The time has come for you to look after your mental health, and the process of looking for a therapist can be a daunting experience. I still remember vividly the feeling of having to navigate the mental health world without knowing what it was all about. In this blog post, I’ll shed some light on the counselling profession with the hope that it will offer enough clarity to find a counsellor confidently.
In this blog post, I will share:
- types of mental health professionals
- professional bodies
- accessing therapy
- types of therapy
- delivery of therapy
- where to look for a counsellor/psychotherapist
1. Types of mental health professionals
Counselling, Psychotherapy, Psychology and Psychiatry: what are the differences?
By far, this is the most frequent asked question, and I have to admit, it was mine too when I needed psychological support, and I did not know how to go about it. Knowing what types of mental health professionals are out there and what their remit is can allow you to decide who’s the best person to support you. For the scope of this blog post, the following points will focus only on counselling and psychotherapy.
First things first, psychiatry is different from counselling, psychotherapy and psychology in which psychiatrists are doctors who specialise in psychiatry. They are the only ones who can diagnose and prescribe medication among mental health professionals and run medical examinations and tests. Psychiatrists do not offer talking therapy. A brief note: your GP can prescribe medication and give a diagnosis for common problems such as depression and anxiety, whilst a psychiatrist will offer diagnoses
Psychologists obtain their degree in Psychology, and some titles are legally protected (like clinical psychologist). Their work is either research-oriented or applied (the latter meaning they treat clients). There are different specialisations based on either type of assessment or therapy). Clinical psychologists can diagnose, but they cannot prescribe medication. The main difference between counselling/psychotherapy and psychology is in perspective and training, and they are specialised in working in a specific field (forensic, health, clinical, counselling).
COUNSELLING AND PSYCHOTHERAPY
When talking about counselling and psychotherapy, the distinction becomes a bit more complicated. Partly, this is due to a lack of legislation regulating the profession, making the titles of counsellor and psychotherapist non-protected. Partly, the distinction between counselling and psychotherapy differs from country to country, creating confusion on whom to turn to for those who need help and are from abroad. For example, in Italy, my home country, psychotherapist is a protected title, and only those with a psychology degree who undertook a four-year specialisation in psychotherapy can use that title and register with the Italian psychology society. In the UK, a psychotherapist doesn’t need to train in psychology to practice.
ARE COUNSELLING AND PSYCHOTHERAPY THE SAME?
I would argue that counselling and psychotherapy are on a continuum. Whilst counselling supports you in dealing with a here and now and tends to be more short-term, psychotherapy focuses on the there and then (the past), and it is long-term. Differences lie in the length of training and entry route, the way they formulate and work with distress and the client’s presentation, and, as mentioned, the focus of the sessions. It goes without saying that during a counselling session, you could also explore historic issues and patterns in the same way you would look at present issues in psychotherapy.
Neither counsellors nor psychotherapists can diagnose or prescribe any pharmacological treatment.
In my case, for example, I do have a Postgraduate Diploma in Counselling and Psychotherapy, and I do offer both.
2. Professional bodies regulating the counselling and psychotherapy profession
As mentioned before, counselling and psychotherapy are not protected in the UK. Despite the lack of government regulations, several professional bodies regulate the profession nationwide. These professional bodies ensure that members meet specific requirements (such as extensive training and practice)and professional standards and abide by a code of ethics and complaints procedure. Although counsellors and psychotherapists are not required by law to join a professional body, accessing a therapist who is part of one provides an extra layer of reassurance.
The several professional bodies that are populating the counselling and psychotherapy profession need to be on a register accredited by the Professional Standards Authority for Health and Social Care. Again, this demonstrates a commitment to high standards and public protection. I am currently registered with COSCA.
You can find more information about this in a complementary resource I compiled to support you in finding a therapist.
3. Accessing counselling and psychotherapy
Counselling and psychotherapy provision is offered by a variety of services, which means that you can access counselling through different providers.
This is a free service. There are differences in the ways you can access talking therapies depending on whether you live. Primary health care services (such as your GP) would be able to help. There’s usually a waiting list, and it’s time-limited (up to 12 sessions). For trauma counselling, accessible through your GP, you are offered up to two years of therapy, but the waiting list can be over a year long.
Counselling services in charity settings are usually free of charge or by donation. Nowadays, there are fewer and fewer services offering open-ended therapy. Like in statutory services, the waiting list can be long, and it’s time-limited (up to 20 sessions depending on the counselling service). A simple search of local counselling services on a search engine can be quite fruitful.
