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You are here > Home > Treatment - Therapies > Counselling - Talking Therapy

Counselling - Talking Therapy - A Guide

Counselling is a type of talking therapy where people talk to a counsellor about their
problems. Counsellors are trained to listen sympathetically and can help
people deal with any negative thoughts and feelings that they have.

Introduction
Talking therapies
How counselling works
Where to get counselling
Recommendations for counselling

see also: Mental Health Disabilities and Issues


Introduction

As well as counselling, there are a number of other types of talking therapies. For example, cognitive behavioural therapy (CBT) is a type of talking therapy that can be used to retrain a person’s way of thinking to help them cope with stressful situations.



NICE recommendations

The National Institute for Health and Clinical Excellence (NICE) recommends certain types of talking therapies for treating a number of different health conditions.

For example, counselling may be helpful in treating:

  • depression,
  • anxiety,
  • obsessive compulsive disorder (OCD),
  • post-traumatic stress disorder (PTSD),
  • long-term illnesses,
  • eating disorders, such as anorexia nervosa and bulimia, and
  • substance abuse.

The aims of counselling

Counselling can help people to:

  • discuss their problems honestly and openly,
  • deal with issues that are preventing them from achieving their goals and ambitions, and
  • have a more positive outlook on life.

Everyone has different ways of coping with their personal difficulties. People often deal with stressful situations and events by talking to their partner, a family member or a friend. However, in certain situations, talking to a professional counsellor may be more helpful.

Admitting you need help is a positive step

At some stage, you will probably experience feelings of stress, disappointment and grief. At these times, seeking assistance can help you deal with your feelings and emotions.

Counselling can be a positive way of addressing any unresolved issues that you have. It can help you to understand your problems better, rather than ignoring them and hoping that they will go away, only for them to come back later. It can also give you a better understanding of other people's points of view.

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Talking therapies

There are a number of different types of talking therapies. Each type aims to help people deal with negative thoughts and feelings, and enables them to make positive changes.

The main types of talking therapies are:

  • cognitive behavioural therapy (CBT),
  • psychodynamic therapy,
  • humanistic therapy, and
  • other types of talking therapies, such as group therapy and relationship therapy.

These therapies are discussed in more detail below.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a form of psychotherapy that may retrain a person’s way of thinking to help them to deal with stressful situations.

CBT is used to help solve a number of problems such as:

  • depression,
  • anxiety,
  • obsessive compulsive disorder (OCD),
  • post-traumatic stress disorder (PTSD),
  • managing long-term illness,
  • eating disorders, and
  • schizophrenia.

The National Institute for Health and Clinical Excellence (NICE) recommends CBT for all of these.

CBT was developed from two earlier types of psychotherapy:

  • Cognitive therapy: designed to change a person’s thoughts, beliefs, attitudes and expectations.
  • Behavioural therapy: designed to change a person's actions.

CBT is a talking therapy that is based around the idea that the way a person thinks about a situation affects the way that they act. In turn, a person’s actions influence the way they think and feel. It is therefore necessary to change both the act of thinking (cognition) and behaviour at the same time.

The NHS is using CBT more frequently, particularly for treating common conditions, such as depression and anxiety. CBT courses are usually short-term, for example, between six and 24 one-hour sessions.

See Useful links for more information about cognitive behavioural therapy.

Psychodynamic therapy

During psychodynamic therapy, a therapist will help a person consider how their personality and life experiences influence their current thoughts, feelings, relationships and behaviour. This understanding enables them to deal with difficult situations more successfully.

Psychodynamic therapy can be used to help treat:

  • depression,
  • anxiety,
  • post-traumatic stress disorder (PTSD),
  • long-term physical health problems,
  • eating disorders, and
  • addictions.

NICE recommends psychodynamic therapy for people with depression and other complex illnesses. Psychodynamic therapy is available privately and on the NHS in some areas. It usually lasts between several months and several years, but shorter courses are also available.



Humanistic therapy

Humanistic therapies take a holistic approach to a person’s problem in order to help them develop to their full potential and live life to the full.

To achieve this, humanistic therapies incorporate the body, mind, emotions, behaviour and spirituality. In addressing the problem, they also look at other people, including family, friends, society and culture.

Humanistic therapies are often used to treat problems such as depression, anxiety and addiction. NICE recommends this type of therapy for children and young people with mild depression, and for some cases of schizophrenia.

Humanistic therapies are available both privately and on the NHS and, depending on the problem, can be either short- or long-term, although they usually last for at least several months.

Other talking therapies

Group therapy

The aim of group therapy is to help people find solutions to their problems by discussing them in a group setting. Sessions are led by a facilitator who helps by directing the flow of conversation.

NICE recommends group therapy for people with obsessive compulsive disorder (OCD), and for children and young people with mild depression.

Relationship and family therapy

Relationship therapy is where couples who are having difficulties in their relationship work with a therapist to try to resolve their problems. Family therapy is similar but involves a therapist working with a family that is having problems.

NICE recommends relationship therapy for people who have tried individual therapy without success, and family therapy is recommended for children with depression, or where a family member has a condition such as anorexia nervosa or schizophrenia.

