9 questions for starting therapy

Dear reader, I understand nobody is happy about contacting a therapist. You may be feeling afraid, nervous, or worried about the future. It can’t be shifted by simply ignoring it, ordering a new pair of shoes or going for another run (we’ve all been there). Not only does meeting a therapist seem like a speed bump on the way to the future, the process of reaching out is confusing and painful too. It’s confusing and painful because - put simply – you have choices! But this guide helps to answer nine key questions.

1. Who can be my counsellor?
2. What is therapy?
3. What type of therapy is best for me?
4. Is now the right time?
5. How do I know when to stop?
6. How much to expect to pay, and can I get it for free?
7. Online or face-to-face?
8. How high can expectations be?
9. What should I do now?

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There are more than 40 types of therapy. Any idea what type you'd like? And, would you like to meet your therapist face-to-face or online? Also, who do you want as your therapist? It's a lot to consider.

According to the British Association of Counsellors and Psychotherapists (BACP), in 2020 there were over 57,000 counsellors working in the UK alone, meaning you can tailor your experience... Just half a dozen Sunday evenings and lunch breaks spent googling therapy and you’re on your way to reaching out.

As a psychotherapist, bewildered individuals will ask how they can get started in accessing therapy. But unless guided, the process isn’t easy to navigate. So let me explain it to you, and to do so, let me share with you what I shared with my friend, Graham.

Meet Graham, and why he’s important

Having a few years to catch up on, Graham and I arranged to have lunch in a café down a cobbled street in Edinburgh. Over the phone, Graham showed interest in my new position as a psychotherapist in private practice, and I knew he had also started a new job in an accountancy firm. There was plenty to chat about.

Walking up the Royal Mile and headed towards our meeting place, I reminisced the days we lived together in a shared house at university. Graham was likeable because he wasn’t afraid to share his opinion or how he felt. He was the kind of guy everyone wanted to sit by at a party. He could switch from glorifying how he got paid to sit his friends’ exams in High School to detailing a painful childhood experience and back again. He’d talk in a way that was surprisingly open and funny that meant nobody felt the need to make sure he was okay. I shuddered at the thought I’d overlooked Graham’s subtle displays that he was struggling.

“Lily”!

Graham had spotted me first and stepped out the café entrance with his arms outstretched to greet me. All 6 foot 3 inches of him spread out to scoop up the last four years and me. He must be okay these days, thank goodness, I thought as he pressed my face against his shoulder and dangled my feet over the cobbles.

Before our coffees arrived, Graham had both made me laugh and mentioned his new job wasn’t as rewarding as he’d hoped. He was true to style. Though, I was determined to give him the attention he’d always deserved. I leaned forward, looking him straight in the eye and asked how he’d been. He sighed and shifted his wooden chair on the stone floor.

“Lily, let me tell you. Things have been grim since Uni. Everything’s alright on the outside – I’m earning well and my girlfriend and I have been together for almost three years”.

Indeed, this did seem to be going well. Graham couldn’t hold a girlfriend or a job when we shared a house together. I leaned closer, ready to understand. The waiter sat down our coffees.

“But it’s not about that. It’s that things aren’t so pretty on the inside. I go to work and come home like a good lad, but I feel empty. I can’t explain it. I barely understand it”.

My heart felt empty for him, and I watched him shift again.

“It’s like yesterday - I got a gym membership because I’ve gained weight. But I’ve gained weight because I eat junk every night, and I do that because I don’t have motivation for anything else. My girlfriend complains that I don’t talk to her enough about my feelings. Though how can I explain that I feel nothing? Should I just say ‘empty’”?

I opened my mouth to offer my thoughts, but Graham kept talking. Let him speak, Lily.

“So now she’s unhappy with me”, Graham stopped, rubbing his forehead in a way that made me think there was more about his relationship in which he didn’t feel comfortable sharing with his friend. “I just feel more alone and some sort of empty void. I’ve been spending money on random stuff and that makes me wonder why I bother to work so hard. I basically trade in my life for junk. Everything seems so connected and out of control”.

He paused and looked at his coffee. I kept my eyes focused on him. “I don’t have any rest thinking about my parents and how things have turned out”.

There it was. All this time, Graham had held up for everyone to see what had been troubling him. I tried to suppress my regret and shame at never having acknowledged his signs of needing to talk.

“Thank you for sharing that with me. I’m so glad you told me”.

Graham let out another sigh and picked up his coffee. “You’re a therapist now, and I want to talk. Will you be my counsellor? I don’t want mates’ rates, and don’t go easy on me”.

I smiled, “I’m sorry, Graham, but I can’t be your counsellor. You and I are friends, and your counsellor must be impartial”.

“But I want you to counsel me for exactly that reason. You’re my friend”.

I smiled again, “That’s not how it works. Besides, why should they be a friend?”

“Because I know and trust you”.

He had a good point. I would have loved to be Graham’s counsellor. I cared enormously about him and so wanted to help him feel better. But that was exactly why I couldn’t be my friend’s therapist. I began to explain this. Graham nodded and asked the first of his nine questions I want to share with you.

