Talking therapy: an introduction

This is an article for those not knowing where to start or what to expect from therapy.

The process in brief

You can expect an introductory session or assessment. You may be required to pay for this, some therapists offer a shorter, informal introduction for free. The assessment is the time to consider whether you feel the therapist understands you and you can work with them. Think of it as an opportunity for you both to assess each other. 

In this initial appointment, it is good practice for the therapist to provide you with a contract. This will cover paying for and cancelling appointments and if there is a charge for missing them. It should also reference confidentiality, and how to make a complaint.

After the assessment, you can have as many sessions as you want! This is a benefit of private therapy; the therapist can work with you as long as you want. The number of appointments you have usually depends on the issues you bring to therapy and how your therapist works (the modality*). This can range from a single appointment to many years of therapy.

The frequency of sessions can vary, weekly is usual. Appointments typically last 50-60 minutes there are some exceptions. Ideally, the ending of therapy is negotiated between you both. You will be able to talk this through with your therapist. 

Many individuals return to therapy, not because it hasn’t ‘worked’ but because they recognise how useful it is and identify other aspects of their lives where they want support.

Insight into therapy

Therapy is more than talking. Therapy is being guided to be curious about the thoughts and processes going on inside your mind/body/soul/consciousness. The therapist provides a safe, non-judgmental space to enable you to do this. The safety of the therapy room can then facilitate a change within you that is useful and promotes healing. 

Factors at work in therapy:

1. the individuals
2. the relationship

The individuals

Both you; the client, and the therapist make each therapeutic relationship unique. The therapist brings specific skills, knowledge, and experience; their individuality whilst the client brings a different set of skills, knowledge and experience; their individuality (themself). 

The therapist brings a certain skill set to the relationship, generally, these skills are:

• Communication skills: one of the fundamental skills of a therapist. Communication involves both talking and listening, holding silence, being able to encourage, showing understanding, asking for clarification when uncertain, observing body language, and noticing tone. The therapist will help the client to communicate experience and emotions as well as information. 
• A skilful therapist will also be able to create emotional safety. This enables the client to explore feelings and emotions without feeling judged (if this is what will support their therapy).
• The person-centred therapist: Carl Rogers (1902-1987) described some core conditions for therapy that therapists believe are still important today, these are: ‘attunement’ or empathic understanding - responding to your needs, unconditional positive regard - having respect for you as an equal, without judgement, and congruence - behaving with authenticity, truthful and trustworthy, acting with integrity.
• Therapists also provide boundaries. This might feel negative or uncaring, but boundaries provide safety, trust, and space to talk freely without judgment. They can be useful to minimise anxiety during a session. Clients may also recognise the usefulness of boundaries in their own relationships.
• Knowledge: Academically a therapist will have a counselling qualification ranging from a level four qualification (first year of a degree) to a level seven (Master’s degree). The variation is due to training establishments requiring different levels of knowledge and experience. However, it is useful to know that research maintains that the most important factor in the success of therapy is the relationship (not the modality*).

The client is the other half of the therapeutic relationship. What they bring is themselves. This will be made up of experience, knowledge, culture, beliefs, genetics, and the social context into which they were born. The client will also have something that they want to change or make different. This is the focus of the work, both therapist and client want and believe this change is possible.

The relationship

Research, regardless of modality*, shows that the relationship between therapist and client has the most impact on the outcome of therapy. This is why you will always be encouraged to find the right therapist for you. If you have a recommendation from a friend, it does not necessarily follow that this therapist is the ‘best fit’ for you. 

You might want to consider whether you want someone who is like you, and likely, but not necessarily true, to better understand some of your experiences. Conversely, someone not like you might be more challenging, some clients prefer this, and some don’t. Unfortunately, therapists in private practice don't always represent the diversity of clients needing support. It might be difficult to find someone who you feel is like you.

Much has been written about the therapeutic relationship. Very broadly speaking it is a unique relationship. Key components include:

• confidentiality
• trust
• no judgment
• safety
• The therapist being able to pay full attention to the client.
• Recognition of the potential of a power dynamic (often power being given to or being assumed by the therapist, or created due to gender or social stereotyping) and working towards minimising this.
• The core conditions - empathy, respect, congruence.
• Boundaries - these are factors that help the client to know what is expected of them, and what they can expect of the therapist, examples include attendance at appointment time and place, appropriate venue, payment, cancellation procedure, contract, professionalism, standards of practice (e.g. ethical, work within competence) accountability.
• An understanding that most issues brought to therapy are not due to something being wrong with you. It is common for them to be an adaptation to something in your past, often childhood that is no longer useful.

Talking therapy is more than talking. Therapists have a collection of skills, wisdom and experience that enable a client to feel safe enough to talk to a stranger without feeling judged. Empathy, non-judgement and respect are important traits of a therapist. Having boundaries and agreements between you and your therapist contribute to making it feel safe. 

Each relationship is unique.

You can expect your therapist to be appropriately trained to meet your needs. Ask for evidence if this is not obvious in their advertising material. 

*Modality: The way a therapist will work. Common modalities include person-centred, integrative, cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) humanistic, and existential.