Therapy

What is talking therapy?

In all forms of talking therapy, you will talk with your therapist about the things that impact or have impacted your quality of life, including negative thoughts, difficult situations and past experiences. 

Before entering therapy, it is important to feel prepared enough to have these conversations and to have the right support around you. 

Therapy can work well as a treatment on its own for some people, but others find it useful to do it alongside other things like exercise or mindfulness and people with more severe mental health conditions will also need to take medication.

Types of talking therapy

There are many different types of therapy, which relate to different schools of thought about how people can improve their mental health. It can be confusing to know what kind of therapy to seek so it is important to understand the differences.

Cognitive Behavioral Therapy (CBT)

CBT focuses on the patterns of your thoughts and the resulting behaviors, rather than on past experiences. If you enter CBT, you will focus on what is going on in your life at the moment, not the root causes of your issues.

It is often a short-term therapy and people who start CBT often want to stop struggling with a particular thing, for example, an obsessive thought. 

In CBT, your therapist will work with you to understand patterns you have learnt and how to re-route those mental routines to find different outcomes. Most CBT involves practicing outside of sessions and doing work to observe your own patterns and try to change them.

CBT sessions are highly structured, working through different models to understand your processing, and reflecting on the work you have done outside of the session.

CBT is an incredibly widely used type of therapy. For example, in England it is offered to anyone through the National Health Service, because of its effectiveness. ^[1]

Dialectical Behavior Therapy (DBT)

DBT originates from the same school of thought as CBT and focuses on self-acceptance and learning to regulate your feelings.

The use of ‘dialectical’ means this therapy aims to help someone to bring together two things that seem in opposition – that they can accept who and how they are while also trying to achieve change.

In DBT you will work on developing skills to cope with distressing or difficult life situations and how to cope with emotions that unsettle you when they come up. DBT often includes working in groups with others.

Behavioral therapy

Behavioral therapy is similar but does not focus on the cognitive processing around behaviors. This includes exposure therapy; for example, working with someone with OCD to become less anxious about the subject of an obsession by slowly exposing them to it, and decreasing their reliance on compulsive behaviors to cope .

Psychotherapy

This type of therapy often involves longer term work. Sessions are led by the person seeking support, so that they can talk about the issues they feel are most pressing or that they want to tackle. 

The school of thought behind this type of therapy, originating with Sigmund Freud, is that all present issues have their roots in childhood. If you are entering psychotherapy you should be ready to talk about your upbringing and your family relationships.

Psychotherapists also understand the roots of many feelings and behaviors come from the unconscious mind. One way of accessing this is through dreams, so you might talk about pre-occupations that come up regularly in your dreams.

In this type of therapy, there is a lot of focus on the relationship between the therapist and the person; for example, how learned behaviors from other key relationships play out in the therapy room and how observing this can help a person to grow. ^{[2] [3] [4]}

You will also explore how your mind works; for example, the associations you have with things and how you interpret your own and others’ behaviors and actions. Psychotherapy acknowledges that these associations come into the therapy room through transference, both for you and your therapist, so it is important to understand how and why this is happening. ^[5]

Although this type of therapy and its originator, Freud, have occupied a prominent position in the development of talking therapy, many of Freud’s ideas are now discredited and seen as controversial. It is, however, still widely used and understood to be an effective type of therapy, especially if combined with other approaches. ^[6] 

Humanistic therapy

Humanistic therapy explores how your worldview affects the choices you make, especially the choices that don’t make rational sense because they cause you distress. The starting point for this type of therapy is that the person seeking help knows best and is the expert on their own life.

Humanistic therapy seeks to help people to reach a level of fulfilment, where they feel they are their truest self and the different parts of who they are feel in sync or ‘congruent’.

In this type of therapy, your therapist should hold you in ‘unconditional positive regard’, which means they lead with empathy and, regardless of what you bring into the therapy room or how you bring it up, they will continue to hold you in high esteem.

