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Summary

• Most therapies will help but some are better suited to particular issues

  Look at the table to see which is indicated to help with your issue

• Counselling tends to be shorter-term

  It is well suited for many issues. Longer term counselling is rarely available on the NHS

• Psychotherapy

  Often looks deeper and makes connections between past and present. Many presentations need this in-depth approach and therapists are specially trained to work this way

• Cognitive Behavioural Therapy is popular in NHS settings

• Also available privately

  There is good evidence for CBT's efficacy and it can work quickly. It suits those with good insight into how their thoughts affect feelings and behaviour. It is 'problem focussed' which is fine if there is a specific problem and you know what it is.

This page looks at different types of presentation ('issue' or 'problem') and indicates which therapies may be helpful. Keep in mind that there will be considerable overlap between different presentations. A person with depression may also be anxious for example. Problems with, say, assertiveness or loss may have a deeper underlying cause.

A tick in a column indicates that this type of therapy is well-suited to this presentation.  The absence of a tick does not mean that a particular therapy cannot help or will be ineffective but evidence suggests that other therapies may be particularly effective.

Keep in mind that therapists are individuals and will have unique life experiences or may have specialised in a particular problem area. This can have a big impact on their effectiveness at working with particular problems, perhaps more so than the 'type' of therapy officially offered.

1 - Longer term counselling or psychotherapy is usually indicated

2 - Provided specialist training has been undertaken by the therapist

WHAT'S THE DIFFERENCE BETWEEN ...?

I am frequently asked about the differences between counsellors and psychotherapists or between different types of therapy. This can be confusing and there will always be exceptions to any definition. However, the following notes may provide some clarity. (There is an even more detailed answer on my FAQ page - click on Q11 "What is the difference between Counselling & Psychotherapy?" or look at the bottom of that page.)

COUNSELLING

Although there is no legal minimum training in counselling, practicing Counsellors typically undergo a minimum of 2 years of part time training (and sometimes more), during which time they will have undertaken a minimum of 100 hours of supervised client hours. Counsellors receive a minimum of 1½ hours of clinical supervision per month (and often more) on an ongoing basis. Counsellors who achieve British Association for Counselling & Psychotherapy (BACP) Accredited status have completed a BACP Accredited Training plus they have completed a mimimum of 450 client hours and demonstrated rigorous standards of practice, as well as a commitment to ongoing professional development. 

Counselling helps you to look at problems you are facing now. It may focus on a specific problem like bereavement, separation, redundancy or post-natal depression or on a decision, crisis or conflict. You are encouraged to talk about the feelings you have about yourself and your situation, and the counsellor helps you find ways to come to terms with or tackle them. Counselling on the NHS is usually short term, typically 8-10 sessions. Longer term counselling may go deeper and be more like psychotherapy. 

At the moment relatively few GPs in Kirklees employ counsellors in their surgeries (although this is likely to change after April 2013). You may be referred as an outpatient. Many GPs in Calderdale have counselling on-site. Waiting lists can be 4-6 months or even longer. Mental health professionals such as psychologists, social workers or community psychiatric nurses may also offer counselling. Voluntary organisations like UCHM, Cruse (bereavement), Relate (relationships) and Women's Space (just for female clients) may offer low-cost or free counselling for specific problems.

PSYCHOTHERAPY

Psychotherapy training usually takes at least four years. During training, trainee psychotherapists are required to undertake psychotherapy themselves, as clients. This helps them to 'work through' or come to terms with, issues from their own past, so they may be aware of their potential  influence in their future work. This is important because psychotherapists often work at great depth with their clients over sometimes long periods of time. There are a number of different schools of psychotherapy; examples include Psychodynamic, Gestalt, Transactional Analysis, Cognitive Behavioural and Integrative (in which different approaches are combined in an integrated way). Psychotherapists are normally registered with the United Kingdom Council for Psychotherapy (UKCP) and sometimes with British Association for Counselling & Psychotherapy (BACP), or the British Association for Behavioural & Cognitive Psychotherapy (BABCP), all  of which have stringent ethical codes of practice.

During psychotherapy the therapist listens to your experiences, explores connections between present thoughts, feelings and actions and past events. Therapy aims to help you understand more about yourself and your relationships. Therapists have different approaches and different styles of working – some may seem detached and analytical while others seem friendly and supportive. Some will take the lead with questions, while others will follow your train of thought. Psychoanalytic and psychodynamic therapy may often continue for a year or more, but can sometimes be short term. It is usually one-to-one, but sometimes psychotherapy groups are available where a therapist aims to help group members understand themselves and others better. NHS psychotherapists normally work in a hospital or clinic where you will see them as an outpatient. Private psychotherapists often work from home or from premises they rent.

CLINICAL PSYCHOLOGY

Psychologists study the science of human behaviour at university and obtain an undergraduate degree. A ‘clinical’ psychologist will also have had further training in clinical psychology, usually as masters degree level; this enables them to work with people with mental health problems and many undertake additional training that enables them to also offer counselling or psychotherapy. They are usually based in hospital settings or specialist centres, occasionally in GP surgeries. Some work privately. They are members of and are regulated by, the British Psychological Society, who bestow the status of 'Chartered Clinical Psychologist' on suitably qualified and experiencerd members.

Clinical psychologists are not doctors and cannot prescribe drugs, but offer a range of psychological treatments. Depending on their training they may offer behaviour therapy, cognitive behaviour therapy, counselling and psychotherapy. 

COGNITIVE BEHAVIOURAL THERAPY 

Cognitive behavioural therapy (CBT) is a highly structured therapy that is based on the principle that it is not things themselves which upset or annoy us but rather, what we think about those things. In this view, changing how you think and behave also changes how you feel. The client agrees goals for treatment with the therapist and tries thinking and behaving differently between sessions i.e. 'homework'. CBT is usually provided by an NHS psychologist, but doctors, nurses, counsellors, psychotherapists and social workers may also use it. It is increasingly common as a GP referral to what is called 'IAPT'. CBT has been the subject of much research that shows it to be effective for many people but it doesn't suit everyone; you need to feel comfortable with the structured approach and with the idea that it is your own negative thoughts which are responsible for much of your distress.  An average number of sessions is 10-15. CBT may be undertaken in the NHS by telephone or even by the patient interacting with a computer. 

PSYCHIATRY

A psychiatrist is a medically trained doctor, who has had further training in the diagnosis and treatment of mental health problems. If you see a psychiatrist, it will normally be because you are referred by your GP, just as you might be referred to other types of specialist consultant. A psychiatrist may prescribe drugs, alter an existing prescription, or they may refer you to a counsellor, psychologist or a psychotherapist for talking therapy. It would be rare for a psychiatrist to offer talking therapy his/herself, certainly in an NHS setting. Psychiatrists usually work in hospitals (either NHS or privately), but can be part of community mental health teams. Like all doctors, Psychiatrists must be registered with their professional body, the General Medical Council.

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Page modified 21 March 2013