Care, treatments and therapies
More commonly known as counselling or therapy, talking treatment, or psychological therapy is a term that is used more by professionals than on a day-to-day basis.
There is a wide range of talking therapies available. This page aims to give some information about the main types. However, there is a basic premise that underlies all counselling and therapy approaches.
Counsellors and therapists provide a confidential space where people can talk about anything that is troubling them. They provide a non-judgemental, accepting presence where you are free to express whatever thoughts and feelings you wish to explore.
The individual sets the agenda. You can decide what you wish to speak about. For many people, the sense of being listened to, and being able to speak without having to be concerned about being judged or about the emotional impact of what they’re saying, is significant in itself.
While people often seek counselling or therapy for help, counsellors or therapists do not provide advice, and will not tell people what to do. This may contradict people’s expectations or wishes, and some people may still seek this form of help.
However, many people find it beneficial to be given the space to explore situations and feelings and to find their own solutions to their difficulties.
Talking things through and exploring them in this way can help people to find ways of managing their circumstances and feelings in a way that is more helpful and supportive. The process may help them realise that their current patterns of behaviour or thinking are not serving them well.
The relationship with the therapist or counsellor may give them an opportunity to test out or explore different ways of being in a relationship without fear of consequences in their day-to-day lives or relationships.
Talking treatments alone can be effective in treating mental health problems for some people. For others a combination of talking treatments and medication may be most effective. Medication tends to work by treating the symptoms of a problem, whereas talking treatments aim to address the underlying causes.
When are talking treatments suitable?
Counselling and therapy can help with a wide range of mental health conditions ranging from depression and anxiety through to bipolar disorder and schizophrenia, depending, to a large extent, on whether the individual feels able, or is willing, to incorporate this kind of support as part of their treatment.
There are times when a talking treatment may not be suitable, for example when an individual is actively psychotic. This is because, at these times, the individual has lost touch with reality and so will not be able to engage with the therapist or counsellor, or with the process, in a way that is helpful.
If an individual is actively using alcohol or drugs in a way that impacts on their daily life, they may not be able to make best use of counselling or therapy.
However, individual practitioners may take different views of this, depending on their experience of working with addictions, or if the individual has some level of control over their substance use and is still able to engage with the process in a productive way.
The issue of dual diagnosis, for example, a mental health problem combined with drug or alcohol use, can be a difficult one both for individuals and practitioners. Some practitioners may insist that they cannot work with individuals if they are actively using and dependent upon a substance.
The converse argument is that people may need therapeutic or counselling support to enable them to understand their addiction better and to find alternative ways of coping.
Medication, in the form of antidepressants, mood stabilisers or antipsychotics may provide a stability that enables people to engage with a therapist or counsellor in a way that would not be possible without medication; this combination of treatments can be effective for all kinds of mental health conditions.
Counselling and therapy can also be effective in helping people to come to terms with and accept their condition, particularly if it is a chronic condition. It may provide a means of exploring ways of managing difficult symptoms. It can also allow a space to consider and to grieve for the alternative life, for example, one lived without mental illness.
Conversely, it can provide a space where positive aspects of living with mental illness can be explored and acknowledged. This may not apply to everyone, but for some individuals this may be important as part of their personal way of finding ways of dealing with mental illness.
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What are the different types of talking treatments?
The words counselling and therapy are sometimes used interchangeably, and there is a fair degree of overlap. A simplistic, but helpful, way of understanding the two processes is that counselling tends to focus more on the here and now, and problems that people have in their current life, for example, difficulties in relationships, the challenges presented by being out of work, difficult bereavements, challenges at work.
Counselling may also be conducted on a shorter-term basis than therapy, and may have specific objectives – linked to finding ways of dealing with the particular presenting problem.
Depending on the practitioner, the process may also be based in working on the conscious level of awareness and not attend to unconscious processes in the way that psychotherapy does.
However, many counsellors incorporate elements of psychotherapy in their work. They may work long term and may work with the unconscious as well as the conscious. Counsellors may also incorporate elements of other therapies in their work, for example using art or other creative activities to support their work.
Counselling is provided in a safe environment and the content of what you talk about should be kept confidential. The aim of the counsellor is to help you, and they can do this in many different ways.
They may just listen, as speaking out loud about your problems can help you put your thoughts in order.
The counsellor will not tell you what to do, and you will be left to make your own choices. Some counsellors, however, may go through a list of options, and examine the pros and cons of each option, so that you can make informed decisions.
