What is counselling?
Counselling is a type of talking therapy that allows a person to talk about their problems and feelings in a confidential and dependable environment.
A counsellor is trained to listen with empathy (by putting themselves in your shoes) and they can help you deal with any negative thoughts and feelings you have.
Sometimes the term "counselling" is used to refer to talking therapies in general, but counselling is also a type of therapy in its own right.
Other psychological therapies include psychotherapy, cognitive behavioural therapy (CBT), and relationship therapy, which could be between members of a family, a couple, or work colleagues.
What is counselling used for?
Talking therapies such as counselling can be used to help with many different mental health conditions, including:
- borderline personality disorder (BPD)
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- long-term illnesses
- eating disorders, such as anorexia and bulimia
- drug misuse
How counselling can help
Counselling aims to help you deal with and overcome issues that are causing emotional pain or making you feel uncomfortable.
It can provide a safe and regular space for you to talk and explore difficult feelings. The counsellor is there to support you and respect your views. They won't usually give advice, but will help you find your own insights into and understanding of your problems.
Counselling can help you:
- cope with a bereavement or relationship breakdown
- cope with redundancy or work-related stress
- explore issues such as sexual identity
- deal with issues preventing you from achieving your ambitions
- deal with feelings of depression or sadness, and have a more positive outlook on life
- deal with feelings of anxiety, helping you worry less about things
- understand yourself and your problems better
- feel more confident
- develop a better understanding of other people's points of view
Counselling can often involve talking about difficult or painful feelings and, as you begin to face them, you may feel worse in some ways. However, with the help and support of your therapist, you should gradually start to feel better.
In most cases, it takes a number of sessions before the counselling starts to make a difference, and a regular commitment is required to make the best use of the therapy.
What to expect from counselling
During your counselling sessions, you'll be encouraged to express your feelings and emotions. By discussing your concerns with you, the counsellor can help you gain a better understanding of your feelings and thought processes, as well as identifying ways of finding your own solutions to problems.
It can be a great relief to share your worries and fears with someone who acknowledges your feelings and is able to help you reach a positive solution.
Counselling can take place:
- face to face
- individually or in a group
- over the phone
- by email
- using a specialised computer programme
You may be offered counselling as a single session, as a short course of sessions over a few weeks or months, or as a longer course that lasts for several months or years.
Trusting your counsellor
A good counsellor will focus on you and listen without judging or criticising you. They may help you find out about how you could deal with your problems, but they shouldn't tell you what to do.
For counselling to be effective, you need to build a trusting and safe relationship with your counsellor. If you feel that you and your counsellor aren't getting on, or that you're not getting the most out of your sessions, you should discuss this with them, or you can look for another counsellor.
If you're seeing an NHS counsellor attached to your doctor surgery, your doctor may be able to arrange for you to see another NHS counsellor. Alternatively, you could pay to see a private counsellor. Many counsellors and counselling organisations offer a sliding scale of fees where the more sessions you have, the cheaper it becomes.
Who provides counselling?
As counselling involves talking about sensitive issues and revealing personal thoughts and feelings, your counsellor should be experienced and professionally qualified.
Different healthcare professionals may be trained in counselling or qualified to provide psychological therapies. These include:
- counsellors – trained to provide counselling to help you cope better with your life and any issues you have
- clinical and counselling psychologists – healthcare professionals who specialise in assessing and treating mental health conditions using evidence-based psychological therapies
- psychiatrists – qualified medical doctors who've received further training in diagnosing and treating mental health conditions
- psychotherapists – similar to counsellors, but they've usually received more extensive training; they're also often qualified applied psychologists or psychiatrists
- cognitive behavioural psychotherapists – may come from a variety of professional backgrounds and have received training in cognitive behaviour therapy; they should be registered and accredited with the British Association for Behavioural & Cognitive Psychotherapies (BABCP)
In 2010 the government announced plans to make psychological therapies widely available on the NHS. This is because they've been shown to be effective treatments for common mental health conditions. The programme is called Improving Access to Psychological Therapies (IAPT).
As a result of the IAPT programme, evidence-based psychological therapies can now be accessed through:
- doctor surgeries
- the workplace – most workplaces now offer access to a counselling service, sometimes in-house but more often through an Employee Assistance Scheme
- universities, schools and colleges – UK universities and many further education colleges provide an in-house counselling service for their students; school-based counselling is universal in Wales and Northern Ireland, but provision is more patchy throughout the rest of the UK
- some voluntary and charitable organisations
IAPT services offer a range of psychological therapies, including individual and group-based therapy. While a group may seem a bit intimidating at first, many people find that once they've overcome this worry, they really benefit from sharing and meeting with other people.
If you're referred for counselling or another psychological therapy through the NHS, it'll be free of charge. However, your choice of the type of therapy may be limited. If you have a preference for the type of therapy you receive or the time or location of your appointments, you may choose to look for a private therapist.
If you decide to pay to see a private therapist, make sure they're qualified and you feel comfortable with them. The cost of private counselling can vary considerably. Some therapists may be willing to adjust their fees in accordance with your income.
Many private counsellors offer an initial free session and concessionary rates for students, job seekers and those on low wages. You should ask about charges and agree on a price before starting a course of counselling.
Charities and voluntary organisations
Some charities and voluntary organisations also offer counselling. These organisations usually specialise in a particular area, such as couples counselling, bereavement, or family guidance.
