- Who do I need – a psychotherapist or a counsellor?
- What qualifications should my psychotherapist or counsellor have?
- What sort of therapy do I need or will suit me?
- What do I need to know before I commit to therapy?
The above are among the most common concerns for anyone considering embarking upon a course of psychotherapy or counselling. It is ironic that there exists so little readily available information about how to prepare for a process which will inevitably involve a considerable investment of time, and if you seek private help, money. Furthermore, whether it’s good or bad, your experience of therapy is likely to be something that stays with you for some time, and can potentially influence what you go on to do in life. With that much at stake, it makes sense to pause, think about your needs and do a little research before signing up with first practitioner you come across.
Psychotherapist or Counsellor?
What’s the difference? This is a question which even psychotherapists and counsellors struggle to answer satisfactorily. The traditional response has always been that psychotherapy is about exploring issues and problems in more depth, but this is not always the case, as increasing numbers of psychotherapists practice “brief therapy” and counsellors move towards long-term work.
Another response to the question is that psychotherapists have generally trained to a more advanced level – the minimum length of training for psychotherapists is 4 years of post-graduate work, although many will have trained for considerably longer, especially if they also have a background in psychology or psychiatry. They will also have been required to be in therapy themselves for at least the length of their training, so as to better understand both themselves and the complexity of the therapeutic process. By contrast, the average length of a full counsellor training is three years, often at under-graduate level. Counsellors will usually only have been required to experience a maximum of 40 counselling sessions, with some courses requiring only a fraction of that.
While many experienced counsellors can also provide an excellent service for difficult cases, if you have particularly complex problems or if you are seeking personal growth, you will probably benefit from working with a psychotherapist rather than a counsellor.
Is My Therapist Qualified?
Far more important than what the practitioner calls him or herself are his or her professional credentials. What type of training did he or she have? How long did it last? Is he or she accredited by one of the mainstream professional bodies?
Unlike lawyers, doctors and some other key professions, it is not currently a legal requirement within the UK for anyone calling themselves a counsellor or psychotherapist to have followed a particular training schedule – or indeed, to have had any training at all. It is likely that this situation will have changed by 2012, when all practitioners of psychological therapies will be legally required to be registered and in order to practise, to have followed a prescribed training and post-qualification programme.
The fact that there is currently no statutory registration process in no way means the profession is a hotbed of charlatans. For many practitioners, legal registration will simply be another checkbox to fill, since they are already members of a professional body which has strict requirements for the education, experience, standards and continued professional development of its members. The main professional bodies for psychotherapy and counselling, each of which will be the means by which members will be eligible for entry onto the statutory register in 2012 are as follows:
As a minimum, you should ensure that your chosen psychotherapist or counsellor is a full accredited member of one or more of these bodies – several of them permit training/associate membership for individuals who are still in training. In order to become a full member of any of these professional associations, a practitioner will need to have successfully completed an approved training course and to have completed a minimum of 450 hours working face-to-face with clients. In addition, he or she may have had to meet a number of written requirements demonstrating his or her competence to practise.
What Kind of Therapy or Counselling?
There are dozens of different types of therapy (also referred to as therapeutic orientations or modalities). All have the same goal – bringing about an improvement in psychological health – but the means they use to achieve that goal can vary greatly. Knowing which orientation is likely to be the most suitable for you is going to be difficult if you know nothing about psychotherapy and counselling. However, don’t let this worry you too much. There is evidence to demonstrate that a significant determinant in the success of therapy is the relationship between the therapist and the client/patient (often referred to as “the therapeutic relationship”).
Here’s a brief outline for some of the most popular therapy orientations practised in the UK:
Analytic and Psychodynamic Therapies
These very traditional therapies draw on the works of early psychotherapists such as Freud, Jung, Klein and Adler. Focus is on using therapy to bring about an understanding of the link between the client’s (here called patient) early experiences and relationships and the way he or she now is in the world. Therapists who work in this way to use the therapeutic relationship to help the client explore very deep feelings he has has about himself and the people he is close to. Such therapists tend to say very little, allowing the client to explore his own thoughts. Clients may be encouraged to lie on a couch in order to better concentrate on themselves. Therapy may take place weekly, but is often more frequent – up to four times per week.