Counselling is generally face-to-face, but can also take place via the telephone or internet. It may be offered as a one-off session, for a limited period, or on an ongoing basis for several months or longer.
Psychotherapy is a term that covers a range of therapy approaches. As with counselling, there are some common factors.
When therapy is delivered on a one-to-one basis, it involves the therapist providing a confidential, accepting space for people to explore the issues that may be troubling them.
Psychotherapy can be helpful for a wide range of people, including those with a mental health diagnosis. There are similarities to counselling, as outlined earlier.
However, psychotherapy is likely to be undertaken over a longer period of time, and perhaps with more than one session per week. This gives you a chance to explore past aspects of your life, as well as what is happening in the present.
While psychotherapy can also be used in a very focused way to address specific difficulties or aspects of a person’s life, it can also be helpful when there is a wish or need to explore a more generalised need involving a wide range of symptoms, or to make things different.
As with counselling, a therapist will not provide answers or advice. They provide a space where people can explore options for themselves.
It can help you make connections between past events and family history and how you behave and react in the world in the present.
Psychotherapy can provide a space for you to identify and express feelings you may not have felt able to do previously, perhaps because you felt you shouldn’t or because you were worried about the effect it might have on your family.
For many people, it acts as a way to explore how to express themselves more freely, to understand themselves better, develop a stronger sense of self and how they want to be in the world.
Depending on the relationship with your therapist, it can act as a mirror of how you relate to people in general, to understand the role you play in relationships and explore how to make this work better for you.
Psychotherapy is also likely to incorporate a focus on the unconscious aspects of the individual.
Sometimes unconscious thoughts and feelings can contribute to the way we react and behave. For instance, we may say or think things like, “I don’t know why I did that, but I wish I hadn’t” or “I don’t know why I feel like this.”
The process of psychotherapy can help to make these unconscious thoughts and feelings conscious. This awareness can be helpful as it enables us to consider options for reacting and responding in a way that was not possible previously.
Psychotherapy is an active process requiring concentration, energy, courage, and a willingness to be open and honest with yourself and your therapist. This may not feel easy at times, but the therapist is there to help you with this process.
You may agree a particular timescale for therapy with your therapist, or the therapy may be open-ended and continue for several years. This is quite a commitment from both parties, and is something you may wish to discuss over time.
There is a range of different psychotherapies, including humanistic, psychodynamic, personcentred, integrative, psychoanalysis, and psychoanalytic psychotherapy. There is a degree of overlap between these different approaches, though each also has their own unique aspects as well.
However, the most important aspect of either counselling or therapy is that you should feel comfortable with the counsellor or therapist and feel that you can work with them. See below for Choosing a counsellor or therapist.
- Cognitive Behaviour Therapy (CBT)
Cognitive behaviour therapy combines two very effective kinds of therapy – cognitive therapy and behaviour therapy.
Behaviour therapy helps you to identify connections between particular situations and your habitual reactions to them, such as anger, fear, depression or rage, and self-defeating or self-damaging behaviour. It teaches you ways of calming your mind and body, so you can feel better, think more clearly, and make better decisions.
Cognitive therapy helps you to understand how certain thinking patterns may be causing your symptoms. These thinking patterns can give you a distorted picture of what’s going on in your life, and make you feel anxious, depressed or angry, or provoke you into ill-chosen actions.
Combined as CBT, this approach can provide very useful tools for identifying the components that may contribute to your symptoms, or influence your behaviour. It can help you to manage your symptoms and feel more in control of your life. CBT is usually offered in the form of a series of weekly sessions for a period of eight to 12 weeks. Many counsellors also use CBT techniques as part of their overall practice.
Of the talking treatments available, CBT is the most widely available on the NHS. Its generally limited duration makes it more viable to be provided in this way, and it can also be demonstrated that it provides useful tools to help manage symptoms.
For some people, this may be sufficient to address their difficulties; for others it may benefit them sufficiently to enable informed decision-making about other areas of their lives.
For others, it can be helpful, while also identifying that there are other aspects of underlying symptoms that may need to be addressed in a different way. For some, as with all approaches and therapies, it may not be suitable for their particular needs.
- Group therapy
Group therapy uses concepts similar to those described for individual therapy, but the process involves exploring and understanding the interaction and relationship between group members.
The process is facilitated by a therapist and the group members’ interaction with the therapist is also an active part of the process.
Group therapy can focus on interpersonal relationships or on particular concerns shared by the group members, for example drug or alcohol use. Such groups may have a focus on learning more about the particular issue and developing tools and techniques to help manage problems arising from that issue.
