Counselling is a type of talking therapy that allows a person to talk about their problems and feelings in a confidential and dependable environment.

A counsellor is trained to listen with empathy (by putting themselves in your shoes). They can help you deal with any negative thoughts and feelings that you have.

Sometimes, the term ‘counselling’ is used to refer to talking therapies in general, but counselling is also a specific type of therapy in its own right.

Other psychological therapies include psychotherapy, cognitive behavioural therapy (CBT) and relationship therapy (which could be between members of a family, a couple or work colleagues).

Read more about other psychological therapies.

What is counselling used for?

Talking therapies, such as counselling, can be used to treat many different health conditions including:

• depression 
• anxiety 
• borderline personality disorder (BPD)
• obsessive compulsive disorder (OCD)
• post-traumatic stress disorder (PTSD)
• long-term illnesses
• eating disorders, such as anorexia nervosa and bulimia
• drug misuse 

How can counselling help?

Counselling aims to help you deal with and overcome issues that are causing pain or making you feel uncomfortable.

It can provide a safe and regular space for you to talk and explore difficult feelings. The counsellor is there to support you and respect your views. They will not usually give advice, but will help you to find your own insight and understanding of your problems.

Counselling can help you to:

• cope with a bereavement or relationship breakdown
• cope with redundancy or work-related stress
• explore issues such as sexual identity
• deal with issues that are preventing you from achieving your ambitions
• deal with feelings of depression or sadness, and have a more positive outlook on life
• understand yourself and your problems better
• feel more confident
• develop a better understanding of other people’s points of view

Counselling can often involve talking about difficult or painful feelings and, as you begin to face them, you may feel worse in some ways. However, with the help and support of your therapist, you should gradually start to feel better.

In most cases, it takes a number of sessions before the counselling starts to make a difference, and a regular commitment is required to make the best use of the therapy.

What to expect from counselling

During your counselling sessions, you will be encouraged to express your feelings and emotions freely. By discussing your concerns with you, the counsellor can help you to gain a better understanding of your feelings and thought processes, as well as identifying ways of finding your own solutions to problems.

The counsellor may encourage you to identify issues and, if appropriate, take personal responsibility for them. They will be able to help you recognise the effects of other people and their actions, and explore alternative ways of coping with them.

It can be a great relief to share your worries and fears with someone who acknowledges your feelings and is able to help you reach a positive solution.

Trusting your counsellor

A good counsellor will focus on you and listen without judging or criticising you. They may help you find out about how you could deal with your problems, but they should not tell you what to do.

For counselling to be effective, you need to build a trusting and safe relationship with your counsellor. If you feel that you and your counsellor are not getting on, or that you are not getting the most out of your sessions, you should discuss this with your counsellor.

If the situation does not improve, or your counsellor is dismissive or unwilling to discuss the issue, it is perfectly acceptable to look for another counsellor with whom you feel more comfortable.

If you are seeing an NHS counsellor who is attached to your GP surgery, your GP may be able to arrange for you to see another NHS counsellor. Alternatively, you could pay to see a private counsellor. Many counsellors and counselling organisations offer a sliding scale of fees, where the more sessions you have, the cheaper it becomes.

Who provides psychological therapies?

As counselling involves talking about sensitive issues and revealing personal thoughts and feelings, your counsellor should be experienced and professionally qualified.

Different healthcare professionals may be trained in counselling or qualified to provide psychological therapies. These include:

• counsellors – trained to provide counselling to help you cope better with your life and any issues you have
• clinical and counselling psychologists – healthcare professionals who specialise in assessing and treating mental health conditions using evidence-based psychological therapies
• psychiatrists – qualified medical doctors who have received further training in diagnosing and treating mental health conditions
• psychotherapists – similar to counsellors, but have usually received more extensive training; they are also often qualified psychologists or cognitive psychiatrists
• behavioural psychotherapists – may come from a variety of professional backgrounds, and have received specific training in cognitive behaviour therapy; they should be registered and accredited with the British Association for Behavioural & Cognitive Psychotherapies (BABCP)

Counselling formats

Many different types of counselling are available in a range of formats. For example, counselling can take place:

• face-to-face
• individually or in a group
• over the phone
• by email
• using a specialised computer program

You may be offered counselling as a single session, as a short course of sessions over a few weeks or months, or as a longer course that lasts for several months or years.

Availability

In 2010, the government announced plans to make psychological therapies more widely available on the NHS. This is because they have been shown to be effective treatments for common mental health conditions (see above). The programme is called Improving Access to Psychological Therapies (IAPT).

As a result of the IAPT programme, evidence-based psychological therapies can now be accessed through:

• GP surgeries
• the workplace
• universities, schools and colleges
• some voluntary and charitable organisations

If you are referred for counselling, or another psychological therapy through the NHS, it will be free of charge.

If you decide to pay to see a private therapist, make sure they are qualified and you feel comfortable with them.

