Talking therapies

Overview

• Talking therapy includes things like counselling and psychotherapy.
• Talking therapy involves talking with a professional therapist about issues that may be affecting your mental and emotional health.
• Talking therapies can help you to figure out what may be causing you problems and help you to learn ways to manage them.
• There are different types of talking therapy. Finding the right therapy will depend on your problem, what is available and what outcome you are looking for.
• Cognitive behavioural therapy (CBT) is widely available on the NHS. CBT mainly focuses on the “here and now”. CBT looks at how thoughts can affect how you feel and aims to change these.
• All NHS trusts offer free talking therapy through their Improving Access to Psychological Therapies (IAPT) programme. You can usually self-refer to your local IAPT or you can ask your GP to refer you.
• You can find a private therapist. It’s important that they are accredited. Some therapists offer reduced rates if you are on a low income.

About

What is talking therapy?

Talking therapy is a general term to describe any psychological therapy that involves talking. You may also hear the terms counselling or psychotherapy used to describe talking therapy.

Therapy should offer you a safe, confidential place to talk about your life and anything confusing, painful or uncomfortable. It allows you to talk with someone who is trained to listen attentively and to help you improve things.

Talking therapy often takes place face to face. But you may also be able to have therapy over the phone, by video call or online.

Talking therapies can be useful to treat mental health or behavioural problems. You might be offered talking therapy and medication together.

What can I expect from talking therapy?

At the start of therapy, the therapist will ask you about your reasons for coming to therapy. The therapist is likely to ask about your history. The therapist will ask you specific questions to try and figure out what your needs are.

These questions help your therapist come up with a treatment plan for your therapy. You and your therapist should agree:

• what you expect from one another,
• your commitment to the therapy, and
• how to end the therapy.

You can go to individual 1 to 1 therapy or group therapy. Some therapies may be a combination of 1 to 1 and group sessions. The length of therapy can vary depending on the type of therapy and what you need to work on.

Types

What are the different types of talking therapies?

The term ‘therapy’ covers a range of approaches and methods. You may also hear talking therapy being called psychotherapy or counselling.

A therapist may use a range of techniques to help explore your emotions, from 1 to 1 talking sessions to techniques such as role-play or dance. Some therapists work with couples, families or groups.

The different types of talking therapy are:

• Counselling
• Cognitive Behavioural Therapy (CBT)
• Computerised Cognitive Behavioural Therapy (cCBT)
• Cognitive Analytical Therapy (CAT)
• Dialectical Behaviour Therapy (DBT)
• Family intervention
• Interpersonal therapy
• Mentalisation-based therapy (MBT)
• Mindfulness
• Psychodynamic psychotherapy
• Schema therapy
• Creative therapies

Below we’ve explained what each of these therapies are and what they aim to help people with.

What is counselling?

In counselling, a therapist can help you to find ways to deal with emotional issues. Your counsellor can help you to understand how you are feeling.

Counselling can help you if you are going through a difficult time. For example, a bereavement, relationship breakdown, redundancy or other life changing events.

Usually, you can only get a certain number of counselling sessions from the NHS. For example, the National Institute for Health and Care Excellence (NICE) recommend that for mild to moderate depression you should have around 6 to 10 sessions. If your symptoms haven’t improved after this, this might be increased to 16-20 sessions.

What is Cognitive Behavioural Therapy (CBT)?

CBT can help you to change the way you think and what you do. Making these changes can help you to feel better. CBT mainly focuses on problems and difficulties in the present rather than your past or childhood. CBT can help you to understand how your learned thoughts and behaviours affects your reaction to situations.

Below are some of the conditions CBT is often useful for:

• depression,
• anxiety,
• bipolar disorder,
• borderline personality disorder (BPD),
• psychosis,
• schizophrenia,
• obsessive compulsive disorder (OCD),
• panic disorder,
• post-traumatic stress disorder (PTSD),
• phobias,
• eating disorders,
• sleep problems, and
• problems related to alcohol.

CBT is widely available on the NHS. Guidelines recommend that all therapists should complete a relevant professional qualification.

Sessions are usually between 30 to 50 minutes. You will usually have between 5 to 20 sessions, but this depends on your needs and what’s available. There is more information below on the recommended number of CBT sessions for different conditions.

What is Computerised Cognitive Behavioural Therapy (cCBT)?

cCBT is the same as CBT, but you can do cCBT on your computer at home. You may find it helpful to use this if you prefer to read information in your own time.

