Taking that first step towards working with a therapist can feel like both a huge hurdle and an achievement worth celebrating. But how much do we really know about our therapists, and what we should be looking for when seeking help?
Conversations around mental health have become much more commonplace. Whether it’s in the workplace, with friends or family, we’ve all become a lot more open and honest about how we’re doing. But are we as careful with looking after ourselves mentally, as we are physically? Or do many of us not realise the pitfalls that could be waiting when we seek support for our mental health?
Chances are, you wouldn’t consider going to see an unregistered doctor or nurse. But is that through choice, or because we’re all so used to knowing that the NHS is there to offer us access to fully qualified, experienced healthcare professionals? When we’re at our lowest, are we really in the right place to be asking tough questions about the support that is available to us?
The state of mental health support in England
NHS England and the Department of Health jointly set out to improve access to mental health services by 2020. Yet research shows that as of October 2020, two in five patients waiting for mental health treatment have been forced to resort to reach out for emergency or crisis services. Research by the Royal College of Psychiatrists found that as many as one in nine (11%) end up in A&E.
With wait times between referral and second appointments reaching over four weeks for 64% of adults, more than three months for 23%, and over six months for 11% of us, those living with severe mental illnesses such as eating disorders and PTSD have been left to wait up to two years for treatment. Others seeking treatment for anxiety, depression, and suicidal thoughts have waited up to four years for treatment. It’s no wonder that 38% have resorted to contacting emergency or crisis services during the wait between their first and second appointment. Not to mention nearly one in five (39%) reporting a decline in their mental health whilst waiting to access treatment.
Despite consultant-led mental health services being covered by the NHS 18 week maximum waiting time guidelines, which services are available to individuals - and how they can access them - varies greatly depending on where you live and what you are seeking help for.
While mental health services are free on the NHS, some areas require GP referral, while others allow (or require) self-referral. In some instances, it’s recommended individuals ask employers what occupational health services are available to them, or in the case of those in school or college, they may be encouraged to seek support through those avenues. Oftentimes, charity support is highlighted to individuals which, while beneficial, doesn’t always offer the same level of support being referred to a therapist, psychotherapist, psychologist, or psychiatrist would.
It can be an extremely frustrating, confusing, and all-around unfriendly experience for those who have reached a point where they recognise that they are struggling and would benefit from or need help and support.
For young people, the frustration has grown exponentially over recent months. Since lockdown ended, young mental health referrals in England doubled. With cases hitting record highs and waiting lists to access support growing, the rise in private, self-funded patients has grown.
With only so much capacity in the system, 1.6 million on waiting lists, and 8 million people left without help, more and more of us are turning to privately funded mental health support. But are some of us unwittingly facing new risks and failures in support?
Is therapy regulated?
In the UK, counselling is not under statutory regulation. That means that for counsellors or therapists to practice, there is no legal requirement to belong to a professional membership or body.
In 2020, the UK Government announced that they have no plans to introduce statutory regulation of counsellors or psychotherapists. When responding on behalf of the Government, Lord Bethel commented: “While statutory regulation is sometimes necessary where significant risks to users of services cannot be mitigated in other ways, it is not always the most proportionate or effective means of assuring the safe and effective care of service users.” But what does this actually mean for those of us searching for a therapist? Can just anyone call themselves a therapist and offer counselling services?
Counselling: Can anyone do it?
Working with a counsellor or therapist is an intimate process that can leave you feeling vulnerable. Designed to create an environment where you can feel comfortable to explore your thoughts, feelings, and deep-seated emotions without fear of judgement, it’s important to find someone you feel comfortable opening up to and that you can trust. But how do you know the therapist you’ve found will provide a high standard of care?
Currently, there are no laws against anyone operating as a therapist, psychotherapist, or counsellor in the UK. A BBC investigation in early 2020 revealed that thanks to cheap online courses that are easy to cheat, many qualifications could be ‘meaningless’.
While there are no laws in the UK regarding counselling and psychotherapy, there are guidelines in place. According to these guidelines, practising counsellors should have at least an appropriate diploma, or have completed a course with 400 or more hours of therapy training. They may have further qualifications, such as a BSc or BA (Hons) degree, a postgraduate diploma, MA, or MSC, or even a PhD.
At this time, it is completely voluntary for counsellors, therapists, and psychotherapists to become a member of a professional body. Designed to ensure that their members are working to a high standard of practice, professional bodies are there to help reassure us that counsellors and therapists are who they say they are - and that they have the experience and qualifications they say they have.
What are professional bodies?
As explained by Counselling Directory, professional bodies exist to help self-regulate counselling and psychotherapy. Whilst not a legal requirement, professionals who chose to join must meet certain requirements and abide by a code of ethics and complaints procedure, as set out by each individual professional body. Each professional body has a different set of requirements, varying in their degrees of standards. Some offer a single membership type, while others may offer a variety of options, such as Associate Member, Member, or Accredited Member.
Different professional bodies have different requirements for their members, and may even have different levels of membership. For example, one such body, the British Association for Counselling and Psychotherapy (BACP) requires members to have completed a minimum of 450 hours of formal training, in addition to 450 hours of supervised practice with clients (at least 150 of which was completed after receiving a diploma).
