Questions about Psychotherapy / Counselling
For many people psychotherapy can feel like something of a mystery before commencing and in the early days of your work with your therapist. Here are some answers to questions that clients, patients and friends often ask me. If you would like more information or have a query that is not listed here, feel free to contact me and I will do my best to help you or point you in the right direction.
For an appointment please contact me: denise.dunne@gmail.com or +44 (0) 782 535 1919. I aim to offer an initial consultation within a week of your enquiry.
For an appointment please contact me: denise.dunne@gmail.com or +44 (0) 782 535 1919. I aim to offer an initial consultation within a week of your enquiry.
What is the difference between psychiatry, psychotherapy, psychology and counselling?
This is a question I get asked really frequently. Basically, if you are looking for talking therapy, you need someone who has officially recognised specific training in providing psychotherapy. While all of the above mental health professions can have this training, you cannot assume that they do, and you should always look for evidence of training.
Psychiatrists are medical doctors who have specialised training in mental health conditions which they can treat with medication. Some but not all psychiatrists have additional training as psychotherapists and so can provide talking therapy.
Psychotherapists who are registered have completed a minimum of five years of post-graduate clinical and academic training in talking therapy, human development and pathology. Psychotherapists are experts in talking therapy and aim to tackle problems at a very deep level, to help bring about personality change. It is important to note, that unlike psychiatrists and psychologists, psychotherapist is not a protected title, basically anyone can call themselves a psychotherapist! For this reason, it is essential to make sure that your therapist is professionally registered with one of the main professional bodies such as UKCP, BPS or BACP.
Psychologists have academic degrees in the science of human behaviour. Clinical and Counselling Psychologists will have additional post-graduate training as counsellors (talking therapy). The focus of their training includes greater focus on conducting research and the concept of measurability of human behaviour. Clinical Psychologists tend to be specifically trained in more severe mental health difficulties than Counselling Psychologists.
Counsellors in general tend to have less clinical and academic training than psychotherapists, and tend to work shorter term with a more problem/ solution focus rather than personality change focus. I use the word 'tend' as this is the norm but not the rule. Some counselling psychologists for example will refer to themselves as counsellors, and some psychotherapists will include it in their title as they are aware that potential clients often conflate the two terms (as I do here).
Do I need psychotherapy / counselling?
There is perhaps some truth in the statement that everyone can get some benefit from psychotherapy; simply having the space to talk openly about yourself to someone who will not judge you can bring the clarity you need. However it is important to bear in mind that to embark on psychotherapy is an investment of energy, time and of course money. Good psychotherapists will always be very open with potential clients about their suitability for psychotherapy, for example if I find a potential client is not quite ready to do the work I will refer them to their GP to consider medication, or will direct them to CBT practitioner or a very good book that may help them.
However, if you are somewhat stuck trying to decide if you really do need to talk about your problems, it might be worth thinking about what is lying beneath your doubt. Often we can find that we are living with certain beliefs around asking for help such as ' I don't deserve help - there are so many people worse off than me', or 'If I ask for help, it proves I can't cope alone, and I will feel weak or deficient', or perhaps even 'I have been hurt so many times by people I trusted, how can I trust a stranger to really care'. These sort of ideas are built around an idea of self-reliance and strength, but they can ultimately weaken us by preventing us from reaching out for what we need in life in order to move forward. It may well be that these beliefs actually underlie or come from the problems that you are considering bringing to therapy.
What type of psychotherapy do I need?
When I was training, research was indicating that the answer to this question is that it does not matter what type of psychotherapy you have providing you have a good relationship with a well trained psychotherapist. While this is still basically the case, there is now some evidence that certain types of therapy can work particularly well for certain types of symptoms, for example symptoms of PTSD (Post traumatic stress disorder) are seen to respond well to EMDR and CBT, Borderline Personality Disorder responds well to MBT, DBT and CAT and psychosis can be managed well with CBT.
It is perhaps worth researching the different forms of therapy and asking prospective psychotherapists to tell you a little bit about how they work to help you form a feeling about whether that specific approach is the right fit for you. Mind also offer a helpful breakdown here.