“Who can be my counsellor?”

“Well, absolutely somebody you trust! That’s non-negotiable. Even if you doubt one part of this person or if you don’t like how they treat you or are professionally, you stop seeing them. That’s simple. Also, you should know that currently in the UK, there aren’t regulations about who can and can’t call themselves a counsellor. You want to be sure this person has experience and knows how to behave”.

Graham frowned.

“Yes, you’d be surprised. This isn’t only about qualifications, you know. Counsellors have a lot of power. If you share every detail about yourself with another person in your most vulnerable hour, you need to know they’re proper and are acting in your best interest. Ethically”.

He gave one long nod. “Right, this stuff is serious then. I hate to think of all the people I’ve over-shared with”, he added.

I responded with a few nods in agreement. Again, we’ve all been there. I could see him pondering as though I’d introduced him to a whole new world. My friend now seemed confused.

“Then, what even is therapy?”

I got myself a little more comfortable and explained that psychotherapy is talking to a trusted, impartial and qualified person about what’s on your mind. It’s different to chatting with a friend because you have the reassurance that this person works ethically and wants what’s best for you. For you, meaning without getting over invested in improving your life or guessing what’s best for you or, worst of all, acting in their best interests. This isn’t always your loved one. Your partner may want what’s best for you, unless it involves your career change. Your friend may want what’s best for you, until that involves you moving to Australia. Your parent may want what’s best, but not if you quit University.

I wondered if Graham would ask the next common question, so I offered the answer anyway. “A therapist doesn’t simply sit and listen. They’re doing a lot more than that. They’re ready to dive into the depths of despair with their clients. Rock ‘n’ Roll if you ask me. They’re helping you learn about yourself and trying to discover what underlines your barriers. Their aim is to clear your path so you can continue on your way in life”.

“Maybe Rock ‘n’ Roll, but please don’t get all metaphorical”.

“I don’t have to. I promise… Therapists will do a lot more than friends”.

I took a sip of coffee and glanced at Graham to see if he’d sensed my shame in not doing enough as his friend. His next question proved that he hadn’t.

“What type of therapy is best?”

I raised my eyebrows as I swallowed. There isn’t an easy answer to that question. “Shucks, I don’t know. There are certainly many types. They all work differently and do great things for different people”.

Graham lowered his chin and looked at me from below his eyebrows.

I laughed, “Alright, but I can’t say one is best… They’re different in that some focus on certain aspects more than others. Some focus on emotions, some on dreams, some on separating the good parts of you from the bad parts and aiming for change. There are many types though they all involve talking with the other person”.

I sensed I should continue. “The way I like to think of it is not to focus on what the therapist does. It doesn’t matter if they focus on dreams or behaviour or not – unless you care about that, of course. Be interested in how they approach you as a person. Know what I mean?”

Our food had now arrived, and Graham had begun eating.

“Not really, Lily. I see cognitive behavioural therapy and I often hear about person-centred therapy. Tell me about that”.

“A perfect example of therapists who approach their clients differently. The cognitive behavioural therapist tends to see their client’s life in different parts. For instance, an issue with food is dealt with separately to a work issue. And money is addressed separately to family values, for example”.

“Right”, Graham said thinking aloud, “They might not touch upon all aspects of my life in one session?”

“Or not at all. You’d enter therapy with an agenda to focus and change one single area of your life. The therapist will work to keep you on track”.

“So, they’d tell me what to talk about?”

“Exactly. They’re very much in charge – albeit caringly and gently. And that works wonders for some people”.

Graham set his cutlery down and lent back on his chair, “What was the other one?”

“Person-centred therapy, which is quite different. This therapist doesn’t see themselves as in charge or the expert in the client’s life, though they will keep the client focused and working hard if they know they can get more out of their client. And they very much see parts in their client’s life as connected. Person-centred therapists will be in there swimming alongside the client and engaging fully in the relationship, which is really where many believe the magic happens”.

“That’s another metaphor”.

“Sorry”, I picked up my sandwich.

“I understand. Although surely the person or client should be at the centre of all therapies?”

“Absolutely!” I wanted to make clear, “The client is always at the centre no matter the therapy. Perhaps person-centred therapy should really be called ‘Client-is-the-expert-of-their-own-life-and-the-therapist-doesn’t-make-assumptions therapy’”.

“And-everything-is-connected”, he was starting to understand.

Graham stretched out his arm onto the chair next to him.

“It all seems great, Lily”.

There was more on his mind.

“How do I know if now is the right time for me to start therapy?”

“That’s a great question and something to be considered at length. Therapy isn’t easy – a lot can come up for a person that can needs time to properly work through. But if you want it and are ready, then the right time is now. Why would you wait? But, listen,” I wanted to add, “It’s common to have only one session every week or fortnight. Or to stop and come back when necessary. But know that therapists have thick skin and are used to people trying out their service and never coming back or coming back every now and again. The point is - don’t feel you’re committing to your therapist as though they’re your new life partner”.

