We British have never been that good at helping ourselves: too stoical, too embarrassed perhaps. But my goodness, we’ve always been terrific at helping others. From visiting lonely strangers in hospital to simply helping a housebound neighbour, we’ve been brought up to lend a cheery hand, ear or shoulder as required – and for free.
Now, that instinct to help others seems to be becoming formalised as a startling number of us are training to work as therapists or counsellors – often as a midlife career change – at about the same time as more of our unhappy peers are realising that it is OK to seek help.
A million Britons now see therapists every year. And with good reason: one in four Britons will experience some kind of mental health problem in the course of a year, says the Mental Health Foundation. An LSE economic think tank stated in 2012 that mental illness accounted for nearly half of all ill health in the UK.
“There is no doubt that people are much more open to discussing their mental health – and to the ideas of psychotherapy and counselling,” says Mark Hoelterhoff, a senior lecturer in applied psychology at the University of Cumbria and a counselling psychologist (registered with the Health and Care Professions Council). “The shame that surrounded 'needing help’ is going away. And among the middle classes, we’re seeing a growing trend of those who can afford it turning to private practice to seek help with their problems.”
But however glibly we laugh about seeing someone, or getting help, it seems we don’t have a clue how to go about finding assistance, or what different treatments, known as talking therapies, are on offer.
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While some conditions merit psychiatric help and medication, there is good evidence suggesting that non-pharmaceutical treatment – specifically cognitive behavioural therapy (CBT) – can be useful in many cases, especially those classified as mild to moderate.
CBT deals with your current problems, rather than focusing on issues from your past; the NHS recommends a course (six weeks to six months) for conditions ranging from anxiety to drug abuse and eating disorders.
But what if CBT hasn’t worked, or your problems are more deep-rooted or recurring? According to mental health charity MIND, in a recent report We Need to Talk, nearly three in five people aren’t offered a choice in the type of therapy they receive. And who knows where to start looking anyway?
Louise Chunn, one of the UK’s most successful editors (heading up InStyle, Good Housekeeping and Psychologies), decided to see a therapist herself five years ago. “At that point, I didn’t want to just talk to friends – they naturally want to help but are not necessarily able to. Nor did I want people to know what I was doing. So I didn’t want to ask friends or colleagues for recommendations. I had no sense of who I needed to see or how to find them.”
Louise tried a basic search provider on the website of the British Association for Counselling and Psychotherapy (BACP), a professional organisation that strives to promote ethical practice in the UK. She was offered a choice of counsellors based on her postcode: “I had no sense of who would be the right one for me; as it happened, it was fine. I lucked out. But I had no idea how to compare therapists – some of whom didn’t even have their own websites.”
Louise has now used her experience to launch welldoing.org – a website devoted to helping match counsellors and psychotherapists to would-be patients, taking account of preferences ranging from language and culture to gender and experience.
“People’s needs can be very specific: their anxiety may have been triggered by a clash over religion, or cultural difficulties around rearing children. Bereavement and loss can be particularly hard to deal with alone. So I wanted to put people in touch with therapists who would be apt for their situations.”
She points, too, to the sheer range of therapies available – “about 400 I should think” – which causes more confusion. “Most people simply don’t know what modalities, or types of therapy, are available,” explains Jennie Miller, a qualified psychotherapist and couples’ counsellor in Hampshire.
Too often it seems anyone looking for help, especially through the NHS, is likely to be steered towards CBT. But some people may benefit from a more classic psychotherapy: person-centred, empathetic, compassionate, a “listening experience”.
Jennie uses Transactional Analysis (TA) to work with couples – which can be husband and wife, but might equally be father and daughter. TA, which is becoming a better-known therapy, looks at the way people interact and how they are affected by each other’s behaviour.
Another therapy on the up is EMDR (Eye Movement Desensitisation and Reprocessing) – where eye movements, sounds or taps are used to stimulate the left and right sides of the brain. It may sound strange, but research backs the theory up – there are 24 clinical trials supporting its use in the treatment of emotional trauma.
Some therapists work using Skype or even email or text. MIND recommends ecotherapy, in which patients work on community gardens. Who can be ignorant of mindfulness – a meditative practice that can help users in emotional distress? The permutations are endless.
So how do the new generation of counsellors fit in to this brave new therapy world?
“I’ve seen and helped train lots of midlife career changers,” says Mark Hoelterhoff. “Often they come from a profession where they already interact with the public like the police force or teaching, and encounter those with mental health problems yet can’t help. They’re not trained to engage. But this new generation of counsellor wants to give more back and get involved – that’s no bad thing.”
Jennie Miller agrees. “Women experiencing an empty nest often seem to move into counselling. I’ve trained with hairdressers, life coaches and journalists. These are people who are used to others opening up but don’t know how to help and feel frustrated. It has to be a good thing.”
But it is important patients know what level of expertise they are buying into. Psychotherapists are not the same as counsellors, says Mark: “We are more highly skilled, with postgraduate qualifications, and trained in diagnosis, so we help you understand what is wrong from a deeper level – not just try to ease the symptoms as a counsellor would do.”
Jennie adds: “Counselling is usually shorter term – you might still see patients for anywhere from six to eight sessions up to about 40 – it costs about £45-60 a session. In psychotherapy, treatment is normally longer – a few years perhaps. It becomes part of the package of looking after yourself, like going to the gym.”
One of the most important things you can do, says Louise Chunn, is to find someone you like. ''Don’t get too hung up on the modalities. Find someone you feel a connection to – someone you like.’’
How to choose a therapist
The questionnaire on welldoing.org aims to explore the type of therapy you need via targeted questions around your feelings as well as practical considerations, including how long you want or expect therapy to last. But here, says Louise Chunn, are some points to bear in mind before you begin:
- How soon is “now”? Are you happy to join a waiting list or is the problem becoming acute?
- Is gender a concern? Some people will not be comfortable with a male or female stranger discussing intimate matters. It’s your decision.
- Is sexuality an issue? Talking through problems with someone who identifies as lesbian, for example, may be important.
- Do you share a common language? If you are British Indian, for example, and want to discuss a sensitive cultural matter, finding a therapist who speaks Hindi can be reassuring.
- Would you be happy with sessions where the therapist is mostly silent, or do you want interaction?
- How much are you happy to pay?
- Would you prefer your therapist to be a similar age to you, older, or younger?
- Do you want to focus on an immediate problem or check here something that happened in the past?
- Do you want to attend in a group, as a couple or alone?
- Would you prefer to see someone close or are you interested in using Skype?