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It can be difficult to know where to start when you are considering seeking professional help. To help, I've compiled a brief summary below of the most common and widely available types of talking therapies. Waiting lists for free or low cost therapies provided by charities or the NHS sadly can be very long (often around 5-6 months), so I would recommend reaching out to be placed on a waiting list sooner rather than later. Private therapists often offer a sliding scale where clients pay according to their income, so it is worth also checking online directories such as the BACP and COSCA to find private practitioners near to you.
You may be more inclined more towards one modality than another. On the other hand, if you can't decide, then please don't worry - not one of these methods has been proven to be more effective than any other. So whatever modality you choose or are offered, rest assured it's more to do with personal preference rather than efficacy. Some modalities may be more suitable to certain situations and client groups than others. For example, EMDR (see below) is more useful in helping clients who have experienced trauma and are specifically looking for help in coming to terms with that trauma. What has been proven in multiple research studies is that the most essential factors in therapy are (a) the quality of the relationship between the client and therapist; and (b) the level of the client’s motivation.
Psychodynamic Counselling
This method is based on the concept that past experiences have had a significant bearing on how you perceive experiences and feelings in the present, and that significant relationships, perhaps from early childhood, may be being re-played, or acted out, in some way with other people later on in life. The central tenet is to uncover and understand the (often unconscious) conflicts and early developmental experiences associated with a person’s symptoms. The psychodynamic counsellor usually aims to be as neutral a figure as possible, giving little information about him or herself, making it more likely that important relationships (past or present) will be reflected in or “transferred” to the relationship between the client and the counsellor. This relationship is therefore an important source of insight for both parties, and this then helps the client to ‘work through’ some of their difficulties in their life. Developing a trusting and reliable relationship with the counsellor is therefore essential for this work.
Person-centred Counselling
This method is based on the principle that the counsellor provides three ‘core conditions’ (or essential attributes) that are, in themselves, therapeutic.
These are:
empathy (the ability to imagine oneself in another person’s position)
unconditional positive regard (warm, positive feelings, regardless of the person’s behaviour)
congruence (honesty and openness).
Again, the counsellor uses the relationship with the client as the primary means of healing and change. This is perhaps the most ‘reflective’ and the most non-directive form of counselling. Sessions are client led and person-centred counselling is much less structured than others such as CBT, where clients are set weekly tasks and work to continue at home.
Integrative Counselling & Psychotherapy
Combines ideas from more than one theoretical approach (usually including person-centred and psychodynamic, as well as others), drawing on elements of each as appropriate for the client’s issues.
Cognitive-behavioural Therapy (CBT)
This is another directive model, concerned with the way people’s beliefs about themselves shape their thoughts about themselves and how they interpret experiences. The objective is to change self-defeating or irrational beliefs and behaviours by altering negative ways of thinking. Clients learn to monitor their emotional upsets and what triggers them, to identify self-defeating thoughts, to see the connections between their beliefs, feelings and behaviour, to look at the evidence for and against these thoughts and beliefs, and to think in a way that is more realistic and less negative. The counsellor usually gives the client tasks or homework to do between sessions. This could mean recording thoughts and feelings, or doing something that tests out a basic assumption about themselves. This might mean, for instance, going to the shops when their fear is that they may panic.
There are various therapeutic offshoots connected with CBT: Cognitive Therapy, Behaviour Therapy, Acceptance & Commitment Therapy (ACT), Dialectic Behaviour Therapy (DBT) and Rational-Emotive Behaviour Therapy.
Acceptance & Commitment Therapy (ACT)
ACT is a new behavioural therapeutic approach that uses processes of acceptance, mindfulness, commitment and behaviour change to increase psychological flexibility, defined as “the ability to contact the present moment more fully as a conscious human being, and to either change or persist in behaviour when doing so serves valued ends” (Hayes et al., 2004). The ACT approach aims to help the client to look at the control strategies they are using and highlight their workability according to context. ACT works on the premise that:
People are stuck, not broken or sick
The processes that get them stuck are normal, expected ‘side effects’ of language, learning history and social context
Whatever the client is experiencing is not the enemy – it’s the struggle against it that is harmful to the client
Dialectical Behaviour Therapy (DBT)
DBT was developed out of CBT and has been adapted to include various meditation techniques. DBT is aimed at clients who experience emotions very intensely. It helps clients deal with difficult or overwhelming emotions by experiencing, recognising and accepting such emotions. Similarly to CBT, DBT aims to help clients change unhelpful behaviours or ways of thinking. But additionally, DBT also encourages clients to focus on accepting who they are. NICE recommends DBT for persistent binge-eating disorders and also for people with personality disorders who self-harm. It can suit the specific needs of people with Borderline Personality Disorder and is available mainly through the NHS or specialist services.
