Mental Fitness Matters | choosing a therapist

Some Therapeutic Clarity

It can sometimes seem impossible to navigate the many different types of therapies and therapists. So many people try therapy and say that it’s not for them. This may be true for some, but usually when you get into the weeds of it, it boils down to either: they have not had a therapeutic approach that suits their needs; a therapist they connect with; or worse, they have not seen a qualified therapist. It’s helpful to recognise that there are good and bad professionals in all facets of therapy. The importance is ensuring you know exactly what your therapist is trained to offer, and not on what they propose to offer. Unfortunately, some can be very misleading in how they ‘sell’ themselves. They can provide the pretence of having reputable skills and experience while the small print links to rudimentary training courses often totalling only a few years, or worse days or even hours. Often as the client you are oblivious to the support you are receiving and if this is not to the standard it should be, it can have serious implications to your development as an individual as well as to your mental health. Individuals offering a service they are not properly trained in can be very dangerous for you. With this in mind, we have provided a brief overview of things to look out for when choosing a therapist. We have also included a brief description of what some of the professions do with pros and cons of each. The hope is that this will make you better informed for your future therapy experience. Please note that this is meant as a brief guide to get you going. We suggest that you follow the guidance and search online for a more detailed understanding of therapists that appeal to you.

Therapeutic Guidance

A brief note from Dr Twizell - Founder of Mental Fitness Matters

I made a decision early in my career to become as qualified as I can be in the field of therapy. My reason for this was that it provided me with robust training in the skills required to work across many fields of therapy. Other therapist’s will have their reasons for training but it can be helpful to understand why they took their training journey, as it will likely inform the way they work. So, ask prospective therapists to give you clarity on the points below if their profiles do not paint a clear enough picture.

Robust qualifications should mean that your therapist is training at a bare minimum to a masters level. Their masters should specialise in the field of therapy they are practicing in, for example Cognitive Behavioural Therapy (CBT), or Person-Centred Therapy. People who have done training courses that were a few weeks long are nowhere near long enough to support you effectively, safely, and ethically. I’m sure you can do a crash course on how to fly a plane in a couple of days, you may even be able to sit in a simulator and fly one, but would you trust someone with this training to fly you on your holiday?!

Most reputable psychologists are registered with the Health and Care Professions Council (HCPC), the British Psychological Society (BPS), or some similar registration. Look out for these registrations and track their registration number. HCPC is the gold standard registered body and only bonified qualified professionals are allowed to register. If your therapist is not registered then take this as a tale of caution. You can check the HCPC register here.

Again, we can’t emphasise this enough, if you are contacting people and don’t have clarity on the above, then don’t be afraid to ask these questions. After all, you are parting with good money and you should want to feel confident that it is being put to good use by someone who can effectively help you.

The Therapist

There are many different training qualifications out there and hopefully the definitions of job titles below helps you navigate your way through any confusion. One word of caution: there are differences within each role below, so this is only meant as a set of guidelines for understanding who’s who. There will always be exceptions to these general rules. If you are uncertain about a specific therapist we recommend that you research their credentials. The Health and Care Professions Council (HCPC) is the most reputable place to check accredited professionals. You can check their register here by inputting their surname and selecting their profession.

“Counselling psychologists use psychological and psychotherapeutic theory and research. They work to reduce psychological distress and to promote the wellbeing of individuals, groups and families” (NHS definition).

For counselling psychologists, the relationship is considered to be central to understanding particular psychological difficulties and how these apply. They treat a wide range of mental health problems such as depression and anxiety, eating disorders, psychosis, 'personality disorder', negative life events, bereavement, domestic violence, sexual, emotional and physical abuse, trauma and relationship issues. Counselling psychologists work using a range of counselling skills, techniques, and approaches that are informed by psychological knowledge and research. This is usually a self-funded doctorate, but there is also an alternative route to those undertaking a professional doctorate at university known as the Qualification in Counselling Psychology (QCoP) which is the independent route to training as a counselling psychologist, but all will have a thorough robust training. The practical training requirements are in fact more robust than clinical psychologists and focuses on specific therapeutic one-to-one experience with a range of clients.

“Psychiatrists must be medically qualified doctors who have chosen to specialise in psychiatry. This means they can prescribe medication as well as recommend other forms of treatment” (NHS definition).

After qualifying as a doctor and gaining experience in general medicine and surgery, they specialise in psychiatry. So, the training is robust and thorough. Often Psychiatrists work in hospitals, but some work privately. Unfortunately, often a lot of time is focused on medication type and dosage and less on the therapy. The ones who are afforded the time to work on therapy will do a very similar job to counselling or clinical psychologists, with the addition of being able to prescribe medication. Their caseload will usually be people experiencing serious mental disturbances that may result in them being considered a danger to themselves of others. The best psychiatrists will ‘manage’ treatment rather than ‘deliver’ treatment.

“Clinical psychologists work with people of all ages on a wide range of psychological difficulties in mental and physical health. This can include anxiety, depression, psychosis, 'personality disorder', eating disorders, addictions, learning disabilities and family or relationship issues” (NHS definition).

