Therapy Space, Portishead
What are Counselling and Psychotherapy?
Counselling and psychotherapy are complementary therapies that use talking to help you work through things that you might be struggling with. This might be to do with illness, grief and loss. It could be focused on relationships. It may be related to the mental health difficulties that we can all experience during our lives, such as depression and anxiety, or because of traumatic events we have lived through. We might just feel stuck. Talking to a therapist gives you space to reflect on what is happening in your life. This can help you cope with change or make changes at your own pace with support, if that is what you decide is the best option for you.
How does therapy work?
Different approaches have different ideas about how therapeutic change takes place. A neuroscientific explanation might focus on the fact that our brains are plastic and it is possible to change at a neural level. A psychodynamic practitioner might suggest that therapy works because you gain insight. A narrative therapist may well say that this type of therapy achieves change through creation of a new narrative. A relational therapist might say that the experience of trust and security gained in a therapeutic relationship helps us change. A CBT practitioner could suggest that change occurs through alterations to thinking patterns. Integrative practitioners may suggest a combination will effect change.
What are the alternatives?
Talking to a GP can help you find out more about medical treatments that could help you. For example, your GP might prescribe anti-depressants, if you are feeling depressed. There are a number of self-help books published that can help you understand more about your difficulties, as well as a range of complimentary medicines that can provide additional support. For example, acupuncture can help with chronic headaches, migraines and pain management (NHS, 2016). In addition, peer support can be a helpful way to improve your emotional health and wellbeing, so working with a group can be helpful. You can also choose to take no action.
What are the benefits?
Non-medical approaches to health and well-being mean that you can access help and support without consulting a doctor. However, your therapist may suggest you see a doctor, as there are sometimes biological explanations for problems.
What are the disadvantages?
This often revolves around commitment and finance. Meeting weekly, usually at the same time each week for the length of time agreed with your therapist can be difficult to fit in to busy schedules. In addition, there can be a significant financial outlay working privately on a weekly basis for long periods of time.
Are there any risks involved?
Some people find that working with a therapist makes them more aware of uncomfortable emotions. Others find that their relationships with others change. A few experience strong feelings towards their therapist. A very small number of people report negative effects after counselling or psychotherapy (Crawford et al., 2016). You might decide that therapy is not the right course of action for you right now.
Are therapy sessions confidential?
Yes, but there are limits to that confidentiality that focus on prevention of harm to yourself and others, as well as prevention of terrorism or drug trafficking. In addition, therapy work needs to be discussed with a supervisor to make sure it meets the ethical guidelines that counsellors and psychotherapists work within, such as the BACP’s Ethical Framework for the Counselling Professions.
Are you able to commit to meeting at the same time, on the same day, each week?
Are you able to pay for counselling and psychotherapy?
What will happen in my therapy sessions?
Often, therapy starts with an informal telephone conversation where you can ask a few questions before you book your first appointment. This first appointment enables you to tell your therapist more about you and the reason you have sought counselling or psychotherapy. At this point, your therapist is likely to ask you questions about your personal history. It is a chance for both of you to decide if you want to work together. If you feel uncomfortable, it is important to look for someone who you do feel comfortable with.
In your first session, you will be asked to agree to a contract, which sets out the rules that you will both work to, including limits to confidentiality, session fees and what notes will be kept. You will be asked to sign a written contract before your therapy begins. The BACP’s guide “What happens in therapy” is a helpful resource if you have not had therapy before.
What will I be expected to do when I am working with a therapist?
A key part of working with a therapist is to be willing to examine your thoughts, feelings, reactions and motives. This is not always an easy thing to do.
How many therapy sessions will I need?
This is a hard question to answer because we are all different. There is some research that has estimated the following: 30% of people experience change in 1-2 sessions; 60%-65% of people experience change in 1-7 sessions; 70-75% of people experience change after 6 months and 85% of people experience change at one year (Howard et al., 1986 cited by Bohart and Tallman, 2010, p.91).
What do I do if I don’t experience any change?
If you are not feeling as if change is occurring, be brave. Tell your therapist.
Regular reviews of your work with are important because they give you chance to you tell your therapist what has worked well for you, as well as what has not, and help you both check your progress towards your therapy goals. It can also be a good idea to use clinical measures to monitor change. There are several different forms that can be used for this purpose. Some require you to answer questions about the way you have been feeling over the past week or two and take a few minutes to complete. There are also forms that can be used to help you rate your therapy session, or feedback what you have found helpful about it.