I am always mystified by those who insist counselling does not work. Since 2006 I have been counselling people from all walks of life, different ethnicities, socio-economic backgrounds, different sexual orientation, and various types of issues. I can definitely say that counselling does work.
Of course, not all styles of therapy suit everyone. Some may find psychodynamic or CBT helpful, while others might not. It also depends a great deal on the therapeutic relationship. In fact that has been found to be one of the main factors of a good outcome.
A person has to be ready for counselling. After all, a person must put all their trust in a counsellor, telling them things perhaps they have not been able to tell anyone before. They might be afraid of looking foolish, getting emotional, or of being judged. They might be reluctant to even admit they have a problem. Perhaps they see it as a weakness or other kind of inadequacy. Perhaps the issues is about something frowned upon by their caregivers or partner; and therefore it is even harder to confide. Perhaps they are even reluctant to admit they need therapy, saying: “I don’t really believe in this but my mother/partner/friend told me to come”.
I have heard people comment that it is ridiculous paying a counsellor to listen to problems when you can just discuss it with a friend; but this isn’t counselling.
In fact, a year or two ago, I had such an experience. It was at a time when there was a problem in my life. I knew what I wanted to do but circumstances made the decision difficult. Should I do it now, or should I wait? How easy would it be to bring about what I wanted at that busy time?
Around that time I went to lunch with a friend; not a close friend but someone I felt comfortable enough to open up to when she enquired about the situation. At the end of the lunch she smiled and said: “You see, so now I have counselled you”. She had confused listening, giving opinions, and advice, with counselling. She had confused a discussion with counselling. It was also very clear to me that she had used none of the techniques of counselling and psychotherapy. She had also, unwittingly, insulted me. Three years of a psychology degree, three and a half years of counselling studies, numerous hours of ‘Continuing Professional Development” courses, reading, and research, and numerous hours spent with client from all backgrounds, is not the equivalent of a casual chat over lunch. It is undermining the counselling or psychotherapy process.
Quite the opposite of that is when a professional counsellor/psychotherapist has a personal issue and they are told: “Well you shouldn’t have a problem. You’re a counsellor. You should know how to solve it.” Of course during training we have the benefit of considering many different issues and we also have our own therapy. This might help make us more insightful (if we hadn’t already had the propensity to be insightful), but we don’t have some super-human power. It is usually easier to have clarity when observing issues from an objective, uninvolved, perspective than when in the middle of things experiencing matters subjectively. It is somewhat like viewing a maze from above or being in the middle trying to find a way out.
So why doesn’t counselling or psychotherapy work for everyone and work quickly?
In some cases it is perhaps like trying to find the correct medication for a complaint. Not all medication works for everyone. Also, when an issue is more complex or deep seated more in-depth or longer term sessions may be required. So, again, comparing the work with a doctor finding the right medication for a complex complaint, if the medication is to be taken regularly and for a length of time, it would be no use taking a pill for a few days then complaining to the doctor that the medication doesn’t work. Nor would it be any use taking the medication intermittently; or not telling the doctor the full extent of your symptoms or injury; and yet, there are some who approach counselling that way and then complain it does not work.
In my own practice I have seen at least two people who insisted they came from a wonderful family background and there would be absolutely no issues that affected their present state. After quite a few session with one client it emerged, almost as a passing comment, that he had regularly been called a derogatory name (due to his weight). It had become his nickname in the family. It took some time before he could admit (to himself) that he found the name hurtful and abusive. However, due to the “nice family” image he had fooled himself into thinking it was just a little fun and ok. To admit it was not ok was, to him, like presenting his family in a bad way, and being disloyal. Similarly, another client presented as though coming from a perfect family then, again, in one session, almost as an aside comment, referred to some physical abuse.
So, when a person comes to counselling they might not even be aware of what the issues are; or if they are aware the experiences could be deeply submerged and “forbidden”. In the case of some abusive relationships a person might actually get convinced they are the cause of all the issues. When they question matters they might get told they are “crazy”, “mad”, “suspicious”, “paranoid”, or “selfish”… until eventually they start to doubt their own sanity.
Short-term therapy can be very helpful in some cases. When I initially started work as a counsellor-psychotherapist I saw referrals from various GP practices across two London boroughs. Usually the referral was for six to eight sessions; on some occasions clients requested a further six to eight sessions. In nearly all cases we made a lot of headway and issues were either resolved or greatly improved; either way clients had some new perspectives from which to view issues and some strategies to use. In some cases longer time is needed. It depends how involved the case is, how long it has been allowed to continue or escalate, and how willing the client to reveal and work on issues.
In order to resolve matters it can often mean a lot of work, and a determination to learn new patterns of behaviour and new ways of relating.
After all, if a person visited a dietitian for a healthy eating plan, then ate really healthy meals for a few days but at weekends they had a drinking binge and ate ten pastries, how much would they be helped?
The counsellor-psychotherapist isn’t a magician. They can listen, offer support and empathy, reflect, compare options, highlight similarities, probe for further insights, challenge deeply held beliefs and opinions, work with the client to find acceptable solutions, offer certain exercises and strategies, but they cannot tell you what to do, advise you on how to live your life, or wave a magic wand.
I have read articles, statements, and clinical trial conclusions that counselling does not work, that only CBT works, that counselling definitely works, that TFT and EFT (tapping technique) works, and does not work, and that hypnosis works, and does not work… and some therapists actively put down other forms of therapy in order to attract clientele; or simply because it hasn’t worked for them.
There are always conflicting reviews about how things do or do not work; and there are sometimes “fashions” in different therapy techniques, both traditional therapies and newer “alternative” therapies. It can be a minefield.
It is because we are individuals and one approach doesn’t necessarily suit that I choose to practise in an integrative way.
If you are uncertain as to which therapy suits you, then you can always ask a therapist if they would consider offering an initial reduced price session. This might allow you to gain some insight into whether a certain approach might be useful for you.
Also, it is very important to be honest with your therapist. It isn’t any use paying £50 or £200 for a treatment, telling the therapist: “Thank you. I am much better now”, then going away and telling everyone what rubbish it was! That doesn’t help you, the therapist, or others. To have the maximum chance of success, the therapeutic alliance should be based on integrity, openness, and respect.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097447/
https://www.mentalhealthtoday.co.uk/cbt-vs-counselling-what-s-next-for-the-mental-health-of-the-uk
https://www.psychologytoday.com/gb/blog/the-couch/201011/does-talk-therapy-really-work
https://counsellingresource.com/therapy/types/effectiveness
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