What is counselling?

If you're reading this blog, chances are, you already have some understanding of what counselling and psychotherapy are. Even if you've never had counselling yourself, you may know someone who has, or you might have read about counselling or seen it depicted on TV or film.

Perhaps you have a picture in your mind of a troubled client reclining on a couch, whilst a bespectacled, bearded man takes notes from his armchair - although this classic Freudian set-up is sometimes used, it's not the only way therapy is done (and from personal experience, I've never had a therapist who's asked me to lie down on the couch and tell them about my mother!)

So what exactly is counselling? Or should I call it psychotherapy? Is there a difference? Who is it for? What is it for? How does it work? What happens? What are the rules? What's the difference between "person-centred counselling", "cognitive behaviour therapy", "existential therapy"...or any of the seemingly endless approaches to "the talking cure"?

Over the coming months, I'm going to be posting a series of "Counselling Basics" - short, informative posts in which I'll answer some of these common questions, shed some light on the hows and whys, and aim to demystify the world of counselling. In this first post, I'll start at with the most basic question of all: what exactly is counselling?

I should probably start by clarifying that I'll be talking about individual therapy (which is what I offer) - whilst couple and group counselling exists, the most common form of counselling is, at its bare bones, two people in a shared space, talking confidentially. Whilst this most commonly happens in a dedicated counselling office (mine is a purpose-built log cabin style building), other modes and settings are becoming increasingly popular, particularly since the beginning of the COVID-19 pandemic. Like many other counsellors, I offer remote therapy via videoconferencing software and over the phone, and I'll soon be offering outdoor "walk and talk" therapy in the nearby Suffolk countryside.

Whilst these different modes of conducting therapy have different benefits and drawbacks, they all have one thing in common: the opportunity for you to explore whatever it is you want to explore (thoughts, feelings, challenges, past experiences) with a trained professional.

So is it "counselling", or is it "psychotherapy"?

There's a million dollar question! I use the terms interchangeably, as do many other practitioners.

There's a lot of debate around this, and if you Google it, you'll find a lot of differing opinions. It's a contentious issue, made more complicated by the fact that in the UK at least, counselling and psychotherapy are unregulated industries - anyone can call themselves a counsellor or psychotherapist and set themselves up in private practice.

Wait, what?

Yes, I was surprised too, when I first found this out. And it can be a scary thought - how do I know I can trust that my counsellor is properly trained, insured, and trustworthy? I'll be writing another post in this series about how to choose a counsellor, but for now I'll simply say: go to a trusted directory that verifies listed practitioners' credentials (such as Psychology Today), check that the counsellor you're considering is registered with a recognised membership body (such as the BACP, UKCP, or NCS), and ask the counsellor what training or qualifications they have.

Isn't counselling just for people in crisis?

Not at all! The first time I went to counselling was because I wanted to explore my sense of identity and goals in life, with someone who was relatively neutral, who wouldn't tell me what to do, and wasn't biased by their existing relationship with me. Friends and family, whilst they mean well, may tell you "get that job" or "just dump him", and think they know you better than you know yourself.

Counselling can be helpful for a whole range of different things, and different counsellors specialise in different areas. When looking for a potential counsellor, read their profile or webpage - they should explain who and what they have experience in. I specialise in life transitions - and by this, I mean any point in your life where things are changing significantly. This might be adjusting to a new medical diagnosis, a break down in a relationship, a bereavement, or simply exploring your sense of identity in a new way.

In fact, most counselling services aren't really well-suited or set-up for people in crisis (and by crisis, I mean things like thoughts of suicide) Whilst some specialist counselling services are well-placed to offer this level of support, most private practice counsellors offer appointment-based sessions, and aren't available 24/7.

If you are in crisis, at risk of serious harm to yourself or someone else, and need immediate support, the best thing to do is to contact your local emergency services. Alternatively, Samaritans offer a free, confidential 24-hour support line - just call 116 123.

Will my counsellor diagnose me or give me medication?

No. Counsellors aren't doctors. Counsellors and psychotherapists are not trained or licenced to provide diagnoses or medication. If you are seeking a formal diagnosis or medication, your first port of call should be your GP.

Yes, I have a doctorate, and yes, I'm a psychologist, but only medical doctors (such as psychiatrists) can prescribe medications. Some psychologists can conduct assessments and give formal diagnoses (for example for depression), but this is not a service I offer. However, I do understand diagnostic criteria and labels, and if you have received a diagnosis and want to explore how this has affected you or your sense of identity - that's something I can support you with through counselling.

What will my counsellor do? What happens?

Each counsellor has their own way of starting and conducting therapy, but usually they will conduct an initial consultation, so you and the counsellor can introduce yourselves to each other, you can ask any questions about them or the way they work, and you can decide if you want to work with them. There should never be any obligation to work with a counsellor if you don't feel the "fit" is right.

In your first session, most counsellors will ask some basic questions, such as why you're seeking support, what you hope to get from counselling, and some history of the challenge or issue you're facing. They may ask for some other basic information, such as GP or emergency contact details, and some counsellors may ask you to complete initial assessments or forms. Finally, they should always go through a contract or terms of service with you, detailing how they provide services, payment terms, limits to confidentiality, and how personal information is stored. This might be agreed verbally, or in writing for you both to sign. Most counsellors offer weekly sessions, at an agreed regular time and day, and most sessions are 50 minutes long (known as the "therapeutic hour"). But this varies - ask your counsellor what they offer before signing anything!

What happens next all depends on what modality the counsellor offers - counselling isn't just one unified approach. The couch-glasses-notepad stereotype is usually associated with psychoanalysis/psychodynamic therapy (although it really is a worn-out cliché!), but you may have heard of other approaches: CBT (cognitive behaviour therapy), EMDR (eye-movement desensitisation and reprocessing), and person-centred therapy (which is what I am primarily trained in) are just a few. I'll be doing a few other posts in this series exploring some of these in a little more detail, but some facts are true of all approaches:

• Your counsellor should keep what is said between you in complete confidence - they shouldn't disclose anything to anyone else unless they're worried about your safety, or someone else's (and even then, most counsellors will discuss this with you first. But all counsellors should explain their policies and procedures around confidentiality before starting therapy with a client. I'll talk more about confidentiality in counselling in a future post)

• Your counsellor shouldn't judge you or make you feel bad or guilty - their role is to support you to freely and honestly explore whatever it is that you bring to therapy

• Your counsellor shouldn't give you advice or tell you what to do - no one knows you better than yourself, and no one understands your personal circumstances better than you do. Whilst a counsellor can help you to explore a situation or options from a new perspective, your life and your decisions are ultimately your own

If you're ever concerned or feel uncomfortable with anything in your therapy or the way your counsellor practices, and you don't feel able to talk to them directly about this, most counselling membership bodies offer support or a complaints procedure for registered members (see for example the BACP, who I'm registered with).

In the next part of this Counselling Basics series, I'll be giving the low-down on Person-Centred Counselling - what it is, what it involves, and what it's good for.

Want to know something about counselling? Please leave me a comment below, or email me at dr.astridcoxon@gmail.com!