If you are reading this article, you are probably considering counselling. If you have never had therapy before; the different titles of the people providing therapy in addition to the different styles of therapy can be confusing. People may have the false assumption that counselling can only be delivered by counsellors, in that they need to have the title of counsellor, but psychiatric nurses, psychologists and therapists all deliver counselling.
I am writing a series of articles to help explain therapy in order to help you make an informed decision. It is important to situate myself in the helping profession. I am a counselling psychologist, which means I have trained to a doctoral level and have worked with all types of mental health problems. This training and experience put me in a good position to explain the world of therapy, as I have both the relevant qualifications and experience to speak about the subject matter.
If you are embarking on therapy, it is important that you understand
- the counselling professions, and
- the theories of the counselling professions
The terms ‘therapy’ and ‘counselling’ are used interchangeably, but both represent a contained, safe space, where you can discuss your current difficulties with a professional who is trained to help and not judge.
What is counselling?
According to the Oxford Dictionary, Counselling is the provision of professional assistance and guidance in resolving personal or psychological problems. Arriving at a definition amongst the people who provide counselling in Dublin, and their corresponding professional bodies is not so simple.
- British Psychological Society – counselling psychology is a specific discipline of applied psychology that is concerned with the study of being (ontology), the nature of ‘how we know what we know’ (epistemology) and praxis (clinical application.)
- British Association for Behavioural and Cognitive Psychotherapies (1) states that counselling and psychotherapy are umbrella terms that cover a range of talking therapies.
- Irish Association for Counselling and Psychotherapy (2) states it is an activity involving a practitioner who offers a professional service as a helper, and a client who seeks the service.
What is Therapy?
Therapy, sometimes called “talk therapy, ” is provided by mental health professionals to diagnose and treat mental health issues. In previous articles, I explained the different types of psychologists and discussed the benefits of therapy with a psychologist. If you haven’t already done so, it is essential to read these articles, as not all psychologists can provide therapy, and not all types of therapists are trained to work with all mental health conditions.
For example, most psychologists are trained to work with all mental health conditions, whereas, for example, some counsellors do not have sufficient training to work with complex, enduring mental health conditions.
The counselling professions
The helping profession
The helping profession is in essence people who provide some sort of talking therapy. The people who provide the service vary considerably in terms of training and qualifications, who they can work with, and what models of therapy they can provide.
The therapy itself is also varied and somewhat confusing, so I shall start by explaining the types of counselling professionals and their regulatory bodies before discussing the models of counselling.
What is a profession?
Members of a profession can differentiate themselves from people who provide a service on a voluntary basis or where their work is not regulated.
The helping professions consist of different professions, each with its own professional body, which sets minimum standards, regulations and ethical practices.
What are the counselling professions?
Counselling professions include the following.
- Psychiatrists
- Psychologists
- Psychotherapists
- Psychiatric nurses
- Family therapists
- Therapists
Each profession has its own regulatory body.
Regulatory bodies
Ireland
- IACP- Irish Association for Counselling and Psychotherapy
- PSI- Psychological Sciety of Ireland.
UK
- BACP – British Association for Counselling and Psychotherapy
- BABCP- British Association for Behavioural and Cognitive Psychotherapies
- BPS- British Psychological Society
Why do we have professional bodies?
Regulation protects you, the public. This HCPC article explains the need for access to trained, qualified and experienced practitioners.
If you are fortunate enough to avail of counselling through bodies such as for example, the HSE or NHS, your therapist will have met stringent criteria to provide you with a counselling service. However, in private practice, for example, it is difficult to navigate through a potential minefield of information, qualifications, and models of therapy. Adherence to the regulations of professional bodies offers protection.
Professional bodies exist to;
- maintain a register of practitioners – this allows you to choose a counsellor who has met certain standards and adheres to the rules and regulations of their professional body.
- outline good practices
- provide a code of ethics, which includes topics such as fitness to practice, respect for the clients, and self-responsibility.
- set minimum standards of education and training.
- inform the general public
Confidentiality and Privacy
When considering whether to try therapy, it is crucial to understand confidentiality and privacy considerations. Confidentiality is an integral part of building trust with your therapist and means that your therapist will not go out and tell people about your session.
They must also adhere to the guidelines set down by their professional body.