A process-oriented group focuses on the actual experience of being in a group as the learning and development opportunity. For example, the process of expressing your thoughts, feelings, and experiences as they arise within the group can be the very vehicle by which you discover change.
Group therapy can be a helpful way of exploring how we relate to other people, how we feel about ourselves, and how other people experience us. It can provide a space in which to experience a wide range of feelings. This can include caring for and wishing to support other members of the group.
It can also include more challenging emotions such as feeling angry with other members, feeling scared or anxious, apprehensive about how others see you, or about how you react to others.
When people interact with other group members, they usually recreate those difficulties that brought them to therapy in the first place. Exploring these feelings in a therapy group can help you feel more confident about expressing a wide range of feelings, and develop a stronger, clearer sense of self. Seeing how other people experience us can be particularly helpful for this.
There is a sense in which whatever happens for one member of the group happens for everyone.
This may be because you can identify with what another person says or feels, or you may discover alternative ways of looking at particular aspects of yourself and your life because another member has demonstrated a different way of looking at, or experiencing, life.
This process can help form strong bonds between group members as each learns and develops through sharing their own experience.
Under the direction of the therapist, the group is able to give support, offer alternatives, and comfort members in such a way that these difficulties are resolved.
During therapy, people may begin to see that they are not alone and that there is hope and help. It can be comforting to hear that other people have a similar difficulty, or have already worked through a problem that disturbs another group member.
Group therapy may not be suitable for everyone, or may not be available in a particular area, but it can be a very supportive and effective form of therapy. Groups may be closed or open.
Closed means that once the group has been established no new members will join. This allows people to build up relationships of trust and understanding, which, over time, allow the exploration of potentially painful and difficult feelings and experiences.
Open groups have a more flexible approach, with members joining and leaving in a more fluid fashion. Such groups will have a different structure and ground rules, although all groups are likely to have common ground rules such as confidentiality, respect for others, and allowing space for others to speak.
The criteria for joining a group depends on the intention of the group, what subject matter is to be addressed, and who would benefit the most from attending. The frequency with which groups meet and the length of time for which a group may remain together depends on the group’s objective or focus.
- Relationship counselling
Counselling can also be beneficial for those in relationships. This may be at times of crisis, or it may be used to help understand ongoing or long-term difficulties in a relationship.
As with other forms of therapy and counselling, the process needs to be voluntarily entered into by both partners. Sometimes one partner will be more receptive than the other, and this is an aspect that may be considered by the counsellor as it may reflect a dynamic within the relationship in general.
Difficulties can arise in relationships at any stage, perhaps shortly after it has started, or during the course of a long-term partnership. Counselling can be helpful at any stage; it requires commitment and engagement from both partners, and, like all forms of counselling, may also be quite challenging.
Particular events may be the source of difficulties or unexpected challenges, for example, pregnancy or the birth of a baby may trigger tensions or difficulties. Infidelity, communication problems, health problems, sexual issues, work or finance-related difficulties can all be a source of difficulties.
Relationship counselling enables couples to examine and decide how best to cope with such difficulties in a confidential environment with the help of professional counsellor.
As with all forms of counselling, the practitioner has no agenda, and advice is not given. Individuals are helped to understand their situation more clearly and to make decisions about how they wish to address their difficulties.
Options may include finding ways of working through difficulties while remaining a couple, or a decision may be taken to separate or divorce. However, even when such a decision is reached, people often find they can do so in a way that feels more considered, having worked through some of their feelings and difficulties through the counselling process.
Relationship counselling can also be supportive to parents whose difficulties may be affecting their relationships with their children. It can also be helpful if parents decide to separate or divorce as they may understand their feelings and situation more clearly and feel more able to navigate what can be a very painful process for children in a way that is more able to cope with difficult and painful feelings.
- Family therapy
Family therapy works with whole families or parts of families. Sometimes families come to therapy because difficulties are being displayed by one member, perhaps a child.
This kind of therapy may help the family understand that such difficulties may be contributed to by all the members of the family.
Family therapy can help each individual understand the role they play within the family and how their behaviour and interaction with other family members can influence and contribute to relationships and behaviour within the family as a whole. The therapist can help the family understand how difficulties arise and provide a means by which they can explore and discover new ways of dealing with difficulties.
Therapists sometimes work in teams so that different perspectives can be offered to the family. This may be useful for families, or stimulate a discussion that can help them consider perspectives that are new or different from those they’ve been living with.