Rational-Emotive Behavioural Counselling
This approach takes the view that people have two main goals in life: to stay alive and to be happy. It aims to remove the obstacles that people place in their own way, and also to achieve a healthy balance between short-term and long-term goals.
Brief Solution Focused Therapy
A short-term, structured form of counselling, usually carried out over one to about five or six sessions. Unlike most other talking therapies, therapist and client usually spend little time on the details and causes of the client’s problems. The client is helped to define their own goals and therapy focuses on finding the best way towards the goals in the briefest time possible. It helps the client to recognise their own strengths, resources and abilities: to focus on what is getting better and to build on this.
Interpersonal Therapy (IPT)
IPT is a semi-structured therapy that examines how problems in relationships contribute to emotional difficulties, such as depression, and vice versa. It explores how to link mood with the way you relate to the people close to you. IPT was originally designed to help clients experiencing symptoms of depression. Disturbing events and stress may precipitate low mood, but social support can counteract this. When depressed, it may become more difficult for a person to engage socially, so there is less social contact, the person’s mood lowers further and they find social contact even more difficult and contact is less ‘competent.’ IPT has now been extended to treat other issues such as eating disorders.
NICE (the National Institute for Health and Care Excellence) recommends IPT for people with eating disorders and various forms of depression. IPT primarily focuses on working and improving relationships with the aim of bringing about change, leading to improvements in mood, or other troubling symptoms. IPT is usually offered over the course of up to 16 sessions: available mainly through the NHS, but only in some areas.
Goals of IPT
Reduce symptoms of depression
Improve the quality of the person’s social and interpersonal functioning
Supporting a person to link mood with interpersonal contacts
By increasing understanding of this link, the client can improve interpersonal relationships and reduce symptoms
Features of IPT
Manualised
Time limited
Focuses on the ‘here and now’
Non-neutral, active therapist
Concentrates on an ‘affectively meaningful’ problem area
Systemic Counselling
Systemic Counselling entails approaches that works therapeutically with individuals and their families and/or significant others. It seeks to address current relationship patterns to bring about change. Systemic counselling approaches problems practically rather than analytically (it doesn't seek to treat causes or symptoms). In short, it views the situation not just as a person with a problem, but as a system of people involved. Systemic Counselling is based on the belief that:
We live our lives through relationships
Our sense of who we are is associated with our relationships
The individual is seen as part of that system (of relationships)
There are complex interactions between these systems (the parts of these systems (e.g. relationships) that make up the whole)
When there are changes in one part of the system, there are changes in the other part
There is no linear cause and effect
Humanistic Counselling
Humanistic Counselling advocates a more holistic vision of a person, focused more on their uniquely human issues, such as the self, self-actualisation, health, hope, love, creativity, nature, being, becoming, individuality, and meaning – in short, understanding more about what it means to be fully human. The goal of the counselling is therefore to help the person ‘actualise’ more of these faculties.
Transactional Analysis Counselling
Transactional Analysis counselling (TA) seeks to enable clients to regain absolute autonomy over their own lives. It works on the theory that people are personally responsible for their feelings, thoughts and behaviour. It believes people can change, if they actively decide to replace their usual patterns of behaviour and types of ‘transactions’ with better ones. The TA counsellor offers:
‘permission’ (for new messages about yourself and the world)
‘protection’ (when changing behaviour and thoughts feels risky)
‘potency’ (to deliver what he or she promised).
Planning the goals of the counselling is part of the process. The focus is on uncovering the ‘life scripts’ (life plans) that reflect on the messages the client was given as a child.
The counselling helps the client to identify in which of the following 'ego states' he or she is operating, at any given time:
the ‘child’ (replaying their childhood patterns)
the ‘parent’ (copied from their parents or parental-type figures)
the ‘adult’ (more appropriate to the present situation)
and the interplay (transactions) between these three ego states.
