Understanding therapy and counselling

Most of us have heard that talking through our issues can help. But speaking to a professional can feel like a big step. 

We’re here to explain what therapy and counselling are all about. 

I didn’t want to feel the emotions I had inside, so I bottled them up and blocked them out. Until a friend suggested I speak to a professional.

What is therapy?

Therapy is a common treatment for mental health issues. It involves talking to a trained professional about your thoughts, feelings and behaviours.

There's lots of different types of therapy. But every therapy aims to help you:

• Have a safe and confidential space to talk to someone who won't judge you
• Make sense of things and understand yourself better
• Resolve complicated feelings, or find ways to live with them
• Recognise unhelpful patterns in the way you think or act
• Improve your relationships, including with yourself   
• Find and learn new ways to cope 

It might take place in-person, online or over the phone. You might meet your therapist one-to-one. Or it could be in a group, or with your family or your partner.   

And it’s always a collaborative process between you and the therapist. You work together. 

Therapy or counselling – what's the difference?

You might hear people talking about:

• Counselling
• Psychotherapy
• Talking treatment
• Talk therapy

Usually there's not much difference between these terms. They all describe talking with a trained professional about your difficulties.

The definition of counselling isn’t distinct from the definition of therapy. 

But that doesn’t mean that all therapy is the same.

Sometimes these terms might reflect differences in a therapist's training and education. Or they might refer to a specific style of therapy.

Keep reading to learn about different types of therapy.

What issues could therapy help with?

Talking therapy could help you manage:

• Difficult emotions, like grief, guilt, sadness, worry, fear, confusion, anger and low self-esteem
• Difficult life events, like bereavement, or losing your job
• Major life changes, like pregnancy or retirement
• Upsetting or traumatic experiences – both recent and from the past
• Relationship and sexual problems
• Long-term physical health problems
• Struggles with addiction, such as alcohol and drugs
• Specific diagnoses, like depression, anxiety, eating disorders, OCD, PTSD and others

Unfortunately there's still some stigma about therapy and counselling. So you might think of therapy as an extreme option. You might feel like unless things get really bad, you should try to manage on your own. Or that speaking to a counsellor would be a 'sign of weakness'.

But this isn’t true.

The truth is: it's OK to try therapy at any point in your life, whatever your background.

In fact talking to a therapist when you're not in crisis can be a great help. It might make it easier to reflect on what's going on. And it could help you keep things from getting worse.

Does talking therapy really work? 

There's lots of clinical evidence that talking therapies work well for many people. That’s why therapy is available on the NHS, and why doctors recommend it.

But it's difficult to say whether a particular therapy will work well for you or not. Because it depends on lots of factors. 

For example, it can depend on: 

• Your feelings and motivation about therapy generally
• Your relationship with your therapist
• How complex your needs are
• How well-adapted the therapy is for you

And it’s important to understand that therapy isn't a quick fix for all your problems. 

So it might take some time to see whether it's helping you or not.   

Starting out seeing a new therapist can feel very vulnerable. You might be starting a process of opening up about things that feel quite personal. It’s normal for this to feel uncomfortable at first. But your therapist is there to help you. 

Our guide to how to get the most out of therapy has lots of tips on making any therapy work best for you. 

Some talking therapies are designed to treat specific mental health problems. You can find details about treatments in our guides to types of mental health problems.

The importance of your relationship with your therapist 

Research shows the relationship you develop with your therapist makes a big difference. It's a significant factor in whether the therapy helps you or not.  

This relationship can be as important than the type of therapy they practice – or even more important.

If you don't like or trust that person you're less likely to feel able to open up to them. So you’re less likely to have a positive experience. 

What’s it like to have therapy?

Learn all about what can happen in therapy sessions in our guide to what to expect from therapy.

Watch Selin talk about her experiences of having therapy for anxiety. And finding the right therapy for her:

I first time I had therapy I didn’t quite click with my therapist. But this time round I feel a lot more comfortable.

What different types of therapy are there? 

