So many kinds of counselling and therapy, what’s right for me?

This is probably the most asked question (or variations of it) after ‘what’s the difference between counselling and psychotherapy’? There are many different kinds and these are sometimes known as modalities. I’ll give a run down on the more popular modalities and you’ll be able to see what the differences and similarities are and I’ll also talk about what’s important to look for when you’re thinking of seeing a therapist.

A bit like pilots and their flying hours, therapists’ experience can be measured by their supervised client hours. For instance before you can register with most professional bodies you must have completed a course which included at least 100 hours of supervised practice, some are more stringent on the number of academic contact hours and supervised client work. Some professional bodies also have levels of membership which recognise post-qualification client work experience. For example the British Association of Councelling and Psychotherapy (BACP) have members, accredited members and senior accredited members depending on how many hours of client work you have undertaken and gives some indication of experience. This may not always be an indicator of how good a therapist is. Just because someone has been a therapist for 20 years doesn’t mean they’re right for you. What’s more important is what you feel about them. This could be how comfortable you are with them, how trustworthy they seem to be, whether they have availability that’s convenient for you and also whether you can afford their fees, if you’re seeing someone privately.

So lets have a quick overview of some of the different type of therapy:

  1. Person Centred Counselling. This is one of the most common type of counselling available in Scotland. It was developed in the 1940s & 50s by Carl Rogers and the focus is on the development of the therapeutic relationship with the client at the centre of that relationship. Roger’s believed that clients were best served by a less interpretative, directive and behavioural approach and developed core principals by which therapists should operate: unconditional positive regard, congruence and empathic understanding of the client. The client is expected to be able to self-actualise, ie to have an ability and drive to reach their fullest potential (self-actualisation is from Maslow’s hierarchy of needs and manifests when more basic needs are met, such as food and shelter). If the therapist is lead by the client and demonstrates the core principals within the therapeutic relationship the client will be encouraged to find their own solutions and interpretations of what they are finding difficult in their daily lives. The focus is very much on the here and now rather than what may have happened in the past and does not involve any interpretation or explanation of unconscious processes. This style of therapy is non-directional and so for the client can feel uncontained but at the same time listened to and understood by the therapist.
  2. Gestalt therapy. This has similar principals to Person Centred type therapy and was developed by Franz and Laura Perls and Paul Goodman around the same time as Carl Rogers was developing his methods. There is a greater focus on the here and now and encourages the client to think about immediate thoughts and feelings and can be quite lively, spontaneous and creative. There is a greater emphasis on the processes that are taking place in the room rather than the content of what you might be talking about. The goal is an increased holistic awareness of and insight into what we think, feel and act and can be quite liberating as an experience. Therapy sessions follow no fixed guidelines with therapists being encouraged to find their own creative ways of working with clients.
  3. Psychoanalytic psychotherapy. This is what we might think of as classical analysis although the client may not always lie on a couch with the analyst out of their view. Sessions may happen as frequently as once, three or five times per week and may include free association (saying whatever comes to mind) with very little interaction with the therapist. It draws on theories and practices of analytical psychology and psychoanalysis from Fraud and Klein through to more recent theory on attachment and relational psychology. The aim is for the client to understand and resolve their problems by increasing awareness of their inner world and its influence over relationships both past and present and to understand and change complex, deep-seated and often unconsciously based emotional and relational issues. The Psychodynamic approach to counselling and psychotherapy has a similar theoretical background with a less intense frequency and no couch.
  4. Cognitive Behavioural Therapy (CBT). This is most likely what you’ll be offered if you access NHS counselling services. This is usually a short term therapy and focusses on how you think and act. Problematic thoughts and behaviours in the present are addressed and solutions and strategies are offered in order to change of manage these. It is more common to see a CBT practitioner for around 6 weeks but could be as long as six months if the issue is severe. It’s quite a practical, directive and structured therapy and so might be a good choice if you have difficulty with less directive, open ended modalities. Training is varied with short CPD type courses for mental health professionals to post-graduate level. Some courses do not meet the standards for membership of the British Association of Behavioural & Cognitive Therapies (BABCP) but that is also true for other types of therapies.
  5. Integrative Therapy. This type of therapy is a mixture of many modalities. Quite often integrative therapists will use techniques and theory from psychodynamic, person centred and gestalt therapy but may have included study and practice of more than these three or a different combination of modalities, depending on where training took place. Integration also refers to integrating the personality of the client, taking unaware, disowned or unresolved aspects and making them part of a cohesive whole. Blending the best parts of many approaches to therapy sounds like a very complete kind of therapy.

Having said all that, what’s most important, according to the research literature, isn’t the modality but the therapist themselves and the quality of the therapeutic relationship. Therapists are not superhuman and won’t be able to work effectively with everyone, so there is still an element of good fit between therapist and client. Gender, age, modality, availability and accessibility may be things you want to consider before contacting people to arrange appointments. Some things might be more important to you than others. Sometimes you might walk into someone’s therapy room and find the carpet so hideous you don’t want to go back (a real example of why a therapist (not me) decided not to go with a particular supervisor). Go with your gut and trust your feelings and intuition when deciding.

There is no regulation of counselling or psychotherapy in the UK. This means anyone can say they are a counsellor and start seeing clients, but it doesn’t mean they have any training or experience. So there are no statutory organisations like the British Medical Association (BMA) for doctors or the Nursing and Midwifery Council (NMC) for nurses and midwives. There is voluntary regulation provided by a number of organisations and membership, on the whole, requires proof of completion of training and supervised practice by a reputable training organisation. However, there is no requirement to be a member of any regulatory organisation in order to practice.
Things to be wary of are:

  • Therapists who have been trained with no requirement to have personal therapy. This is important because not only will they not have worked on their own issues, they won’t have any experience of being a client themselves.
  • It is imperative that anyone practicing as a counsellor or psychotherapist have a supervisor. This ensures there is someone to provide ongoing professional guidance and oversight of practice as well as support. This is also a requirement for membership of professional bodies.
  • A practitioner who is not a member of a professional registration organisation. Apart from the attributes mentioned above, registering bodies deal with any complaints by clients and can strike someone from the register if they have not complied with the code of ethics and practice. There are many and they deal with different sorts of therapists and there is some overlap. Some examples are the British Psychoanalytic Council (BPC), British Association of Counselling and Psychotherapy (BACP), Councelling & Psychotherapy in Scotland (COSCA), UK Council for Psychotherapy (UKCP), to name a few.

Some other resources to consider in your search:

This article is useful, despite the American context on training etc.

This is also useful on what to look for in a therapist.

If you’d like to talk about coming to see me or to arrange a Skype meeting please    contact me

CBT, gestalt, integrative, person centred, psychodynamic, therapy, type of therapy

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