Selecting a Counsellor or Therapist: Narrowing the Choices

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Choosing a counsellor well-suited for your own particular needs and preferred ways of working is no small task, but a little preparation can make the job easier. The separate section on Finding Counsellors helps with the problem of finding them in the first place.

The Informed Consumer

If you’re visiting this site, chances are you already have some informed ideas about counselling and psychotherapy, and if you’ve visited the section “Types of Counselling and Psychotherapy”, you may already have narrowed down the search to one or two approaches to counselling which could benefit you. Once you have located some possible counsellors, this section is designed to help you evaluate the services which different practitioners might offer.

Not all of the following questions will necessarily be relevant to every person, and some people will find certain questions relevant but comparatively uninteresting or unimportant. Each one, however, is a reasonable question which any counsellor or psychotherapist should be happy to answer — or if they don’t have an answer, they should at least be happy to explain why. Many of the questions will probably be addressed by individual counsellors’ practice leaflets.

It is possible that a counsellor approached with every single one of these questions could find it a little odd: most clients do not ask anything like this range of questions. Some, possibly including therapists from psychoanalytic traditions, might even begin to form hypotheses about the unconscious motivations of a client prone to asking so many questions. But on the other hand, it is your right to ask anything you want, and it is your right to ask for clarification of anything that you do not understand. You should never be made to feel uncomfortable for asking questions, however distinguished or authoritative or self-confident your counsellor might seem.

Some of the resources in the annotated bibliography (“Counselling, Psychotherapy & Mental Health Bibliography”) — particularly including the 1995 book by Dryden and Feltham, Counselling and Psychotherapy: A Consumer’s Guide — may prompt more questions, but here’s a start…

Specific Questions for Counsellors and Therapists

Some of the questions below may be helpful for exploring whether a given counsellor or therapist is right for you. Of course, you’ll undoubtedly have your own questions, too — these are just intended as a starter!

Confidentiality and Security

Q. Will our discussions be kept confidential?
Ordinarily, you should expect session content to be kept confidential, although most counsellors work under supervision and will share client details with their supervisors. See our separate page about supervision: “Supervision in Counselling and Therapy”.
Q. Are there any circumstances under which my personal details would be shared with someone else?
Most counsellors operate under ethical guidelines which require them to divulge client details under certain circumstances, such as instances where the counsellor believes the client has become an immediate threat to themselves or others. Counsellors in the UK are also obliged by law to report intances of terrorist activity, and counsellors working under the auspices of the UK’s NHS are required to report certain instances of child abuse. In virtually all cases, counsellors should make their clients aware if a situation develops that they believe may require them to break confidentiality.
Q. Are you registered under the Data Protection Act (UK only)?
In the UK, it is a crime to hold personal details on a computer (for all but very narrow purposes) without being registered under the Data Protection Act. If personal details are held only on paper, the Data Protection Act does not apply, but it may also be of separate interest to you to know if your counsellor relies entirely on paper records.
Q. Do you keep written notes of counselling sessions, and if so, how are these secured?
Many counsellors keep notes of client sessions, and you have every right to know how these are handled in terms of physical security for paper records and in terms of physical and electronic security for computerised notes.
Q. Will you tape record any of our counselling sessions? May I record the sessions?
It is common for counsellors to ask to record sessions for use in supervision. If they do this, it should always be with your permission, and they should provide you a written assurance of how the recording will be used. It is less common for clients to record sessions, but some people find it helpful to reflect on recordings after the session.

Ethics and Supervision

Q. Which ethical guidelines do you work to? Where can I find a copy?
Every counsellor should be able to answer this question and to point you in the direction of a copy of the relevant document. You may wish to consider carefully whether to work with a counsellor who subscribes to an ethical framework without the backing of a recognized professional organization.
Q. How can I make a complaint if there is ever a problem?
All ethical frameworks for counselling and psychotherapy provided by major professional organizations include a specific procedure for handling complaints against practitioners.
Q. Is your counselling work supervised?
In the view of many people (and this site), supervision should be an integral part of every counsellor’s and psychotherapist’s practice. As mentioned above, we have a separate page about supervision: “Supervision in Counselling and Therapy”. We also have a whole section on “Clinical Supervision, Training and Development”.