What happens in psychotherapy / counselling?
Although different therapies may have slightly different emphases or ways of looking at things, with the exception of perhaps CBT, EMDR and more classical forms of Psychoanalysis, the experience of different types of psychotherapy will feel broadly similar; providing you with the space to talk and reflect, to help you explore and understand your feelings, thoughts and behaviours, so that you can make better choices in life. It will involve you speaking to your psychotherapist about your current and past problems and your psychotherapist listening in a particularly empathic and skilled way. They will be looking for and carefully highlighting previously uncovered patterns, meanings, emotions, defenses and beliefs, the understanding of which will help you see yourself more clearly and thus clear the pathway to change. As the therapy progresses you will gain a better understanding of and compassion for why you live as you do, and you will observe when and where your problematic patterns are being enacted. Over time as your feelings and confidence start to change through the process of psychotherapy, you will begin to feel secure enough to start co-formulating and experimenting with new and more satisfying ways to be; reducing your symptoms and improving your relationships.
Most good modern psychotherapies can be described as 'relational'. This means that your psychotherapist will also have an eye on what is happening between you both in the room, based on the understanding that you will react to your therapist in a similar manner to the way in which you react to the other people in your life. Bringing this to light and exploring it together in the moment is understood to be one of the more influential transformative techniques in psychotherapy.
There are plenty of examples of psychotherapy in action on Youtube. Here is one of MBT's co-creators demonstrating psychotherapy with an actor-client.
How long does psychotherapy / counselling take?
While psychotherapy can and does help, lasting change generally tends not to happen quickly. While a limited number of psychotherapy sessions will benefit you by bringing you some insight into your feelings and life, or by teaching you techniques to help you manage your symptoms; you are unlikely to get to grips with your underlying anxiety or catalyse much change in a short period of time. I generally advocate that clients commit to an initial six months (roughly 24 sessions) of weekly psychotherapy, during which we will agree to review progress periodically (for example every 10 weeks). This can understandably feel like quite a commitment at first, however do be aware that time passes very quickly indeed (it might be worth asking friends who have had psychotherapy about their experience in this regard). Good psychotherapy lasts until you and your psychotherapist agree together that you are ready to leave. I often offer completing clients follow up sessions one and then three months later which can help them manage the ending with more confidence. You can of course elect to end therapy at any time during your treatment, however it is strongly advised that you do not end suddenly and without first discussing it with your psychotherapist. This is for a number of reasons explained below, but includes the likelihood that a sudden ending to your treatment can lead to a deterioration in your mood.
Should psychotherapy feel difficult?
While psychotherapy should ultimately bring about an improved sense of well-being, at times it can and will feel difficult. Exploring troubling events and relationships and opening up uncomfortable feelings so that you can ultimately better manage them, can feel challenging. Looking ourselves in the eye, although invaluable can often also feel initially tricky. However, any good well trained psychotherapist will be very mindful of the need to pace the work so that you do not feel overwhelmed. If the work does begin to feel too hard, make sure that you speak up, your psychotherapist will really want to know. While psychotherapy may at times feel difficult, it should never be punishing. Your psychotherapist should and most likely will be supportive, non-judgmental, accepting and empathic at all times. They will be interested in and receptive to your feedback about how you are experiencing the psychotherapy.
Is there any evidence that psychotherapy / counselling works?
A frequent criticism of psychotherapy is that there is no evidence that it works. This is absolutely unwarranted. There is ample evidence that psychotherapy can be very effective in treating mental health conditions. In support of this, in order for any treatment, physical or psychological to be offered by the NHS it must first be approved by the body NICE, which demands that treatments are supported by a robust evidence base. In addition, contemporary research findings in neuroscience and developmental psychology are further validating the theories and techniques of psychotherapy, and in particular those theories from the psychodynamic/ psychoanalytic schools.
Why won't my psychotherapist / counsellor give me advice?