Some local community centres offer free or donation-based counselling to people within their community. This includes centres of faith, social enterprises or community centres, to name a few.
Therapy is provided by Employment Assistant Programmes (EAPs) through your workplace as part of your company benefits (if you have any). Therapy can be accessed through your manager for work-related issues. It is time-limited.
SCHOOL, COLLEGE, UNIVERSITY
Time-limited therapy offered by your institution with varying waiting times, free of charge. Counselling services are advertised on the institution’s website.
This is when you approach a private therapist, and it is a paid-for service. Fees vary from therapist to therapist and are region-sensitive, and the length of therapy depends on the way of working of the counsellor/psychotherapist you contact. Some therapists may have a waiting list and offer a sliding scale.
4. Types of therapy
There are many types of therapy out there, and finding the right fit can be quite challenging, let alone finding a therapist you gel with. That said, research suggests that the most important factors for a positive therapeutic outcome are the relationship between client and therapist and the belief that the approach used is the right one. A meta-analysis on the efficacy of different therapeutic approaches was carried out throughout the years showing that there are only trivial differences among approaches. Ultimately, it is also down to other factors: the client’s readiness for therapy and the counsellor/psychotherapist’s continuous professional development, skills and attitudes.
That said, you can have different types of therapies based on the approach and techniques used, the focus of the sessions/therapy and the theory underpinning the therapeutic work. When going through the list, please bear in mind that the therapeutic world is constantly evolving, and not all therapies will be mentioned there. If you are interested in knowing more, in the complementary resource I compiled, I link to a website where you can find an exhaustive list of all approaches.
This type of therapy uses materials, tools and/or your body to express and process emotions through creative processing guided by an experienced therapist. The following are some examples of therapies using creative arts: music therapy, psychodrama, art therapy, etc.
This type of therapy focuses on the inner capacity of the person to heal by focusing on the relationship the person has with themselves, others and the world around them. It helps the client to develop a strong sense of self, explore feelings and find meaning. Some examples of approaches within this umbrella are existential, gestalt, person-centred and phenomenological, to name a few. Solution-focused brief therapy is also part of humanistic therapies. As the name suggests, it is time-limited and is based on solution-building rather than problem-solving.
COGNITIVE AND BEHAVIOURAL
By focusing on either cognitive or behavioural patterns that a person is finding distressing, a therapist offering cognitive, behavioural or cognitive-behavioural therapy would support the client to change those patterns. They are aided by worksheets. Some examples of this type of therapy are Cognitive Behavioural Therapy (known as CBT), Dialectical Behavioural Therapy (known as DBT), relational-emotive therapy or Cognitive Analytic Therapy (known as CAT).
PSYCHOANALYSIS AND PSYCHODYNAMICS
This type of therapy focuses on bringing unconscious meaning and motivations to the surface with a particular focus on the relationship between client and therapist.
This form of therapy is used for children by therapists who have specialised and done further training in working with children and young people. Play is used to support the child to explore and process what is going on for them.
Therapists who identify with this type of therapy don’t subscribe to one approach, although they may lean towards one more than others. They integrate two or more types according to the client’s presenting needs and the therapist’s predispositions/interests.
This type of therapy is mainly carried out outside. According to the approach used, you would have further integration of natural elements into the sessions. Some examples of nature-based therapy are therapy outdoors, animal-assisted programmes (usually involving horses or dogs), adventure and wilderness therapy and therapeutic farming and or horticulture.
5. Delivery of therapy
Counselling and Psychotherapy sessions can happen in different spaces. Choosing a space that feels right for you is important as it would offer you the necessary comfort and privacy to do therapeutic work.
This is a traditional setting, the one that we may imagine when we think of therapy. According to the type of therapy offered, the access route to therapy and your therapist’s room arrangements, counselling/ psychotherapy can take place in a variety of indoor places.
Examples of indoor spaces range from rooms in private lettings, holistic centres, GP practices and universities, to name a few.
Online therapy is offered in various formats. The two most common ones are video and telephone therapy, using conferencing services or a mobile device. This way of accessing therapy allows for connecting to therapists who do not live in your area, it may overcome some accessibility issues, reduce potential commute time and fit better in a busy schedule. There are other two less popular ways of accessing therapy: instant messaging and email.
Instant messaging works like video and telephone counselling, but the session will develop using an instant messaging system. Emails help you witness your experience from a safe distance, and they promote a sense of authorship by allowing you to tell your story the way you want and mean it. Due to the nature of emails that do not allow for immediacy in contact, this way of delivering therapy is better suited for people who are not in a crisis.