Offering a form of self-regulation for counsellors and therapists, while there is no legal obligation to belong to a professional body, being a member can provide not only valuable benefits for the therapists themselves, but for their clients as well. Members of many professional bodies must meet and follow strict codes of ethics, as well as complaints procedures. Finding a therapist who is registered or accredited with a professional body can be a sign of significant levels of training and experience, however not all professional bodies have the same standards or expectations from members. As an individual seeking professional help and support, this can make the whole process feel like a minefield.
The impact of under qualified mental health support
BBC reporter Jordan Dunbar reported on the impact of unregulated mental health treatment in 2019. Having chosen to open up about his mental health and access support privately, his negative experience led him to further exploring the mental health industry.
“I had someone giving personal opinions on my problems, not professional ones. They confirmed my fears, and compounded my low self-esteem. We didn’t question my fears of problems, we didn’t talk them out. The therapist didn’t try and help me sweep them away or pick them up and examine them. If I thought I was in a bad way when I went in, I crawled out feeling like there wasn’t any hope left in the world.” He explained during a BBC Radio 4 broadcast.
Others who shared their own negative experiences with therapists explained how unethical therapy led them to wanting to shut back down, due to therapy spaces feeling unsafe or frightening thanks to badly managed sessions or unexplored issues.
In mid 2021, The Guardian shared the devastating impact unregulated therapy can have on individuals, as many do not realise terms such as psychotherapist, psychoanalyst, therapist, and counsellor are all unprotected terms in the UK. The relationship between patient and therapist - whether positive or negative - can have a huge impact on the patient’s mental health and wellbeing, affecting not only the issues that they are seeking help for, but also impacting whether they will seek further help and support.
How, then, are we supposed to know what to look for in a counsellor? And how will we know we’ve found the ‘right’ one?
How to find a qualified, experienced, accredited therapist
If you are looking for a private therapist or counsellor, there are some steps you can take to help you feel safer and more comfortable.
Ask about their accreditation. Ensuring the professional you are considering working with is a member of a professional body is an important first step. Once they have told you which body they belong to, follow-up by double-checking they are listed with the body that they say they are.
Many of the major accredited bodies, such as the BACP, the UK Council for Psychotherapy (UKCP), and the British Psychoanalytic Council (BCP) allow you to check their list to ensure counsellors are indeed members as they say they are. In order for counsellors to have joined these bodies, they will have had to have shown their credentials and qualifications. By finding a therapist on one of these lists, you’ve also got the option to complain officially if things do go wrong.
Some websites such as Counselling Directory only list therapists who have shown proof of membership with a professional body. As explained by Counselling Directory, “Our verification policy is at the centre of everything we do. Therapists joining Counselling Directory must hold individual registration with a robust professional body, with transparent qualifying and experience criteria, and a clear policy for investigating complaints. We display the therapist’s professional organisation on their profile, so anyone wanting to learn more can do quickly and easily.”
Ask about their experience. Knowing if your therapist has worked with similar issues in the past can help to give an extra layer of reassurance and confidence. The more comfortable and confident you feel in their experience, the more likely you are to feel able to open up about issues that are really affecting you.
Ask about their sessions. Getting to know more about the structure a therapist uses for their sessions can help you to get a better idea of if you will be able to engage with the process itself. With so many different types of counselling available, not every approach will work for everyone. If you’re new to an approach, asking your potential therapist about it and how they incorporate it in their sessions can be a good way to get a feel for whether or not it could be the right option for you.
Have an informal chat. Many therapists will offer a free 10-15 minute informal chat before you sign up for paid sessions. Having a short, informal conversation can help you to better understand your potential counsellor’s approach, as well as to see if you feel like this may be someone you feel comfortable opening up to. It’s ok to not click with every type of therapy or with every therapist. Finding the right approach and therapeutic relationship can be key to getting the most out of your sessions.
As Integrative Therapist Joshua Miles explains, the therapeutic relationship (the connection developed between the therapist and client) is important for effective, meaningful therapy.
“A strong bond is crucial to the success of counselling and psychotherapy. It can be especially valuable to clients who may have struggled forming relationships in the past, and those who experienced traumatic events in their early years. Therapy allows clients the chance to explore their relational attachments, bonds, and experiences through their relationship with their therapist, which is why this relationship is so important.”
Genuineness, empathy, trust, and non-judgemental attitudes, along with a sense of care, warmth, insight and experience are all key characteristics to keep an eye out for.
Take time to reflect. Finding the right counsellor isn’t just about them - it’s about you, too. Ensure you take the time to ask yourself the big questions: What am I comfortable with? Do I know what I need help with? Does a certain ‘type’ of therapy appeal more to me - or are there any that I really don’t want to try? You don’t need to know everything, but having a rough idea of what you feel comfortable with, and what you hope to achieve with therapy can help you to narrow down all of the options out there, and find a professional who’s the right fit for you.
Once you’ve found a therapist you feel comfortable working with, there are still some things to keep in mind. As Counselling Directory member and Counsellor Graeme Orr explains, a good therapist isn’t just there to listen - they’re there to work with you towards getting out of therapy.
“Good counselling is about making clients independent of therapy, not dependant on it. A great therapist will offer you genuine encouragement that you can change. They develop your confidence and independence, noting changes and successes.
“By helping you become independent, a great therapist is making sure that you have confidence in yourself and the future. A great counsellor will help you to make changes in your life. Take your time to choose; call a few therapists. Ask questions. Great therapists will be happy to help you find the right counsellor for you.”
To find out more about accredited, professional counsellors and therapists, and how they could help you, visit Counselling Directory.