For this reason, this type of therapy can be really effective at boosting confidence and self-esteem, and for tackling preoccupation  with others’ assumed negative perception of you. Similarly to psychotherapy, humanistic therapy is very directed by the person, so don’t expect the therapist to tell you what to do or cover in the sessions. 

This type of therapy takes a ‘person-centered’ approach, which means you will focus on self-acceptance, and can also include an approach called ‘Gestalt’, in which you examine how things work in your relationships, sometimes using role play to address those dynamics. ^{[7] [8]}

Integrated therapy

Many therapists use elements of different types of therapy and adapt according to the person. This is called an integrative approach. Some also use creative methods to help people to explore what is going on for them, like art or music.

Signs you might benefit from talking therapy

Talking therapy can benefit a wide range of people and is worth considering for anyone who is struggling with their mental health, whether they have a diagnosed mental health disorder or not. Through working with a therapist, you might seek a diagnosis so that you can access other support alongside it. 

People often try to access therapy because they have just gone through a big life change, like bereavement, illness, losing a job or a divorce. Therapy can also be used to address ongoing difficult feelings, the physical and mental symptoms of a mental health problem, or to improve your relationships.

There has been some disagreement in the therapeutic community about certain groups in society not being ‘therapeutically minded’ enough to benefit from it, or some mental health problems being too acute to engage in a therapeutic relationship. This has largely been discredited, with the onus now on therapists to learn how to adapt approaches to work with groups from different backgrounds if they seek help in this way. ^[9]

Which mental health problems talking therapy is used to treat?

Cognitive Behavior Therapy (CBT)

Cognitive Behavior Therapy is widely recommended for a range of common mental health problems and has been shown to be particularly effective with people with Obsessive Compulsive Disorder, anxiety, depression and bipolar disorder. ^{[10] [11]}

Dialectical Behaviour Therapy (DBT)

Dialectical Behavior Therapy tends to be recommended for people with more complex mental health problems like borderline personality disorder, also known as emotion dysregulation disorder, but there has been some disagreement in the medical community about how effective it is with these diagnoses. It is now also sometimes used for other mental health problems, like eating disorders. ^[12]

Psychodynamic Therapy

Psychodynamic therapy is also used for a wide range of mental health problems, including depression and anxiety, and is particularly recommended for people who have experienced their symptoms for a long time or not made progress through other treatments. 

Humanistic

Humanistic therapy is often recommended for ongoing issues or general struggles in daily life rather than just for people with diagnosed mental health problems. People often enter humanistic therapy because they feel motivated to change the way they view the world and address the underlying causes of their feelings.

How to know if you are doing the right kind of therapy

Before entering therapy, it is important to consider your mental health and which of these approaches best fits what you are trying to achieve through therapy. For example, while talking therapy is a collaborative process, the onus is not entirely on the client – the therapist is there to provide their clinical opinion and guide them.

You should also think about how long you want to be in therapy for and what you can afford, as well as finding the right therapist to work with.

What to look for in a therapist

There are lots of things to think about before beginning to work with a therapist. First, set a budget and hone your search to focus on people you can afford to work with. Many therapists offer reduced rates for people on low incomes, so if it is not clear, ask them if that is an option. Also consider how often you can see them.

You should also think about whether you are looking for certain traits and qualities or particular things about who your therapist is, for example, their age, gender or ethnicity. Think about who you would feel most comfortable opening up to, and how important it is to you that they come from a similar or very different background to you.

Be aware that when working with your therapist, you might address concerns   that reveal why you have picked them. If there is a reason this might limit your work in therapy, your therapist has an ethical duty to tell you if they think they are not the right person for you to work with. ^[13]

You might also want to look for someone who specializes in your diagnosis or what you are going through, for example, an eating disorder specialist or someone who has a lot of experience working with bereavement.

You can ask a therapist you are interested in what training and qualifications they have, as well as any professional bodies they belong to, before starting to work with them. 

Remember you can always change your mind. Your contract with your therapist is about confidentiality, not how long you work with them for. 

What happens in therapy sessions

There are lots of different formats therapy sessions can take, which can impact what happens in them. For example, family therapy, couples therapy and group therapy will all be different to individual therapy.

