Really Important Questions. Upset180

Really Important Questions

How do I find a counsellor or therapist?

At the moment, anyone can call themselves a psychotherapist or counsellor, so for assurance of professional standards you should ideally look for someone registered (and hence also accredited) with the United Kingdom Council for Psychotherapy (UKCP) or, if that is not possible, accredited by the British Association for Counselling and Psychotherapy (BACP). UKCP registration is usually regarded as the more rigorous qualification since the trainings that meet its standards are generally longer and more demanding, but you will find excellent therapists on both lists. Counselling Directory now seems to provide the best directory of practitioners with proper professional qualifications and includes both UKCP and BACP members. Counselling and Psychotherapy in Scotland (COSCA) claims to be Scotland's professional body for counselling and psychotherapy, but so far I am not very familiar with what they do. Their website seems rather hard work and their "Find a Therapist" facility does not yield much information. Beyond a reputable professional listing, look for experience and evidence of additional training. Both are likely to add to the price, however, and do not necessarily guarantee a better result.

What else should I look for?

There are many different trainings and traditions (see What Type of Therapy Should I Choose?), and you may have one of these in mind. Also, look for experience or special interest in the issue you are bringing. Research suggests that you are more likely to benefit from the process if you relate well to your counsellor or therapist, regardless of their approach. Talk to a prospective counsellor on the phone, and arrange a no-commitment first meeting. Even an email exchange will tell you a lot about someone. Allow yourself to go with your "gut instinct" when you first talk to them. Do you like this person? Do you trust them? Do you feel safe where they work? If the answer to any of these questions is a big "no", find someone else. Your heart may be a better guide than your head, but don't ignore either.

What will I have to do?

You need to commit to a session each week, usually at a regular time, and be prepared to talk about yourself for 55 minutes or so. In fact you don't always need to talk, but you will need the urge and the curiosity to understand yourself better, and some courage to face not just difficulties but also the possibility of change. You may be asked to observe rules like paying for sessions if you cancel at short notice: this is not just to protect the counsellor but also helps to ensure your commitment to the process.

What about my privacy?

What you tell your therapist is up to you. You are entitled to your privacy and should not be pushed to say more than you feel comfortable with. Sessions are confidential within the terms of the law and a professionally-approved Ethical Framework.

How long does it take?

That depends what you want. Some short-term techniques, like Solution-Focused Therapy, can help a great deal in a very few sessions. Cognitive-Behavioural Therapy, such as may be available on the NHS, has been shown to be helpful in just 6-12 sessions, though in practice the time offered is likely to be determined by funding considerations. Change - real, deep change that will endure stress and the movements of life - is not an overnight process and you should also allow for the fact that it takes a while to build up a safe and trustworthy relationship with your therapist. You should be prepared for a process that is likely to take months and that you may even wish to continue longer. However, the journey itself can be joyful and liberating.

Why go privately?

Much NHS therapy is directed at acute or long-term psychiatric patients, or is very time-limited. You may have to wait a long time and are unlikely to have much choice about who you see, when you see them, or the approach they offer. The same is true of counselling offered through specialist agencies, and you may well be asked to support the cost of overheads and administration in such organisations. Many agencies are likely to offer you counsellors who are not registered/accredited to UKCP or BACP standards, or they may be in training to get there (though this need not be an issue as trainees often do fantastic work.) Paying for counselling or therapy gives you a full, adult say in what you are getting. You won't need to wait: you can choose someone local, agree a convenient time, and negotiate flexibility if you need it. And you will really value every minute of the time.

Humanistic psychotherapy… is a process of questioning all that is false in the person, and its object in doing that is to lay bare what is true in the person, in the confidence that what is true in the person is always OK.
- John Rowan

How much does it cost?

As a potential client, it is not easy to work out what you should pay. In central Scotland, the session costs for individuals seeing a registered/accredited practitioner range from about 40 to at least four times that amount. All too often, clients are asked to pay for things that won’t help them very much, like irrelevant qualifications, unnecessary techniques, nice buildings and certain city addresses. On the other hand, a therapist who charges above the bottom end may be bringing vital experience and a formidable commitment to understanding client problems. They may know the value of what they are offering, and think it right that clients should value it too. A course of therapy may end up costing a few hundred or even a few thousand pounds, but if done well it will almost certainly represent far better lifetime value than the phone, the holiday or the car that costs the same amount.

The hourly rate may seem a lot, but there are quite a few "invisible" overheads for the practitioner, involving both cost and time. The therapist needs each client to bear a share of supervision fees, membership and other professional costs, insurance, continuous professional development and accommodation bills. In addition, a dedicated therapist may spend equal time privately thinking and working on a client’s issues, sometimes even more. They may aim to look like a swan above water in sessions, but for the rest of the week they will be paddling hard.

If money is a critical issue for you, and you can't get (or wait for) free counselling through the NHS, look for a local charitable agency (click here for ideas). Sadly, there is rather more pressure on such services since Covid, but they are still around. You could also try to negotiate with the therapist of your choice. Many offer a couple of places at a reduced rate for those on a low income. You shouldn't get a cut-price service and anyone who minds you asking wouldn't have been a good choice anyway.

What sort of work do you do around Asperger's and autism?

The diagnosis and understanding of Asperger's syndrome, also known as autism spectrum disorder level one and sometimes as high-functioning autism, has blossomed in the last few decades. Children and adolescents, or those with high support needs at any age, often require complex multi-disciplinary interventions, but there is also an increasing number of "aspies" whose neurological status was only recognised well into adulthood. These are people who may have struggled for years without quite knowing why they were struggling. I work with people who have either had (or suspect) a late diagnosis, to help them make sense of their story against this new template, and make decisions about their future.

The world is not designed for people who are autistic. The world is designed for neurotypical people in that the set-up of it is geared towards a good and intuitive social understanding of how things work.
- Mike Lloyd

How about choosing a couple counsellor?

Saving a relationship requires solid commitment, and finding a weekly time to suit you both may be more important than finding the perfect counsellor. Furthermore, couples may not consider counselling until they are in crisis, so they may need someone who can meet without delay and without going through a separate assessment process (often leading to another waiting list). Levels of qualification may not be very clear. Some therapists who are well-qualified for individual work may set themselves up as couple counsellors without any specific training. Equally, many counsellors who are well-trained in couple work (e.g. through Relate) may have no background or qualifications in individual therapy. None of these things may matter. Again, look for a bit of experience, ask some questions, and trust your gut instinct. In some couples the woman takes the initiative in seeking counselling and the man comes along reluctantly. Think what that might mean in terms of choosing a male or a female counsellor. Same-sex couples may need to be even more thoughtful about their choice.

If you have any more questions that it might be useful to answer here, please let me know.

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