Psychotherapy Part 1: Considering Starting Psychotherapy or Counselling?
This article is one of over 600 original articles and audio recordings that can be found in the Resources section of this website. Access to Resources is available to patients who complete Assessment and start attending sessions weekly.
Facts
Here are some brief facts about Psychotherapy and Counselling:
You don’t need to have anything ‘wrong’ with you to benefit from psychotherapy
A psychiatric diagnosis is not required to understand, work with or overcome psychological, relationship, emotional or ‘psychiatric’ problems
Psychotherapy and counselling are processes, not one-off events. As such they take time and regular attendance to develop and to effect change. The psychotherapy process continues beyond each session in the mind and feelings of both therapist and patient.
Success in therapy relies heavily on a mindset of commitment, goodwill, honesty, openness to new experiences and openness to being challenged in your existing views and ways of acting in the world. Without these qualities to your mindset you risk wasting your time in therapy.
Change is natural. It takes more time and energy to resist change (and so maintain old habits and problems) than it does to fully engage in the change process
The psychotherapist’s skills and experience, and the patient’s motivation and mindset are more important than the type of psychotherapy
You can talk about everything and explore anything in psychotherapy
It is best to seek help sooner rather than later
Individuals, couples, groups and families can benefit from psychotherapy
Where to start
Psychotherapy, counselling, analysis, psychology, psychiatry and other approaches to helping people can be very confusing if you are unfamiliar with how it all works and have no experience of seeking such help and don’t know where to start. READ Psychotherapy Part 5 in this Series.
Many people wait until they are in or near crisis point, when their decision-making may be compromised, before seeking help. It is best to seek help when you are able to think clearly. The following page has information and links to assist you in clarifying your thoughts and navigating your way to the type of help that may be best for you, and covers both private and public sector help. Use the information when you are calm and able to make informed choices about the type of help that is best for you:
“A good psychotherapy relationship is one in which both therapist and patient respect, care about and value one another enough to invest energy in the relationship.”
Your Mindset: Are you ready for change?
Engaging in the therapy process is about your investment in your personal development. To do so requires you to have a genuine openness to new experiences that allow change to happen. Just attending the sessions and paying your fee is not enough to bring about change. Change involves talking very openly and truthfully about yourself and being prepared to persevere in doing the therapeutic work offered by the therapist. A good psychotherapy relationship is one in which both therapist and patient respect, care about and value one another enough to invest energy in the relationship. This forms a trusting space between you where you can tell your truth – truths that may be uncomfortable to reveal, discuss and work with in other kinds of relationship. If you don’t feel free enough to speak openly and truthfully then it’s important to question this and whether psychotherapy is right for you.
You are responsible for how you use the psychotherapy or counselling sessions, what you focus on and what you take away from them. Your psychotherapist or counsellor responds to and works with whatever you bring, developing a deeper and fuller understanding of you over time. The proper starting mindset, then, is that you the patient are ultimately responsible for any changes that you make in your life (or don’t make). Your psychotherapist or counsellor is there to help facilitate that change, not do the work for you.
If you feel ambivalent about starting therapy, or feel a bit stuck or scared to look at difficult things this can also be a source of uncertainty when considering the therapeutic change process, and in these cases only you can decide whether or not you are ready and what you are willing to tackle. Now may not be the right time. Ask yourself how you will do if you just carry on as you are without help, then consider your mindset and level of motivation.
What mindset do you have for facing, talking about and doing the work needed to overcome your current difficulties?
Resistant: Not at all motivated
Reluctant/Indifferent: I’m not bothered one way or the other
Very Ambivalent: I need to make changes but wish I could just take a pill to fix me
Moderately Ambivalent: I know I can’t go on like this but am uncertain about change
Mildly Ambivalent: I want to make changes and see how I feel
Resolved: I’m ready to address my issues and am willing to do what it takes
Committed: I’m keen to learn more about myself and to persist with the work in order to make the necessary changes to my life
The stronger and clearer your mindset is for embracing change, acting with goodwill, and channelling your energies into the work, the more chance you have of benefitting from psychotherapy. Strong commitment to engage, to being open to new ideas, to motivating yourself to facing some discomfort in the service of personal growth (stepping outside your comfort zone), and to making a real effort to attend sessions weekly and apply new learning each week are essential requirements if your work with any psychotherapist is to have any chance of success. If in doubt, an informal chat with a prospective therapist can often allay any fears, answer any queries, and help you be clear on your level of motivation without spending very much money. I offer a reduced fee introductory meeting for this purpose. After that, if you want to have a detailed picture of your problems, needs and what therapy might entail you can take the next step and attend an assessment.
Public Service or Private Help
Once you are clear that you are suitably motivated, decide whether you want public sector help such as the NHS, or private sector help. READ Psychotherapy Part 2: Public or Private on the Guide page.