Cognitive Behavioural Therapy (CBT)
Particularly good for people who have specific problems such as depression, anxiety, panic, OCD, phobias. Its chief premise is that people are hampered by their negative thoughts and assumptions, which they lead to them making huge generalisations about the catastrophic nature of their lives. Thus for example, that spider lurking under the bed will definitely find its way into the client’s ear, lay eggs, then go on to produce an inoperable brain tumour, or the fact that one’s partner doesn’t call at least once every exactly 24 hours must mean that he or she is having an affair.
Transactional Analysis (TA)
Helps individuals resolve their psychological issues by helping them understand the ways in which they relate to the world. Focuses on Ego states – Parent, Child Adult and works to help clients move towards free and appropriate movement between these states.
Focuses on personal growth and emotional healing through awareness of self, intellectually, emotionally and bodily.
Person-Centred Therapy (also known as Rogerian therapy)
Is non-directive, with the therapist demonstrating an unconditional positive regard for the client so as to encourage the client towards a similar acceptance of self.
As we’ve said above, there are very many more forms of therapy – some are a mixture of the above, others are completely distinct. Therapy doesn’t have to be done individually – many therapists work with couples, families and groups. There are even forms of psychotherapy which include touch and exercise as means of re-connecting the mind with the body.
Talk to potential therapists about their training, type of therapy they are currently using and how they use it. There is absolutely no need to remain in the dark about your own therapy – you may not understand everything that is happening in the beginning phases, but in order for your therapy to be successful, you and the practitioner need to be able to build sufficient trust to facilitate a therapeutic working environment – this comes through being clear about the terms of engagement.
One of the mistakes beginning clients often make is to rush into a working relationship without taking time to consider. Most of us will automatically shop around when it comes to making a major purchase. While price is nearly always a consideration, whether it’s a car, a washing machine or a hi-fi, making sure our potential purchase is able to to what we need it to is even more important. This being the case, why do people find it so difficult to ask for “thinking time” when it comes to selecting a therapist?
After ensuring your therapist is properly qualified, the single most important question you should be asking yourself as you leave your first appointment is, “Did I like him/her”? A string of qualifications cannot compensate for the one thing that is the vital ingredient for successful therapy – an interest between two people. You don’t have be best buddies (indeed, over-familiar behaviour is to be strongly discouraged), but you do need to have a basic liking and respect for each other.
I always encourage would-be clients to go away and think out our initial session before making any further commitment – even go meet one or two other therapists. I would much rather clients be enthused and certain about working with me when they start, rather than wander blindly in, then make an excuse to leave a few weeks later.
11 Steps To a Solid Therapeutic Relationship
You’ve identified the type of therapy you want, you found someone suitably qualified who you trust, but there are still a raft of questions that need addressing before you commit to therapy. Some may have already been addressed or answered before you meet your therapist for the first time, others may emerge as you move towards making a commitment. I like to draw up a list of important issues as a “contract for working” which we both sign – it identifies the rights and responsibilities my client and I have towards each other. Without or without a document of this sort, before you begin working, you should find out the following;
- Exactly when will sessions take place, for how long and where?
- What arrangements exist if you arrive early?
- Accessibility – public transport, parking, steps, wheelchair access, toilet facilities?
- How much do sessions cost? When and how is payment to be made? Are reduced fees available?
- Arrangements for missed sessions and holidays? Are there cancellation charges?
- With whom will information about you be shared? (Usually only the therapist’s clinical supervisor. Confidentially should always be observed except when the therapist has serious concerns about your safety or that of people around you). Are any recordings of sessions to be made?
- Do any rules about what you can do or say in sessions exist?
- What are the terms under which you can contact the therapist outside sessions?
- What is the name and address of the therapist’s professional association?
- Does the therapist have professional liability insurance?
- Is there any indication of how long the therapeutic relationship is expected to last, or is it open-ended? What are the arrangements for ending therapy?
On paper, it can seem like you have to know an awful lot to avoid potential pitfalls when choosing a suitable psychotherapist or counsellor. Happily, it’s a lot simpler in real life. Experienced therapists meet new people all the time. Most are nervous, uncertain about what they need and what questions to ask. As therapists, we recognise this, so we try to have all the answers to hand, even before you ask. Take your time – if you need more information, you can always ask for it later on.
Remember, therapy is for life – even when you’ve finished, so get it right first time!