The aim of psychotherapy is ultimately to enable you to better and to more authentically navigate your life, making more positive and considered relationships and choices. This means coming to rely confidently on your own judgement. Feeling more able to do this, comes about not by your psychotherapist telling you what they would do in your circumstances; but by working with you to help reveal how and why you form the judgments and make decisions you do, and how you might improve these processes so they both feel right more often and get more satisfactory results for you. Although it can be frustrating when you feel anxious and your therapist refuses to tell you what to do, withholding advice in favour of helping you look at your situation from different and/or deeper perspectives actually helps you get better in a much more sustainable way.
Why won't my psychotherapist / counsellor answer questions about herself?
Initially for some people this can feel like a very strange part of psychotherapy. Understanding why your therapist is deliberately evasive about themselves can sometimes be difficult. However this is actually a very important aspect of psychotherapy for a number of reasons. It might seem that knowing more details about your psychotherapist may make you feel more comfortable sharing your private thoughts and feelings with them; however, more often than not it can work in the opposite way. Knowing personal details about your psychotherapist might actually make you less comfortable talking about certain issues; for example knowing they are married might make you think that they couldn't understand what it is like to be single in London. Similarly it may seem that knowing that you share certain experiences with your psychotherapist, for example childhood bereavement, would be helpful, however it could actually mean that rather than engaging in the very important process of fully and deeply exploring your experience, you may bypass this by assuming that your therapist already understands it. Additionally, and more importantly for psychodynamic and other relational psychotherapies, a significant part of psychotherapy is about learning to notice the assumptions that you make about people and in particular your therapist. These assumptions which tend to be habitual and to emanate from past experiences, influence how we see and feel about ourselves and how we behave with other people, which can on occasion cause us problems leaving us and other feeling misunderstood and even frustrated. Skillfully noticing, exploring and challenging these assumptions is an essential component of psychotherapy. To reveal these assumptions, it is thought that the less you know about your therapist, the more you will assume about them and therefore reveal about your unique way of seeing the world and how, if at all, it is contributing to your difficult circumstances and feelings.
How do I know if a psychotherapist / counsellor is qualified?
If your psychotherapist/ counsellor/ psychologist/ psychiatrist is a qualified psychotherapist they will be registered or accredited or a member of one of the main professional bodies such as UKCP, BPC, BPS or BACP. This will be noted on their marketing material (websites, directory listings, business cards etc). If it is not detailed, it is always worth asking them which body they are a member of. Being a registered psychotherapist means that they have been trained on an approved and monitored post-graduate clinical and academic program. It also means that they are insured, adhere to professional and ethical standards and are committed to continued professional training.
Is my psychotherapist / counsellor ethical?
Psychotherapists who are members of the main professional bodies agree to practice in accordance to that body's particular code of ethics. These may vary very slightly depending on the body, however they all clearly state that psychotherapist's must not engage in 'dual relationships' with clients. This means that they must be psychotherapist and psychotherapist only; they cannot be a friend, a business partner, a romantic or sexual partner, or in any significant way a creditor, meaning they should not allow their clients to run up large amounts of debt with them. In addition, all psychotherapists have a duty of confidentiality towards their clients. This means that information about their clients' identities and session content cannot be shared. This is however subject to important but very narrow legal limitations which should be detailed in their client contract and outlined in the first session. Arguably the most common reason to break confidentiality is when a client is considered to be a significant risk to themselves and/or others, and it is prudent that another professional (most likely your GP or prescribing psychiatrist) be consulted on the best form of combined care in order to keep you safe. Your psychotherapist will normally endeavour to discuss this with you before taking any such action.
I want to finish psychotherapy but my psychotherapist / counsellor disagrees
This is a tricky one and an issue that often receives the greatest debate in the media, with the question of whether it is ethical for a paid professional to insist that a client stays in treatment they no longer feel comfortable in. The reason therapists weigh so heavily on the importance of endings is that so much pain in life, and emotional, psychological and thus relational difficulties come from the previous unfortunately less than ideal management of endings; be it death, infancy, relationships, ways of life, health, jobs etc. Much of psychotherapy is about investigating and reworking the protective but now a bit problematic processes that resulted from these experiences, when we put in place defensive strategies to try and prevent us from getting hurt in a similar way again, but which often inevitably lead us to end up getting hurt. Often when you find yourself wanting to end therapy suddenly, it is indicative of a pattern that has emerged between you and your therapist that awakens your fear being or getting hurt. In life more often than not, we are not thoughtful of why we do what we feel is just the normal way we do things, and what alternatives we really have. It is very normal therefore that you may not be aware that this is happening; all you know is that you have had enough and want to leave. By encouraging you not to fall into a repetition of these old defensive patterns of avoiding something, your psychotherapist is inviting you to look at discord and endings in a different way, albeit uncomfortable but better and potentially healing way. This will help you see that both parties can survive a difficult revelation or an ending, giving a strengthening experience for future similar interactions.
