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Counselling and therapy

Often when we're struggling, counselling and therapy can make a big difference. Find out what happens during counselling and therapy and how it can help you feel better. 

What is counselling/therapy?

A happy couple laughing together outdoors

Counselling and therapy (sometimes called ‘psychotherapy’) are both types of talking therapy, which can be a source of support if you’re struggling with something.

As the name suggests, ‘talking therapy’ often involves talking about your feelings, thoughts and experiences. This can help you to make sense of what’s going on in your life, and give you a safe place where you can talk about difficult feelings, get things off your chest, and find ways of coping when things are difficult.

Counselling or therapy may be offered to you as a treatment for a specific mental health problem, but you don’t need to have a diagnosed mental health condition, or even a specific ‘problem’, to do talking therapy.

The first session was the scariest, I had so many questions racing through my mind: would I get along with my therapist? Could she really talk to me without judgement? Am I in control of the session? The answer to all of these was yes! The first step into therapy is often the hardest but, for me, it was the most rewarding.
Eleanor, 18
A boy and his parents smiling during a family meeting

What is the difference between therapy and counselling?

You may hear people use the words ‘counselling’ or ‘therapy’ to mean the same thing, but there is a slight difference between the two. Counselling is usually short-term and often focuses on finding solutions for a specific problem that you are struggling with now. For example, if you have recently lost a loved one, you may attend grief counselling.

Therapy is usually medium- or long-term and focuses more on exploring thoughts, feelings or behaviours that impact your life. For example, if you have difficulty with relationships or you’ve been struggling for a while and things aren’t getting better, you might go to therapy to understand what is causing the issue.

In talking therapy, a trained therapist or counsellor will listen to your problems and work with you to help you understand what is causing these problems, and find solutions to help you overcome them.

How can therapy or counselling help me?

Different people may find therapy or counselling helps them in different ways – everyone’s experience is different. Sometimes it can be helpful just to talk to somebody confidentially and without judgement. This can help us feel less alone, or it may just be a relief to talk about what we’re going through with someone who will listen.

For some of us, talking therapy can be a really helpful way to understand our problems better, which can help us change how we deal with difficult situations and other people so that we manage these things in a more positive and helpful way.

Therapy and counselling can also help us find practical solutions to the problems we are facing - for example, how to manage anxiety.

What happens during therapy or counselling sessions?

In your first session or ‘consultation’, you will discuss what you can expect from the sessions. Your counsellor or therapist will explain practical details like how many sessions you have, or what to do if you can’t attend a session. This is a good opportunity to ask any questions you have.

After the first session, you will normally see your therapist or counsellor once a week, although they may suggest you see them more often if they think it is necessary.

What you discuss will depend on what you’re struggling with and the type of therapy or counselling you are doing.

It might feel scary or difficult, but it’s important to try and be as honest with your therapist or counsellor as possible so they can help you in the best way. But, if there is anything you don’t feel comfortable talking about, that’s okay – just let them know. This is your therapy, so it is important it feels right for you.

  • I know that it is daunting to open up to somebody who you do not know, but trust me you will feel the benefits if you put the work in.
    Laura
  • Creative therapy has helped challenge my perfectionism and the high expectations that I put on myself, and instead has helped me to stop judging my art, or other creative expressions of my emotions.
    Elsie
  • Therapy helped me to gain a better understanding about how I was feeling and it allowed me to learn how to cope with my emotions without getting overwhelmed by them.
    Laura
  • A counsellor won’t push you to talk about something that makes you feel uncomfortable - you only have to talk about things that YOU want to talk about. And just as you can do in a regular situation, you can say you’re uncomfortable with the topic and move on.
    Caitlin

Difficult feelings during and after sessions

You may find that doing therapy or counselling brings up some difficult emotions for you. This is completely normal and it does not mean that you are doing it ‘wrong’. In fact, it is often a sign you are dealing with important problems. However, if you are feeling overwhelmed by your emotions during a session, it’s ok to let your therapist or counsellor know and take a break if you need to. Together you can think about what might help make it easier, or what you can do after a session to look after yourself.

Some people also find that they feel physically drained after sessions too. For this reason, it can be a good idea to make sure you have some time after your sessions to relax and do some self-care.

It’s important to remember that there is no ‘right’ way to experience talking therapy or counselling. However you’re feeling is valid. If you’re worried that your sessions are not working for you, talk to your therapist or counsellor. It is their job to listen to this and talk it through with you so that they have a better idea of how to support you in future.

Real stories

Common types of talking therapy

There are several types of talking therapy that you might be offered. A doctor or psychiatrist might suggest what they think it best for you, but it is important you feel comfortable with the therapy you choose.

CBT is a type of talking therapy used to help you understand how you think about things and to change any behaviours that aren’t helping you. It is normally very practical, and your therapist may ask you to put into practice what you discuss in your sessions. You might then report back to your therapist about how you found it . The aim is to help you apply the skills you’re learning in your daily life to help you manage your problems.

A course of CBT normally lasts between 12 and 20 sessions.

Studies show that CBT works for a variety of mental health problems, including:

DBT is similar to CBT in that it is about helping you understand your feelings and change unhelpful behaviour, but it also helps you learn to accept yourself. DBT is done for a bit longer than CBT – normally around six months. It also often involves working with groups.

The focus is to identify unhelpful behaviours, understand why you might have developed them, and learn new coping strategies that are more helpful in the long term.

