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Therapist or counsellor?

Has there ever been a time in your life when the weight you were carrying upon your shoulders became so heavy and burdensome, that you knew you needed to find a way to lighten it, to share it, to find another way to carry it? Or perhaps you had arrived at a crossroad and you weren’t sure which path to take.

Sometimes, life throws unexpected events at us such as a death, a break-up, or a trauma, and we need help with the healing process, or to find a better way forward. Then there are the times when nothing dramatic happens at all, it’s all same old same old, but instead of your usual take on things, comes a rising panic or a descending black cloud, or just a deep sense of dissatisfaction.

It is at times like these that many people turn to a counsellor or therapist. But how do you know who to turn to, and if you are choosing wisely?
 
It has been said that most people put more care and attention into choosing a pair of shoes than they do into choosing a counsellor or therapist.

This is not surprising really, because the trouble is, when you are in the midst of difficult times or a crisis, your thinking may not be as clear as it usually is, and taking a rational approach to ‘shopping around for a counsellor’ is not going to be all that likely. Adding to the confusion is that currently, in the UK, there is no statutory regulation for talking therapies- so anyone is free to call themselves a counsellor or a therapist if they want to.

That’s all due to change within the next couple of years, with a statutory framework poised to come on board requiring minimum standards of training, supervision and ethical guidelines. But for now, make sure the practitioner you choose is a member of one of the established self-regulating professional organisations, and check on their qualifications. (See contacts below).
 
Getting a referral from your GP or a professional body, or a personal recommendation from a friend, is the route most of us take to find someone. This isn’t a bad start, but it involves a degree of luck that you’ll end up sitting in front of someone you feel comfortable enough with, to open up to and work with. For whatever a therapist’s model of working, research shows that the one most important factor in successful talk therapy is the relationship you have with the therapist. And like any relationship, what may be your friend’s (or your GPs’) cup of tea, may not be yours.

It’s a personality thing, and while you may hit it off with the first person you sit in front of, you may not. Sometimes you need to meet more than one counsellor to find the one you want to get stuck in with. 

Thinking ahead

Before you contact a counsellor, it helps to think through the following points:

  • What do I want to get out of therapy?
  • Will I make space in my diary to fit in regular sessions, typically weekly?
  • Are there any resources available which will help me with the cost, such as workplace counselling schemes, insurance provision or agencies which operate on a sliding scale for clients to accommodate those with lower incomes? 

First Contact

Once you have a name, you might wish to have a brief chat on the phone with the counsellor, and if that goes well, to request an initial meeting to see how you might get on together. Helpful areas to cover in your first conversations include:

  • Their skills, experience and qualifications
  • The approach they take. How might this way of working relate to your presenting issues?
  • Your goals and expectations of counselling
  • If individual counselling is the best way forward, or if couple or family therapy would be more appropriate.
  • Fees, frequency and estimated duration of your work together.
  • Counsellor, psychotherapist, therapist, psychologist or something else?

The distinction between a counsellor and a psychotherapist is becoming increasingly blurred, but it all depends who you ask. In many circles these terms are used interchangeably. Traditionally psychotherapists worked using a psychodymanic approach (which has its roots in Freud, and works with the interplay between the conscious and unconscious) whereas counsellors took a humanistic or ‘person-centred’ approach. But these distinctions no longer apply across all models.
 
Then there are the clinical psychologists who, typically, can offer testing of mental functioning, such as memory or IQ and are also trained in talking treatments, usually CBT (cognitive behavioural therapy). Counselling psychologists have a second degree in a talking therapy. Other specialities include relationship and psychosexual counsellors, who will see couples together, and family therapists, who are skilled at bringing whole families into the therapy room. 

Do I really need counselling when I have friends?

Friends and family can be a great support, and if you are lucky enough to have a few good listeners in your orbit,that may reduce the need for a counsellor when you simply need to get things off your chest or deliberate a decision or strategy.

