Why people choose to have therapy
Usually individuals choose to have therapy because they are experiencing difficulties and distress in their lives. Sometimes people can be isolated but at other times, even where an individual has the most supportive family and friends, they can find it difficult if not impossible to explain why, for example, they may be feeling anxious and or depressed. Or it may be easier to talk about personal, family, or relationship issues with a person who is independent of friends and family. Other life issues and events which can be very difficult to deal with include bereavement, divorce, redundancy, health issues, bullying and so on. However, you do not have to be in crisis or on the verge of one, before choosing to have therapy. You may be experiencing underlying feelings of dissatisfaction with life in general, or be seeking balance in your life and spirituality. All of these reasons and more will bring individuals to therapy.
What is therapy?
Therapy is time set aside by you and the therapist to look at what has brought you to therapy. This might include talking about life events, (past and present), feelings, emotions, relationships, ways of thinking and patterns of behaviour. The therapist will do their best to help you to look at your issues, and to identify the right course of action for you, either to help you resolve your difficulties or help you find ways of coping. Talking about these things may take time, and will not necessarily all be included in one session. The number of sessions offered may be limited, and so it is best to ask about this in advance, for example, brief therapy or short term therapy might provide a maximum of 6, 8, 10 or 12 sessions.
Types of therapy
A therapy session is a time set aside on an agreed date at an agreed place, which provides a 'safe' space, which is private, undisturbed, and cannot be overheard or interrupted. The counsellor will reach an agreement with you about confidentiality. Therapy may be available for individuals, couples, families and groups, and there are different ways of working with people, usually referred to as 'approaches', 'techniques' or 'modalities'.
Therapeutic models in brief
Therapy may involve specific techniques or approaches. This means therapists have had different training and have different ways of working with clients, for example CBT, brief therapy, drama therapy, person centred therapy, psychodynamic therapy, trauma therapy. In addition, some therapists may have specific approaches for working with people with eating disorders, addictions, issues of sexuality, etc. It can be helpful to have a general understanding of the approaches offered by your therapist, to enable you to think about what approach would possibly work well for you. Though therapists may train specifically in one model of therapy, many incorporate different techniques from other models if they feel it will be helpful for their client. For example, some may use art materials in individual or couples therapy, with agreement from the client(s). You can find out about the different types of therapy on 'It's Good to Talk website'
Therapists usually work for a mutally agreed set period of time for each session. The length of sessions may vary depending on the therapist's training, how the therapy is delivered and also whether it is a specialist treatment. Therapists and clients need to keep sessions to a reasonable length of time, to ensure that they both can maintain their energy and focus and get the most out of the session. In one to one therapy, a session may be time limited – usually 50 minutes to an hour per session. However, a specialist therapy, for example trauma treatment, may involve longer sessions. In the initial meeting with your therapist, you may find it useful to discuss the way they work, i.e. their approach or preferred modality.
Confidentiality is essential in a therapy relationship as part of building trust (BACP Ethical Framework for the Counselling Professions). However, confidentiality is not absolute, and there are exceptions. Sometimes, in the public interest, counsellors may need to make a referral to an agency or organisation (for example GP, police or social services) when there is a serious risk of imminent harm to their clients or to others, for example where a client is seriously mentally ill and needs hospitalisation, or in cases of child or elder abuse. These referrals are usually (but not always) made with the client's knowledge and consent. This decision will depend on the particular circumstances of each client. There may be times when a therapist is required by law to break confidentiality, for example, about terrorist activities. It may also be a criminal offence to 'tip off' a client when such a disclosure has to be made. Disclosures may sometimes be made at the client's request, for example, where a client asks for help when they are the victim of abuse, or for an assessment or report to help with a court case involving a claim for damages by the client.
You and your therapist should talk together in their first session and reach agreement about the limits of confidentiality for your work together. Therapists do not make telephone calls or engage in discussions about you to your GP, employer, partner, family members, friends or to other agencies to find out, clarify, or add to your personal information without your knowledge. This would be an absolute breach of confidentiality and trust. However there may be some circumstances when your therapist may be obliged to disclose information but your therapist should discuss this with you when agreeing your contract. You may wish to ask the counsellor to contact your GP and/ or other agency, in which case you would agree and confirm the issues to be discussed between the counsellor and other named party, and this would not be a breach of confidentiality. In some organisational settings, such as GP practices, schools, universities and some therapeutic agencies, your information may need to be shared with the organisation in order to best help you. However, after discussion with your therapist, you should be clear about what information may need to be shared and with whom it may be shared.
Contracts and boundaries
Therapists should establish clear 'boundaries'. This is a framework where you and the therapist have agreed a contract covering the following:
- dates and times of therapy sessions
- how and when the therapist and client can be contacted
- agreement about the limits of confidentiality
- clarification of the nature of the relationship, i.e. that it is a professional one, where the therapist will not be a personal friend
Some therapists provide written contracts for you to take away, usually in their first meeting, stating the agreement you have made to work together. These are useful and if your therapist doesn't offer this, you may wish to ask for it.
What therapy is not
Therapy is not advice giving or persuasion orientated to the therapist's point of view,,, although therapists may offer information and some therapeutic approaches may ask you to do homework as part of your therapy. Nor is it just a friendly chat discussing the week's events as you would with a friend. Talking with a therapist is not the same as talking with a friend, a parent or sibling, who would probably have an opinion about the issues discussed. The therapist is an impartial professional, who is able to listen to you non-judgementally and to work with your emotions and not get emotional themselves. The therapist helps you to develop understanding of yourself and others and to find your own solutions, making no demands upon you except for the terms agreed in your therapeutic contract. Therapy sessions are normally regular and not held at random, for example, two sessions this week, one next week and then 'see how we go'. Some therapy models allow some flexibility in the spacing of sessions. Sessions should not be held in cafes, bars, hotel reception areas, works canteens, or any place where client and therapist can easily be over heard and with the possibility of being recognised and interrupted by family, friends or colleagues.
Therapists should aim to be impartial, and be able to express warmth and empathy to assist you to talk openly about your feelings and emotions. They should also be non judgmental (this means not judging what a person discloses about themselves, their attitudes or behaviours); fair; open and trustworthy to enable a respectful working relationship to develop between them and the individual. Therapy is a very personal experience, for you and the therapist, and to a certain extent, feelings about the relationship will help determine whether you both can work effectively together. The therapist should also provide a good standard of care for you, which includes being aware of their own training, experience and limitations and referring you on when appropriate if the therapist feels unable to assist you.
The therapist should be professionally trained and qualified, and have knowledge about the issues that you want to discuss. They should be aware of their own issues and support needs and also be receiving regular supervision. Supervision is a formal arrangement for therapists to discuss their work regularly with someone external in order to maintain adequate standards of therapy. (Ideally the supervisor should not know the identity of the client). The therapist and their supervisor should be members of a recognised professional body such as the BACP, and preferably accredited by them. In the BACP Ethical Framework therapists are encouraged to develop their personal qualities in terms of their empathy, sincerity, integrity, resilience, respect, humility, competence, fairness, wisdom and courage.
Information taken from: bacp.co.uk [Accessed 10th August 2016] What is Counselling & Psychotherapy?
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