It is however important to read the question on 'Ethics' in conjunction with this reply and also to note that as with any relationship, sometimes through no one's fault, it just doesn't work. You will normally, although not always, know this within the first several weeks of psychotherapy. If you choose to end for this reason, it is still very important to talk it through with your therapist and have a good ending with them.
Can I get free psychotherapy / counselling?
As a UK resident you are entitled to free NHS psychological treatments provided by your local trust. These are accessed primarily through your GP. Generally you will be given an assessment by a psychological clinician who works in your GP surgery and who will then signpost you to the NICE recommended treatment of choice for your symptoms and their severity. Unfortunately due to funding shortages and high and increasing demand for services, the NHS tends to suffer from quite long waiting lists which may mean that you will not get access to the care you would like immediately. However, if you are prepared to wait, the NHS is home to excellently trained clinicians who will likely provide the most up to date treatments and a similar quality of care as you could expect to receive privately. It is important to bear in mind however that all NHS psychological treatments are 'time-limited', meaning that unlike private care you are unlikely to receive psychotherapy for more than a matter of months. The treatment duration tends to be defined by the type of psychotherapy offered, e.g. CBT tends to be offered for 6-12 weeks, CAT for 24 weeks, MBT, DBT & Psychodynamic Psychotherapy can be offered for up to 18 months.
While there are no longer many free charity-based counselling centres in or indeed outside London (thank you funding cuts!) there are still a few available and there are a number of good low cost counselling centres where you can generally expect to pay c.£15-30 a session. The best resource to locate low cost or free psychotherapy services is your local Mind, the excellent national mental health charity. Mind operates counselling services across the country and can also help with information and signposting. Alternatively consider contacting one of the Psychotherapy Training colleges who may offer low cost sessions with experienced and well supervised Trainees.
Is psychotherapy really confidential?
Confidentiality is one of the cornerstones of a relationship of trust between a client and their psychotherapist. The fact of and content of your psychotherapy sessions are 'legally privileged' i.e. confidential. This privilege is subject to some legal and professional ethical exemptions. Legally there are some idiosyncratic but important exceptions. These include where the client chooses to disclose information about terrorism, the whereabouts of a missing child who is in the care of social services or the courts, or if they disclosed details about a road traffic incident they were involved in and your psychotherapist is approached by the police. Otherwise your psychotherapist will not be required to reveal any information about your sessions to the legal authorities without them first issuing a formal subpeona. A client may of course waive their right to privilege where they wish information disclosed in their sessions to be shared with an agreed party e.g. with their solicitor, prescribing psychiatrist or social worker, however it is advised that they always think about this very carefully and first discuss the ramifications of the break in confidentiality in detail with their psychotherapist.
Ethically there will be times when your psychotherapist will make a professional judgment to set aside confidentiality. This will be when your psychotherapist considers that you represent a serious risk of harm to yourself or others. These occasions rarely arise over the course of treatment, however when they do, most psychotherapists will endeavour to make all reasonable efforts to discuss with you their intention to disclose, to whom they intend to disclose, and the content that they intend to disclose, and why they believe it to be necessary. It is important to discuss this with your psychotherapist in your first session. It is also important to bear in mind that 'serious risk of harm' is interpreted quite strictly by good qualified psychotherapists. Sometimes clients worry that disclosure of 'feeling like they would like to commit suicide' might trigger a break in confidentiality. While you must discuss this with your psychotherapist, most clinicians are able to distinguish between normal or commonly occurring albeit serious and upsetting 'suicidal ideation' and the distinct and less common 'suicidal intention', when the client has made actual plans to commit suicide and vocalises this intention and presents psychologically in a manner which indicates their likelihood to do so. Similarly so with risk of harm to others.
