Counselling

Action on Depression spoke with Shane Buckeridge, who is both the lead advisor in Scotland for the British Association for Counselling and Psychotherapy and an NHS Counsellor to find out more about counselling and how it might help someone with Depression.

1. What does the term ‘counselling’ mean?

Counselling is about offering a therapeutic relationship with a trained professional to help you understand the underlying causes of your problems and help you to find different ways of coping with and dealing with your difficulties.

2. How might counselling help someone with Depression?

Counselling can help people to understand the underlying causes for their Depression such as earlier life events which may affect how you view yourself, or identifying patterns of behaviour which may add to the Depression. Counselling can help people to understand their own expectations of themselves which may be unrealistic or difficult to maintain and to find alternative ways of dealing with life’s challenges.

For many people with Depression the worst part is that they each feel that they are the only ones in the world feeling this way. Counselling can offer a safe non-judgemental space to help them to understand the underlying causes, find methods of coping and to find ways forward.

Often I find that people with Depression can deny themselves the very things that may help them, for example by withdrawing from those close to them, not attending appointments or punishing themselves for their depressed feelings.

3. What happens in a typical counselling session?

This can be different depending on the type of counselling but normally the counsellor will try to explore the background to your difficulties, what led you to seek help, clarify boundaries (of confidentiality, number and frequency of sessions available, payment etc.) and what you’d like to get from the work. The sessions then tend to build upon each other by getting deeper into the underlying causes for the problems. It is very much a collaborative process in which you are encouraged to take the lead in terms of the topics that are explored.

4. Can you summarise the different types of counselling available so I know what is right for me?

There are many different theoretical approaches practised by counsellors. The most popular ones in Scotland are: Person-centred, Psychodynamic, Gestalt, Humanistic, Transactional Analysis, Cognitive Behavioural and Integrative. There are explanations of these on the BACP website.

The most important aspect for people to consider when choosing a counsellor is how comfortable you feel with him or her, as research suggests that the most important aspect of successful therapy is the therapeutic relationship.

If you have any questions about the counsellor’s training, qualifications, practise or their membership of professional associations you should feel free to ask them.

In spite of the range of approaches the aim of the counsellor is to create a safe and confidential place in which to help you understand and address your problems.

5. How much can I expect to pay?

Many agencies offer free or by donation counselling sessions. Normally a private arrangement can cost approximately £25 – £50 per appointment. Some counsellors working privately offer fees based on a sliding scale meaning that the cost would depend upon your own financial circumstances. This should be made clear at the outset. Many counsellors working privately offer a free first appointment so that you can get the chance to see if you feel able to work with them.

6. How can I find free counselling?

Normally your GP should be able to tell you about local counselling services available, alternatively try BACP or COSCA. For some people working in organisations your employer may offer a free Counselling Service through your Occupational Health Department or through an Employee Assistance Programme (EAP). Details of either of these should be available through your Human Resources Department or on notice boards at work.

Additionally many voluntary organisations offer free or by donation services. Details of these are available in your local telephone directory, through your GP or in your local library.

7. Why do I have to go on a waiting list to see a counsellor?

Counsellors that are employed through agencies or NHS may be contracted to work limited hours and so this may mean that the amount of referrals they receive will outweigh their capacity. In services where people are referred to counselling, the service can sometimes prioritise referrals so that those in most need can access the counselling services sooner.

8. How do I go about finding a good counsellor?

See the response to question 4 and 6. Additionally recommendations from a friend or colleague can be useful. For others who don’t feel comfortable with this, contacting your GP or other health care professional may be easier.

The most important aspect is that you feel safe with the counsellor and that he or she is a member of a reputable professional association such as BACP, COSCA or UKCP. All of these organisations have a register of approved members, codes of practice/ethical frameworks and have a complaints process that members subscribe to.

9. How long can I expect to be in counselling?

The length of counselling depends upon the nature and severity of the underlying issues. Everyone’s circumstances, supports available and internal resources are different so the counsellor will try to work with each individual to develop an appropriate contract. It is important that reviews are built into this so that the client can have some control over the number and frequency of sessions.

Many agencies, NHS services and EAPs offer a fixed number of sessions – normally between four and six, and the counsellor should make this clear at the beginning of the work. In some services it may be possible to extend these. If the counsellor has concerns that the number of sessions that are available may not be enough then he or she will discuss this with you early on and make recommendations about other services that may be able to offer longer term work if this is what you need.

10. Are sessions totally confidential?

Counsellors are bound by their ethical frameworks or codes of conduct and practice depending upon which professional association that they belong to. Normally what is discussed in the session remains confidential with the exception of situations whereby clients reveal details of their intention to harm or abuse someone else or themselves. Additionally counsellors are required by law to disclose information relating to acts of terrorism, drug trafficking and in certain circumstances, abuse to a minor.

In some services counsellors may be required to provide feedback to referrers about the counselling work but this should be made clear in the first meeting or through client information leaflets. In these situations the information given should not include specific details about what you are talking about. This should be confidential between you and the counsellor. But the referrer may request information about whether or not you are attending counselling and if the counselling is useful.

11. What happens if I decide that it isn’t for me and I want to stop?

Ideally this would be discussed with the counsellor to see if the sessions can be improved, but you can always choose not to return. Ordinarily having reviews of the work (either suggested by yourself or the counsellor) offers the opportunity to explore the value or otherwise of continuing.

For many people counselling can be a painful process as it may mean revisiting very difficult memories and how they impact on the present. In my own practice I often find myself telling people that the times that they least feel like seeing me (excluding physical sickness) are probably the times that they can get most benefit from the work.

Many people who are experiencing depression find that they withdraw from the world making them feel worse and making it harder to re-engage with others. If people can’t get to the appointments to see me then it’s hard for me to help them!

12. I have a specific problem. Can I just get counselling for that problem?

Yes, you can always focus on one area. It is important that you feel in control of the work with the counsellor and that it is a collaborative process. Counselling takes a holistic approach recognising that our emotions are not compartmentalised, for example: if I’m feeling particularly stressed at work then this will impact on other areas of my life such as not being able to sleep or being short tempered in my relationship with my partner so it is important to bear in mind that there may be other areas that are affected by the presenting problem.