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How to decide between different types of therapy
Therapy is in demand more than ever before in the UK, with an increasing number of people seeking professional mental health support. However, it can be difficult to distinguish between the different types of therapy available - especially privately - and to know what kind of therapist or counsellor you need.
There's no one type of therapy that suits everyone. Not only are there dozens of different styles, the benefits of certain methods can depend on the issue being brought to the session. It can be easy to be overwhelmed by the number of different therapeutic approaches out there.
However, research shows that the key to the success of therapy is the relationship you build with your therapist - rather than their style. That being said, a therapist's approach can have a significant impact on the relationship.
What are the common types of therapy?
Person or client-centred therapy is a humanistic approach based on the view that everyone has the capacity and desire for personal growth and change, if given the right conditions. Rather than directing the therapy, the counsellor offers unconditional positive regard, empathy and congruence to help clients work through an issue or negative feelings.
"Person-centred counselling is led by you, the client, rather than the counsellor. You know best what has happened to you and what is important to you, so that is where the focus is," explains Counselling Directory member Jenny Warwick, a BACP-registered counsellor.
"The counsellor is completely non-judgemental and works with you to help you become more self-aware and accepting of yourself as you are so that you can work things out for yourself."
Cognitive behavioural therapy
Cognitive behavioural therapy, or CBT, is widely offered on the NHS. It aims to help you change the way you think - which is the cognitive aspect - and also your behaviour. Rather than looking at past causes of problems, it focuses on current issues and practical solutions.
"It looks at how you think and behave and helps you find other options and solutions you can use to feel better. You will look at what happened in certain situations, how this made you feel and how this, in turn, affects how you behave," says Warwick.
"It can help you to recognise the emotions and feelings that perhaps made you behave in a certain way, and gives you alternative options so you can deal with situations in a more positive way."
Dialectic behaviour therapy
Similar in some respects to CBT, dialectic behaviour therapy (DBT) concentrates largely on mindfulness, accepting uncomfortable thoughts and feelings and regulating your emotions. CBT is more about recognising, challenging and adapting the thoughts and behaviours which arise from your feelings. DBT may instead focus on helping you to cope with challenging situations and emotions.
The therapy was first developed by psychotherapists working with people with borderline personality disorder (also called emotionally unstable personality disorder).
Psychodynamic therapy can be traced back to Sigmund Freud's approach to psychoanalysis, established in the 1890s. At the time, Freud explored the impact of early childhood events, the conscious and unconscious elements of the mind, repressed fears and defence mechanisms.
"Psychodynamic counselling focuses on the unconscious - what's happening underneath your conscious mind," Warwick explains. "It looks at your past experiences and how they impact your behaviour now. You might talk a little bit more about your childhood and how you got on with significant people such as parents and carers."
Transactional analysis incorporates elements of humanistic, cognitive-behavioural and psychodynamic therapy. "Transactional analysis looks at three main parts of your personality - the parent, adult and child - and this helps you understand how you interact with other people," says Warwick.
"You look at your beliefs and how you interpret the world around you and how this creates habits and patterns of behaviour. The counsellor will work with you to help you to understand and to change these."
Eye movement desensitisation and reprocessing (EMDR)
Developed in the 1980s by American psychologist Francine Shapiro for the treatment of PTSD, EMDR aims to resolve symptoms linked to trauma. Rather than focusing on behaviour, this newer kind of therapy concentrates on memory and the processing and storage of traumatic experiences.
During EMDR therapy sessions, you relive traumatic or triggering experiences in brief doses while the therapist directs your eye movements. It is thought to imitate the psychological state that we enter when in rapid eye movement (REM) sleep, during which we are able to make new associations between things.
Rather than using one approach, integrative counsellors use various techniques and methods depending on the client's needs.
Integrative therapy looks at the client as a whole, taking into account their mental, physical and emotional needs. This kind of therapy is based on the idea that there are many different ways to support a client.
Gestalt therapy, which originates from Germany, is another humanistic approach. It is holistic, meaning it focuses on the 'whole' of the client - rather than breaking things down into parts. It focuses on the person's present life and challenges, rather than exploring their past experiences.
Therapists help people to focus on their immediate thoughts, feelings and behaviour to better understand how they relate to others and to situations. Gestalt therapy also concentrates on how we perceive the world and our experiences.
How to choose the right therapist
"Finding the right counsellor for you is so vital. The relationship you have with your counsellor will have a direct impact on the effectiveness of your counselling," says Warwick.
"You need to feel you can speak about whatever you need to talk about in your sessions. For that to happen, you need to feel comfortable, safe and that you will not be judged. Even the counsellor your best friend recommended will not be a good match if you do not feel connected with them."
Ensure they are qualified
Qualifications and experience count, so it is important to make sure that they are registered with the appropriate counselling body.
Clinical psychologists have completed a university course in psychology and three years' Doctorate training under supervision. The titles practitioner psychologist, clinical psychologist, counselling psychologist, registered psychologist and health psychologist are 'protected titles': it's illegal to work in any of these professions without being registered with the Health and Care Professions Council, who ensure anyone registering meets all the required professional standards.
Counselling and psychotherapy are not protected titles. However, there are several governing bodies which provide voluntary registration, ensuring their members adhere to agreed professional standards.
The BACP (British Association for Counselling and Psychotherapy), BPS (British Psychological Society), UKCP (UK Council for Psychotherapy) or the BABCP (British Association for Behavioural and Cognitive Psychotherapies) are all professional organisations.
Look at the therapist's experience
"Have a look at their experience and the issues they work with people on,” Warwick advises. “See if they have worked with other people with similar issues to yours.”
Many therapists specialise in specific problems, such as anxiety, addiction or eating disorders. A strong, therapeutic relationship between the professional and the client is essential for therapy to be a success. It's important to find someone you trust who understands and respects you.
Your relationship with your therapist can sometimes be linked to their lived experience or identity. This could be especially important if age, sexuality, gender, race or disability are important to you.
Shop around for the right person
It can be daunting to consider finding a new therapist, especially if you have been having sessions with the same person for a while. Sometimes though, trying someone new can provide a different perspective.
"Because that connection between you is so vital, it is fine for you to shop around for counsellors," says Warwick. "Most counsellors offer a free initial chat before booking the first session so you can get a good feel for them. It is OK to trust your gut and your instincts - you will know whether you feel comfortable talking to them."
Consider their location
"Think about their location - are you going to be able to get to them easily enough? How far are you happy to travel to see them? Would you rather sit and speak with them face-to-face or would you want virtual therapy?" asks Warwick. "Many counsellors work online now and this could be a good option for convenience, comfort and accessibility."
Where the therapist is based can also affect their rates, too. Often, online therapy sessions carried out via Zoom are cheaper than in-person ones, which may be worth considering if you are on a budget.