In individual therapy, sessions usually last 50 minutes and take place at regular, planned times, with similar intervals in between them. For all of these types of therapy, they can be face-to-face, on the phone or online.

During a session you might talk generally about how you are feeling and anything that has come up for you since the last session, or you might go through specific exercises, depending on the type of therapy you are in.

Again, depending on the type of therapy, be ready to open up about your childhood, your close relationships and deep concerns. 

Your session should always be a confidential space, unless you pose a threat to yourself or others. Your therapist should go through this with you when you first start working together and agree upon a contract. 

Most types of therapy are structured by the person seeking help and are collaborative processes, so you should feel empowered in the session to bring what you feel ready to, and to work at your own pace. Think carefully about what you do before and after a session, for example, if you see your therapist during the working day and something difficult comes up, will you be able to carry on working?

It can take time to build a relationship with your therapist and for you to begin to see the effect, especially if you are doing longer-term, in-depth work. Therapy is not a quick fix, so it might take several sessions to work out whether it's helping you or not, even for shorter term work. 

Therapy also isn’t right for everyone. If you have tried different types of talking therapy and not seen a difference, you might benefit from joining a peer support group or finding a coach or mentor.

Complementary treatments

Therapy can work well on its own, or it can be something you try alongside other complementary treatments, including exercise or medication. Some people might also try alternative therapies while doing talking therapy, such as herbal remedies, acupuncture or massage to see if they complement each other. 

If you are struggling with a mental health problem, many doctors and therapists will suggest that you should take medication to stabilize your symptoms before you are able to engage in therapy.

Therapy might also form part of your treatment for an inpatient stay, for example, if you have been admitted in a mental health crisis. Working with others who have experienced similar things can help people to get to a place where they are no longer a danger to themselves and are ready to transition back into their community.

Supporting someone who is in therapy

If your friend, family member or partner has entered therapy, it is important to be supportive, as you could play a key role in how much that person gets out of it. 

People have differing views on talking therapy but if someone you know has decided to start seeing a therapist, try to refrain from giving your opinion on it and let them work out for themselves if it’s the right thing for them.

While someone is in therapy they might feel particularly emotionally sensitive and if they have a mental health problem, their symptoms might even worsen for a short time as they confront difficult things and come to terms with their experiences. Be on hand to support them in whichever way they need most, particularly around the times they have a session.

Offer a listening ear if they want to talk about their sessions or what they have learnt, but don’t push them to tell you about it. It can be unnerving if you worry that they might be discovering things about their relationship with you, but try to trust the process.

Be patient with the person while they are in therapy, and help them to be patient too. They might not see an immediate change and sometimes things can seem to get worse when someone first enters therapy before they get better.

FAQs about talking therapy

Psychotherapy vs psychiatry - what’s the difference?

Psychiatry and psychotherapy are different disciplines that require different types of training. 

A psychiatrist is a medical doctor who specializes in mental health. Some psychiatrists work with particular diagnoses and can advise on symptom management, medication and other treatment options. They also have knowledge about the physical elements of mental health problems and can support someone to get treatment for them.

Unlike psychotherapists, psychiatrists can prescribe medication and diagnose mental health problems.

Common misconceptions about therapy

While therapy has become more popular in recent years, there is still a lot of misunderstanding about what it is. A key misconception is that your therapist will tell you what your problems are and how to solve them, including giving diagnoses.

In all forms of therapy, a person will be expected to know what they want to address and be willing to work on it. While some types of therapy are more prescriptive than others, all share the common assumption that the person seeking help holds the power to get better. 

Therapy also now takes place in a variety of settings, and there is a greater diversity of therapists specializing in different disciplines. Unlike the common trope of a person lying on a couch while another, older person interprets their thoughts and behaviors, many people now engage in therapy through apps, video calls, over the phone or in their office. 

There is much ongoing debate about the effectiveness of remote therapy in comparison to face to face work, particularly since the pandemic, when it became popular because of international lockdowns and people wanting more flexible and affordable options.  ^[14]