It’s very normal to have queries and concerns when first thinking about psychotherapy or counselling. So here’s some jargon-free information about how it all works – including answers to a few of the most common practical questions.
The terms ‘psychotherapy’ and ‘counselling’ both refer to talking therapies. There is currently no legal definition for either profession in the UK.
A therapist’s initial qualifications are different: psychotherapists undertake a lengthier and more in-depth foundation training than counsellors. This can help them to support more complex emotional explorations, and potentially to work with more serious mental health issues, if and when required. However, therapists often undertake further training over the years, which can blur those initial differences.
What happens during sessions in both psychotherapy and counselling is usually very similar. It’s basically a highly-focused, collaborative conversation about you and whatever may be troubling you. This may be an explorative endeavour – examining your memories and dreams, your longings and values, your loves and fears; helping you understand and find ease within your deepest self. Or it may be a more goal-oriented process – clarifying where you are and how you got there; identifying helpful and unhelpful patterns of thought or behaviour; and helping you resolve problems and move forwards with your life. The differences in the ‘feel’ and ‘purpose’ of a session will be far more affected by the personality of the therapist, and the type of therapy being offered, than whether you are sitting with a “psychotherapist” or a “counsellor”.
Some people use the word “counselling” to refer to shorter-term or more ‘goal-oriented’ work, and “psychotherapy” for longer-term or ‘deeper’ work. But on this website, the two terms are used interchangeably.
I am a fully-qualified psychotherapist and have undertaken extensive additional training over the years since my initial qualification. For more information about my training, see About Sarah.
Psychotherapy and counselling provide a safe and highly focused space for you to talk through whatever it is you’re facing. There is room for you to bring your life experiences, your thoughts and feelings, your hopes and fears, your memories and dreams – all without fear of being hurried or judged.
Each psychotherapist or counsellor works with all this in a different way. I generally start by looking at how things are currently affecting you emotionally, physically, and relationally. We build a picture of your life-patterns, your habits of thought, your coping strategies and resources. And we agree and regularly review what you want from your sessions, so we can ensure the process remains supportive and ‘on track’, till you feel ready to cope on your own again.
You can find out more details about how I work in About Sarah.
Independent research shows that people who undertake counselling at times of stress feel better than 80% of those who don’t. So it’s definitely worth trying! But it’s vital to find a therapist who is the right ‘fit’ to help you achieve change. Psychotherapy or counselling with the wrong person either won’t work at all, or can drag on for far longer than it needs to.
If therapy with a particular therapist is going to work, most people will see clear signs of changewithin the first 6 weeks, even if it takes much longer than that to completely resolve their difficulties. As you are the expert on how things feel for you, it’s important to trust your own judgement during the first few weeks of counselling.
When we start working together I will regularly check with you how you think things are progressing. That way I can adjust how I’m working to suit you, and make sure we remain focused on what you want to achieve from therapy. And if you are not seeing positive signs of change then we can talk together about what might be the best way forwards for you – including a referral to a different therapist if needed.
There are more than 1,000 different types of psychotherapy and counselling(!). You may have heard of some of the most common, such as CBT, or Person-Centred. Each type of counselling is essentially a different kind of map for understanding how the mind works, with its own range of map-reading and path-finding techniques. Some use very clear-cut, step-by-step methods; some suggest specific ‘techniques’, for use on a flexible mix-and-match basis; and some outline broad principles which act as a framework for more creative and individualised work. Like any map, each approach generally comes with a wide range of benefits, and some limitations.
Some of the most important types of psychotherapy and counselling that I draw on include:
Person-Centred: Provides an empathic, understanding environment where you can feel safe and supported, so that your own natural movement towards healthy growth can flourish.
Psychodynamic: Examines the influence of early experiences and attachments on how you approach life and relate to others today, to deliver greater understanding and less reactivity.
Mindfulness: Develops your capacity to observe and be curious about experience, so you can begin to feel more fully alive, with a solid sense of calm and a growing self-kindness.
Existential: Looks directly at the core elements of our human experience such as freedom, loneliness, uncertainty and death – so you can better understand who you are, and discover a more authentic and meaningful life.
Coherence Therapy: Assumes that even our difficulties ‘make sense’ on some level – and aims to uncover that coherence, embed new understandings in the mind, and remove previous barriers to natural change and growth.
Focusing: Looks at the bodily sensations that arise with emotion, using that information to uncover your own natural insights into problems, and intuitions about how to handle them.
Somatic Experiencing: Uses an understanding of the body’s natural self-regulating physiology to integrate and balance different aspects of overwhelming experiences, and safely treat trauma and PTSD.
