organisation. You should also be aware of the costs. Typically, a 50-minute one-to-one session can range from £40 to £100.

Finding counselling and psychotherapy services

When looking for a therapist, make sure they're fully qualified and, if appropriate, that they have experience of treating your specific condition.

Your GP may be able to recommend a service locally, or you can check one of these registers of qualified therapists:

Counselling & Psychotherapy in Scotland (COSCA)

British Association for Counselling and Psychotherapy (BACP)

UK Council for Psychotherapy (UKCP)

The National Counselling Society

Different therapies and how they work

One of the key objectives of counselling and psychotherapy is to help you gain a better understanding of the issues that are troubling you.

Therapy can help you work out new ways of approaching situations that you find difficult, as well as suggesting new methods to help you cope.

Developing a trusting relationship with your therapist is very important, and will help you be able to talk about long-standing problems. However, this can take time.

Depending on the type of therapy you have and the reason you're having it, your treatment may need to last several months or, in some cases, years.

Types of counselling and psychotherapy

There are many different therapies. The type used will depend on your personal needs and which method your therapist thinks will be most helpful for resolving your issues.

Some of the main types of therapy are:

Psychodynamic (psychoanalytic) psychotherapy

A psychoanalytic therapist will encourage you to say whatever is going through your mind. This will help you become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems.

Art, music and movement therapies often use similar methods to psychodynamic therapy, but encourage you to express yourself and communicate in other ways as well as talking. Even young children can take part – this is known as play therapy. You don't need to have musical or technical skills for this type of therapy to be successful.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a treatment based on a combination of cognitive therapy and behavioural psychotherapy.

Cognitive therapy explores ways your thoughts and beliefs may be causing emotional problems. Your therapist will discuss these issues with you so you can try to develop more helpful ways of thinking to allow you to overcome your problems.

Behavioural psychotherapy involves finding ways to help you change the way you act. It's often used to overcome a specific fear or phobia by encouraging you to gradually face these fears and help you relax and feel comfortable as you do it.

During CBT, you and your therapist agree on tasks for you to do in between sessions. This will help you deal with problems yourself so you no longer need therapy.

CBT is usually aimed at a specific problem and the courses are often brief, typically involving 6 to 20 sessions.

Cognitive analytical therapy

During early sessions of cognitive analytical therapy (CAT), you'll discuss events and experiences from your past to help you understand why you feel, think and behave the way you do now.

After the first few sessions, your therapist will write down what you've discussed on paper, and will work with you to map out problem patterns that have emerged to help you understand how these problems occurred.

Your therapist will use this to help you figure out ways of changing these problem patterns. They may suggest using diaries and progress charts to help you develop skills you can use to continue improving after the therapy sessions have finished.

Like CBT, a course of CAT is often brief. It may involve about 16 sessions.

Humanistic therapies

Humanistic therapies encourage you to explore how you think about yourself and recognise your strengths. The aim is to help you think about yourself more positively and improve your self-awareness.

There are a several types of humanistic therapies.

Person-centred counselling aims to create a non-judgmental environment where you can feel comfortable talking about yourself and are able to see that you have the ability to change. Your therapist will try to look at your experiences from your point of view.

Gestalt therapy takes a holistic approach, focusing on your experiences, thoughts, feelings and actions to help improve your self-awareness. This type of therapy often involves activities such as writing or role-playing.

Transactional analysis aims to explore how the problems in your life may have been shaped by decisions and teachings from childhood. You'll work with your therapist to help you find ways to break away from these unconscious repetitive patterns of thinking and behaving.

Transpersonal psychology encourages you to explore who you really are as a person. It often involves using techniques such as meditation and visualisation.

Existential therapy aims to help increase your self-awareness and make sense of your existence. Existential therapy is not too concerned with your past, but instead focuses on the choices to be made in the present and future.

The Counselling Directory website has more information about the different types of humanistic therapies.

Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) has been shown to be particularly effective in treating depression.

Your therapist will be interested in the link between your relationships with others and your emotional problems. They will help you develop new approaches to dealing with interpersonal difficulties to help improve your mental health.

IPT usually involves about 12 to 16 sessions.

Family and couple (systemic) therapy

Family therapy focuses on family relationships, such as marriage, and encourages everyone within the family or relationship to work together to fix problems.

The therapist encourages group discussions or exercises that involve everyone, and promotes a healthy family unit as a way of improving mental health.

In some cases, there may be more than one therapist involved to make sure everyone involved in the therapy has their say.

Accessing counselling and psychotherapy

Counselling and psychotherapy are available in some areas of the NHS by referral from your GP.

However, there are often long waiting lists, so you may want to consider seeing a private therapist.

Mental health specialists, including counsellors and psychotherapists, already work in some GP surgeries. If there is not one available in your surgery, your GP may be able to refer you to a:

community mental health team (CMHT), which decides what treatment is needed and refers you to a specific member of the team or to a specialist psychotherapy service
specialist psychotherapy service, which carries out an assessment to determine appropriate treatment and refer you to one of its teams of psychotherapists
consultant psychiatrist in psychotherapy, who is trained and experienced in a wide variety of methods and can work out which treatments are needed

If you're already seeing a psychiatrist or a local mental health team, they may be able to help you get psychological therapy as part of your treatment.

You may also be able to refer yourself for counselling if this is an option in your local area. This means you can go directly to a professional therapist without seeing your GP first.

Private counselling or psychotherapy

You can also arrange to see a therapist privately.

There is no statutory regulation of counselling in the UK. This means that anyone can practice as a counsellor, even if they have no qualifications or experience.

You should choose a therapist from an organisation with an accredited register, such as:

Your GP may also be able to recommend a qualified psychotherapist in your local area.

Different therapies may be recommended for different disorders. It's important to make sure you choose a therapist you're happy with, as a good relationship with them is crucial if you're to get the most out of treatment.

The cost of private psychotherapy will depend on the type of therapy and the individual therapist. Ask how much each session will cost and agree on a price beforehand. Typically, a 50-minute one-to-one session will range from £40 to £100.

Self-help therapies

In some cases, you may find it helpful to try an online self-help psychotherapy course instead of seeing a therapist.

A range of online resources for depression, anxiety and other mental health problems are available. Research shows they can be just as effective as having face-to-face therapy with a therapist.

They're also often available free on the NHS and mean you don't have to be put on a potentially long waiting list before getting treatment.

Explore mental health self-help guides on NHS inform

Explore online mental health and support from Silvercloud