This therapy can help with a wide range of family relationship difficulties. It can be useful in identifying patterns of behaviour that may have been problematical over long periods of time, even over generations, and explore ways of dealing with them differently. It can be effective in addressing and helping understand and manage eating disorders, addictions, and emotional and behavioural problems.
This kind of therapy is also useful when a family member has a mental health diagnosis. Serious mental illness in a family member inevitably has a major impact on the rest of the family, and the way the family reacts can help or hinder the patient’s recovery.
Conditions such as depression, bipolar disorder, schizophrenia and personality disorders are all challenging for individuals and their families and family therapy can be a useful part of the care plan.
The challenges of counselling and therapy
While counselling and therapy are accepting and non-judgemental, they can also be challenging.
This may be because you talk about difficult or painful aspects of your life – the very aspects you wish to address to help you live in more nurturing and stable way. But it can also be distressing.
Your counsellor or therapist may help you challenge or questions some of the beliefs by which you have lived your life and which may not be helpful to you. This can also feel difficult but ultimately helpful if you can be open to this approach. This is one of the reasons why the pace of counselling or therapy is left with you as the client. You will be in the best position to assess when you are ready to talk about things that are painful.
It is important to let your counsellor or therapist know how you are feeling about the process; after all, it is for you. Sometimes people feel the counsellor or therapist is the professional and therefore can’t or mustn’t be questioned.
However, the relationship with your counsellor or therapist is important. It may reflect how you feel about and react to relationships in general, and if you are able to use it as a way of being honest with yourself and the counsellor/therapist, there is a lot to be gained from it.
Sometimes people hit a point where they feel they don’t want to carry on with counselling or therapy and are tempted to just walk away. This may be the decision you ultimately make, but it isalways worthwhile talking it through with your counsellor or therapist so you are clear about your motivations.
These conversations can be very helpful; they are part of the process that can help you understand yourself better and understand the ways you behave and react to particular circumstances and feelings.
Counselling and therapy are not “soft options”. They require energy, commitment and courage.
While you may not wish to discuss the things you talk about in therapy or counselling with anyone else, you may wish to let family or friends know that sometimes the process can be painful and difficult and you may need some understanding and support at these times.
Choosing a counsellor or therapist
As may be evident from the above, counselling and therapy are challenging and difficult. There are a number of ways in which you can access this kind of support, depending on your circumstances.
The most important thing when seeing a counsellor or therapist is to try to ensure that they are the right person for you. As in any relationship, there are some people we feel more at ease with, more able to trust. This also applies to the counselling or therapy relationship, which is likely to work best where both parties feel able to trust and work with each other.
The way in which you access therapy may, to some extent, dictate how much control you feel you have over this aspect of the relationship, but even if you have been assigned a therapist or counsellor through the NHS or a charitable agency, it is worthwhile discussing the referral with the referring agency if you feel the practitioner is not suitable for you.
Your doctor may be able to refer you to a practitioner on the NHS. These are likely to be for shorter term counselling and therapy, and there may be waiting lists. The waiting periods can feel very difficult if you feel you need help now, and you may wish to think about other support options during this time.
Another alternative for counselling or therapy is through a local community-based organisation. A range of charitable organisations provide counselling and therapy on a low-cost or no-cost basis for those on low incomes. This may be provided by experienced practitioners, as well as by trainee counsellors and therapists who have undergone a significant level of training.
Your doctor may be able to provide details of such services locally, or your local council website may carry relevant information. You can also contact SANE Services (see below) for details of local services.
You may also wish to access counselling or therapy privately. This may offer you a wider choice of practitioners and a wider range of approaches. However, the basic premise remains that the relationship you have with your counsellor or therapist will be the most relevant factor in the process.
If you are choosing a therapist or counsellor privately, it is important to choose a practitioner who is registered with one of the professional bodies that provides a code of practice to which registered practitioners adhere.
These bodies include the BACP (British Association for Counselling and Psychotherapy); UKCP (United Kingdom Council for Psychotherapy); BABCP (British Association for Behavioural and Cognitive Psychotherapies). Details below.
The cost of private counselling and therapy varies; many practitioners operate a sliding scale of fees, with reduced levels of fees for those on low incomes.
Where can I find help and support?
SANE provides emotional support to anyone affected by mental health problems, including families, friends and carers. Using our database, we can also offer support in considering other options for help, including local services and agencies.
One-to-one support from SANE
Other useful contacts
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
British Association for Counselling and Psychotherapy (BACP)
British Psychoanalytic Council
United Kingdom Council for Psychotherapy (UKCP)