Interpersonal therapy

Interpersonal therapy focuses on how a person’s mood can influence the way that they relate to others who are close to them. NICE recommends this type of counselling for people with eating disorders and depression.

Mindfulness-based therapies

Mindfulness-based therapies combine talking therapies with meditation. They are used to make positive changes by helping a person to reduce stress and cope with problematic thoughts and feelings. NICE recommends this type of therapy to help people avoid repeated bouts of depression.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a treatment method that uses eye movements to stimulate the brain. EMDR has been shown to make distressing memories feel less intense.

EMDR can be used to treat a number of traumas, such as addictions, accidents and injuries, phobias, and sexual, physical or emotional abuse. NICE recommends EMDR for post-traumatic stress disorder (PTSD).

Motivational counselling

Motivational counselling involves talking about issues and problems that could prevent a person from achieving their goals and ambitions. NICE recommends this type of counselling for people who have a mental health problem, or a problem with alcohol or substance misuse.

Telephone counselling

Telephone counselling, such as the service provided by the Samaritans, enables you to talk to a therapist without having to meet them face-to-face. It may be available through charities or your employer. Alternatively, you may be able to receive counselling by email or on the internet.

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How counselling works

Counselling can help you deal with a range of issues, from day-to-day worries or concerns to more serious, long-term psychological problems.

Counselling can help you come to terms with distressing or traumatic events, such as the loss of a loved one, divorce, or confusion about your identity or sexual orientation. It can also be an effective way of dealing with long-term mental health problems, such as depression and anxiety.

How can a counsellor help?

A counsellor is someone who is trained to listen sympathetically to your problems and can suggest strategies that will help you to resolve issues and change your behaviour.

By discussing your concerns with you, the counsellor will be able to help you gain a better understanding of your feelings and actions, as well as suggesting ways for you to find your own solutions to your problems.

The counsellor may encourage you to identify issues more easily and take personal responsibility where appropriate. They can help you to recognise the effect of other people and their actions, and to explore alternative ways of coping.

It can be a great relief to be able to share your worries and fears with someone who will confirm your feelings and help you to reach a positive solution.

Counselling can take a range of different formats

There are many different types of counselling that are available in a range of different formats. Counselling can take place:

  • face-to-face,
  • over the telephone, or
  • by email.

You may be offered counselling as a single session, as a short-term course of sessions for a few weeks or months, or as a long-term arrangement that lasts for many months or years.

See Types of counselling to find out more about the different types of counselling that are available, and the conditions for which they are recommended.

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Where to get counselling

Counselling on the NHS

Your GP or another healthcare professional may refer you to a qualified counsellor. In this situation, you will receive counselling through the NHS free of charge. In some areas, the choice of counsellors may be limited and there may be long waiting lists.

In England and Wales, many GP surgeries employ counsellors. If your GP surgery does not offer a counselling service, you may want to ask your GP about counselling as a possible treatment option.

The National Institute for Health and Clinical Excellence (NICE) provides recommendations about the therapies that should be prescribed for certain health conditions. See Types of counselling for more details.

For certain conditions, it may be possible to get some types of therapy on the NHS. For other conditions, it may be more difficult.

Private counselling

Certain types of counselling may not be available on the NHS. For example, some types of psychotherapy may only available from appropriate professionals, such as psychotherapists.

Therefore, you may need (or decide) to seek private counselling. The cost of private counselling can vary considerably. A session can cost between £20 and £100 an hour.

Charities and voluntary organisations

Some charities and independent voluntary organisations may offer counselling. These organisations will usually specialise in a particular type of treatment or skill area such as bereavement, marriage counselling or family guidance.

You may also be able to access support groups through your local church, social services or local community.

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Recommendations for counselling

As counselling can involve talking about sensitive issues, and revealing your personal thoughts and feelings, your counsellor should be experienced and professionally qualified.

There are a number of different healthcare professionals who may have been trained in counselling and be suitably qualified to provide talking therapies. These include:

  • chartered psychologists,
  • psychotherapists,
  • counsellors,
  • psychiatrists, and
  • other healthcare professionals, such as social workers, community psychiatric nurses or occupational therapists.

The British Association for Counselling and Psychotherapy (BACP) and UK Council for Psycotherapy holds details of counsellors who have registered as members with them. They have strict rules regarding membership.

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Trusting your counsellor

A good counsellor will focus on you and listen to your problems without judging or criticising you. They may provide you with advice about strategies that can help you to deal with your problems, but they should not tell you what to do.

For counselling to be effective, you need to build up a trusting relationship with your counsellor.

If you feel that you and your counsellor are not seeing eye to eye, or if you feel that you are not getting the most from your counselling sessions, discuss this with your counsellor. If the situation does not improve, it is perfectly acceptable for you to look for another counsellor who you feel more comfortable with.

If you are currently seeing the NHS counsellor who is attached to your GP surgery, your GP may be able to arrange for you to see another NHS counsellor. Or you may choose to pay to see a private counsellor.



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