In additon as a client your data is subject to the legislative rights and obligations of Data Protection Act (DPA) 1998.
This is a question I get asked really frequently. Basically, if you are looking for talking therapy, you need someone who has officially recognised specific training in providing psychotherapy. While all of the above mental health professions can have this training, you cannot assume that they do, and you should always look for evidence of training.
Psychiatrists are medical doctors who have specialised training in mental health conditions which they can treat with medication. Some but not all psychiatrists have additional training as psychotherapists and so can provide talking therapy.
Psychotherapists who are registered have completed a minimum of five years of post-graduate clinical and academic training in talking therapy, human development and pathology. Psychotherapists are experts in talking therapy and aim to tackle problems at a very deep level, to help bring about personality change. It is important to note, that unlike psychiatrists and psychologists, psychotherapist is not a protected title, basically anyone can call themselves a psychotherapist! For this reason, it is essential to make sure that your therapist is professionally registered with one of the main professional bodies such as UKCP, BPS or BACP.
Psychologists have academic degrees in the science of human behaviour. Clinical and Counselling Psychologists will have additional post-graduate training as counsellors (talking therapy). The focus of their training includes greater focus on conducting research and the concept of measurability of human behaviour. Clinical Psychologists tend to be specifically trained in more severe mental health difficulties than Counselling Psychologists.
Counsellors in general tend to have less clinical and academic training than psychotherapists, and tend to work shorter term with a more problem/ solution focus rather than personality change focus. I use the word 'tend' as this is the norm but not the rule. Some counselling psychologists for example will refer to themselves as counsellors, and some psychotherapists will include it in their title as they are aware that potential clients often conflate the two terms (as I do here).
Do I need psychotherapy / counselling?
There is perhaps some truth in the statement that everyone can get some benefit from psychotherapy; simply having the space to talk openly about yourself to someone who will not judge you can bring the clarity you need. However it is important to bear in mind that to embark on psychotherapy is an investment of energy, time and of course money. Good psychotherapists will always be very open with potential clients about their suitability for psychotherapy, for example if I find a potential client is not quite ready to do the work I will refer them to their GP to consider medication, or will direct them to CBT practitioner or a very good book that may help them.
However, if you are somewhat stuck trying to decide if you really do need to talk about your problems, it might be worth thinking about what is lying beneath your doubt. Often we can find that we are living with certain beliefs around asking for help such as ' I don't deserve help - there are so many people worse off than me', or 'If I ask for help, it proves I can't cope alone, and I will feel weak or deficient', or perhaps even 'I have been hurt so many times by people I trusted, how can I trust a stranger to really care'. These sort of ideas are built around an idea of self-reliance and strength, but they can ultimately weaken us by preventing us from reaching out for what we need in life in order to move forward. It may well be that these beliefs actually underlie or come from the problems that you are considering bringing to therapy.
What type of psychotherapy do I need?
When I was training, research was indicating that the answer to this question is that it does not matter what type of psychotherapy you have providing you have a good relationship with a well trained psychotherapist. While this is still basically the case, there is now some evidence that certain types of therapy can work particularly well for certain types of symptoms, for example symptoms of PTSD (Post traumatic stress disorder) are seen to respond well to EMDR and CBT, Borderline Personality Disorder responds well to MBT, DBT and CAT and psychosis can be managed well with CBT.
It is perhaps worth researching the different forms of therapy and asking prospective psychotherapists to tell you a little bit about how they work to help you form a feeling about whether that specific approach is the right fit for you. Mind also offer a helpful breakdown here.
What happens in psychotherapy / counselling?