Qualifications and Theoretical Orientation

Q. What academic qualifications do you have?
Some people list a couple of dozen initials or acronyms after their names, and this can make it challenging to figure out exactly what they have studied and for how long. For instance, university degrees (a rarity in the subject of counselling itself) usually require several years of full-time study: depending on country, subject and individual, a Bachelor’s degree (e.g., BA or BS) will normally take 3-4 years, a Master’s degree (e.g., MSc or MA) 1-2 years, and a PhD 3-6 years. Diplomas, which may be aimed specifically at postgraduates or at a more general audience, often require up to 1 year of full-time study or up to 3 years of part-time work. Certificates are the most difficult to pin down, since they may range from just 20 or 30 hours up to 100 or more hours. Not surprisingly, it is certificate qualifications which frequently populate counsellors’ lists of acronyms. (Note that the word ‘certificate’ carries a different meaning in some US contexts, where it refers to certification by a counselling body that an individual has met certain requirements.)

If you would like to understand better exactly what someone has studied and for how long, it is often helpful to know how many hours of study were completed and in what areas. This can make it easier to identify the difference between two counsellors each describing themselves as ‘fully qualified’, one of whom might have completed, say, a 30-hour counselling skills certificate and one of whom might have finished a 600-hour postgraduate diploma and a university degree. It can also help distinguish between a counsellor who says they spent three years qualifying and someone who says they only spent a year: without more information, it’s impossible to compare the two, because we have no idea how much of that time was actually spent learning! It really is pointless when therapists say things like “I spent X years getting qualification Y”. As is the case with so many things in life, the real question is not “How long did you take to do X”, but “What did you do in the time you took?”.

With regard to qualifications, it is also worth noting the difference between labels such as ‘counselling’, ‘counselling skills’, and ‘counselling studies’. The first refers to actual counselling and is usually studied by people who want to do counselling. The second refers to techniques of counselling, such as listening skills, which are often studied by counsellors as well as people from a wide range of other professions who may find such skills helpful in their own lines of work; usually, ‘counselling skills’ training includes little if any exploration of underlying theory. Finally, ‘counselling studies’ is usually about counselling and may include research on counselling methods, or demographic studies, or other aspects once removed from the act of counselling itself.

Last but not least, some people in the UK use initials such as ‘UKCP’ to indicate their membership in a professional body and their adherence to a published ethical code. A few also use ‘BACP’ for the same purpose, even though that organization specifically recommends against this practice. The important point is that these initials indicate membership, not qualification. Likewise, initials which begin with ‘F’, such as ‘FRS’, ‘FRSE’, ‘FRSA’, ‘FBACP’, etc., indicate fellowship in the relevant body; fellowship is normally bestowed only upon individuals who have distinguished themselves in some way in the view of that body, but fellowship is not itself a qualification. (Also, criteria for fellowship vary wildly: FRS or FRSE, for instance, are by far the strongest indicators of professional standing of those acronyms listed here.)

Q. What is your theoretical orientation?
If you are drawn specifically to one or more approaches to counselling, the question of theoretical orientation may be one of the most important determining factors in selecting a counsellor. Keep in mind, however, that a counsellor from the ‘wrong’ theoretical orientation, but with whom you feel a strong personal rapport, may be more helpful than a counsellor from the ‘right’ theoretical orientation, but with whom you feel uncomfortable or otherwise unable to form a sound working alliance. You may wish to consider carefully whether to work with a counsellor who espouses ‘eclecticism’ — adopting techniques from other schools of thought — as their sole theoretical approach.
Q. Do you work strictly within your theoretical orientation?
Many counsellors incorporate ideas or techniques from other theoretical approaches, so you may find it useful to know whether a given counsellor works entirely within one theoretical framework. Working strictly within one theoretical orientation does not necessarily indicate that a counsellor has a ‘closed mind’; it may be that they strongly value the underlying theory of that particular orientation and feel that they can be of most help to their clients by remaining within that theoretical framework. Likewise, working very broadly and drawing on whatever seems to work may not indicate that a counsellor has an ‘open mind’; such a counsellor may simply be reluctant to engage with the relevant bodies of thought in any great depth.
Q. If you draw on other approaches, do you have any qualifications in these other areas?
Since many counsellors do draw on ideas from approaches other than their own, it may be worth knowing whether they have studied any of these approaches at length. Even if they have not earned qualifications in these areas, it may still be possible to get an idea of their depth of familiarity with them. There seems to be significant value in learning about more than one approach, and many of the leading figures of counselling and psychotherapy qualified in one area before going on to pioneer schools of thought either slightly or completely different (e.g., Beck, Ellis, Jung).