The Royal College of Psychiatrists recommend that a health or social care professional guides you through cCBT.

The NHS also recommend different cCBT courses which you can try. You can find out how to access cCBT from your local NHS talking therapies service. You can find out details of your local service here:
www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/ Or you can speak to your GP about it.

What is Cognitive Analytical Therapy (CAT)?

CAT looks at the relationships you had in your childhood. It helps you to understand why you may have learned unhealthy or unhelpful behaviour.

It can help you to look at healthy and helpful techniques to manage your relationships and deal with difficult emotions.

What is Dialectical Behaviour Therapy (DBT)?

DBT helps you to become more aware of your emotions and learn healthy ways to deal with them. The main purpose of DBT is to help you to break the cycle of feeling very strong emotions like being vulnerable and worthless.

DBT aims to help you learn that your emotions are valid and acceptable. And ways to be open to new ideas or other people’s opinions that may be different from yours.

The National Institute for Health and Care Excellence (NICE) recommend DBT for women with borderline personality disorder and significant selfharming behaviour.

You will be expected to go to a combination of group sessions, one-to-one sessions, and education groups.

What is family intervention?

Family intervention is where you and your family work with mental health professionals to help you to manage your relationships. This might be offered to people who you live with or who you are in close contact with.

The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions.

Family intervention can be used to:

• learn more about your symptoms, and
• improve communication among family members.

Family intervention could help you and your family to:

• learn more about your symptoms,
• understand what is happening to you,
• improve communication with each other,
• know how to support each other,
• think positively,
• become more independent,
• be able to solve problems with each other,
• know how to manage a crisis, and
• improve mental wellbeing.

What is Interpersonal Psychotherapy (IPT)?

Interpersonal Psychotherapy (IPT) is a short-term therapy used for the treatment of depression. The therapy focuses on your relationships with other people in the present or in the past. It can help you to identify issues that are causing you to feel depressed.

What is Mentalisation-based therapy (MBT)?

Mentalisation-based therapy (MBT) is a type of long-term psychotherapy.

Mentalisation is your ability to understand the mental state that underlies behaviour, in you or others. Mentalisation is something we all use in everyday life. Some people find it more difficult to mentalise in certain situations than others.

MBT helps to improve your capacity to mentalise. It helps you to look at what you and others are thinking about and how this could create helpful or unhelpful behaviours.

What is mindfulness?

Mindfulness helps you to focus on the present moment using techniques like meditation, slow breathing and yoga.

It can help you to become more aware of your thoughts and feelings. By being mindful, you can learn how to manage your thoughts and feelings and not be overwhelmed by them.

What is psychodynamic psychotherapy?

Psychodynamic therapy focuses on helping you understand how your past experiences may shape current behaviour. This type of therapy can help you discuss feelings you have about yourself and other people. Particularly family and those close to you.

Psychodynamic techniques can also be used in individual sessions, couple’s sessions, group psychotherapy sessions, and within family therapy.

What is schema therapy?

Schema therapy can help you to change negative patterns or beliefs that you may have lived with for a long time. These patterns are called ‘schemas.’

People can develop schemas during childhood but also as adults. Some common schemas that people may experience could be, feeling abandoned, feeling vulnerable or afraid, or feeling very negative about the future.

Schema therapy looks at how you may have developed unhelpful behaviours, patterns of thinking and coping strategies. With help from the therapist, you can learn healthier ways to think and respond to situations.

What are creative therapies?

Creative therapies use activities such as art and drama to:

• make you more in touch with how you feel,
• improve how you communicate with other people,
• make you feel less anxious, or
• make you feel better about yourself.

Art therapy encourages you to express emotions and explore your problems using a wide range of art materials. Art therapy can be helpful to people who may have difficulty expressing themselves in words.

Drama therapy uses drama or theatrical techniques, such as roleplay, mime and storytelling) to help you express yourself and understand how you feel.

There is a wide range of other therapies available and the one that suits you may not be in the list above. You can get more information about different therapies available by contacting the UK Council For Psychotherapy or British Association of Counselling and psychotherapy.

Their details are at the bottom of this page.

Getting therapy

How can I get therapy?

What are NHS talking therapy services?

NHS talking therapy services are sometimes known as ‘IAPT’ services. IAPT stands for Improving Access to Psychological Treatments.

The following things apply to NHS talking therapy IAPT services.