The cost of private counselling can vary considerably. Depending on where you live, a session can cost between £10 and £70. Some therapists may be willing to adjust their fees in accordance with your income. You should ask about charges and agree a price before starting a course of counselling.

Charities and voluntary organisations

Some charities and voluntary organisations also offer counselling. These organisations usually specialise in a particular area, such as couples counselling, bereavement or family guidance.

Charities that may offer counselling include:

• Cruse Bereavement Care – a charity that provides bereavement advice and support
• Relate – a charity that offers relationship advice and counselling
• Rape Crisis – a charity for women and girls who have been raped or sexually abused
• Victim Support – a charity to help victims and witnesses of crime

You may also be able to access support groups through your local community, church or social services.

As well as counselling, there are many other types of psychological therapies, including psychotherapy and cognitive behavioural therapy (CBT).

Psychotherapy

Like counselling, the term ‘psychotherapy’ is sometimes used to refer to talking therapies in general. However, psychotherapy is also a specific type of therapy. It may also be described as psychoanalytic or psychodynamic.

Psychotherapy is a more in-depth form of therapy than counselling, and it can be used to address a wider range of issues.

A psychotherapist can help you explore your thoughts, feelings and beliefs, which may involve discussing past events, such as those from your childhood.

They will help you consider how your personality and life experiences influence your current thoughts, feelings, relationships and behaviour. This understanding should enable you to deal with difficult situations more effectively.

Depending on your problem, psychotherapy can be short or long term. Adults, young people and children can all benefit from psychotherapy. Sessions can take place on a one-to-one basis, in couples, families or in groups whose members share similar problems.

Read more about psychotherapy.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that helps you manage your problems by changing the way you think and behave.

CBT does not remove your problems, but helps you manage them in a more effective way. It encourages you to examine how your actions and thoughts can affect how you feel.

It is based on the idea that the way you think about a situation affects how you feel and act. In turn, your actions influence the way you think and feel. Therefore, it is necessary to change both thinking (cognition) and action (behaviour) at the same time.

CBT is an active therapy and you will be expected to work on your problems between sessions, trying out different ways of thinking and acting, as agreed with your therapist. The aim is for you to develop the skills to become your own therapist.

CBT is usually a short-term treatment. For example, a course may consist of between six and 24 one-hour sessions.

The National Institute for Health and Care Excellence (NICE) recommends the use of CBT for:

• depression 
• anxiety 
• panic disorder 
• obsessive compulsive disorder (OCD)
• post-traumatic stress disorder (PTSD)
• long-term illnesses
• eating disorders, such as anorexia nervosa and bulimia 
• schizophrenia 

CBT is now widely available on the NHS for treating depression. If you feel that CBT may be helpful, you should first discuss it with your GP. Private therapists are also available.

Before starting CBT, it is recommended that you check that your therapist is accredited by the British Association for Behavioural & Cognitive Psychotherapies (BABCP).

Computerised CBT (CCBT) packages are also available. CCBT is delivered in a series of weekly sessions and should be supported by a healthcare professional. NICE recommends CCBT for some people with depression.

Read more about CBT and access to CCBT. 

Humanistic therapy

Humanistic therapy incorporates your body, mind, emotions, behaviour and spirituality. It encourages you to think about your thoughts and feelings, and to take responsibility for your actions.

A humanistic approach provides a distinct method of counselling and focuses predominately on an individual’s unique, personal potential to explore creativity, growth, love and psychological understanding.

Group therapy

Group therapy aims to help you find solutions to your problems by discussing them in a group setting. Sessions are led by a facilitator who directs the flow of conversation.

As well as group therapy, many people find psychoeducational groups or courses very helpful. These provide information and skills without having to discuss personal problems in depth.

NICE recommends group therapy for people with obsessive compulsive disorder (OCD), and for children and young people with mild depression.

Relationship therapy

Relationship therapy is where people who are having difficulties with their relationship work together with a therapist to resolve their problems. It can be used to help couples, family members or work colleagues.

NICE recommends relationship therapy for people who have tried individual therapy without success.

Family therapy can be used for children with depression, or where a family member has a mental health condition, such as anorexia nervosa or schizophrenia.

Mindfulness-based therapies

Mindfulness-based therapies help you focus on your thoughts and feelings without becoming overwhelmed by them.

They can be used to help treat depression, stress, anxiety and addiction. Techniques such as yoga, meditation and breathing exercises can also be incorporated.

NICE recommends mindfulness-based therapies to help people avoid repeated bouts of depression.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a treatment that uses eye movements to stimulate the brain. It has been shown to make distressing memories feel less intense.

EMDR can help a person deal with traumatic memories, such as those that occur after an accident, or following sexual, physical or emotional abuse.

In particular, NICE recommends EMDR for treating post-traumatic stress disorder (PTSD).

Telephone counselling

Samaritans provides a confidential listening service to those who would like to talk about whatever is getting to them. Everything is off the record and without judgement.