Fees, Contracts and Duration

Q. How long will counselling sessions be?
For adult clients, the ‘counselling hour’ is usually 50 minutes long, but sometimes it can be longer and very occasionally shorter.
Q. How many counselling sessions will I have per week?
For most types of counselling and psychotherapy, client and counsellor will meet once per week, although two sessions may occasionally be offered. The chief exception to this general rule occurs with psychodynamic, or psychoanalytic approaches, where therapists often require clients to commit to attend three, four, or even five times per week.
Q. How much do counselling sessions cost? Is this negotiable?
Unfortunately, it is impossible to draw conclusions about quality from the level of the fee: there are just too many other variables which bear on both. Some counsellors offer concessionary (lower) fees for students or the unemployed, while some link fees to a client’s level of income. Some may also make special arrangements for clients who find themselves out of work after commencing counselling.
Q. How do you charge for the assessment session?
The initial session — the one where you might be asking some of these questions — may be charged differently, and it may last longer than an ordinary session. There is no set pattern to charging for the assessment session: while some counsellors charge more, some charge less or even offer assessments for free.
Q. How do you accept payment, and on what schedule?
Many counsellors still work with cash payments, although an increasing number accept credit and debit cards. Payment schedules vary widely, including immediately subsequent to a session, in advance, or after a short number of sessions. It is very rare for more than a month to pass before payment will be expected.
Q. How long would you expect us to work together?
Your counsellor may already have some idea of how long you might need to work together, and it may be useful to compare this with your own preferences as well as to consider how this fits with your budget. It is possible that your counsellor will have no idea what to expect in terms of duration until he or she has already spent a significant amount of time with you. Practitioners working within psychoanalytic traditions may require a commitment numbered in years.
Q. Do I have to commit to a minimum number of counselling sessions in advance?
Some counsellors require advance booking of a set number of sessions. Sometimes this is seen as appropriate in view of the commitment the counsellor is making to set aside a particular slot of time during the week which will belong exclusively to one client. Some counsellors view it as important that the client demonstrate commitment to the process by paying for several sessions in advance, while others take the view that some minimum number of sessions is required to make progress with a client.
Q. Am I charged for missed counselling sessions?
Because the counsellor makes himself or herself available at the agreed time, whether or not the client keeps the appointment, most counsellors will charge for sessions which are missed without notification in advance. This may amount to a whole fee or a reduced fee. Some counsellors treat cases of illness differently, and most will specify a preferred notice period for cancellations.
Q. Am I charged for planned holidays and vacations?
Some counsellors charge even for sessions which are missed due to holidays planned in advance, although ordinarily they will not charge you for sessions which they themselves miss due to holidays and vacations. If your counsellor does charge for sessions missed due to holidays, it is important to know this in advance.
Q. Can I smoke during counselling sessions?
Non-smoking policies may be enforced both by individual counsellors and by institutions within which they work.

Effectiveness

Q. Is there any research on the effectiveness of your therapeutic approach for addressing my particular problems?
It may be helpful to know whether research evidence shows a particularly good fit between your particular distress and what your counsellor can provide.
Q. What are your views on researching the effectiveness of counselling?
Some counsellors may be averse to the very idea of trying to determine what works using empirical methods. It may be useful to see how your counsellor’s views compare with your own.

Experience and Specialisms

Q. How long have you been in practice?
Although research does not indicate that practitioners who have been in practice longer provide any more effective service than less experienced colleagues, nonetheless it may be important to you to have an idea how much experience your counsellor has accumulated.
Q. How many client contact hours have you logged during this time (or in the last year, etc.)?
Years of practice do not translate straightforwardly into actual clinical contact time, so another way of gauging counsellor experience is to enquire about total hours directly. Very few counsellors or psychotherapists, even the minority who work in the profession full time, spend more than 25 hours per week of actual contact time with clients — and most spend significantly less than that.
Q. Have you worked previously with clients experiencing my type of distress?
In some theoretical orientations, it is not considered necessary to have domain-specific knowledge in order to work effectively in a particular area, while in others it is considered essential. Previous experience with your particular type of distress may or may not be relevant to whether your counsellor can help you effectively, but you have every right to ask.
Q. Do you specialize in any particular areas?
It may be useful to know whether your counsellor devotes particular effort to any particular areas, although again this may or may not be relevant to what they can offer you.

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