There are nuanced differences between a clinical and a counselling psychologist, such as the style of training. Trainee clinical psychologists are funded by the NHS which inevitably influence its teaching. However, from a practical perspective within personal therapy they operate in very similar ways. Both are doctorates with a highly selective entry requirement and involve three years full-time training, and the NHS recruit people from either qualification into the same role.

“Health psychologists use their skills and knowledge of psychology to promote wellbeing and healthy behaviours across the population.” (NHS Definition)

Health Psychologists are specially trained to understand the psychological and emotional aspects of health and illness and to bring about improvements in healthcare and related behaviours. For example, they may help people to lose weight or stop smoking. They use their skills to try to improve the healthcare system overall, for example by advising doctors about the best ways to communicate with patients.

Health psychology is a rapidly evolving profession that uses the practice and application of psychology to study behaviours relevant to health, illness and healthcare. Health psychologists are doctors similar to counselling psychologists or clinical psychologists but with a specialism in health. They use psychological science to promote health, prevent illness and improve psychological and physical health. If you wish to work on a physical health issue then a health psychologist may be the profession you seek out.

Educational psychologists “work within the educational system, in the community and with individuals and families. They are concerned with children’s’ learning and achievement, well-being and development at individual, class, school and local authority wide levels.” (NHS Definition)

If you wish to work on an educational issue then an educational psychologist may be the profession you seek out. Educational psychology is the study of how people learn, including teaching methods, instructional processes, and individual differences in learning. It explores the cognitive, behavioural, emotional, and social influences on the learning process. An educational psychologist has a doctorate just like a counselling psychologist or clinical psychologist. They use their understanding of how people learn to develop instructional strategies and help students succeed in school. Educational psychologists focus on the learning process of early childhood and adolescence. However, they also explore the social, emotional, and cognitive processes that are involved in learning throughout the entire lifespan.

“Psychotherapists are trained to help you express your thoughts and feelings and explore what comes up when you do. They listen and provide a non-judgmental space so you can feel heard and understood… and deal with a whole range of emotions.” (UKCP definition).

Psychotherapists employ a range of therapeutic techniques for helping clients and there are many different ‘schools’ or approaches in psychotherapy, so look around for the person you think will help you most effectively. They are not trained to doctorate level but should have reputable training. You can find registered psychotherapists on the UK Counsel for Psychotherapy (UKCP) website (UKCP register).

The role of a sport psychologist has long been ambiguous. The British Association of Sport and Exercise Sciences (BASES) definition of sport psychology is vague and there are conflicting ideas of the role within the industry that further confuses things. Some feel is it performance enhancing for the team, and others the individual. Others think it is therapy, despite the training not being adequate enough to provide this service. Finally, there are others who feel it is a step down from therapy and is emotional support to athletes. The training is at masters level and requires further practical training that usually takes 1-2 years to gain what is called ‘stage 2 qualification’.

It could be argued that the reason for misunderstanding a sport psychologist’s role could be in part due to sport psychologists taking on such a broad and seemingly all-encompassing role and therefore creating differing interpretations that inadvertently confuses the public. This leads to an inability to effectively communicate the role outside their profession, which further compounds the misunderstanding.

Dr Twizell has researched this confusion and proposes the following definition:

“The role of a sport psychologist is to use psychological assessment and expertise to provide coaches, professional staff, athletes and significant others with additions to training programmes that ultimately improves performance in athletic competition.”

All three are extremely broad terms and cover all manner of sins. Training is a key aspect to this and always check the persons qualifications. The psychologist may be the most reputable of the three, but even this only requires an undergrad in psychology and nothing related to therapy. Counsellors should have a minimum qualification of diploma, which is a level below undergraduate but sadly there are many that won’t even have this. Look out for people who have done a BACP accredited course. Confusingly, all these terms used on their own are not protected titles which means that anyone can call themselves a counsellor, therapist, or psychologist. If someone refers to themselves as one of the above on its own then treat it with real caution.

Very broadly, a counsellor “can help you gain a better understanding of your feelings and thought processes and find your own solutions to problems. But they will not usually give advice or tell you what to do.” (NHS definition).

“Coaching is a process where a coach supports you to make a change, learn something new or achieve your goals.” (life coach directory definition).

This is as vague as it sounds. Please do not consider this in anyway as therapy in its traditional form. There are some very experienced, skilled, and credible life coaches out there but unfortunately, they swim in a sea of charlatans. If you are looking for a life coach, firstly do thorough research into a clear definition of what it is and whether it accurately matches what you are looking for. I’m afraid you will have to do a great deal of due diligence to dig beneath the surface of fraudsters. While there have been attempts to create clarity on this role, at the time of writing this, it remains highly unregulated. Unfortunately, there really is no clear consensus on the role, remit, training, pay, or almost any other aspect of coaching. The sheer number of people advertising this service on social media platforms has made it even harder to control. Chances are, if you are on this website, a life coach is not what you are looking for. A fundamental difference between a coach and therapist is that a coach will tell you what to do and is not trained to dig deep into engaging in the explorative aspect that underpins why you might want to change or what might have got you in the room in the first place.