Charities that may offer counselling include:
- Cruse Bereavement Care – provides bereavement advice and support
- Relate – offers relationship advice and counselling
- Rape Crisis – for women and girls who've been raped or sexually abused
- Victim Support – provides victims and witnesses of crime with help and support
You may also be able to access support groups through your local community, church, or social services.
Finding a qualified counsellor
Most reputable counsellors will be registered with a professional organisation that's been accredited by the Professional Standards Authority (PSA) (a government body).
Counselling and clinical psychologists must be registered with the Health & Care Professions Council (HCPC), and may also be chartered with The British Psychological Society (BPS).
The British Association for Behavioural & Cognitive Psychotherapies (BABCP) maintains a list of accredited CBT practitioners.
Therapists registered with a professional association have met the PSA's requirements for governance, standard-setting, education and training, information, management and complaints. They must also maintain high ethical and professional standards. This gives the public greater protection and guarantees a minimum level of training and continuing professional development.
The PSA's website allows you to check a practitioner in 3 simple steps.
As well as counselling, there are many other types of psychological therapies, including psychotherapy and cognitive behavioural therapy (CBT).
Like counselling, the term "psychotherapy" is sometimes used to refer to talking therapies in general. However, psychotherapy is also a specific type of therapy. It may also be described as psychoanalytic or psychodynamic.
Psychotherapy is a more in-depth form of therapy than counselling, and it can be used to address a wider range of issues.
A psychotherapist can help you explore your thoughts, feelings and beliefs, which may involve discussing past events, such as those from your childhood.
They'll help you consider how your personality and life experiences influence your current thoughts, feelings, relationships, and behaviour. This understanding should enable you to deal with difficult situations more effectively.
Depending on your problem, psychotherapy can be short or long term. Adults, young people and children can all benefit from psychotherapy. Sessions can take place on a one-to-one basis, in couples, families, or in groups whose members share similar problems.
The Improving Access to Psychological Therapies (IAPT) programme provides a type of specific evidence-based brief psychotherapy called dynamic interpersonal therapy (DIT). This offers a focused approach over 16 sessions of therapy.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a talking therapy that helps you understand the links between thoughts, feelings and behaviour. This allows you to manage your problems by helping you change the way you think and behave.
CBT doesn't remove your problems, but helps you manage them in a more effective way. It encourages you to examine how your actions and thoughts can affect how you feel.
It's based on the idea that the way you think about a situation affects how you feel and act. In turn, your actions influence the way you think and feel. It's therefore necessary to change both thinking (cognition) and action (behaviour) at the same time.
CBT is an active therapy, and you'll be expected to work on your problems between sessions, trying out different ways of thinking and acting, as agreed with your therapist. The aim is for you to develop the skills to become your own therapist.
CBT is usually a short-term treatment. For example, a course may consist of between 6 and 24 1-hour sessions.
The National Institute for Health and Care Excellence (NICE) recommends the use of CBT for:
- panic disorder
- obsessive compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- long-term illnesses
- eating disorders, such as anorexia and bulimia
CBT is widely available on the NHS for treating depression. If you feel CBT may be helpful, you should first discuss it with your doctor.
Private therapists are also available. Before starting CBT with a private therapist, you should check the therapist is accredited by the British Association for Behavioural & Cognitive Psychotherapies (BABCP).
Computerised CBT (CCBT) packages are also available. CCBT is delivered in a series of weekly sessions and should be supported by a healthcare professional. NICE recommends CCBT for some people with depression.
Humanistic therapy incorporates your body, mind, emotions, behaviour, and spirituality. It encourages you to think about your thoughts and feelings, and take responsibility for your actions.
A humanistic approach provides a distinct method of counselling and focuses predominantly on an individual's unique personal potential to explore creativity, growth, love, and psychological understanding.
Group therapy aims to help you find solutions to your problems by discussing them in a group setting. Sessions are led by a facilitator who directs the flow of conversation.
As well as group therapy, many people find psychoeducational groups or courses very helpful. These provide information and skills without having to discuss personal problems in-depth.
NICE recommends group therapy for people with obsessive-compulsive disorder (OCD), and for children and young people with mild depression.
Many people are initially anxious about attending a group, but find they benefit from meeting people who share the same experiences and work together to overcome them.
Relationship therapy is where people who are having relationship difficulties work with a therapist to resolve their problems. It can be used to help couples, family members, or work colleagues.
NICE recommends relationship therapy for people who've tried individual therapy without success.
Family therapy can be used for children with depression, or where a family member has a mental health condition, such as anorexia or schizophrenia.
Mindfulness-based therapies help you focus on your thoughts and feelings without becoming overwhelmed by them.
They can be used to help treat depression, stress, anxiety, and addiction. Techniques such as yoga, meditation and breathing exercises can also be incorporated.
NICE recommends mindfulness-based therapies to help people avoid repeated bouts of depression.
Eye movement desensitisation and reprocessing
Eye movement desensitisation and reprocessing (EMDR) is a treatment that uses eye movements to stimulate the brain. It's been shown to make distressing memories feel less intense.
EMDR can help a person deal with traumatic memories, such as those that occur after an accident, or after sexual, physical, or emotional abuse.
In particular, NICE recommends EMDR for treating post-traumatic stress disorder (PTSD).
Samaritans provides a confidential listening service for people who would like to talk about whatever is troubling them. Everything is off the record and without judgement.