Money
If you decide to seek private help, start looking around at fees and get an idea of what costs might be involved for the duration of work you might need to do.
It’s useful to check around your area and compare fees, which can vary widely. However, high or low fees should not be considered an indicator of quality or competence. You’re paying for the therapist’s depth and quality of experience, qualifications, insight, skills, sensitivity, intuition and perception of your difficulties and needs: qualities that you’ll often only gauge by meeting them. Some practitioners/ private clinics, for example, will charge you £160 or more for a standard 50 minute session for little more than simple CBT, and £350 per hour for assessment of your needs.
Decide what your budget will allow. Psychotherapy and counselling are not quick fix solutions and if you are serious about psychotherapy you can expect to attend weekly for anywhere between twelve sessions (brief work) and any number of sessions (over forty sessions begins to be medium to long-term), depending on your needs. Regarding how much money you invest in your support and wellbeing, it can be useful to get therapy fees into perspective by, for example, considering the average hourly rates you might pay a local tradesman, mechanic or a dentist, doctor or chiropractor (at the time of writing this ranges from £60 per hour to hundreds of pounds per hour in some cases), or what some people spend on petrol, alcohol, socialising each month, or going on holiday.
Come to terms with the costs before you commit. Decide for yourself what value you give to your development or recovery as a human being to be realistic about your therapy. You might ask yourself ‘what is more valuable to me: my personal development, or X-amount of money?’ in order to determine your mindset. Begrudging paying a therapist because, for example, you haven’t fully accepted his/ her fees, or because you feel entitled to free help, will only impede the therapeutic relationship by bringing a metaphorical ‘elephant’ into the consulting room each session.
Compare session length offered: do fees reflect 50 or 60 minute sessions for example? I offer 60 minute sessions with a 90 minute option, with some fees reducing according to how frequently and how long you attend. The standard ‘therapeutic hour’ offered by most practitioners is only 50 minutes. Ten 60 minute sessions are the equivalent of twelve 50 minute sessions, when comparing fee rates for example.
My fee rates take into account the work involved, not only during each session, but also:
the length and depth of experience I have
the preparation time before sessions
consideration and analysis of your experiences between sessions
written work after each session
time spent emailing you or sending you supportive materials
additional reading or research required to better understand or support your particular needs
producing articles, experiential work and audio recordings to support you in between sessions
Choosing a Service or Practitioner
Look at the type of therapy offered. Be aware that symptom- or diagnosis-focussed therapies locate a person’s life problems solely in the type of thoughts or behaviours they have e.g. CBT, EMDR. This may suit you. However, other psychotherapies consider social, family, relationship, economic, political and other environmental factors influencing or causing a person’s distress or troubles to be crucial considerations in how they are treated. Like flavours of ice-cream, there are hundreds of therapies with different names out there: choose a therapist and a therapy that speak to you.
Beware of any marketing hype that suggests one model of therapy or clinic is more effective than another. There is no reliable evidence that this is the case and you may only be paying for appearance or prestige. Remember, like any other field of endeavour, very often it is the individual practitioner’s talent, life and work experience; personal wisdom, intuition and skills that count more than anything else. Research evidence suggests it is the therapist’s ability to listen, empathise, understand and accept that are central to patient change, not the type of therapeutic model, techniques or workplace setting he or she uses. That said, many approaches rely only on talking and developing insight to effect change. Others work at deeper levels and are able to effect deeper levels of change. Many counsellors and psychotherapists also use their silence as a technique for eliciting feelings and thoughts from their patients. This technique doesn’t suit everyone.
Look at the experience, qualifications, length of training and personality of the therapist and how they come across to you on a personal level: genuine, or playing a role? How long was their training? And to what level? Some basic approaches qualify therapists in a few months, for example, and there are practitioners who may hold a Psychology degree or CBT certificate but who have no psychotherapy or clinical experience, and have received no personal psychotherapy themselves.
Has the therapist survived and healed from their own trauma, pain and suffering, or is their life experience largely academic? This can be a difficult one to find out, unless the therapist published his or her account of their journey out of trauma. But seeing a psychotherapist who has received years of psychotherapy to help heal their own wounds as a requirement of their training is, in my view, extremely important. Some models of therapy do not require their practitioners to have had even a single hour of therapy. My training lasted six years, for example, during which time I was in full-time therapy and also working with patients in the NHS. Ask any prospective therapist how much personal psychotherapy they’ve received.
Look for any additional support a therapist might offer, like between-session support, home or location visits, Skype and face-to-face sessions, or help in urgent circumstances
Is the therapy process made clear to you before you start? Is there an assessment process and discussion about how therapy might proceed in your case? If not, are you happy to just start, keep going and see what happens without knowing what’s involved?
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