• Provide talking therapies such as cognitive behavioural therapy (CBT), group therapy and counselling.
• Sometimes provide a treatment called eye movement desensitisation and reprocessing (EMDR) for trauma-based conditions, including PTSD.
• Usually provide online tools too.
• Treat mild to moderate anxiety and depression, and associated conditions.
• Are free to use.
• Are available in all areas of England.

You can self-refer to your local IAPT service. This means that you can contact them directly to get an appointment, so you don’t have to see your GP to do this.

Your local service can tell you what therapies are available and how long you might have to wait to get it.

You will normally get a telephone assessment to begin with to talk about your condition and symptoms. This will help the service to decide if it is right for you and what therapies are suitable.

The service will only treat mild to moderate mental health symptoms. The service might think that you have severe or complex symptoms. If they do, they will refer you to a specialist NHS mental health team. Or say you should see your GP to get a referral.

You can find your local NHS talking therapy service by:

• searching on the following NHS website:
  www.nhs.uk/conditions/stress-anxiety-depression/free-therapy-or-counselling/,
• calling NHS 111 and asking, or
• Asking your GP.

When might I be referred to an NHS specialist mental health team?

Your GP or another medical professional might refer you to an NHS specialist mental health team for talking therapy and other support if:

• you’ve had therapy from an NHS talking therapy IAPT service, but you are still unwell and need more specialist support, or
• your local NHS talking therapy IAPT service have assessed you and say you need more specialist support.

They can offer you therapy such as psychodynamic therapy or dialectical behavioural therapy (DBT).

If you are under a community mental health team, your care coordinator or psychiatrist will be responsible for organising NHS therapy.

Your GP or mental health professional can pass your details to a therapist or local therapy service. This is called a referral.

How can I get private therapy?

How much does private therapy cost?
Private therapy is therapy that isn’t funded by the NHS. You have to pay for it yourself or you may have cover through an insurance policy.

The cost of therapy will be different across the country and by therapist. An average cost of a session is £40 to £60. But this is average cost and it is likely to be higher in London.

You may get your first session free. Or if you’re a student, claim welfare benefits or on a low income you may get reduced rates.

You can ask about charges and agree a price before you start your therapy sessions. It is important to understand the terms and conditions of seeing the therapist and payments before you agree to anything.

What are the benefits of private therapy?
The benefits of private therapy are:

• you have more choice,
• there may be shorter waiting times, and
• you can be more flexible about who you see.

What should I look for when choosing a therapist?
We always advise that you find a therapist who is a member of a professional body. This means that they will meet certain standards, have a complaints procedure and follow a code of ethics. You can search for private therapists in your local area on the following websites:

• UK Council for Psychotherapy: www.psychotherapy.org.uk/
• British Association of Counsellors and Psychotherapists: www.bacp.co.uk/search/Therapists
• Counselling Directory: www.counselling-directory.org.uk

How can I get free or low-cost talking therapy?

You might be able to get talking therapy through.

• Employee Assistance Programme (EAP)
• Counselling for students
• Counselling through charities

Employee Assistance Programme (EAP)
If you are employed, your employer may pay for counselling through an EAP. You can find out about this service by asking your manager or your human resources (HR) department. It is usually bigger organisations that pay for EAP.

Counselling for students
If you are a student, you may be able to get free counselling through your university. Talk to your tutor or student’s union for more information.

Counselling through charities
You can search online to see if you can find any charities that provide free or low-cost talking therapy. You can try terms such as

• free counselling in (town where you live)
• low cost counselling in (county or London borough where you live)

You can also check the following website for free of low-cost therapists:
www.freepsychotherapynetwork.com/organisations-offering-low-cost-psychotherapy/

For bereavement counselling you could try the charities Cruse Bereavement Care or Sue Ryder. You can find their details at the bottom of this page.

Anxiety UK offer discounted therapy to their members. You can read more about membership and therapy costs on their website. You can find their details at the bottom of this page.

Guidelines & problems

Are there guidelines on talking therapy for different mental illnesses?

The National Institute for Health and Care Excellence (NICE) produces guidance for the NHS on how to treat certain health conditions. The NHS doesn’t have to follow NICE recommendations, but their guidance can be useful when asking your doctor for support.

This section looks at what NICE recommends for some of the most common mental illnesses. You can see all the NICE guidance at www.nice.org.uk. If your condition isn’t on the list, you could talk to your mental health worker for advice.

