When it comes to choosing a partner for an emotional relationship or business partnership, it’s generally a good idea not to choose the first person that comes along. That rarely ends well. A therapeutic relationship is similarly a very significant one – hopefully life changing – so it’s wise to take some time to consider your options. This checklist should help you focus on the issues involved in such a decision. Don’t be afraid to shop around. Counsellors will often offer a free or reduced price first session.
Top of the lists is the personal rapport you have with the counsellor. You may end up seeing this person every week for a year and no matter how good their qualifications, if you don’t click as people this will limit your progress. Do you feel safe in their presence? Could you trust them enough to share your most vulnerable feelings? Being on the same wavelength is very important so ask yourself “do they get me?” and, when they talk “do I get them?” In other words do you speak the same language? Striking the right balance between informality and professionalism is important. You want to feel confident in their expertise and experience but not feel talked down to.
There are basically three types of counselling you are likely to encounter: Person Centred, Psychodynamic and Cognitive Behavioural Therapy (CBT). The method that is right for you will depend on the kind of issues you are bringing and on your personality. Let’s look at each of these in turn.
Cognitive Behavioural Therapy
CBT looks at personal problems in an intellectual way. It doesn’t explore emotions but rather looks at the ‘distorted thinking’ that can lead to negative experiences such as anxiety and depression. This is the method favoured by the NHS because it is cost-effective: it requires less training; a course of sessions can last as little as a few weeks; and it can easily be done in groups as well as one to one. CBT can be useful when dealing with a single issue such as agoraphobia or eating disorders. It can also suit those who find it easy to be analytical, but find it difficult to get into their feelings. The downside is that most problems have an underlying emotional cause which CBT cannot address.
This therapy, as the name suggests, takes its cues from the client. Unlike CBT, there is less focus on labels, diagnoses or assessments because each person’s experiences are considered unique. Although they may have common identifiable ‘conditions’, such as depression or anxiety, their experience of and the roots of these problems will be different and personal. As a result, the emphasis in therapy is on really listening to the client and their story, with a view to understanding how these problems have emerged. Person centred counsellors believe that many problems arise for clients because they have only been partially accepted by significant others in their lives; and that this acceptance is thus ‘conditional’. The counsellor therefore strives to accept and ‘prize’ the client unconditionally, no matter what they say about themselves; and this helps the client to accept themselves and any disowned experiences, feelings, behaviours and thoughts. This therapy is particularly good for people who suffer low self worth or self esteem, or who have problems in relationships. It can be empowering for a client to recognise that they are the best expert on themselves and that the answers to their problems lie within them. However, some argue that not all answers do lie within the self, which can lead clients in ‘pure’ person centred counselling to feel they are going round in circles without help or direction from outside themselves.
This therapy originated with Sigmund Freud, and still incorporates concepts developed by him. It believes that many of our problems originated in childhood and now lie in the unconscious; and that the aim of therapy is to raise these issues into consciousness, where they can be understood and resolved. Psychodynamic therapy uses several concepts to help clients, such as ‘ego defence mechanisms’, which describe the ways in which we keep difficult feelings out of consciousness; and ‘attachment theory’, which explains different parenting styles and how these can affect us in later life (particularly in close relationships). It also recognises phenomena such as ‘transference’ in the counselling relationship, where clients ‘transfer’ feelings they have towards others (e.g. a parent or boss) onto the therapist. The counsellor uses their understanding of these concepts and unconscious processes to help the client gain insights. This can be a very useful therapy for those who experience powerful emotions but do not understand the causes. However, unlike person centred therapy, there is a danger the counsellor can become the ‘expert’ on the client’s problems – which can feel disempowering if not conducted sensitively or with humility.
You may find your counsellor refers to themselves as ‘Integrative’ which means they are trained in more than one technique, and are able to integrate different tools and methods depending on the needs of the client. This can be useful, because different approaches suit different personalities. Also, one method which might work at a particular time for a client, may not be as effective with the same client at a different time or when looking at a different issue.
You should always check the practitioner has the appropriate qualifications and is registered with a professional body such as BACP or UKCP (you should be able to find them on the relevant website if they are a member). Belonging to one of these organisations means they must adhere to certain ethical standards, which protects you from harm and provides you with a complaints procedure should the therapy fall below these standards. Membership of these bodies also requires therapists to have adequate supervision, which even the most experienced counsellors should have. Supervision is essential for counsellors to gain insight from someone more experienced, and to provide a space to work on their own issues which may get in the way of their work with you.
What is the counselling room like? Is it a space where you feel relaxed and undistracted? Is there a quiet space where you can sit after a session? Sometimes after an intense session it can be hard to go straight back into the world – particularly if you are feeling vulnerable. With this in mind you may want to consider the location of the practice. You might not want to take a busy train back after a session, for example; or you may not want to get stressed out searching for a parking space before.
For many trades being busy is a good sign. It shows the service provider is in demand and has a good reputation. However, counselling can be emotionally and intellectually draining. The more clients a counsellor takes on the harder it is for them to be fully present with you. Don’t be put off by a counsellor with a lot of space in their diary because they only see a handful of clients each week, as they may be doing this consciously to enable them to work ethically and build a therapeutic relationship with you. The other downside of a busy therapist is you may not be able to get the time slot you need. If the counsellor is constantly shuffling times to fit people in this may also disrupt you getting into a rhythm. Also ask yourself are they busy because they get a lot of personal recommendations, or do they simply advertise a lot.
You will generally find hourly rates for private counsellors are around the £40 mark, give or take £10, so price may not be a significant factor when choosing a counsellor. The higher rate may reflect higher rental costs or the cost of a receptionist. Don’t assume, however, an expensive therapist means a more competent practitioner. I have known, for example, an individual who paid five times the going rate to see a celebrity therapist and I could see no evidence that this money was well spent. After all, the most expensive therapists are not necessarily the best; they might just think they are! You might want to consider the low cost counselling provided by local charities in some areas, where costs are generally around half the price of private counselling, and where the counsellor you see will usually be a trainee working as a volunteer in order to gain experience or accreditation. This doesn’t necessarily mean you will see a second rate counsellor but it can be pot luck how helpful they will be. Remember, it will prove more expensive in the long term to go with the wrong counsellor, just because their costs are low. After all, you might discover some weeks or months into the therapy that they’re not actually helping you, and end up having to start again with someone new and at more expense. There can also be a lack of flexibility with booking, time slots and cancellations within low cost counselling agencies, and usually a long waiting list (often several months). Therefore, take this into account if your issues are affecting you particularly adversely right now.
It’s very difficult to estimate how long counselling will take, as it varies so much from person to person. However, it’s worth bearing in mind that it’s not unusual for a course of therapy to take up to a year or more – which means the costs inevitably add up. Try not to be deterred by this because, if it works well, counselling can bring significant changes in life, including financial. However, you might want to check out my blog post – ‘How to get the most out of a counselling session’ – to read tips on making counselling as efficient as possible, which will keep the costs down in the long term.