DBT is most often recommended for people with borderline personality disorder (BPD), but it can be helpful for anybody who feels emotions very intensely.

IPT focuses on helping you address problems in your relationships with important people in your life. It is normally suggested for people struggling with depression who have already tried other types of treatment. The theory behind IPT is that having poor relationships in your life can cause you to feel depressed.

In IPT sessions, you will explore relationships you have, what difficulties you have in these relationships, and try to find solutions.

A course of IPT normally lasts between 12 and 16 sessions.

EMDR is used to help people process distressing memories and reduce their emotional impact. It is a relatively new form of therapy, but it is increasingly being used to help people with post-traumatic stress disorder (PTSD).

Dealing with or talking about trauma can be very difficult and distressing. EDMR involves doing repetitive side-to-side eye movements while you explore a trauma. We don’t fully understand how this works yet, but there is evidence to suggest that it does, and many people find it helpful.

A course of EMDR normally lasts between eight and 12 sessions.

Creative therapies like art, music or drama therapy can be used to help people express difficult feelings. These types of therapy are often done in groups, but can be done individually. Normally in creative therapy sessions, you will use a form of expression like art or music to explore your feelings, then discuss the outcomes.

There are many other types of talking therapy available to you. If you are unsure or have questions, you can ask your GP. The important thing is to find the therapy that works for you.

Being introduced to CBT practices has helped me develop some new coping techniques, and I feel better prepared to cope with shifts in my mental health.
Natasha

How to access therapy

close up of a boy wearing grey hoodie listening to an advice of his teacher in front of him

If you think you would like to try counselling or therapy, a good place to start is by talking to your GP. They can let you know what services are available in your area and how to access them.

Have a look at our page on how to speak to your GP about mental health for more information and tips.

If you live in England, you can also refer yourself for psychological therapies on the NHS without a doctor. For more information about what services are available in your area and how to self-refer, look on the NHS website.

If you are 18 or under, you can access psychological therapies on the NHS through Child and Adolescent Mental Health Services (CAMHS). For more information about CAMHS and how to access their services, have a look at our CAMHS page.

Write things down beforehand, in case you get flustered and forget what you need to say. It’s not as bad as your brain is telling you it will be.

Private counselling and therapy

You can also get counselling or therapy privately if you are able to pay. The cost will depend on who you see, what type of counselling or therapy they offer and where they are based. Many therapists or counsellors offer a free session to begin with, so it can be a good idea to meet with a few different therapists to see who feels right for you before you start paying. Some counsellors and therapists also have reduced prices for students, people who are unemployed or people on low wages. If you are seeking therapy or counselling privately, it’s important to confirm the cost before you begin.

You can search for therapists or counsellors that work specifically with young people, or search by therapists who work on specific condition or problems.

It is also very important to make sure any therapist or counsellor you speak to is fully qualified, so that you are getting support that is helpful and safe. There are a few websites you can use to find qualified therapists who are registered with a professional body, such as:

medium-shot-of-three-young-people-smiling-while-looking-at-their-phone-while-sitting-in-class

Therapy and counselling at school, college or university

Many schools and universities offer free counselling or other forms of talking therapy.

If you are a student, it is a good idea to talk to whoever is in charge of student welfare at your school, college or university. You can also talk to a teacher that you feel comfortable with, and they can help find out what is available at your school.

It is okay to not know what to say. A counsellor is there to support you so they will know that you are anxious.

Will my therapist/counsellor tell anyone what I say?

Anything you say in counselling and talking therapy sessions is confidential. But, your therapist or counsellor may have to tell someone if they think you or someone else might not be safe. Usually they will try to let you know first.

They may also discuss what you tell them with a supervisor (the person who helps them think about how they can best support you), but this is only to ensure you get the best treatment possible, and their supervisor also has to keep your information private and confidential.

If you are doing group therapy, the therapist leading the sessions should discuss confidentiality with the group before you begin.

It’s important to remember that your counsellor is working in your best interest, even if you may doubt that at times.
Caitlin

What to do if you're not happy with your therapist/counsellor

Remember that therapy and counselling has to work for you. The important thing is that you find someone you feel able to talk openly with. If you don’t feel comfortable talking to your therapist or counsellor, you can see someone else. Speak to your GP or CAMHS team and they can arrange this.

You deserve the best treatment possible for you, so if something isn’t working, please don’t worry about speaking out! People want to provide the best support for you and so letting them know what isn’t working is important for you and them.

Complaints and how to make them

If you feel you have been treated unfairly by a counsellor or therapist, or any member of NHS staff, you are entitled to make a complaint. To make a complaint about treatment in the NHS, follow these steps:

  1. If you're unhappy with how your treatment is going but you don't want to make a formal complaint, speak to the clinician treating you, or contact your local PALS (patient advice liaison service) at your hospital for confidential advice and support.
  2. Check the complaints process. Every NHS organisation has its own process, but they must all follow the same NHS rules. If you can't see the complaints process online, call or email the complaints department.
  3. Find out who to complain to. It will either be the service you used, or the commissioning group who paid for the service. The gov.uk website can help you find out where to send your complaint.
  4. Send your complaint and wait for a response. Your complaint should be acknowledged within three days, with details of what happens next.
  5. Need to take it further? If you're not happy with the results of your complaint, you can contact the Parliamentary and Health Service Ombudsman.

If none of this works, you can write to your MP who can complain on your behalf.

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