A beginner's guide to starting therapy: how to tell what will work for you

Jennifer Savin
·8-min read
Photo credit: Katie Wilde - Getty Images
Photo credit: Katie Wilde - Getty Images

From Cosmopolitan

More of us than ever are seeking help for mental health issues, be it for anxiety or depression, OCD or following a difficult life event, such as a bereavement. But how do you know what the right treatment for you looks like, especially when you're in the midst of a dark cloud?

Remember, no matter what route you take, that sadly therapists don’t have a magic wand and it's important to approach therapy with a willingness to work if you want to see the best results. Timing is important too – go because you want to, not because someone else has told you that you should. While it may feel daunting taking that first step, writing notes before reaching out to a potential therapist can be helpful too.

With that in mind, here’s the 101 on what’s available (side note: therapy is still ongoing throughout the pandemic/lockdown)...

HYPNOTHERAPY

WHAT IS IT?

Forget spinning pocket watches. In reality, sessions involve being guided into a relaxed state, imagining various scenarios (ranging from those that evoke an extreme response in you, to picturing a ‘safe place’), and listening to your hypnotherapist's suggestions. You’ll remain in full control throughout. “Your hypnotherapist will ease you into focused concentration, similar to meditation, and, though people talk of “going under”, you won’t be ‘under’ for the whole session,” explains Darren Marks, hypnotherapy instructor for The International Association of Counsellors and Therapists. “It has a wave-like quality – you’ll be deeply absorbed one minute, distracted the next.” By this point your brain should be more open to change.

WHO SHOULD GET IT?

Anybody hoping to quit smoking, break a bad habit or conquer a phobia. The British Medical Association also once described hypnosis as the ‘treatment of choice’ for dealing with anxiety and stress-related disorders. There have been trials suggesting it can help with physical issues like IBS too – with 71% of patients responding positively in one study – plus, chronic pain and some sleep disorders.

ANY DOWNSIDES?

By law, hypnotherapists aren’t required to have any specific training – so do your homework before booking in and look for someone with a healthcare background who’s accredited by the Professional Standards Authority. It’s also unsuitable for anybody suffering from psychosis or a personality disorder.

HOW MUCH AND HOW MANY?

Private sessions start from £50 and last up to two hours; the number required varies from person to person. Find a reputable hypnotherapist on the British Society of Clinical Hypnosis’ database.

Photo credit: Artur Debat - Getty Images
Photo credit: Artur Debat - Getty Images

COGNITIVE BEHAVIOURAL THERAPY (CBT)

WHAT IS IT?

“In CBT we look at how the way someone thinks and behaves may be causing or exacerbating a particular difficulty and how to change those patterns,” explains Dr Victoria Galbraith*, a registered counselling psychologist. After your first consultation session, your therapist will set clear goals with you and work out the best way for you to achieve them, by breaking problems down into: situations, thoughts, emotions, physical feelings and actions. You’ll learn a series of coping techniques and may be given worksheets to complete in your own time.

WHO SHOULD GET IT?

Anybody concerned with how they’re thinking and acting in the present day, including eating disorder, depression and panic attack sufferers, rather than those attempting to resolve past issues. Exposure therapy is also a form of CBT, helpful for those with OCD and severe phobias, and involves you facing your fears in manageable ways (e.g. if your fear is spiders, your therapist may suggest you read about them, then later show you pictures). As CBT is structured around the individual’s targets, a course of it can be completed in a relatively short period of time, so it may be a more suitable approach if you’re self-funding. It's best for stopping negative thought patterns and cycles – some coping techniques you’ll learn may also be applied to other problems that arise in future too.

ANY DOWNSIDES?

There’s homework – such as noting down your feelings in between sessions and practicing techniques – so you need to really commit to see a change. It's also not always a long-term solution either, and you may need more sessions later on.

HOW MUCH AND HOW MANY?

If you have one-on-one CBT, you'll usually meet with a therapist between five and 20 times, with each session lasting up to an hour. It’s available on the NHS, or privately from £40 to £100 a pop. Seek out someone recognised by the British Association for Behavioural Cognitive Psychotherapies.

GROUP THERAPY

WHAT IS IT?

