Your counselling directory guide to seeking support
Counselling Directory
Counselling is a broad term referring to many different methods of assisting people. These and other 'talking therapists' (psychologists, coaches) support clients with various difficulties. However, it can be a nightmare to find an effective professional who makes you feel at ease.
In this article
Individual Therapy
Talk therapy and medication are the two main treatment options available to people when faced with mental health or psychological challenge.
Types of therapists
There are a confusing number of names for professionals who offer 'talking therapies'. Psychotherapist is one title, but you may come across counsellor, psychologist, and psychiatrist. Regardless of title, many practitioners complete extensive training and multiple qualifications (e.g., bachelors, masters degrees).
Psychotherapists work with people individually and via group therapy. There are pros and cons for each of these formats. Practitioners also work with many different problems, not just mental health problems (e.g., substance abuse, depression, relationship issues).
Types of therapies
There are many talk therapies (e.g., psychodynamic therapy, family therapy). Some approaches have strong research support (e.g., Cognitive Behaviour Therapy, CBT). Other treatments are less developed in this area. Some professional groups (e.g., Clinical Psychologists) only use evidence-based interventions.
Each therapy is based on specific assumptions about the causes and best treatment strategies for psychological distress. CBT, for example, focuses on unhelpful behavioural and thinking patterns underpinning mental health difficulties. CBT is a well-validated form of talking therapy widely used in many countries.
Some therapies focus more on the 'style' of sessions rather than specific techniques. The client-centred method (or 'person therapy') is one example. Psychologist Carl Rogers developed this model where clients direct the counselling process and discussion topics.
Therapeutic
As mentioned, we have different amounts of research evidence for therapy models. The best or 'gold standard' treatment depends on problem type. However, CBT is the recommended psychological treatment for many issues (especially depression and anxiety) (1). You can see reviews of several treatments on this resource page published by the American Psychological Association.
A growing number of studies have indicated that online therapy is effective. Earlier (and pre-pandemic) research suggested online treatments worked, but conclusions were tentative given the questionable quality of some research (2).
The pace of research has accelerated over the past decade, and we have seen an increasing volume of evidence supporting online cognitive behavioural therapy / CBT (3,4) and other forms of psychotherapy (5,6).
There is also evidence to suggest online therapy is equally effective as in-person therapy (7).
What Kind Of Therapist Do I Need?
When looking to work with a psychologist remotely or in person, you should always be clear on what attributes constitute a reputable professional. Consider factors such as:
Registration/accreditation with a recognised body
Experience level
Commitment to ongoing professional development
Regular attendance at supervision sessions
Expertise in the difficulties you are experiencing
How comfortable you feel working with a person
The practitioner should always make this information available to you when requested. You can now check details online through the relevant registration/licencing body in many instances. Licencing requirements vary between jurisdictions and countries. But there are usually standard requirements for training and skills. You can find more information on therapist screening in the article How to start therapy.
Because there is a range of styles, each counsellor's approach to your difficulties will differ. However, you should always experience a professional, safe, and effective service.
To learn more about the process of therapy, I have written some articles you might find helpful:
This article might be interesting if you feel uncomfortable about talking therapy.
My Online Therapy
Today, it is easy to access mental health professionals online. Virtual therapy has become an acceptable alternative to face-to-face treatment. Operating on this platform has become far more commonplace since the pandemic.
While many people benefit from increased access to these services, you should carefully assess a practitioner's qualifications and background before booking an appointment. It is still vital to work with a licenced therapist. An online counsellor should have received specialist training to provide a safe service that gets results.
You can choose to access services through a large online platform (e.g., Talkspace) or look for an independent practitioner. There are pros and cons to each option. One advantage of working with an independent online counsellor is that there is no algorithm acting as a gatekeeper and choosing a therapist for you.
Advantages
There are several pros and cons to consider with online working. Some advantages include:
Reduced/no travel time
Accessibility to a wide range of practitioners
An ability to access therapy when living in remote geographical regions
Increased ease of working around existing commitments (e.g., childcare)
Overcoming mobility and other medical issues that impede attendance at in-person sessions.
Disadvantages
While there are advantages and supportive evidence for online therapy, there are also disadvantages. Firstly, many people don't want to have this type of human interaction via a video screen. Understandably, some want to sit face-to-face when talking about psychological distress and other difficult personal topics. Other issues can include:
Technology problems (e.g., poor video connection)
The need for some technological competence
Potential issues around data security
Legal, ethical, and professional issues that may come with working between countries
These are just a few examples of the issues you may want to consider before working online with a practitioner. First, people need to choose a method of accessing therapy that best suits their needs.
Virtual or in person, you should choose a setting that best suits your circumstances because online therapy will not be best for everyone.
How Much Does Therapy Cost?
The cost of therapy depends on where you live and what type of service you access.
In general, therapy rates vary considerably from country to country. Costs tend to be higher in wealthy countries and in cities. Some countries provide free online therapy through their publically-funded health systems, but this is usually in limited supply. Given the rise in online therapy, anyone with decent internet access has the option of private treatment. But, not everyone can afford this service. Some practitioners work with a sliding scale fee.
If you are looking for free online therapy or online counselling, you may have access to local public health services. These services are generally accessed via a referral from your GP. For instance, some people can access the IAPT (CBT) scheme in the UK.
Some health insurers provide access to mental health services. Check with your provider if you have a policy.
Therapistaid
There are several ways to find a therapist.
People often ask me whether a platform like Better Help is worth it. While you get access to many online therapists in one place, options can be restricted through screening algorithms (set of questions). Communication options might also be limited according to the platform's policy.
An algorithm can never tell you if a therapist will 'feel right' once you meet them. So be cautious when exploring any of the big therapy platforms. My opinion is that you should be able to have a no-cost quick chat with a potential therapist before deciding to book an appointment. However, large online platforms exist primarily to make money. Otherwise, they wouldn't exist. We all need to generate an income, but there's a difference between making a living and seeking maximum profit!
We are Coaching & Clinical Psychologist with extensive experience helping people conquer a range of wellbeing and performance issues at home and in the workplace. Read more about our work, watch practical skills videos or browse other articles. Get in touch anytime.
References
(1) David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004
(2) https://www.ncbi.nlm.nih.gov/books/NBK76016/
(3) Bowen, Lucy A. DMSc, PA-C, CPAAPA Assessing the effectiveness of online cognitive behavioral therapy in adults with chronic insomnia, Journal of the American Academy of Physician Assistants: December 2020 - Volume 33 - Issue 12 - p 1
(4) Maria Roman, Ticu Constantin & Cristina Maria Bostan (2020) The efficiency of online cognitive-behavioral therapy for postpartum depressive symptomatology: a systematic review and meta-analysis, Women & Health, 60:1, 99-112
(5) https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00993/full
(6) Boekhorst, M.G.B.M., Hulsbosch, L.P., Nyklíček, I. et al. An Online Mindful Parenting Training for Mothers Raising Toddlers: Assessment of Acceptability, Effectiveness, and Personal Goals. Mindfulness 12, 519–531 (2021).
(7) Bisen, S.S., & Deshpande, Y. (2018). Effectiveness of Internet Based Psychotherapeutic Intervention in Common Psychiatric Disorders. Int. J. Cyber Behav. Psychol. Learn., 8, 51-62.