Existential Counselling
This method helps people to clarify, to think about and to understand their life better, so that they can live it more fully. It encourages clients to focus on the basic assumptions that they make about the world that we live in, about other people and about themselves, so they can come to terms with life more - ‘as it is’. This process thus helps them to make sense of their existence. The counselling focuses the client on how much they already take charge of their life, and not on whether they are doing things rightly or wrongly. At the same time, it takes note of any real limitations, so that they can make better choices based on a wider view of the options available.
Gestalt Counselling
This is a slightly more directive type of counselling, focusing on the ‘gestalt’ (overall patterns of thought, feeling and activity). It encourages people to have an active awareness of many different aspects of their present situation, and also incorporates communication that goes beyond words. A key part of gestalt counselling is the dramatisation, or acting out, of certain important conflicts in a person’s life, so as to understand them better and appreciate the ‘whole’ picture, from different perspectives. This could involve using objects like cushions or two or more chairs, for instance, so that the client can take up different physically positions to represent different aspects of themselves or other peoples’ perspectives. This is often known colloquially as "the empty chair". It can be particularly helpful for clients who are seeking counselling for issues related to interpersonal relationships.
Counselling Psychology
The practice of counselling psychology integrates psychological theory with therapeutic practice. It entails an active collaborative relationship between practitioner and client which can both facilitate the exploration of underlying issues and can empower the client to confront change. Counselling Psychologists are usually members of the British Psychological Society and registered under the Health Professions Council.
Mindfulness-Based Therapies
Counselling that combines traditional talking therapy with a form of meditation: mindfulness practice. It can be particularly helpful for people with anxiety. It focuses on how you are feeling, both physically and emotionally, precisely in this moment of time. This can help people reduce stress, switch off from difficult thoughts and feelings and make changes in their life. NICE recommends this treatment to prevent people who have had depression from experiencing the same problems again. Other versions of this treatment include mindfulness-based stress reduction and mindfulness-based cognitive therapy.
Eye Movement Desensitisation & Reprocessing (EMDR)
This is a technique of stimulating the brain through eye movements, which seems to make distressing memories feel less intense. It is used for a range of traumas, including past sexual, physical or emotional abuse, accidents and injuries, phobias and addictions. It can be a helpful way of treating trauma without the client having to verbalise their experience in a great amount of detail. The client focuses on a moving object, usually either the counsellor's finger or a flashing light as the direction and speed changes. Alternatively, the counsellor may use a tapping sound instead of an object. Although the mechanisms by which it works are unclear, EMDR has proven to be a very effective treatment method and NICE recommends EMDR treatment for post-traumatic stress disorder (PTSD). The practitioner will occasionally ask prompts, but descriptions can be kept at a minimum.
Arts Therapies
These therapies encourage you to express how you feel through art (painting, drawing, music, theatre or dance). Arts therapies can be incorporated into traditional talking therapy. They can help you work out how to tackle difficulties, release emotions and understand yourself better.
Telephone Counselling
This offers an easy way of talking to a therapist if you do not want to meet a face-to-face counsellor or if you can’t find one. It is sometimes provided by employers and charities and is not specific to a certain therapeutic modality. On-line or e-mail counselling is another option, although these may not be suitable for all clients (for example those who require in person meetings to help foster trust and build a relationship).
Computerised Cognitive Behavioural Therapy
No talking required! You work through a series of exercises on your computer screen and learn self-help techniques for managing problems in your life. NICE recommends 'Beating the Blues' for mild to moderate depression, and 'FearFighter' for panic and phobia. There are many smartphone apps available that incorporate CBT principles and practices (for which I have created a separate blog post).
The main thing to take away from this is that there are a whole host of options for you. If in doubt, talking to your GP is a good place to start. Although the options may seem overwhelming, remember that at the focus of each therapeutic modality is the importance of the relationship between you and your therapist.
Take Care,
Hannah
References and Resources
Information adapted and updated from the Edinburgh Voluntary Sector Counselling Services Forum.
British Association for Counselling & Psychotherapy (BACP): www.bacp.org.uk Counselling & Psychotherapy in Scotland (COSCA): www.cosca.org.uk United Kingdom Council for Psychotherapy (UKCP): www.psychotherapy.org.uk
National Institute for Health and Care Excellence (NICE): https://www.nice.org.uk/guidance
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