“Talking therapy”, a word often used interchangeably with “psychotherapy” or “counselling”, refers to the treatment of mental disorders by discussing your thoughts, feelings, and behaviour with a registered professional. In the UK, only therapists registered with a recognized regulatory body can call themselves a counsellor or psychotherapist. Licensed psychotherapists, CBT practitioners and clinical or counselling psychologists go through extensive postgraduate training and are trained to treat enduring and serious mental health problems, while registered counsellors have a shorter education and typically deal with transient situational issues like relationship problems and bereavement. Working with a therapist registered with a regulatory body warrants that you will receive quality and effective treatment.
Although many people only consult a psychotherapist when suffering from severe mental illness or debilitating symptoms, psychotherapy is for everyone and can protect you from developing problems in the first place. You do not have to be seriously ill to benefit from psychotherapy and it may be helpful to think of talk therapy as a form of routine health care that will help you deal with issues as they arise. The therapeutic setting is a safe space and psychotherapists are bound to strict rules of confidentiality. They may not reveal information about you to others.
Although the NHS does provide provisions for mental health care, it is best to meet with therapists in private practice should you only want to try talk therapy for self-improvement or preventative health care. This is because the strain on public mental health care in the UK is very high, and public health providers have the mandate to treat mental illness in the first instance.
The most common forms of therapy
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy focuses on practical interventions that help ease the symptoms of mental health conditions like anxiety, depression, OCD and phobias and is often used in conjunction with medication. It is based on the idea that feelings are the result of thought processes and that reconfiguring unhelpful patterns of thought can help people suffering from mental health conditions to place their feelings into perspective. CBT teaches strategies to avoid cognitive distortions like catastrophic and polarized thinking, overgeneralization and emotional reasoning.
Because of its practical focus and short-term efficacy, CBT does not aim to uncover the psychological origins of trauma or the causes of mental health problems. Instead, it relies on proven strategies – including “homework” in between sessions – that help patients track and understand their thought processes in order to make cognitive adjustments that can help ease symptoms.
Psychodynamic psychotherapy places more emphasis on the explanations behind symptoms, emotional distress and relationship difficulties. Psychodynamic psychotherapy assumes that a part of our mind operates outside of our conscious awareness and that early experiences shape later development. These experiences lay down patterns of interactions with others and influence how we manage feelings and deal with life’s challenges.
Understanding past experiences and how they influence current ways of thinking and relating can help one deal with current anxieties and life difficulties. This, in turn, can enable you to make better life decisions, develop your own voice and reach your full potential
Therapists commonly combine PDT and CBT in treating mental health problems, but this is not something you need to worry about. Therapists are trained to identify treatment strategies appropriate to your context and specific health concerns.
Although psychoanalysis has, for the most part, been superseded by psychodynamic psychotherapy (PDT) and other more results-driven forms of therapy, it remains the foundation of modern talking therapy. Proponents of the psychoanalytic method believe that deep psychotherapeutic work at an intense pace and over longer periods – often several years – can help dislodge persistent and long-term mental and behavioural problems. The goal is to achieve a deep understanding of your personality and motivations and how past relationships continue to influence your everyday behaviour.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioural therapy is a form of CBT initially developed to treat borderline personality disorder but has since been adapted for the treatment of other mental health problems. DBT is particularly helpful in treating emotional disregulation and self-destructive and self-harming behaviours like eating disorders. Individual sessions with a therapist are often supplemented with group therapy and, in severe cases, clients have access to telephonic crisis coaching in-between sessions.
Family refers to the treatment of relatives or more than one member of a family at the same time. Couples therapy can also be included under this rubric. Relationship issues are often a major contributing factor to overall mental wellbeing. Since our closest relationships are with those we live with, problems arising within a family can have a significant impact on everyone involved. Family therapy regards the family as a mutually-connected system where the wellbeing of every member effects that of everyone else. A mental health diagnosis of one family member may, for example, have a significant impact on other family members and require clinical interventions.
For some mental health problems group therapy can be an excellent approach. Unlike family therapy, where the members of a group are related, group therapy brings together people with similar problems, like abuse, eating disorders, or traumatic experiences, to discuss and share their experiences a therpaist and with each other. Group therapy is a safe space where people benefit from each other’s social support. It can be extremely reassuring to discuss one’s experiences with people who have shared similar experiences and may help counter feelings of isolation and stigma.
Which therapy is right for you?
Finding the right form of therapy and a therapist with whom you have rapport may require some research and trial and error. Certain mental health conditions benefit from specific forms of therapy. Research has repeatedly shown, for example, that CBT is the preferred form of psychotherapy for generalized anxiety disorder (GAD) while dialectical behavioural therapy may be more beneficial for people suffering from borderline personality disorder. Reputable online sources may help you narrow down your options and a general practitioner may be able to advise or recommend a suitable therapy for your specific needs.
Regardless of the form of therapy you choose, you can discontinue treatment whenever you want. Usually, it is recommended to allow around three sessions with a therapist before deciding whether to continue treatment. If you don’t feel comfortable with a therapist, it might be wise to consider a different one. It often takes a few tries before finding a therapist you feel comfortable with.