Therapy outdoors can take place in different settings, depending on your therapist’s availability. Some of these spaces may be from urban parks and woodlands, the coast, paths along the canal, to more remote areas. Working outdoors can take different forms, from sitting on a bench or chair to walking freely. The way the session goes depends on a conversation between you and your therapist so you can negotiate what works for you.
The majority of training teaches about one or multiple approaches, and when we first start our counselling career, we tend to work for a generic service. This means that most counsellors and psychotherapists can work with the most common presentations (such as anxiety and depression), and later in their careers, they may specialise in one or two areas.
There are, though, a few exceptions to this statement.
First thing first, if you are looking for counselling for adoption in the UK (meaning, your life is affected by adoption), the 2010-amendments to the Adoption and Children’s Act of 2002 state what the lawful boundaries are in relation to therapy in this area. On one hand, only counsellors and psychotherapists registered as an adoption support agency with Ousted are able to offer specialist adoption services (such as therapists working for Barnardo’s Link Counselling service or PAC-UK (Voluntary Adoption Agencies in Northern Ireland). On the other hand, if you are looking for a private therapist, they must be registered with Ofsted (RQIA for Northern Ireland); this is a public register.
COUPLE, GROUP, FAMILY
If you are looking for couple counselling, group or family therapy, I would recommend you approach therapists who obtained further training in these areas of work. This is due to the relational complexity that is inherent when working with more than one person in therapeutic settings. Therapy with more than one person tends to be overall cheaper per head. Group therapy has also the advantage of including peer support and camaraderie, learning from other experiences and supporting you with your social skills.
CHILDREN AND YOUNG PEOPLE
Therapy for children and young people (under the age of 16) is offered by counsellors/ psychotherapists who have had further training in the field.
What should I know about specialisation?
If you are interested in working with someone who specialises in an area that is affecting you, you may look at the person’s further training or if they have worked or volunteered in a specialised service. Specialisation simply means that a counsellor/ psychotherapist had a specific interest in an area of their work and studied it further whilst still being competent to work with the majority of presentations (due to rigorous training to become a therapist). It is good practice (ethical, I may add) for a counsellor to refer on if they feel like they are not in a position to support you. For reference, some areas therapists may specialise in are substance or alcohol use (known as addiction), relationship with food and body image (known as eating disorders), trauma, sexual abuse, domestic abuse, and dissociative processes, to name a few.
And if you are from abroad and are looking for someone who speaks your language (or etchinity, faith, etc), there is also an option to look for a counsellor/ psychotherapist who does. For example, I do offer therapy in Italian and English and I have a particular interest in working cross-culturally (and I wrote a blog post about it that you can find here)
7. Where to look for a counsellor/ psychotherapist
If you have made this point and still wondering how to go about looking for a counsellor, look no further. This chapter will offer some pointers on how to find one.
Word of mouth
If talking to friends and family about your mental health doesn’t feel safe, social media are a great place where to ask peers for help in a way that still feels private. For example, most FB groups offer an anonymous posting option where you could ask these questions.
The most known directory listings in the UK are Psychology Today (also for the USA) and Counselling Directory. You would be able to find therapists based on the vicinity, approach, areas of interest and sex.
Directory listing of professional bodies
These listings are open to therapists who are registered with that professional body, meaning that they have already passed all the necessary vetting required to join as a member (for example, I can be found on COSCA open register).
Some private therapists, like myself, and counselling services are advertised through Google My Business. This means that you can find them by searching on Google Maps. Some private therapists also have an online presence through blogging, podcasting and YouTubing, and they can be found on most search engines, whilst others opt for creating a business interface on various social media platforms.
I hope this post has helped to clarify some of the questions you may have about this profession. I have created a complementary resource, a journey to support you to formulate questions to ask therapists when you contact them.
When I am working with someone who accesses therapy for the first time, I always give the same type of advice. Ultimately, when you meet with a therapist, it may feel uncomfortable: you are talking about yourself and sharing your struggles with someone who is, at that stage, a complete stranger. Despite being at times awkward and difficult, if not uncomfortable, therapy should never make you feel shamed, unheard or not accepted. Meeting with a therapist is a very human experience, and as such, there may be therapists with whom we click instantaneously, whilst with others, it can feel extremely difficult. Challenges will happen in therapy, and you deserve someone who can attend to them with support rather than friction.
If you have read to this point and feel like I may be the right person for you (by browsing the rest of my website and blog posts), why not get in touch?