“My anxiety is getting worse.”
“I’m weighed down by everything.”
“I never feel genuinely happy.”
“I want to talk to my partner without it turning into a fight.”
“I want to feel calm, not tense all the time.”
“I want to untangle the maze in my mind.”
“There are so many thoughts buzzing round in my head. I want it to stop.”
There are many reasons people come to therapy and there is an almost limitless number of triggers, answers to why now. But there is a common theme – people want change. They want to feel differently, to have more rewarding relationships, to be understood and accepted, to be able to put themselves in the mix.
Deciding to engage in psychotherapy or counselling is a good first step. Deciding on the type of therapy and picking the therapist, though, can feel like pot luck when faced with the huge range of modalities. Do you need cognitive behavioural therapy? Or would emotionally focused therapy be better. Perhaps the best solution is Gestalt therapy, transactional analysis, psychodynamic therapy, or integrative therapy? The list is almost endless.
As therapists we can be very committed to our own modality but the evidence is clear – it’s you and your relationship with your therapist that counts! A study by Lambert (1992, in Hubble et al, 2006) suggests the person’s own capacity and their environment account for 40% of outcome variance. 30% of outcome variance depends on the quality of the therapeutic relationship and 15% from the placebo effect (the belief in the therapist and process). Only 15% depends on the type of therapy and techniques on offer.
If it’s your relationship with the therapist that really matters, how do you find the right one for you?
If you go to your GP, you might get referred to the NHS’s mental health services. The likelihood is the counsellor will be a CBT (Cognitive Behavioural Therapy) practitioner, but as the study suggests, it’s the relationship not the technique that matters and you’re unlikely to have a choice in the therapist you see. It’s worth asking if you can change if you really don’t feel comfortable. The long delays are well publicised and waiting months to see someone may not be okay for you. You could also be limited to a very few sessions. What then?
You might be lucky and have some good, low-cost counselling charities in your area, able to offer an appointment in weeks not months. While the service is probably run by qualified counsellors, the counsellors themselves are often trainees, giving their time for free. Again, if you’re not comfortable with your assigned counsellor you can ask to change but it might be difficult to do so in practice. To balance their limited resources, these charities also often have to restrict the number of sessions.
If you don’t feel you can wait, don’t want to limit the number of sessions, and want complete freedom to pick your therapist, private practice is really the only option. But how do you know if they are qualified to help you? Counselling and psychotherapy are not legally regulated professions. While most have trained and practised for years to qualify, someone with no experience or training can call themselves a counsellor. The main registering bodies are lobbying the Government to change this and progress is being made but nothing is going to happen in the immediate future. How, then, do you find a well qualified, capable therapist who’s right for you?
Most people start on Google. Directories like PsychologyToday.com and Counselling-Directory.org.uk come high in the listings. They check the therapist’s credentials before accepting them onto their directories. Regulating bodies – the United Kingdom Council for Psychotherapy, and the British Association for Counselling & Psychotherapy being two of the main ones – also have online directories of their therapists, each of whom has appropriate qualifications and clinical experience. Think twice, three or four times, about anyone who is not a member of a regulating body.
Then draw up a shortlist of possibilities and ask to chat to or meet them before you make your final decision. A good therapist will be happy to engage in this way. If you meet them you may have to pay for the initial assessment, but a ‘get to know you’ telephone chat is probably going to be free. Ask how much therapy they have had. You don’t want your therapist’s issues to play out in your therapy, so you want them to have done the work on themselves. It also means they are more able to give you the depth of support you may need.
You could short cut all this and ask friends and family for recommendations. It’s a good option but remember a therapist who was right for your best friend may not be right for you and there are potential conflicts working with someone recommended in this way.
If you have decided to make a change, I wish you the very best and if that change involves working with a counsellor or psychotherapist, I very much hope you find the right fit for you.
HUBBLE, M., DUNCAN, B. and MILLER, S. (2006) ‘Introduction’, in HUBBLE, M., DUNCAN, B. And MILLER, S. (eds) The Heart and Soul of Change: What Works in Therapy. Eleventh edition. Washington DC: American Psychological Association, pp. 1-19.