Talking therapies

Talking therapy is a general term to describe any psychological therapy that involves talking. You may also hear the terms, counselling or psychotherapy. Talking therapies can be useful to treat mental health or behavioural problems. 

 

Overview

  • Talking therapy can also be called counselling and psychotherapy.
  • Talking therapy involves talking with a professional about issues or problems that may be affecting your mental and emotional health.
  • Talking therapies can help you to figure out what may have caused problems and 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 you want.
  • Cognitive behavioural therapy (CBT) is widely available on the NHS. CBT focuses on the “here and now”.
  • CBT looks at how thoughts can affect how you feel and aims to change these.
  • Most NHS trusts offer free talking therapy through the Improving Access to Psychological Therapies (IAPT) programme. You can usually self-refer or ask your GP to refer you.
  • You can find a private therapist. 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.

You may also hear about the following types of talking therapy:

  • Behavioural therapies: focuses on thoughts and behaviours. Cognitive behaviour therapy (CBT) is an example of this.
  • Psychoanalytical and psychodynamic therapies: focuses on the way we make relationships from childhood.
  • Relationship counselling: helps to resolve problems with relationships. This can be for couples or families.
  • Mindfulness-based therapies: focus on your thoughts and feelings without becoming overwhelmed by them.
  • Behavioural activation: encourages you to develop more positive behaviour by planning practical activities that you may usually avoid.

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, via email or Skype.

Talking therapies can be useful to treat mental health or behavioural problems. Talking therapy may be used in combination with medication.

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 will ask you specific questions to try and figure out your therapy needs what may be blocking your recovery.

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.

Types

Are there different types of talking therapies?

There are many different types of talking therapies. Below is a list of some of the most common types.

The term ‘therapy’ covers a range of approaches and methods. You may also hear it called psychotherapy. Counselling is one type of talking therapy, but sometimes people use the word counselling to mean all types of talking therapies.

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

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.

Sometimes the term "counselling" is used to refer to talking therapies in general, but counselling is also a type of therapy.

Counselling can be helpful for people who are going through a difficult time such as 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-moderate depression you should have around 6 to 10 sessions.

Cognitive Behavioural Therapy (CBT)

Through CBT you can try to change the way you think and behave, which are linked to the way you feel. CBT focuses on problems and difficulties in the present rather than your past or childhood. CBT can help you to understand how you think about yourself and the things around you and how that affects your reaction to situations.

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

  • obsessive compulsive disorder (OCD),
  • panic disorder,
  • post-traumatic stress disorder (PTSD),
  • phobias,
  • eating disorders,
  • sleep problems, and
  • problems related to alcohol misuse.

CBT is widely available on the NHS. Guidelines recommend that all therapists should complete a professional qualification and a course involving a minimum of 450 hours training.

Sessions are usually between 30 minutes and one hour. An average number of sessions is between 5 and 20 but this depends on what you need. There is more information at the bottom of this page on the recommended number of CBT sessions for different conditions.

Computerised Cognitive Behavioural Therapy (cCBT)

You can do CBT on your computer at home. Research has shown some cCBT programmes have a 50% success rate in treating depression and anxiety, which is similar to antidepressant medication.

NICE recommend that a health or social care professional guides you through cCBT. The NHS also recommend different cCBT courses which you can try. 

These include, but are not limited to, the following:

Big White Wall

Big White Wall is an anonymous digital service that supports people experiencing common mental health problems, such as depression and anxiety. They have different self-help programmes that may help you to manage your own mental health. You can find more here.

SilverCloud

SilverCloud is an online course to help people manage stress, anxiety and depression. You work through a series of topics selected by a therapist to address specific needs. The eight-week course is designed to be completed in your own time and at your own pace.

SilverCloud is only available via an NHS referral. Speak to your GP or local mental health services to see if you can free access to this treatment on the NHS.

Psychodynamic therapy

Psychodynamic therapy focuses on helping you understand how your unconscious and past experiences may determine current behaviour. You are encouraged to talk about your relationships with significant people. These techniques can be used in individual psychotherapy, group psychotherapy, and family therapy.

Family therapy

Family therapy is recommended by NICE for people with schizophrenia and their carers and family members. Caring for someone with a mental illness can sometimes put a strain on family relationships. Family therapy focuses on educating family members on schizophrenia. It can help them to develop coping techniques and strategies to support their relative.

Research shows that family interventions may reduce the risk of relapse and going back into hospital for people with schizophrenia.

Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) is a form of talking therapy that can be used for people with borderline personality disorder and significant self-harming behaviour.