Depression

NICE recommends cognitive behaviour therapy (CBT) to treat depression. The length of treatment and the type of CBT will depend on how severe your symptoms are.

For mild to moderate depression NICE recommend that you are offered self-help material, computerised CBT or 6-10 sessions of one-to-one CBT.

If you experience moderate to severe depression you should be offered antidepressants and CBT.

What is mindfulness-based cognitive therapy for depression?
Mindfulness helps you to focus on the present moment. It can help you understand your thoughts and feelings and the world around you.

Once you are well, NICE recommends that you are offered mindfulness-based cognitive therapy. This can help to stop you from becoming unwell again.

You should be offered this if you have had 3 or more episodes of depression in the past.

Anxiety Disorders

Nice recommends using a combination of treatments. What you are offered will depend on how severe your symptoms are.

This can include:

• group education about anxiety,
• self-help exercises supported by a therapist,
• CBT,
• applied relaxation techniques, and
• medication and inpatient care

Schizophrenia

NICE recommends you should be offered CBT and medication if you live with schizophrenia. Your therapy should aim to reduce your symptoms, reduce feelings of distress, improve your coping skills and improve your quality of life.

Bipolar disorder

You might live with bipolar disorder and your condition might be stable but still have some symptoms. NICE recommend you should be offered psychological treatment. CBT and interpersonal therapy are some types of therapy recommended for long term treatment of bipolar disorder.

The type of psychological therapy that would suit you will depend on your symptoms. You should discuss psychological therapy with your health care professional.

Borderline personality disorder (BPD)

NICE recommends that if you have borderline personality disorder you shouldn’t be offered brief psychological treatment that is less than 3 months.

They recommend you should get therapy sessions which suit your need and fit around your other commitments.

Dialectical Behaviour Therapy (DBT) is one of the main therapies offered to women with BPD on the NHS.

Some NHS trusts may also offer other types of therapy such as Mentalisation-based therapy (MBT) and Cognitive Analytical Therapy (CAT). What you are offered will depend on what is available from your local NHS trust.

You can find out more information about:

• Anxiety disorders by clicking here.
• Bipolar disorder by clicking here.
• Borderline personality disorder by clicking here.
• Depression by clicking here.
• Schizophrenia by clicking here.

What if I have problems getting therapy on the NHS?

You may come across some problems getting talking therapy on the NHS. Some of these problems may include the following.

• Long waiting lists.
• You didn’t get enough sessions.
• Your GP doesn’t understand mental health conditions or treatment.
• Talking therapy isn’t included in your care plan.
• Your healthcare professionals don’t think you need therapy.
• The therapy you want isn’t available in your local area.

There are some things you can do such as:

• get the support of an advocate,
• ask for a second opinion of your treatment plan,
• ask for a review of your care plan, or
• make a complaint.

You can find more information about:

• Advocacy by clicking here.
• The Care Programme Approach (CPA) by clicking here.
• Complaints by clicking here.
• Second opinions by clicking here.
• NHS your rights by clicking here.

Therapists

Are therapists regulated and accredited?

There is no standard regulation system for therapists. This means someone can advertise themselves and work as a therapist without being checked or having appropriate training.

If you are thinking about using a private therapist, it is important to consider their qualifications. Therapists can get a certificate or accreditation, which shows that they meet certain standards.

By registering with accredited bodies, therapists agree to be checked to see if they are following professional standards. It is important to check that your therapist is registered with an accreditation body. All accredited therapists must show that they meet certain standards. For example, having appropriate training and qualifications working to a code of ethics.

These organisations provide lists of accredited therapists in the UK.

• Health & Care Professions Council (HCPC)
• British Association of Counselling and Psychotherapy (BACP)
• UK Council for Psychotherapy (UKCP)
• British Psychological Society (BPS)

You can find their contact details at the bottom of this page.

Will my therapist keep everything I tell them confidential?

All accredited therapists must work to a code of ethics.

Part of the code of ethics should include a section on client confidentiality. This should explain how they will treat the information you share with them. This includes things like keeping records and sharing of information with other health professionals. They should explain the situations when they might tell other people your confidential information. This might be if you or someone else is at risk of harm.

If you have any concerns about confidentiality, you should ask to see what set of ethics and standards your therapist follows. You can ask for their confidentiality policy.

