Depression

Accessing talking therapies

Current government policy aims to make talking therapies more easily available on the NHS. Guidelines for the treatment of depression advise doctors to refer patients with a new diagnosis of mild to moderate depressive symptoms for talking therapies before prescribing antidepressants. Types of services and the availability of them vary enormously across the country. The NHS in England is increasing the availability of talking treatments through their Improved Access to Psychological therapies (IAPT) programme. You can access these services via your GP, although many IAPT services allow you to self-refer.

Unfortunately there are shortages of talking therapy practitioners in the NHS, and so there are waiting lists. Some GPs may provide basic counselling themselves their surgeries have a counselling and/or psychotherapy service in-house. Online CBT may be quicker to access than other talking therapies. Some people found their own NHS counsellors/therapists (e.g. from talking to friends or other health professionals) and asked their GP to refer them.

The waiting times for NHS therapies reported by the people we interviewed were in the range of 6 months or longer though this has improved slightly in recent years. MIND the mental health charity did a survey of 2,000 people in 2014 and found ‘Half had waited more than three months for an assessment, with 1 in 10 waiting more than a year for assessment’. A few of the people we talked with felt they had to really fight to get to see a therapist on the NHS. One woman fought to see the only NHS therapist in her area. Shopping around for a therapist that suits you on the NHS can be difficult because of long wait times and the potential for disappointment if after a delay the therapy is not suitable. For these reasons, some people chose to pay privately for talking therapies, and to find therapists through various means (e.g. Internet, recommendations from friends or professionals, through professional associations). Private therapists usually charged between £20 - 50 per session (this often varied with ability to pay- prices quoted from 2004). Some people liked having some control where they could choose their private counsellor/therapist more carefully and pay them to listen.

Choosing a therapist

People gave advice on how to choose a private talking therapist, and suggested you needed to visit a number of therapists before deciding. While approaches were different, the key question was “Is this talking therapy good enough for me?” In the UK, people can call themselves counsellors or therapists with minimal training, so it is important to check their credentials. It was also suggested that people need to trust their instincts and reject therapy that feels wrong, even if you are not sure why.

One problem is that when very depressed, it is difficult to judge whether a therapy is good enough. It was suggested that people should make decisions about therapy when they are feeling relatively well. Various ways were suggested for working out if a therapist was OK, depending on what you were after. Clearly one therapist/approach might suit one person but not another.

Among those we talked to, men and women tended to have different attitudes to therapy. Women looked at therapy as an important relationship' you don't just form a relationship with anyone. Instead, you look for qualities like honesty, positive regard and trust. One woman liked her current counsellor' she could relate to her as a real human. She appreciated the honesty and challenges in the relationship that helped her to get to the root of her problems.

The men tended to focus on practicalities and finding solutions when evaluating therapies. Many men liked cognitive behaviour therapy for this reason. One man liked a therapy called 'systemic consultation' where his needs were acknowledged, real attempts were made to understand his point of view, the focus was on present difficulties rather than the past, and practical, positive ways forward were discussed. He had previously tried several less helpful approaches to therapy.

Suggested check-lists for assessing good practitioners included:

• Do you like them? 
• Do you feel you have been heard? 
• Do you feel they acknowledge and respect your views? 
• Do you respect them? 
• Do you feel safe? 
• Are boundaries in your relationship respected? 
• Will you be able to be honest and tell them the things you are ashamed about in your own behaviour? 
• Do they respect your confidentiality? 
• Is your therapist warm towards you? 
• Do you come away from therapy with a better understanding of yourself? 
• Do you feel they are non-judgemental? 

One problem in choosing a therapist is that the inevitable imbalance of power favours the therapist. However, a skilled therapist should be able to facilitate a discussion around inequality in the therapist-client relationship to help you better understand how you feel about it. Also, settling on a counsellor/ therapist can be confusing because even when talking is helpful in the long run, some sessions can be uncomfortable, leave you feeling angry, or seem like a waste of time. Skilled therapists can help clients work through such feelings.

Another problem with choosing a therapist is that they can sometimes turn out to be wrong for us many months or years down the track. One woman felt a good deal of hurt and rejection when her counsellor suddenly announced after 6 months that she could no longer work with her. Ordinarily, a therapist should be able to tell you after an initial assessment period (approx. 1 to 6 sessions) whether or not they feel they can work with you.

Last reviewed September 2017.

Last updated April 2015.