Choosing a Psychotherapist or Counsellor

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Related information: Our Accessible Mental Health Support Services resource provides information about how to find free and low cost support and care from the NHS and other organisations.

In this factsheet:

• What therapy is and who provides it
• Types of therapy
• Finding someone suitable
• What to expect
• Getting the most out of therapy

What is therapy?

• Therapy offers a safe and confidential place where you can talk about your troubles and concerns
• Where you will be treated with respect and not judged
• Where you can openly explore difficult feelings, relationships and situations
• Where you can look at options and try to make better sense of your circumstances
• Where you can gain greater understanding of yourself and others so as to be better equipped to cope with the future

Therapists do not

• Offer advice
• Provide miracle cures
• Talk about their own experiences and views
• Pass judgement on you or your opinions
• Take advantage of you in any way
• Offer help with practical problems
• Prescribe drugs (unless they are psychiatrists)

Who offers therapy?

There are four types of mental health professional offering therapy:

• Counsellors
• Psychotherapists
• Counselling and clinical psychologists
• Psychiatrists

All practitioners registered on the BAPAM Directory are suitably qualified and experienced, and professionally registered. In addition they have extensive specialist knowledge of work and lifestyles in the performing arts, and the common issues that arise for creative professionals. Many have industry experience themselves as artists, performers or professionals. 

Types of Therapy

There are several types of psychotherapy and each has its own theory of the causes of people’s problems and its own way of working. Some therapies are particularly helpful for certain types of problem and some have been recommended specifically by the National Institute for Health and Clinical Excellence (NICE).

BAPAM practitioners offer a range of approaches amongst those founded on sound research and clinical evidence and recommended by NICE. The three main approaches used in therapy are:

Client-centred or person-centred therapy

This therapy is recommended for depression, but can also help with other issues. According to this approach, the therapist provides three ‘core conditions’ that are, in themselves, therapeutic. These are:

• Empathy (the ability to imagine oneself in another person’s position).
• Unconditional positive regard (warm, positive feelings, regardless of the client’s behaviour).
• Congruence (honesty and openness).

The theory suggests that if these three core conditions are in place, the relationship between you and your therapist will help to you to feel differently about yourself and your life. This can then help you to make changes in your life, if you decide you want to do so. Many therapists will use aspects of the person-centred approach in combination with other therapies, for example, CBT (see below).

Cognitive Behaviour Therapy (CBT)

CBT is recommended by NICE for a variety of disorders, including depression, anxiety, phobias and obsessive compulsive disorder (OCD), schizophrenia and bipolar disorder. CBT combines cognitive therapy and behaviour therapy. It focuses on how you think about what is going on in your life – your thoughts, images, beliefs and assumptions (your cognitive processes) – and how this impacts on your behaviour and how you cope with emotional problems. It then looks at how you can change any negative patterns of thinking or behaviour that may be causing you difficulties. In turn, this can change the way you feel. Together with the therapist, you will explore your problems and develop a plan for tackling them. You will learn a set of principles that you can apply whenever you need to. You may find them useful long after you have left therapy. CBT focuses on what is going on in the present rather than the past. However, the therapist may also look at how your past experiences impact on how you interpret the world now.

Psychodynamic Therapy

Short-term psychodynamic therapy is recommended by NICE for treatment of depression and social anxiety but it can also help with other problems. It is based on the idea that the unconscious and the past has an impact on your experiences and feelings in the present. This theory also suggests that important relationships, perhaps from your early childhood, set a pattern for how you relate to other people later in life. The therapist usually aims to be as neutral as possible, giving away little information about themselves. This makes it more likely that important relationships (past or present) will be reflected in the relationship between you and the therapist, providing important insights for you and the therapist to help you to work through your difficulties.

Other Approaches

There are many other types of therapy and further information about them may be found in the references below.

You may also come across the terms ‘eclectic’ or ‘integrative’ when a therapist describes how they work. This means that the therapist combines different types of therapy or uses elements from a number of different therapies in their work.

If you have previously had a good experience of therapy using a particular approach you may want to choose someone using that approach again.

Finding the right therapist

How do I know which is the right therapist for me?

• You may decide to choose someone of a particular age range, gender, ethnicity, ability to speak a particular language or other background factors. However, these factors may not be important to you.
• Therapy has to be affordable and the therapy room accessible to you.
• You should feel from the beginning that you can trust them and that you would be comfortable speaking freely about very personal thoughts and feelings.
• It is also important that you feel safe with them and understood by them.

If things are not working out how you expected:

• If you don’t feel comfortable with your therapist when you first meet then contact someone else.
• If you have had several sessions, raise any discomforts with your therapist as frankly as possible: these may need to be addressed as part of the therapy.
• If you feel that the therapy is not making a difference, or is not meeting your expectations, discuss this fully with your therapist to try to find a way forward.
• If you decide to end the therapy discuss it first with your therapist so things can be brought to a satisfactory close.

What to expect from therapy

• A series of appointments of approximately an hour in length in a professional setting, which may take place face to face, or by telephone or video call.
• Everything discussed is confidential with certain legal exceptions which will be clarified by your therapist, relating to concerns about harm coming to your self or to others.
• Your therapist may send reports following an initial assessment session or of the progress of therapy to your GP or other health professional if appropriate.
• With your consent, your therapist may provide reports on the progress or outcome of your therapy to an employer, a college or other party such as an organisation who may fund your care. If you are referred on for treatment elsewhere e.g to an NHS IAPT service, a neurologist, or a Drug and Alcohol Service a report will also be necessary.
• Practical and financial arrangements for payment and missed or cancelled sessions and holidays will be made clear from the outset.
• Your therapist normally keeps notes of sessions which are kept securely.
• Your therapist may give you questionnaires to fill in and will explain their purpose fully. Any scores will be discussed in session.
• You may be asked to carry out certain tasks, or keep certain written notes between sessions. This ‘homework’ is an important part of the therapy and helps speed progress towards recovery.

Getting the most out of therapy

• Therapy often begins with a thorough assessment so you and your therapist are clear and agreed on what is to be covered in the therapy and what the main issues are. You can then agree on appropriate therapeutic goals.
• You may experience a sense of relief when you start therapy, perhaps because you are being listened to for the first time, or because you have been struggling for ages or because your therapist has ‘named’ what has been bothering you, or that you realise you are not going ‘mad’.
• However, you may feel more anxious or distressed when you start, because you have to pay attention to difficult feelings, thoughts or behaviour that you would rather ignore. In this situation, you may feel worse before you start to feel better.
• It is important to discuss with your therapist any concerns you have about how you are reacting to the therapy – at any stage. Give honest feedback. Therapists can often sense when clients have issues but they are not mind readers.

How long will I be in therapy?

Therapy can be just a few sessions and sometimes even one session may be enough. However it may continue over several weeks or months or even years. It is not usually possible to say in advance exactly how many sessions will be needed as this will depend on how well you can engage with the therapy and your individual circumstances. NHS therapy, and therapy funded by charities is often time-limited, for example to 6 or 8 sessions, whereas private work is usually more open ended. Your therapist should discuss this at the beginning and review progress during your course of therapy. 

How often are the sessions?

Most therapists see clients weekly. In performing arts, (with its unusual hours of work, last minute adjustments to rehearsal and other schedules, frequent touring and so on) this pattern may need to be adjusted to suit the demands of incoming work/auditions etc. Your therapist will make clear when they are available to see you and how to notify and manage any changes of plan between sessions.