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. You will learn that your emotions are valid and acceptable. You will also learn ways to be open new ideas or other people’s opinions that may be different from yours.

You will be expected to go to a combination of group sessions, one-to-one sessions, and education groups. You should be offered telephone support between sessions during DBT.

NICE guidance says DBT can be helpful for women with borderline personality disorder who self-harm. Not all NHS Trusts will offer DBT. You can contact your local PALS to find out if your local trust offers DBT.

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 emotion 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 role play, 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 end of this page.

Getting therapy

How do I get therapy?

Improving Access to Psychological Therapies (IAPT)

The NHS’ ‘Improving Access to Psychological Therapies’ (IAPT) programme has made psychological therapy more available on the NHS. IAPT services mainly provide support for low to moderate anxiety and depression.

The service can be run by the local NHS Trust or a non-NHS agency, like a charity who work with the local Trust.

IAPT should be available in your area. You can often self-refer or ask your GP to refer you.

To find your local the IAPT service you can search online here.

You can also ask your GP or PALS service for details of local IAPT services.

Mental Health Services

If you have tried CBT or a low level talking therapy but this is not helping, you may be referred to a specialist mental health team who can offer you some more intensive therapy such as psychodynamic therapy or dialectical behavioural therapy (DBT).

If you are not with a community mental health team, your GP will be responsible for helping you get therapy. If you are under a community mental health team your care coordinator or psychiatrist will be responsible for organising NHS therapy.

Once you have spoken to your GP or mental health professional they can pass your details to a therapist or local therapy service, this is called a referral.

Private therapy

You can choose to pay to see a therapist privately. 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.

However, the main drawback is the cost. Some therapists offer reduced fees for people on low incomes. You can ask the therapist if they offer this. Some therapists may also have cheaper initial assessment appointments. This allows you and the therapist to see if you will get on together. If you don’t feel you would work well with the therapist you are under no obligation to see them again.

It is important to understand the terms and conditions of seeing the therapist and payments before you agree to anything.

You can find organisations that hold lists of therapists at the end of this page. 

Charities

Some charities offer low-cost or free talking therapies for people on low incomes.

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 does not 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 is not on the list you could talk to your mental health worker.

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 advice, computerised CBT or 6-8 sessions of one-to-one CBT.

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

NICE recommends that once you are well you are offered mindfulness-based cognitive therapy 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. Mindfulness helps you to focus on the present moment. It can help you understand your thoughts and feelings and the world around you.

Anxiety Disorders

Depending on your diagnosis, talking treatments may vary. Your GP should offer you a stepped care model of care. This means that they can offer you a treatment for your anxiety. If your anxiety does not improve from this treatment, your GP can offer you the next recommended type of treatment.

Schizophrenia

NICE recommends you should be offered psychological therapy in addition to medication if you have schizophrenia. Your therapy should aim to reduce your symptoms, reduce feelings of distress, improve your coping skills and improve your quality of life. There are different types of psychological treatments which you might be able to get.

Bipolar disorder

If you have bipolar disorder and you are stable, but still have some symptoms then NICE recommend you should be offered psychological treatment. CBT and interpersonal therapy are some types of therapy recommended for long term treatment of bipolar.

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 should not be offered brief psychological treatment (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 people with BPD on the NHS.

Some therapists 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 in your local

NHS trust. You should receive information about psychological therapies you are being offered before you start the therapy.

You can use the links below to find our more about:

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 did not get enough sessions
  • Your GP does not understand mental health conditions or treatment
  • Talking therapy is not included in your care plan
  • Your healthcare professionals do not think you need therapy
  • The therapy you want is not 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 approach
  • Make a complaint.

You can use the links below to find out more about: 

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.

All therapists who work for the NHS should be qualified and accredited to a professional organisation.

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 end 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 is things like keeping records and sharing of information with other health professionals. They should explain the situations when they might tell other people confidential information they have given you. 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.

 

Useful information

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.

Telephone: 03444 775 774 (Mon-Fri 9:30am - 5.30pm)
Text Service: 07537 416 905
Address: Zion Community Centre, 339 Stretford Road, Hulme, Manchester M15 4ZY
Website: www.anxietyuk.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.itsgoodtotalk.org.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: mail@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: 0161 705 4304
Address: Imperial House, Hornby Street, Bury, Lancashire, BL9 5BN
Email: babcp@babcp.com
Website: www.babcp.org.uk

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

Health and Care Professions Council

The HCPC are a regulator, and were 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.hpc-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

Welldoing.org

Website that 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: https://welldoing.org/about

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