The form of therapy you choose will also depend on what you can afford. Only some forms of talking therapy may be available on the NHS. CBT is a shorter-term therapy and you may feel significantly better after only a few sessions, while other forms of therapy take longer to take effect and thus presents a more significant financial investment.
More forms of therapy
Interpersonal Therapy (IPT)
Interpersonal therapy (IPT) is a talking therapy where people with depression or anxiety examine their relationships with other people as potentially contributing to their symptoms. The idea behind IPT is that emotional wellbeing and relationships with other people mutually influence each other and that people can improve their mood by improving their relationships and vice versa.
IPT was developed primarily to treat mood disorders such as depression, but has since been shown to be effective for other conditions, such as eating disorders and substance abuse. IPT is usually short-term therapy, offered over 16 to 20 sessions.
Face-to-face interaction has been the pillar of many forms of psychotherapy, but researchers have found that online treatments for shorter periods can be as effective as traditional physical interaction with a therapist. With the restrictions on physical contact during the Covid pandemic, online therapy has become much more commonplace and some of the major psychological associations now endorse online therapy as a legitimate alternative to traditional face-to-face contact.
Humanistic psychotherapy focuses on the individual as a whole, including mind, body, spirit and soul, and is a collective name for a range of therapies that have developed from the humanistic psychological tradition. This tradition is grounded in the belief that each individual has the capacity to develop and grow. Humanistic psychotherapies include gestalt therapy, existential therapy, and client-centred therapy and tend to focus on conflicts arising from big life or universal issues like freedom and responsibility, death, loneliness, isolation, despair, and feelings of meaninglessness. Humanistic therapies encourage taking responsibility for one’s own development and life choices.
Eye movement desensitisation and reprocessing (EMDR)
EMDR is a relatively new form of talking therapy aimed at treating the symptoms of post-traumatic stress disorder (PTSD). People suffering from PTSD often experience disturbing and intrusive thoughts, nightmares, and flashbacks to past traumatic events. EMDR helps the brain reprocess traumatic memories in ways that make it easier to deal with the impact of trauma in the present. A course of treatment usually involves 8-12 sessions and involves following the movement of a therapist’s finger with side-to-side eye movements, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone. While it has proven to be an extremely effective treatment for PTSD, it can be a distressing process and it is best to have a strong social support network while undergoing EDMR treatment.
Does therapy work? If so, why?
Although researchers still find it difficult to pinpoint why therapy works or to define what successful care amounts to, scientific studies show that therapy is beneficial in the treatment of most mental health conditions for people across different population groups. What is more, a number of studies have shown that therapy can be more effective than medication in treating some conditions and that therapy improves productivity while reducing disability, morbidity and mortality and mental-health related hospitalizations. Therapy is also proven to have long-term health benefits. Patients suffering from anxiety and depression and who have received psychotherapy have fewer relapses than those who have relied only on medication. The positive effects of therapy can be felt long after treatment has ended.
It is interesting to note that the skill of the individual psychotherapist seems to be more important than the type of psychotherapy in the successful treatment of mental health problems. Good therapists have excellent interpersonal skills, can build trust and rapport with clients, offer hope out of despair, are persuasive and influential, assess the client’s problems within their broader life context, have a clear, but flexible, treatment plan and rely on the latest research.
A brief history of therapy
Although modern psychology dates back to the 19th century, people have always been offering each other counsel and reassurance. In ancient times, what we now understand as mental illness were often treated within the paradigms of religion and magic. People suffering from disorders were branded as “demonic” and treatment took the form of exorcism or punishment.
Only with the innovations of Sigmund Freud and his invention of psychoanalysis was mental illness better understood and treated in something approaching a scientific manner. Freud’s work still forms the basis for psychodynamic and interpersonal therapies.
Carl Rogers developed a different strand of psychotherapy in the 1950s based on humanistic principles. He formulated 19 propositions that were to be widely applied both in psychotherapy and in other related fields. Another important 20th-century psychotherapist is Aaron Beck who pioneered the principles of cognitive and behavioural therapy in the 1960s. His insights into human cognition and how it relates to anxiety and depression developed into what is known today as CBT.
Although Some believe that what characterizes today’s psychotherapeutic climate is that the various forms of therapy are increasingly mixed. Perhaps we are moving towards more individualized treatments, where the etiquette of therapy becomes less important than the unique alliance between patient and therapist.
The field of neuroscience (which studies the brain and nervous system) holds much promise for future developments in psychotherapy and it will likely play an increasingly important role in therapists’ toolkit. Contemporary neuroscience not only provides evidence for the efficacy of talking therapies but will help guide therapists in choosing effective counselling strategies in different situations.
How to find a therapist in the UK
In the UK, you need to be registered with a GP to access psychological services through the NHS. You can ask a GP to refer you to a suitable therapist or refer yourself through the NHS’s Improving Access to Psychological Therapies service (IAPT). To find IAPT services near you, use the online IAPT service finder on the NHS website.
Finding a therapist in private practice can also be done by contacting one of the four main regulatory bodies for psychotherapy in the UK: the British Association for Counselling and Psychotherapy (for psychological counsellors) the UK Council for Psychotherapy (for psychotherapists), the British Association for Behavioural and Cognitive Psychotherapies (BABCP) (for registered CBT practitioners) and the British Psychological Society (for clinical and counselling psychologists). Each of these associations maintains a register of accredited practitioners.