How to choose a therapist

Where to start?

Unless you are “in the business”, choosing a talking therapist can feel like taking a shot in the dark. Here are some tips to consider.

Firstly, take advice from someone you know and trust who has some expertise in the area such as your GP - a friend may have limited experience unless they work in the field. 

Qualifications and training

There are a burgeoning number of therapy qualifications, and these vary widely in their rigour and depth, ranging from short courses to many years of training. Well known umbrella organisations for counsellors and psychotherapists include the BPC (British Psychoanalytic Council), UKCP (UK Council for Psychotherapy), BACP (British Association for Counselling & Psychotherapy), BPS (British Psychological Society), and the BABCP (British Association for Behavioural and Cognitive Psychotherapies). Each of these have minimum standards for length and type of training, which you can find out about from their sites, and online registers of members. 

Having said that, each register requires a minimum training, and some members will have done more advanced trainings than others. If you want more help finding a therapist, some of the above, such as the BPC have a clinical service, whereby you are assessed by an experienced assessor who then finds you a suitable therapist who would be a good fit for you. 

Types of therapy

Counselling essentially involves listening carefully and providing a client centred approach to helping people think through difficulties themselves. Psychotherapy is a broad term, but is often seen as uncovering underlying feelings and emotions, and in the case of traditional psychoanalytic psychotherapy, taking unconscious processes into account. Both are explorative approaches designed to deepen understanding of emotional life. Cognitive behavioural therapy or CBT focuses on the thoughts and assumptions behind emotions and behaviour. CBT can be more expensive per session but is a shorter type of intervention.  

NHS therapy 

For many people, their GP is the first port of call. GPs may prescribe medication, (for example, antidepressants) and they can also refer patients to a practice based counsellor or to the local IAPT service (Increasing Access to Psychological Therapy). Patients can also refer themselves to IAPT with forms from their GP practice or information from the Internet. They will be assessed and may be “triaged” over the phone as a way of directing them to the initial contact, which may be computer-based guided CBT, meeting a “psychological well-being practitioner”, a counsellor, or a psychologist.

There is supposed to be some choice about type of therapy, although at present CBT provision is wider than other modalities such as couple therapy or brief psychodynamic psychotherapy. IAPT is a primary care service, i.e. delivered in a GP practice. For patients with more complex difficulties or where IAPT has not worked for them, they may be referred on to a secondary care psychological therapy department, or to a community mental health team if there are significant issues of risk or difficulties that go beyond just seeing a psychological therapist. 

Why pay if you can get it on the NHS?

The NHS has some degree of quality control. However, there is still variability depending on the experience and skills of the person you are allocated to see. There are also time constraints, e.g. up to 12 or 16 sessions in primary care. Secondary care can be longer, but seldom more than a year. Not everyone needs or wants a long therapy. Some people need a brief intervention at a time of crisis, e.g. bereavement or other life event. Others may want to get to grips with more long standing difficulties, and for them, being able to see someone for as long as they want is an advantage. As a rule, more severe difficulties that go back further may require longer in therapy, but an assessment with an experienced professional will help you decide what you need as a next step. 

Is therapy self-indulgent?

Good therapy is not about being self-indulgent, it is about talking and thinking about difficult issues, about making space for things that are important to talk about and not sweep under the carpet. It is about not just keeping a stiff upper lip and keeping going. It is about personal development and growth, about overcoming blocks, about accepting that you cannot do it on your own and that you need professional help. 

Is it the type of therapist/therapy or the person that matters?

It is vital to find someone who you feel some rapport with, who you respect and feel that you can work with. Remember, you are paying. You do not have to work with the first person that you meet. An initial consultation is a chance for the therapist to assess you, but also for you to get a sense of them and how they work. Any good therapist will not be upset if having met them you decide to see someone else instead. It is quite usual to want to meet more than one person before deciding, although if you find that you are meeting more than two or three, you may need to think about whether you are being overly cautious.

However, it is not just the person’s personal characteristics that is important, it is also vital how well they have been trained and their aptitude for the job. This comes back to the type of therapy that you want; whether you want a brief piece of supportive work to help you think something through (counselling), whether you want to focus directly on the problem in hand (CBT), or whether you want a longer and more in depth approach looking at unconscious thoughts and feelings (psychoanalytic psychotherapy or psychoanalysis.) You may be someone for whom the evidence base is very important.   This is a controversial area, as the “experts” do not agree and different types of therapy argue their corner. CBT certainly was a forerunner in proving itself to be effective, but now some other therapies are showing themselves to be as good for particular conditions.  

Individual, couple, family or group therapy

All of these are worth considering, although the middle two require the cooperation of other people you probably live with. Each of these have a long tradition and evidence-base if they are done properly. They are not always necessarily mutually exclusive, although it is better not to start more than one at a time and not to mix individual and group. 

How to be a patient

The main thing to emphasise is to be as frank and open as possible. This may include some of your thoughts and feelings towards the therapist. Try not to worry too much about upsetting them, it is better to be honest and they will appreciate this. Having said this, it is not always easy as you will discover. The other aspect to emphasise is commitment and reliability. It is important to give therapy a chance to work by making sure that you attend every session wherever possible.  

Therapists’ characteristics

As you are paying, it is your privilege to choose someone who you feel comfortable with, e.g. a man or a woman, or a particular ethnicity. However, therapy is not just about creating a warm relationship – and certainly for longer types of therapy you should expect to experience some of the disturbing feelings that brought you into therapy in the room with the therapist, where they can be thought about and understood in a way that has not been possible in normal life. Using the relationship with the therapist to understand your own mind is one of the hallmarks of certain types of therapy, notably psychoanalytic psychotherapy. 

Further reading:

“How to Choose a Psychotherapist” (2003) by Andrew Symington (Editor), David Symington (Editor), Joan Symington (Editor), Neville Symington.