Although different therapies may have slightly different emphases or ways of looking at things, with the exception of perhaps CBT, EMDR and more classical forms of Psychoanalysis, the experience of different types of psychotherapy will feel broadly similar; providing you with the space to talk and reflect, to help you explore and understand your feelings, thoughts and behaviours, so that you can make better choices in life. It will involve you speaking to your psychotherapist about your current and past problems and your psychotherapist listening in a particularly empathic and skilled way. They will be looking for and carefully highlighting previously uncovered patterns, meanings, emotions, defenses and beliefs, the understanding of which will help you see yourself more clearly and thus clear the pathway to change. As the therapy progresses you will gain a better understanding of and compassion for why you live as you do, and you will observe when and where your problematic patterns are being enacted. Over time as your feelings and confidence start to change through the process of psychotherapy, you will begin to feel secure enough to start co-formulating and experimenting with new and more satisfying ways to be; reducing your symptoms and improving your relationships.
Most good modern psychotherapies can be described as 'relational'. This means that your psychotherapist will also have an eye on what is happening between you both in the room, based on the understanding that you will react to your therapist in a similar manner to the way in which you react to the other people in your life. Bringing this to light and exploring it together in the moment is understood to be one of the more influential transformative techniques in psychotherapy.
There are plenty of examples of psychotherapy in action on Youtube. Here is one of MBT's co-creators demonstrating psychotherapy with an actor-client.
How long does psychotherapy / counselling take?
While psychotherapy can and does help, lasting change generally tends not to happen quickly. While a limited number of psychotherapy sessions will benefit you by bringing you some insight into your feelings and life, or by teaching you techniques to help you manage your symptoms; you are unlikely to get to grips with your underlying anxiety or catalyse much change in a short period of time. I generally advocate that clients commit to an initial six months (roughly 24 sessions) of weekly psychotherapy, during which we will agree to review progress periodically (for example every 10 weeks). This can understandably feel like quite a commitment at first, however do be aware that time passes very quickly indeed (it might be worth asking friends who have had psychotherapy about their experience in this regard). Good psychotherapy lasts until you and your psychotherapist agree together that you are ready to leave. I often offer completing clients follow up sessions one and then three months later which can help them manage the ending with more confidence. You can of course elect to end therapy at any time during your treatment, however it is strongly advised that you do not end suddenly and without first discussing it with your psychotherapist. This is for a number of reasons explained below, but includes the likelihood that a sudden ending to your treatment can lead to a deterioration in your mood.
Should psychotherapy feel difficult?
While psychotherapy should ultimately bring about an improved sense of well-being, at times it can and will feel difficult. Exploring troubling events and relationships and opening up uncomfortable feelings so that you can ultimately better manage them, can feel challenging. Looking ourselves in the eye, although invaluable can often also feel initially tricky. However, any good well trained psychotherapist will be very mindful of the need to pace the work so that you do not feel overwhelmed. If the work does begin to feel too hard, make sure that you speak up, your psychotherapist will really want to know. While psychotherapy may at times feel difficult, it should never be punishing. Your psychotherapist should and most likely will be supportive, non-judgmental, accepting and empathic at all times. They will be interested in and receptive to your feedback about how you are experiencing the psychotherapy.
Is there any evidence that psychotherapy / counselling works?
A frequent criticism of psychotherapy is that there is no evidence that it works. This is absolutely unwarranted. There is ample evidence that psychotherapy can be very effective in treating mental health conditions. In support of this, in order for any treatment, physical or psychological to be offered by the NHS it must first be approved by the body NICE, which demands that treatments are supported by a robust evidence base. In addition, contemporary research findings in neuroscience and developmental psychology are further validating the theories and techniques of psychotherapy, and in particular those theories from the psychodynamic/ psychoanalytic schools.
Why won't my psychotherapist / counsellor give me advice?
The aim of psychotherapy is ultimately to enable you to better and to more authentically navigate your life, making more positive and considered relationships and choices. This means coming to rely confidently on your own judgement. Feeling more able to do this, comes about not by your psychotherapist telling you what they would do in your circumstances; but by working with you to help reveal how and why you form the judgments and make decisions you do, and how you might improve these processes so they both feel right more often and get more satisfactory results for you. Although it can be frustrating when you feel anxious and your therapist refuses to tell you what to do, withholding advice in favour of helping you look at your situation from different and/or deeper perspectives actually helps you get better in a much more sustainable way.