You can find an example of the Council for Psychotherapy ethical principles and code of conduct here: www.psychotherapy.org.uk/ukcp-members/standards-guidance-and-policies/

Useful contacts

Anxiety UK
Anxiety UK offer its members fast access to private therapists for a reduced fee. Membership costs £30 per year.

You can find out more about membership and talking therapies here:
www.anxietyuk.org.uk/get-help/access-therapy/

Telephone: 03444 775 774 (Mon-Fri 9:30am - 5.30pm)
Text Service: 07537 416 905
Email: support@anxietyuk.org.uk
Address: Anxiety UK, Nunes House, 447 Chester Road, Manchester M16 9HA
Website: www.anxietyuk.org.uk

Black, African and Asian Therapy Network (BAATN)
BAATN supports people from these backgrounds but open to other People of Colour who are affected by prejudice. You can search online for counsellors, psychotherapists, psychologists and complementary therapists of Black, African, South Asian and Caribbean heritages.

Email: connect@baatn.org.uk
Website: www.baatn.org.uk/

British Association for Counselling & Psychotherapy
BACP is a professional body representing counselling and psychotherapy with over 40,000 members.

Telephone: 01455 883300
Address: BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire, LE17 4HB
Email: bacp@bacp.co.uk
Website: www.bacp.co.uk/

British Psychotherapy Foundation
An organisation of psychotherapists who are working to ensure that the benefits of psychotherapy are available to as many people who need it as possible.

Telephone: 0208 452 9823
Address: 37 Mapesbury Road, London, NW2 4HJ
Email: enquiries@bpf-psychotherapy.org.uk
Website: www.britishpsychotherapyfoundation.org.uk

British Psychological Society
The representative body for psychologists in the UK.

Telephone: 0116 254 95 68
Address: St Andrews House, 48 Princess Road East, Leicester, LE1 7DR
Email: enquiries@bps.org.uk
Website: www.bps.org.uk

British Psychoanalytic Council
The British Psychoanalytic Council is a professional association and voluntary regulator of the psychoanalytic psychotherapy profession.

Telephone: 0207 561 9240
Address: Suite 7, 19-23 Wedmore Street, London, N19 4RU
Email: hello@bpc.org.uk
Website: www.bpc.org.uk

British Association for Behavioural & Cognitive Psychotherapies
The British Association for Behavioural and Cognitive Psychotherapies (BABCP)is a multi-disciplinary interest group for people involved in the practice and theory of behavioural and cognitive psychotherapy.

Telephone: 0330 320 0851
Address: Imperial House, Hornby Street, Bury, Lancashire, BL9 5BN
Email: babcp@babcp.com
Website: www.babcp.com/

British Association of Art Therapists
The British Association of Art Therapists (BAAT) is the professional organisation for art therapists in the UK.

Telephone: 0207 686 4216
Address: 24-27 White Lion Street, London, N1 9PD
Email: info@baat.org
Website: www.baat.org

Cruse Bereavement Care
They have specialist bereavement experts in all types of loss and can offer support however and whenever the death occurred.

Telephone: 0808 808 1677
Email: helpline@cruse.org.uk
Website: www.cruse.org.uk/

Health and Care Professions Council (HCPC)
The HCPC regulate health care professionals and have been set up to protect the public. To do this, they keep a register of health and care professionals who meet their standards for their training, professional skills, behaviour and health.

Telephone: 0300 500 6184
Address: Park House, 184 Kennington Park Road, London, SE11 4BU
Website: www.hcpc-uk.org 

UK Council of Psychotherapy
UKCP is a professional body representing psychotherapists and psychotherapeutic counsellors.

Telephone: 0207 014 99 55
Address: America House, 2 America Square, London, EC3N 2LU
Email: info@ukcp.org.uk or through their online form:
www.psychotherapy.org.uk/contact-us/
Website: www.psychotherapy.org.uk

Sue Ryder
Sye Ryder help people through the most difficult times of their lives. Whether that’s a terminal illness, the loss of a loved one or a neurological condition – they’re there when it matters.

Telephone: 0808 164 4572
Website: www.sueryder.org/

Welldoing.org
Their website provides a range of information and advice about mental health and wellbeing and talking therapies. It also has a directory of accredited therapists based in the UK.

Telephone: 0208 930 8906
Address: Health Foundry, Canterbury House, 1 Royal Street, London, SE1 7LL
Email: info@welldoing.org
Website: www.welldoing.org/about