A final important aspect for you to consider aside from qualifications and type of therapy, is what we call ‘therapeutic rapport’, which basically means whether you feel there is a fit between you and the therapist. There is nothing wrong with any of the professions above, as long as you understand the merits and pitfalls of the training and the approach of your therapist, if therapeutic rapport is there then you can’t go too far wrong.

The Therapy

Sometimes it can feel like there are as many different types of therapy as there are therapists out there. It's true that there are a lot of different therapeutic approaches, but for simplicity we have distilled them into three: person-centred therapy; Cognitive Behavioural Therapy (CBT); and Integrative or Pluralistic. We've added some detail below on the three with some explanations. We've also added some other types that fit within these three families.

“Person-centred therapy seeks to facilitate a client's self-actualizing tendency, ‘an inbuilt proclivity toward growth and fulfilment’, via acceptance (unconditional positive regard), therapist congruence (genuineness), and empathic understanding.” (Wikipedia Definition)

Person-centred therapy typically guides you rather than leads you. This is a skill typically practiced by a humanistic therapist, more commonly known as a person-centred therapist. Humanistic therapy is more of an umbrella term, with other therapies sitting underneath. Person-centred is the big brother, it’s the biggest and most popular. However, it has siblings who have significant value. These siblings include: gestalt, existential therapy, solution-focused therapy, transactional analysis, positive therapy and schema therapy. There are specific person-centred therapists and there are also some therapists that have person-centred therapy as the cornerstone of their approach while also using other approaches. Therapists who use this approach, as the name suggests, puts you in the centre of the process and works with whatever you wish to address, so you have the autonomy in your therapy sessions. The premise of this is that you are the driver rather than the passenger in therapy. You decide where to go in each therapy session and the therapist simply observes and guides you through this. While person-centred therapy is credible and effective for all mental health struggles, there are some specific areas where you may require specialist direction. Discuss this with your therapist because the approach will be unique to you.

Gestalt therapy is centred on increasing a person's awareness, freedom, and self-direction. It focuses on the present moment rather than past experiences. Gestalt therapy is based on the idea that people are influenced by their present environment.

Existential therapy encourages the client to use their free will to create a life of meaning or to find a meaning in their current life.

Solution focused therapy is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought the client to therapy.

“Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.” (NHS Definition)

CBT therapist tend to lead therapy. The premise of this is that the therapist utilises all their skills to guide the client to a place they think would benefit them. A CBT therapist will either teach you skills or assign you tasks to complete in-between sessions. Some therapists specialise in CBT therapy, while others integrate CBT therapy as part of their practice. Whichever you choose is a personal choice for you. Examples of professionals who can integrate CBT within their practice include counselling psychologists, clinical psychologists, educational psychologists, or health psychologists. CBT is seen as a huge umbrella with many therapies falling underneath It. While many purists would disagree with this, there are therapies that are part of the CBT family. Examples include, compassion focused therapy (CFT), schema therapy, acceptance and commitment therapy (ACT), or cognitive analytical therapy (CAT).

Acceptance and commitment therapy (ACT) is a type of mindful psychotherapy that helps you stay focused on the present moment and accept thoughts and feelings without judgment.

Cognitive analytic therapy (CAT) focuses on relationship patterns. It is based on the idea that our early life experiences influence the way we relate to other people and how we treat ourselves. This means that sometimes patterns of behaviour, or our expectations of other people’s behaviour, can develop into unhealthy or unhelpful repeating patterns, as well as those that are healthy and helpful.

Compassion-focused therapy (CFT) encourages people to be compassionate toward themselves and other people. It is grounded in current understanding of basic emotion regulation systems: the threat and self-protection system, the drive and excitement system, and the contentment and social safeness system.

Schema therapy aims to help clients meet their basic emotional needs by helping them learn how to heal schemas by reducing the intensity of emotional memories, bodily sensations, and by changing the cognitive patterns connected to the schema.

“Integrative therapy is a unifying approach that brings together physiological, affective, cognitive, contextual and behavioural systems, creating a multi-dimensional relational framework that can be created anew for each individual case.” (Definition – Positive Psychology)

“A pluralistic therapeutic approach advocates that both participants in the therapeutic relationship — clients as well as practitioners — have much to offer when it comes to making decisions concerning therapeutic goals and the selection of therapy tasks and methods. This means that a pluralistic approach emphasises shared decision-making and feedback across clients and therapists.” (Pluralistic Practice Definition)

Integrative or pluralistic therapy mix different approaches to therapy. Therapists who tend to mix different approaches are referred to as either integrative or pluralistic therapists. These are two distinct therapies. Integrative simply means you integrate different models, and pluralistic means that they use different approaches separately at different times. Utilising these approaches requires specialist skills and advanced training so it would be recommended that you seek out a highly qualified professional such as a counselling or clinical psychologist.

A final important aspect for you to consider aside from qualifications and type of therapy, is what we call ‘therapeutic rapport’, which basically means whether you feel there is a fit between you and the therapist. There is nothing wrong with any of the therapeutic approaches above, it's what feels most appropriate for you.