Why won't my psychotherapist / counsellor answer questions about herself?
Initially for some people this can feel like a very strange part of psychotherapy. Understanding why your therapist is deliberately evasive about themselves can sometimes be difficult. However this is actually a very important aspect of psychotherapy for a number of reasons. It might seem that knowing more details about your psychotherapist may make you feel more comfortable sharing your private thoughts and feelings with them; however, more often than not it can work in the opposite way. Knowing personal details about your psychotherapist might actually make you less comfortable talking about certain issues; for example knowing they are married might make you think that they couldn't understand what it is like to be single in London. Similarly it may seem that knowing that you share certain experiences with your psychotherapist, for example childhood bereavement, would be helpful, however it could actually mean that rather than engaging in the very important process of fully and deeply exploring your experience, you may bypass this by assuming that your therapist already understands it. Additionally, and more importantly for psychodynamic and other relational psychotherapies, a significant part of psychotherapy is about learning to notice the assumptions that you make about people and in particular your therapist. These assumptions which tend to be habitual and to emanate from past experiences, influence how we see and feel about ourselves and how we behave with other people, which can on occasion cause us problems leaving us and other feeling misunderstood and even frustrated. Skillfully noticing, exploring and challenging these assumptions is an essential component of psychotherapy. To reveal these assumptions, it is thought that the less you know about your therapist, the more you will assume about them and therefore reveal about your unique way of seeing the world and how, if at all, it is contributing to your difficult circumstances and feelings.
How do I know if a psychotherapist / counsellor is qualified?
If your psychotherapist/ counsellor/ psychologist/ psychiatrist is a qualified psychotherapist they will be registered or accredited or a member of one of the main professional bodies such as UKCP, BPC, BPS or BACP. This will be noted on their marketing material (websites, directory listings, business cards etc). If it is not detailed, it is always worth asking them which body they are a member of. Being a registered psychotherapist means that they have been trained on an approved and monitored post-graduate clinical and academic program. It also means that they are insured, adhere to professional and ethical standards and are committed to continued professional training.
Is my psychotherapist / counsellor ethical?
Psychotherapists who are members of the main professional bodies agree to practice in accordance to that body's particular code of ethics. These may vary very slightly depending on the body, however they all clearly state that psychotherapist's must not engage in 'dual relationships' with clients. This means that they must be psychotherapist and psychotherapist only; they cannot be a friend, a business partner, a romantic or sexual partner, or in any significant way a creditor, meaning they should not allow their clients to run up large amounts of debt with them. In addition, all psychotherapists have a duty of confidentiality towards their clients. This means that information about their clients' identities and session content cannot be shared. This is however subject to important but very narrow legal limitations which should be detailed in their client contract and outlined in the first session. Arguably the most common reason to break confidentiality is when a client is considered to be a significant risk to themselves and/or others, and it is prudent that another professional (most likely your GP or prescribing psychiatrist) be consulted on the best form of combined care in order to keep you safe. Your psychotherapist will normally endeavour to discuss this with you before taking any such action.
I want to finish psychotherapy but my psychotherapist / counsellor disagrees
This is a tricky one and an issue that often receives the greatest debate in the media, with the question of whether it is ethical for a paid professional to insist that a client stays in treatment they no longer feel comfortable in. The reason therapists weigh so heavily on the importance of endings is that so much pain in life, and emotional, psychological and thus relational difficulties come from the previous unfortunately less than ideal management of endings; be it death, infancy, relationships, ways of life, health, jobs etc. Much of psychotherapy is about investigating and reworking the protective but now a bit problematic processes that resulted from these experiences, when we put in place defensive strategies to try and prevent us from getting hurt in a similar way again, but which often inevitably lead us to end up getting hurt. Often when you find yourself wanting to end therapy suddenly, it is indicative of a pattern that has emerged between you and your therapist that awakens your fear being or getting hurt. In life more often than not, we are not thoughtful of why we do what we feel is just the normal way we do things, and what alternatives we really have. It is very normal therefore that you may not be aware that this is happening; all you know is that you have had enough and want to leave. By encouraging you not to fall into a repetition of these old defensive patterns of avoiding something, your psychotherapist is inviting you to look at discord and endings in a different way, albeit uncomfortable but better and potentially healing way. This will help you see that both parties can survive a difficult revelation or an ending, giving a strengthening experience for future similar interactions.