There are lots of ways therapies can be different from each other.  

For example: 

• Whether the focus is on exploring your past, or solving a specific problem you have now
• Different techniques the therapist might use during sessions
• Different academic theory behind them

And therapists often use complicated words to describe their particular style of therapy. It can be really confusing.

We'll help explain what they mean. 

These are some of the more common terms you might come across when looking at types of therapy: 

This isn’t a complete list of every possible type of therapy. This is just a starting point. But knowing what these terms mean can help you feel more confident about any therapy.  

The lady I saw had practised in a range of different therapies. We decided CBT was best for me to help see what was really going on and where the root of the problem is.

How do I get therapy? 

You can get some therapy sessions for free on the NHS.

But unfortunately, not all therapies are available everywhere across the UK. And waiting lists can be long. Sometimes it can feel like you don't have much choice. It will depend on what's available locally near you. 

For advice, see our guide to how to find therapy or counselling. It covers: 

• How to get therapy through the NHS, step by step
• Other places to find free and low cost therapy
• Where to look if you’re considering going private

If you’re a younger person aged under 18, your options might be a bit different. We have lots of information in our guide to how to get help and support for 11-18 year olds. 

What if therapy doesn’t work for me?

Although many people find therapy helpful, it doesn’t work for everyone.

Some common reasons why therapy might not feel helpful are:

• Poor relationship between you and your therapist
• The type of therapy isn’t a good fit for your challenges, preferences or needs
• Your therapist lacks education about your culture or identity
• You aren't emotionally ready or able to commit to therapy yet
• The therapy ends before you're ready to stop

If you’ve had a bad experience with therapy in the past, it's important not to blame yourself. Doing therapy can be a difficult process.

If you’ve experienced trauma, you might find it extra hard to open up. Or to trust people. Our page on overcoming barriers from trauma has some tips.

And some of us might have more challenges finding the right therapist to work with. For example, if we face social stigma or ignorance about our identity or background.

For ideas about finding suitable support explore in our pages on:

• Racism and mental health
• LGBTQIA+ mental health

Remember that when you’re ready, you could try therapy again.

Our guide on how to get the most from therapy has lots more tips.

What else can I try besides therapy?

You might decide that therapy isn’t the right option for you just now. Or you might be struggling to access the therapy you need. This can be really frustrating.

If you want to explore other things that could help, here are some ideas.

Self-help resources

You might find that exploring self-help resources could help.

For example, take a look at Reading Well for Mental Health. They have books on lots of different mental health problems. These books can also help you learn and practice some therapy techniques by yourself. You can borrow these from your local library for free.

Peer support groups

Support groups bring people together who share a similar set of experiences. So you can relate to what each other are going through. You can get support from the group, and offer your support to others.

Our pages on peer support groups have more information. Including how to find a suitable support group.

Medication

If you see a doctor about your mental health they might offer you some medication. Perhaps an antidepressant, or something to help you sleep. It depends on how severe your symptoms are, and what else you’ve already tried.

They might offer medication because:

• Medication is something you could try right away – but you might have to wait for therapy
• Medication could help ease some of your symptoms – so you can engage with therapy better

Whatever you're offered, it's important to remember that:

• Different medications and therapies work differently for different people
• What you find works best will be personal to you
• You might have to try a few things to work out what helps you most
• Different combinations might suit you better at different times in your life
• It's your choice what treatment you want to try – and it's OK to change your mind

If your doctor offers you medication, it’s important to have all the facts. So you can make an informed choice. See our pages on medication for more information.

Alternative therapies and lifestyle changes

Alternative therapies include options like yoga, massage, meditation and herbal remedies. Find out more in our pages on complementary and alternative therapies.

And making some lifestyle changes could help support your state of mind. We know it’s not easy to make changes when you’re feeling unwell. But even small things could help make a difference.

Read our information on:

• Food and mental health
• Physical activity and mental health
• Tips to improve your sleep

I’ve learned it’s never too late to start the healing process and it’s a long journey.