There are a few exceptions to confidentiality, such as when a therapist must breach confidentiality to protect a client from harming themselves, the therapist, or a third party. In addition, if the therapist is part of a GP practice, it may mean that information is available to the GP and that the therapist must inform the client of this.
Whether you are attending in person or online, the same privacy considerations apply. Your therapist must protect your private information and not disclose it to any third parties without your permission.
Understanding confidentiality and privacy considerations are essential when deciding whether to try therapy, as it helps ensure the therapy’s safety and success.
Where do counsellors work?
Voluntary bodies
- Accord
- Samaritans
- Victim support
Educational settings
- Student counselling services
- School-based counselling
NHS and HSE
- Primary care
- Specialist services
- Secondary care
Private practice
What do people come to counselling for?
Support
Some people seek counselling for support when they do not want a problem solved or help with a mental health issue, rather they want to be listened to and supported through a particular time or change in their life.
Crisis intervention
People are often offered counselling following a crisis such as a bombing or large-scale accident. This type of counselling helps to reduce psychological damage that may occur following the crisis.
Problem-solving and decision making
Counselling can help people with major decisions such as leaving or remaining in their relationship or help with ongoing health challenges.
Help with mental health.
People are often referred by their GP for cognitive behavioural therapy to help with anxiety and depression.
Types of therapy
When considering different types of therapy, it is essential to consider the goals of the treatment and the best approach for achieving those goals. The most common types of therapy include:
- Client-centred therapy (person-centred therapy).
- Cognitive or cognitive-behavioural therapy.
- Existential therapy.
- Gestalt therapy.
- Psychoanalytic or psychodynamic therapy.
- Humanistic therapy.
- Psychodynamic therapy.
- Integrative/holistic therapy.
Each of these therapies has its unique approach to helping you. However, not all therapy models are suitable for all difficulties. For example, CBT is effective in helping with anxiety and depression. However, if you have a personality disorder, then DBT would be recommended. It is not as simple as reading about different therapy and then deciding to try one model or another as it may not be helpful for your specific problem. This is why I recommend people meet with a psychologist if they are attending privately, as a psychologist can recommend the correct therapy model to help with your concerns.
When considering therapy, knowing the different treatment orientations available is essential. Humanistically oriented therapists emphasize people’s built-in abilities to achieve self-fulfilment and focus on present feelings and conscious material rather than past events and unconscious material.
Other orientations include client-centred therapy (person-centred therapy), which is a non-directive form of talk therapy that emphasizes positive unconditional regard; cognitive or cognitive-behavioural therapy, which focuses on making connections between thoughts, behaviour, and feelings; existential therapy, which focuses on free will and self-determination rather than symptoms; and gestalt therapy, which focuses on the “here and now” experience of the client.
Lastly, psychoanalytic or psychodynamic therapy focuses on connecting with and working through painful feelings in the unconscious mind.
Ultimately, no one process or method of therapy works for everyone, and it’s important to find the right therapist who can help you achieve your goals.
What to expect when starting counselling/therapy
Time commitment
Therapy requires an investment of time and effort to be successful. The time needed will depend on your therapeutic goals and commitment to change. Depending on the situation, therapy may be a short-term commitment with a set amount of sessions or a longer-term commitment for managing chronic mental health issues or personal growth.
Feeling comfortable
When considering the comfort level of therapy, it is essential to consider various factors. Firstly, feeling comfortable in the therapist’s presence and the sessions setting is important. It is also important to feel heard and validated by the therapist for therapy to succeed. A good therapist will challenge you, check-in, guide you to your goals, help you learn, show acceptance and compassion, and treat you as an equal.
On the other hand, therapy should not involve judgement, insults, demeaning comments, unreasonable demands, or breaking personal boundaries. A good therapist should make you feel supported, not judged. It is also essential to pay attention to how you feel and if you are making progress. If you are not clicking with your therapist, it is okay to try out different therapists and see what works best for you.
Finally, setting boundaries around your therapy and being honest with yourself and your therapist is essential. Share your feelings, even if it feels uncomfortable. This is how your therapist will be able to help you the most. By considering all of these factors, you can ensure you get the best care from your therapist and feel comfortable in the process.
The first meeting.
The first time we meet is when I take time to determine your current difficulty. This is not just a meeting where I listen, although, of course, I shall listen!
In the first counselling session, I shall find out exactly what the problem is and more importantly, what we can do about it.
Towards the end of our first session, I shall tell you what the problem is, what keeps it going, and what you need to do to make the necessary changes.