It is however important to read the question on 'Ethics' in conjunction with this reply and also to note that as with any relationship, sometimes through no one's fault, it just doesn't work. You will normally, although not always, know this within the first several weeks of psychotherapy. If you choose to end for this reason, it is still very important to talk it through with your therapist and have a good ending with them.
Can I get free psychotherapy / counselling?
As a UK resident you are entitled to free NHS psychological treatments provided by your local trust. These are accessed primarily through your GP. Generally you will be given an assessment by a psychological clinician who works in your GP surgery and who will then signpost you to the NICE recommended treatment of choice for your symptoms and their severity. Unfortunately due to funding shortages and high and increasing demand for services, the NHS tends to suffer from quite long waiting lists which may mean that you will not get access to the care you would like immediately. However, if you are prepared to wait, the NHS is home to excellently trained clinicians who will likely provide the most up to date treatments and a similar quality of care as you could expect to receive privately. It is important to bear in mind however that all NHS psychological treatments are 'time-limited', meaning that unlike private care you are unlikely to receive psychotherapy for more than a matter of months. The treatment duration tends to be defined by the type of psychotherapy offered, e.g. CBT tends to be offered for 6-12 weeks, CAT for 24 weeks, MBT, DBT & Psychodynamic Psychotherapy can be offered for up to 18 months.
While there are no longer many free charity-based counselling centres in or indeed outside London (thank you funding cuts!) there are still a few available and there are a number of good low cost counselling centres where you can generally expect to pay c.£15-30 a session. The best resource to locate low cost or free psychotherapy services is your local Mind, the excellent national mental health charity. Mind operates counselling services across the country and can also help with information and signposting. Alternatively consider contacting one of the Psychotherapy Training colleges who may offer low cost sessions with experienced and well supervised Trainees.
Is psychotherapy really confidential?
Confidentiality is one of the cornerstones of a relationship of trust between a client and their psychotherapist. The fact of and content of your psychotherapy sessions are 'legally privileged' i.e. confidential. This privilege is subject to some legal and professional ethical exemptions. Legally there are some idiosyncratic but important exceptions. These include where the client chooses to disclose information about terrorism, the whereabouts of a missing child who is in the care of social services or the courts, or if they disclosed details about a road traffic incident they were involved in and your psychotherapist is approached by the police. Otherwise your psychotherapist will not be required to reveal any information about your sessions to the legal authorities without them first issuing a formal subpeona. A client may of course waive their right to privilege where they wish information disclosed in their sessions to be shared with an agreed party e.g. with their solicitor, prescribing psychiatrist or social worker, however it is advised that they always think about this very carefully and first discuss the ramifications of the break in confidentiality in detail with their psychotherapist.
Ethically there will be times when your psychotherapist will make a professional judgment to set aside confidentiality. This will be when your psychotherapist considers that you represent a serious risk of harm to yourself or others. These occasions rarely arise over the course of treatment, however when they do, most psychotherapists will endeavour to make all reasonable efforts to discuss with you their intention to disclose, to whom they intend to disclose, and the content that they intend to disclose, and why they believe it to be necessary. It is important to discuss this with your psychotherapist in your first session. It is also important to bear in mind that 'serious risk of harm' is interpreted quite strictly by good qualified psychotherapists. Sometimes clients worry that disclosure of 'feeling like they would like to commit suicide' might trigger a break in confidentiality. While you must discuss this with your psychotherapist, most clinicians are able to distinguish between normal or commonly occurring albeit serious and upsetting 'suicidal ideation' and the distinct and less common 'suicidal intention', when the client has made actual plans to commit suicide and vocalises this intention and presents psychologically in a manner which indicates their likelihood to do so. Similarly so with risk of harm to others.
In additon as a client your data is subject to the legislative rights and obligations of Data Protection Act (DPA) 1998.
