Help! do I need counselling, psychotherapy, hypnotherapy or CBT?
Deciding what therapy you need is bewildering. You are making a crucial, and expensive, decision. There are dozens of types of therapy, many contradictory claims, and maybe no-one you can turn to for advice. These pages are intended to provide some practical guidance. Please see A consumer’s guide to therapies for more information on many individual types of psychotherapy.
My standpoint is UK-centered. Things will be different in other countries.
First: counselling, psychotherapy, hypnotherapy – what’s the difference?
There’s no clear-cut difference. All these therapists do overlapping things. Sometimes a counsellor and a psychotherapist may do virtually the same things; at other times two counsellors, or two psychotherapists, or two hypnotherapists will be so different in their approach that they have nothing in common.
Hypnotherapists obviously use hypnosis, but nowadays do many other things as well. Those who are not hypnotherapists may use a type of hypnosis, in the form of “relaxotherapy”, relaxation and guided imagery. CBT (cognitive-behavioural therapy) is one specific technique, and all three categories of therapist may use it. Psychotherapists and counsellors who use only CBT sometimes call themselves “CBT therapists”.
Who is better qualified?
In general in the UK, psychotherapists are viewed by some as being more qualified, and as dealing with more deeply unhappy people in more depth. Psychoanalysis is the original variety of psychotherapy, founding a lineage from which many other schools of therapy are descended. Nowadays it is just one therapy among many, and by no means any longer the best. Counsellors are viewed as less qualified then psychotherapists and perhaps as dealing more with situational support rather than core emotional issues. Hypnotherapists are less integrated into hospital and social work frameworks than counselors and psychotherapists, and so are seen as a separate type of beast. But in fact they also do similar things. Hypnotherapists have a rather wide spectrum of capability. Some hypnotherapists (perhaps the majority) offer basic supportive work with an emphasis on making changes to habits of thought or action. Other hypnotherapists, such as myself, do counselling and depth psychotherapy.
However the idea “psychotherapist = more qualified, counsellor = less qualified” is approximate and unreal. Many people termed “counsellors” (and social workers) do deep excellent work with clients who are far more challenging than some psychotherapists work with. And then there are all the coaches, relationship coaches, tantra teachers, meditation teachers, sages, enlightened beings, spiritual teachers and so many others under the general umbrella of personal development. For the majority of people who do not have serious metal health problems needing specialist help, these often cover the same ground as psychotherapy. Well-chosen practitioners from among these can be some of the best and most effective therapists.
“Brief therapy” versus “ongoing therapy”
“Going into psychotherapy” is a specific phrase used in the UK to refer to a major commitment to regular sessions over a long period, maybe a year, maybe seven years. However the majority of all types of therapist nowadays are “brief therapists”, seeing people for weeks or months rather than years. I don’t believe in long-term one-to-one therapy for most people. My personal observation is that mostly the money spent on “going into therapy” on a long-term basis would be better spent on a mixture of brief therapy and well-chosen personal development workshops. Sometimes ongoing work is the perfect answer and I do that with some people, normally at intervals of four or six weeks, after an initial phase or more frequent meetings.
To be clear, “brief” does not necessarily mean “in very few sessions.” Technically it means doing the work of the moment in the number of sessions that takes, rather than a committment to ongoing work. Research shows most often that means 5 – 10 sessions as a very broad average.
So how to choose a therapist?
Does that make things clearer which to choose? – probably not, but don’t worry! The point of all this is that many roads lead to Rome. In many situations it doesn’t matter what category of therapist you choose. A small number of people have a serious mental health problem, and need specialist help. It’s also in my own view important to look for a therapist who deals both with specific everyday behavioural change, and also looks at underlying emotions. In general my experience is that the flexible mix-and-match combination of the two is far superior to a specialised emphasis on one or the other.
Otherwise, think less of the category or school which a therapist belongs to. Instead look for an individual therapist who you feel a fit with and who is experienced. Experience counts.
And over and over again, research shows that one main factor in therapy is the relationship with the therapist – do you feel understood and respected? Do you feel safe to share intimate things? Do you feel that the therapist sees, and stands for, the good and strong things in you, or only sees and focusses on weakness and problems? Do you feel met as a person, or treated as a case? Do you feel the therapist is strong enough to safely hold the strength and intensity of your emotions? All these are human qualities which are independent of any school of thought. And they are what matter.