“Right. Then how do I know when to stop?”

I liked that Graham felt comfortable to ask plenty of questions.

“Any respectable therapist will be glad when you’ve achieved what you want from therapy and don’t need to come back. Likewise, if things aren’t working out, a good therapist will give you the number of another counsellor. Not to mention, therapy can be costly and may need to be staggered for people’s budgets, so an end may come unexpectedly. But you’ll know when you feel better. You’ll know”.

Graham thought for a moment.

“How much should I expect to pay? Can I get it for free?”

I could tell Graham was becoming more and more interested.

“How long is a piece of string? Some therapists charge as little as £30 per session and others £90 or more. Instead, ask yourself what’s your budget and if the therapist is worth their price. But you can get it for free”, I picked up my sandwich again.

“There’s the NHS, of course, but expect to wait up to six months for an appointment and only expect to get around six appointments. You may be lucky to have a local charity in your area that has trained, volunteer listeners you could speak to. That can be really valuable and even lifesaving. Of course – going back to professionals – another thing to consider is meeting online, which might be a little cheaper”.

“Would you recommend meeting online or face-to-face?”

I wanted to consider my answer. I wanted to be clear that all the necessary aspects of therapy – empathy, acceptance, honesty, even confidentiality – can be valued both online and face-to-face. So arguably they are the same. But still, there is one obvious difference: being in-person, you can see the other person fully. You can see if they tap their foot or rub their wrists, whether they take care of their appearance or not – all small things that may be nonetheless important to a therapist. Do we feel better connected in person?

“I live in a big city and transport is not cheap! If I can save a commute, I will. And I don’t care about my therapist’s feet”.

“Totally. For people who may not have otherwise been able to access counselling, online therapy has opened huge doors and lain the way”.

We were now scanning the dessert menu though my metaphor didn’t go without a quick glare.

“It sounds brilliant, Lily”, Graham said dropping the menu back on the table. “Sounds like an opportunity to understand things and come to a place of acceptance. Perhaps it’ll help piece together parts of myself that I dislike, make some changes and help my relationship last”.

I could only look at my friend with soft eyes and a smile. A pull seemed to tug between us. It was time for Graham’s eighth question.

“How high can my expectations really be?”

I desperately wanted to keep the enthusiasm and warmth between Graham and I. Temptation stirred to persuade Graham to enter therapy and convince him life would change forever. But that wouldn’t do justice to my friend. Or to me.

“Therapy can do amazing things. The most amazing. It can save lives. Not only from death, but from a life not lived. But a session or two may not change your life forever. Us therapists aren’t superheroes, and we need time to understand something especially if our clients don’t. Besides, some problems are here to stay. I mean, history can’t be rewritten. But perspective can. It’s important you know what therapy is and isn’t. Your therapist should ask your goals and help you manage them”.

I felt like I was talking for myself rather than for my friend at that point.

“Thank you, Lily. I understand you don’t want to give me a false impression”.

Graham lent back and put both hands behind his head.

“So, what should I do now? How do I enquire and book?”

I couldn’t help but feel relaxed. We smiled at each other.

“So after you’ve decided what type of therapy you want, who you’d like to see and where, whether now is the right time for you and how much you’re willing to pay, you can book. That part ought not be difficult. If your therapist is making it hard – like asking for a commitment or minimum sessions - then they’re not for you. The easier it is to enquire and book the better”.

Graham squinted his eyes and looked away.

“I suggest googling the Counselling Directory to find a therapist’s website. Or google therapists but check their experience and certifications. Then send them an email. Book an appointment and show up”, I clarified.

Graham looked at me with a smile. “Do you want dessert?”

I touched my stomach.

“I’m satisfied,” Graham said with his hand on his.

We picked ourselves up, paid and left for the cobbled streets again. A few hours had passed, and the Edinburgh sky was now rainy and darkening. I linked my arm through Graham’s. “Did you enjoy your food?” I asked looking up at him with a hand on my scarf.

“Yes. I appreciate your help too. I can already feel myself being a different man. I want to talk and swim to the depths of my despair with someone Rock ‘n’ Roll and willing. But not with you”. He said looking down at me with a warm smile.

“That’s arguably the most exciting thing imaginable… I really want what’s best for you, Graham”. I spoke with my eyes on where I walked. “You’ve always been the life of the party, and I’m sorry I never wanted to see a part of you that may have been struggling. That wasn’t easy for me to recognise”. I looked back up at him.

“Not at all, Lily. You did more than you realise. Trust me, I understand it’s not easy for friends”.

I squeezed Graham’s arm as we entered Edinburgh’s lamp-lit and sloping Royal Mile together.

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Dear reader, when you’re ready, Loud Lamb offers online person-centred therapy. We empower you to speak for quality of life. We promise we are prepared and committed to help you express what’s on your mind in the hope you can understand yourself, your life and relationships more clearly. Read more on my profile or get in touch.