I shall also find out exactly what you want to change. I shall be asking you for goals. These might be, for example,
- manage anxiety
- help you with health anxiety
- decrease anger
- help with compulsions, intrusive thoughts, or OCD
- pull up your mood
- help you with work-related stress
- stop negative thinking
- get a good night’s sleep
- better relationship skills
- improve your confidence or self-esteem and help you to feel better about yourself
We discuss goals in the first meeting to allow me to tailor a specific plan of therapy that will help ensure that you get what you need. It also keeps me accountable and focuses me on what we need to work on together.
In the first session, I shall tell you if I intend to use a particular model of therapy, for example, CBT (Cognitive Behavioural Therapy). I shall explain the model to you and tell you why I want to use it and why I think it will be helpful.
I will also give you a number of sessions. This will not be vague; I shall give a number and explain my thinking.
I shall also tell you what future sessions will be like and what will be required from you.
Future sessions
Focus on the plan that we arranged in our first meeting. Many people think of counselling as where you come to talk about whatever is on your mind, which can happen within a particular therapy model. Still, I like to keep my counselling focused on taking steps to help you achieve what you discussed with me in our initial session. We could well be working within a model of therapy called Cognitive Behavioural Therapy (CBT) which is highly structured, and you can read whether it really works or not here,
Our future sessions stick to the plan that we both arranged in the first session; think of it as each session builds on the knowledge and progress made in the previous session.
Because of my training, we can ‘pull’ from other therapy models, so to speak, as and when required. If you have read anything about me, you will know my interest and respect for neuroscience, and this shall certainly be included in counselling with me, as you need to understand how your brain works.
Tips for getting the most out of your therapy sessions
Discuss goals for therapy
Discussing goals can help get the most out of therapy sessions by setting expectations and providing direction. Knowing your goals can help you and your therapist stays focused on the issues that need to be addressed in therapy.
Set regular appointments
It is essential to set regular therapy appointments to achieve the best results. Regular sessions allow the therapist and patient to work together to develop goals and create a plan to reach them. Consistent attendance will enable you to learn more about yourself, practice new skills, and have the guidance and support of the therapist.
Be open and honest with your therapist.
Being open and honest with your therapist can help you get the most out of your therapy sessions by providing your therapist with the information they need to help you. When you openly and honestly share your thoughts and feelings, your therapist can better understand your experiences and tailor their advice to your needs.
Additionally, by being open and honest with your therapist, you allow yourself the space to process your emotions and work through complex topics without judgement or criticism. This is critical to making progress in therapy, as it will enable you to feel comfortable and trust in your therapist so that you can work towards achieving your goals.
- Use the tools your therapist provides
- Listen to your therapist’s advice. Your therapist is there to provide helpful guidance, so take the time to listen to what they say and consider how it applies to your situation.
- Ask questions. Feel free to ask questions if you need clarification on something your therapist has suggested or said. This can help you better understand the advice they’re giving you and how to apply it best.
- Take notes. Taking notes during your sessions can help you remember the essential points and tools your therapist provides. Writing down your therapist’s words can help you process and reflect on the information later.
- Follow directions. If your therapist provides you with homework, such as reading assignments or journaling exercises, complete them. Doing the work in between sessions can help you get the most out of therapy and put what you learn into practice.
- Participate in the exercises. During your sessions, your therapist may have you do exercises that help you explore your feelings, work on communication skills, or practice mindfulness. Participating in these activities can help you gain insight and develop new skills that benefit your everyday life.
- Reflect and practice. Often, change takes time and practice, so it’s important to take the time to reflect on your sessions and the tools your therapist has provided. Consider how you can use and practice what you learned daily.
- Follow your therapist’s instructions.
Do I have to come to Dublin if I want counselling?
In a word, no. I have designed a series of courses to mimic counselling sessions with me (without the trip to Dublin), which are available to start immediately. If you want to learn more about them, you can view all my courses here.
The NHS has some great content on what to expect from counselling and you can read it here.
Recap
Counselling is a process that can help the individual with different types of problems and can be administered by different professionals. Professional bodies can help you decide if your intended therapist is qualified and sufficiently skilled to help you with your problem.
- https://www.bacp.co.uk/media/11060/bacp-introduction-counselling-and-psychotherapy-client-information-sheet-march-21.pdf
- https://iacp.ie/iacp-code-of-ethics