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Digesting psychotherapy

Last updated:

12 November 2012

Scotland

frequently asked questions

Welcome to the frequently asked questions (FAQ) page. The most commonly asked questions about psychotherapy and counselling are answered as factually as possible.

Answers which are specific to the United Kingdom and/or Scotland are coloured thus.

what is the difference between psychotherapy and counselling?

The perceived differences between psychotherapy and counselling have long been debated. A fundamental problem is that these activities and any boundaries between them are poorly defined both in practice and in research. None of the criteria often argued to differentiate counselling and psychotherapy (such as: type of problem; symptomatic relief or personality change; 'depth' of working; internal or external focus; working with the conscious or unconscious; directiveness or non-directiveness; duration of therapy; frequency of sessions; practitioner's job title or length of training) appear to be applied consistently or proven clinically reliable. Moreover, research on therapeutic effectiveness does not support the relevance of these supposed distinctions to client outcome. Commonalities between counselling and psychotherapy are, however, considerable and highly significant to outcome. For these reasons, we conclude that there is no meaningful difference between the terms.

how do I find a good therapist?

The evidence is clear: successful therapy depends much more on the individual therapist than on the type of therapy. Also, the competence of a therapist is best measured by the actual results they achieve with clients, rather than relying on their qualifications, training history, or professional affiliations. Consequently, you should seek the most competent therapist possible with whom you can build a good working relationship. Recommendations from family or friends with similar beliefs and values, or referrals from knowledgeable professionals, can be most useful in this regard. The most important characteristics of good therapy and good therapists are discussed in detail in More interesting facts and Tips for clients.

Although you may feel more vulnerable than usual, do not suspend your own personal judgement and common sense when dealing with a therapist, assuming that the professional "knows best". No one knows your life better than you! Beware of trusting a therapist simply because they subscribe to a particular professional code of ethics or practice. Evidence is lacking that these therapists practice more safely or ethically than others. If problems with the therapist arise, consider the recomendations in the When to move on section and elicit the help of trusted family and friends.

You can gain some further reassurance if the therapist has had a criminal history disclosure check. This reveals criminal convictions and police concerns, especially those affecting work with children or vulnerable persons. Such checks are conducted by the Criminal Records Bureau in England and Wales, Disclosure Scotland in Scotland, and Access Northern Ireland in Northern Ireland.

how are psychotherapy and counselling regulated?

(The UK government has declared an intent to regulate these fields through the Professional Standards Authority for Health and Social Care but this will take some time to implement.)

There is currently no special legislation or state licensing governing the practice of psychotherapy and counselling in the United Kingdom. However, the right under common law to offer such services is subject to the same laws of contract, trade description, breach of confidentiality and so on that regulate the provision of any other service. In certain areas of work, such as in the National Health Service and Social Work, there are some statutory measures which do impinge on psychotherapy and counselling practice. Also, the Data Protection Act applies to the gathering and processing of clients' personal data. See Mowbray (1995) for a comprehensive review of the regulatory situation and the substantive recommendations of Hogan (1999).

Many services providers and professional associations of practitioners have their own schemes for self-regulation. However, contrary to popular belief, no professional or trade association (such as BACP, COSCA, UKRC or UKCP) has been granted the statutory power to regulate psychotherapy and counselling in the United Kingdom. Unfortunately, most existing self-regulatory schemes fail to fulfil the requirements for credible schemes (PDF format, 137 kB) proposed by the National Consumer Council, which aim to avoid conflicts of interest between the profession and the public. Also, there is no evidence that current professional accreditation and registration schemes engender more ethical or effective practice. See the Baxter (2004) article.

how can I become a therapist?

Reflecting the diversity of humanity, good therapists come from a wide range of personal and professional backgrounds. Research shows that being effective as a therapist depends much more on your personal qualities and ability to form helping relationships with individual clients than having completed a particular training or possessing certain qualifications. The United Kingdom state does not yet endorse particular routes to becoming a psychotherapist or counsellor. At the present time, the supply of therapists outstrips demand in the United Kingdom.

A therapist's knowledge and skills can be enhanced in a variety of ways, including life experiences, training, and personal development. To ensure that the client's needs take priority, a therapist should have a good sense of balance in their own life and a sufficent network of personal and professional support.

You might consider some of the following steps:

what training courses would you recommend?

Research has proven that not only do therapists need zeal for their therapy, but also they need flexibility to accommodate the client's unique worldview and ideas about change. However, most training courses still reflect the traditional 'orientations' or schools of therapy, which place undue emphasis on only one or two models of psychotherapy and their prescribed therapeutic techniques. Several of these schools evolved more because of having forceful figureheads and skilful marketing than achieving good results for clients. At another extreme, there are gimmicky therapies in vogue, usually with the false allure of obtaining "faster, better results" using special techniques. See Miller, Duncan & Hubble (1997) for a review of the situation. Unfortunately, at the present time there are very few training courses available which can be endorsed as truly evidence-based, emphasizing the importance of the common factors to outcome. (The Heroic Clients, Heroic Agencies manual is a rare exception.) Finally, psychotherapy is very much a practical vocation and no amount of academic study can compensate for a lack of natural aptitude or insufficient experience of counselling real people.

When considering a training course, you can ask:

notes

Disclaimer: This website only provides general information derived from research findings. It is not a substitute for a consultation with a mental health professional about an individual case. While every effort is made to ensure the accuracy and objectivity of information on this site, the authors accept no responsibility for the consequences of errors or omissions. Information about the practice of psychotherapy and counselling in the United Kingdom and/or Scotland may not be applicable in other countries. External websites are linked in good faith, but their contents cannot be vouched for.

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