An umbrella term for working with a therapist in a group of other people who are experiencing similar issues. Whilst you’ll be encouraged to talk, there’s no requirement to.

WHO SHOULD GET IT?

Find the idea of a one-on-one session a bit intense? This could be the right route for you. Plus, there’s the added bonus of potentially bonding with others facing parallel difficulties. As well as anxiety and depression, group therapy can be especially good for people with quite specific problems, such as addiction. It may also be cheaper than individual private sessions.

ANY DOWNSIDES?

The idea of sharing your problems with a host of unfamiliar faces might feel a bit daunting and intimidating at first, but the majority of participants open up after the first few sessions.

HOW MUCH AND HOW MANY?

Costs vary depending on the group you’re joining (Alcoholics Anonymous, for example, pass a collection pot around during meetings to cover running fees, but nobody is expected to donate if they’re unable to). Some group CBT courses and workshops are available on the NHS (for example those focussed on stress, anxiety and depression). Your GP should be able to recommend local support groups for other issues.

COUNSELLING

WHAT IS IT?

Not to be dismissed as a wishy-washy chat over a cuppa, counselling is one of the more common solutions offered at GP surgeries. It’s a branch of talking therapy which involves finding ways to cope with emotional issues and better decipher your feelings, by working with a trained therapist (some argue counsellors are similar to psychotherapists in the way they work). Unlike CBT, counselling is less directive and focusses more on empathy, listening and encouragement.

WHO SHOULD GET IT?

The NHS recommends it for difficult life events, such as divorce or bereavement, as well as work-related stress, sexual identity struggles and physical health conditions, such as infertility. It 's helpful for digging deep into your psyche, evaluating past traumas and tackling challenging life events.

ANY DOWNSIDES?

Depending on where you’re based, NHS waiting lists can be extremely long. Chemistry with your counsellor is important too and if you don't gel, you're well within your rights to raise your concerns with them during a session or look for another.

HOW MUCH AND HOW MANY?

Some charities offer free or low-cost counselling, particularly for students, job seekers and those on a smaller income. Alternatively, you can self-refer or go private, in which case it’s recommended that you agree a price before starting a course of sessions, which can cost anywhere between £10 and £70. The number of sessions needed can range from a few weeks to years. Similar to "psychotherapist", the title of "counsellor" isn't legally protected, so check any credentials via the British Association for Counselling.

Photo credit: Katie Wilde - Getty Images
Photo credit: Katie Wilde - Getty Images

MENTAL HEALTH APPS

WHAT ARE THEY?

There are multiple new apps which claim to help with everything from depression to learning breathing techniques to mindfulness (the practice of bringing awareness to the present and not allowing your thoughts to take over or spiral).

WHO SHOULD GET THEM?

Those short on time or who live in remote areas (or ones subject to long NHS waiting lists), making it difficult to access face-to-face treatments. Apps are also a good way of dipping your toe into therapy before committing to paid sessions. Many apps focus on managing panic attacks (Beat Panic), the urge to self-harm (Calm Harm) or unhelpful thoughts (Chill Panda).

ANY DOWNSIDES?

With so many apps out there, it can be hard to know which are worth your while – luckily, there’s a list of approved ones on the NHS website.

HOW MUCH AND HOW MANY?

Most on the aforementioned list are free (including Thrive, which uses games to track your mood and learn methods of dealing with stress and anxiety), but some have in-app purchases or require a GP referral. Ieso, free in some areas, even allows you to confidentially instant message mental health therapists.

Things it’s totally normal to feel in therapy

Dr Carina Eriksen, a Consultant Counselling Psychologist, offers some words of reassurance

  • ‘I’ve completely lost the plot': Once you learn to manage your problem, you should begin to feel more grounded and in control.

  • ‘I love/hate my therapist’: A therapist is only a human, too. If you have any concerns about the relationship, raise them at your next session.

  • ‘I’m a shitty person’: This kind of thinking is often the problem itself. Remember: just because you think something doesn’t make it true.

  • ‘It’s not working’: Your concerns shouldn’t be shrouded in mystery. Regularly discuss with your therapist how therapy is going and if anything can be improved.

  • ‘I don’t want it to end’: Your therapist will show you how to self-practise the skills you’ve learned. Remember, the aim isn’t to be in therapy forever.

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