CBT (Cognitive Behavioural Therapy): Helps identify thinking patterns that will be supportive to wellbeing, and set practical strategies to adjust problematic behaviours.
For more information about how I work, see About Sarah.
The answer to this question is basically “it depends”. That’s because psychotherapy and counselling are neither fixed treatments like a pill, nor automated processes like a computer programme. Even approaches that advocate quite a rigid method will still end up, in the counselling room, as a fluid, creative conversation with another human being – complete with all the dynamism and riskiness that involves. So, naturally, the ‘feel’ and ‘flow’ of talking with a particular therapist will have a huge influence on the results.
This explains why large-scale research studies have repeatedly shown that the ‘therapist-doing-the-counselling’ seems to have up tosix times more impact on results than the ‘type-of-counselling-delivered’. In fact, the research shows that across any given group of people, no single ‘type’ of therapy delivers better results than any other.
So how do I choose?
What this means is that if you’ve heard about a particular approach or type of psychotherapy or counselling that really seems to resonate with you, then it’s probably worth seeking out a therapist who is familiar with it or even a specialist in it, as your sessions together are more likely to feel like a good personal ‘fit’. But if you (like many people) don’t have a preference in advance, then by far the most effective option is simply to look for a therapist you feel comfortable with.
A standard psychotherapy or counselling session lasts for 50 minutes. Sessions are normally scheduled on a weekly basis, at the same time each week. Most people find that weekly therapy gives enough time to digest what has been discussed, or put new ideas into practice, whilst providing steady forward movement and consistent support.
Attending your sessions regularly is really important, in order to build enough momentum for change and make gradual, steady progress towards your goals (a bit like going to the gym).
As therapy progresses, some people find it helpful to consider spacing sessions out to be fortnightly instead of weekly, as a sort of ‘transition’ towards ending.
Psychotherapy and counselling can last just a handful of sessions, or it can continue for several months, or even years. This depends partly on how complex your situation is and how long it’s been going on for – and partly on your personality, your natural pace, and how you like to approach things.
It also depends on how much exploration you want to do. Some people who come to counselling when they are emotionally ‘drowning’ just want to reach the shore, and feel ‘safe on dry land again’. Others, once they’re feeling more confident, may then wish to explore more deeply – and that naturally takes longer.
My aim is to make sure that our work matches your preferences, doesn’t feel rushed, and doesn’t drag on for longer than it needs to. About three-quarters of those I work with take under 20 sessions to achieve the changes they want to see.
The nature of psychotherapy and counselling means they often involve talking about issues that are difficult or painful. This can, sometimes, initially make things feel worse – or certainly ‘messier’ – than they did when everything was neatly ‘packed away’. Most people find this is part of a helpful process of understanding, cleansing, and moving on. Sometimes, though, you may sense it’s just not the best or safest thing for you to do right now.
If so, it is NOT wise to ignore things and carry on regardless. Much better to say clearly to your therapist that you’re in pain, or struggling. Then together you can try to approach things differently – or go more slowly – or plan an end to your sessions. The important thing is to do what feels right for you. That way you stay in control, and the process remains safe and manageable.
It’s often useful in psychotherapy and counselling to take a look at key events in the past. It enables you and your therapist to better understand the path that led you to whatever difficulty you’re facing now – and the resources that helped you survive. That, in turn, can help you figure out a helpful way to move forwards.
However, if there are details you’d rather not talk about, that’s absolutely fine – you never have to say anything you don’t want to.
I have trained in specialist approaches which enable me to help you achieve change in the present, even when you don’t feel able to discuss what’s happened in the past.
Therapists understand and completely respect the need for privacy and discretion when discussing sensitive issues. All psychotherapists and counsellors abide by stringent professional codes of ethics, set by their membership bodies, which include a commitment to the utmost confidentiality, with the following exceptions:
Clinical supervision: For UK therapists, it is a professional requirement to have regular Clinical Supervision. This means that some details of your sessions may occasionally be discussed by your therapist with their clinical supervisor(s). Any such discussions are bound by the same professional codes of confidentiality that apply to your own counselling sessions.
Serious harm: If what you share in your sessions seems to indicate a high risk of serious harm to yourself or someone else, then your therapist will need to consider if anyone else should be informed. However, this would normally be discussed with you directly, and any eventual disclosure would wherever possible be made with your full involvement and consent.
Child protection: For children under 18, there are certain limits to confidentiality in order to conform to the safeguards of UK Child Protection laws.
Terrorism: If you disclose information related to terrorist activities, then UK anti-terrorism laws require that to be shared with the relevant authorities.
If you have any other questions, just contact me and I’ll do my best to answer.