But sometimes friends or family are part of the problem, or totally entangled in it, and though they may wish to help, won’t be able to offer the space, objectivity, confidentiality or skills of a counsellor to get to the heart of an entrenched issue.
So, it’s time to get help when...

  • Your emotions or moods are causing enduring pain and distress
  • Your life is being harmed by a problem you cannot seem to solve
  • You feel you can no longer manage a problem on your own or with the help of your friends
  • You have lost interest in life or think it's not worth living
  • Your relationships with others have a lot of conflict.

What’s worth noting is that modern talk therapies are not always about problems. Some of the most innovative and satisfying use of them results in enhancing life, rather than fixing it.
 
For example, perhaps you’re feeling a bit adrift and you’re wondering if there is more to life than this. It’s those what’s the meaning of life questions, or how do I get myself – and my relationships to a more satisfying, richer place? which can take emotional development and quality of life to a deeper, more satisfying level. This sort of exploration can be the icing on the cake of a good counselling relationship. 

Ethical considerations

Most counsellors strive to be as neutral and objective as they can be, but of course this has its limits, because we all have our own values, ethics, morals, biases and agendas! It is all too common for a person in a vulnerable situation to view a counsellor as an expert or parent-figure and be overly influenced. A counsellor working ethically will, however, empower you to find emotional health, your own values and ethics and make your own decisions.
 
Counsellor self disclosure can sometimes be therapeutically useful. However, sessions should never be dominated by lengthy discussions of the counsellor’s own history or issues.
 
All sessions are strictly confidential between you and the counsellor. When the counsellor brings your case to supervision to discuss strategies and best practice, your privacy will be protected and full names are not used. The main exception to confidentiality is when, through your disclosures, the counsellor believes that there is a serious risk of harm or danger to yourself or others.
If at any time you feel discounted, undermined or manipulated within the session, it is important to discuss these feelings within the session as they arise.
 
Do not accept social invitations from your counsellor, such as going for a drink or a meal together, as this is an unethical blurring of professional boundaries.
 
Research shows that it is not beneficial for clients to have sexual contact with their counsellor and it is considered unethical to do this with current clients.
 
If you have any doubts about the counselling you are receiving, discuss them with your counsellor. If you are still uncertain, seek advice from your doctor, the Citizens Advice Bureau, or the professional body your counsellor belongs to. 

Perhaps a little DIY?

Getting your hands on a good self-help book, or website, can be a reassuring and productive first port of call and may sometimes reduce the need for seeing a counsellor.
Useful ones include:
 
Mood Gym which offers academically endorsed and free on-line CBT therapy for depression at www.moodgym.anu.edu.au.
 
www.livinglifetothefull.com offers a free online CBT life-skills course and is supported by the Scottish NHS.
 
Change Your Thinking with CBT by Dr. Sarah Edelman (Vermillion, £12.99) is a helpful guide for dealing more rationally with feelings of stress, anger, low mood, anxiety and low self-esteem
 
I Love You But I’m Not In Love With You by Andrew G. Marshall, a Relate counsellor, Bloomsbury, £10.99) offers useful exercises and strategies for couples.
 
Straight Talking by Dr. Linda Blair, a chartered clinical psychologist, (Piatkus, £10.99) offers effective suggestions for dealing with the most commonly experienced problems such as insomnia, anxiety, negative thinking and loss of contentment.
 
The Worry Cure by Dr. Robert L. Leahy, the director of the American Institute for Cognitive Therapy, (Piatkus, £7.99) offers simple steps to take control of your thinking and change your patterns of worry. 

Useful contacts

British Association for Counselling and Psychotherapy (www.bacp.co.uk)
 
British Association for Behavioural and Cognitive Psychotherapies (www.babcp.com)
 
Relate, the Relationship people (www.relate.org.uk)
 
College of Sexual and Relationship Therapists (www.cosrt.org.uk)
 
UK Council for Psychotherapy (www.psychotherapy.org.uk)

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