Get practical advice on where to start, NHS and self-funded options and how to decide what’s best for you
The pandemic has taken a mental toll on many of us, and therapy or counselling can be a helpful option for those finding it difficult to cope. We look at where to seek support and the options available. If you’re struggling, it’s important to seek help. Evidence shows that the earlier you do, the better. We’ve surveyed people about their experiences accessing therapy or counselling during the pandemic and asked experts about the process. In this article, we bring you practical advice on where to start, from how to talk to your GP to what private, NHS and culturally specific options are available – as well as how to decide what’s best for you.
Getting therapy: where to start
The most common first port of call for people we surveyed was their GP, but you can also self-refer – either privately through a therapist directory or online through NHS self-referral service Improving Access to Psychological Therapies (IAPT), currently only available in England. You can also be referred to IAPT by your GP. This service aims to connect people with evidence-based treatments for things such as depression and anxiety. If you’re using IAPT, you’ll fill out an online form and then be contacted by a clinician, who will speak to you more about how you’re feeling and recommend a course of therapy. Another route for referral to therapy is through mental health charities or local community organisations (more on this below). It’s also worth noting that some companies offer a set number of free therapy sessions as part of their health and wellbeing benefits, so you might like to check if this is an option for you. Under Covid-19 restrictions, therapy is mostly being done over the phone or online via video chat.
How to talk to your GP about mental health
It can be daunting to take the step of having a conversation with your GP, but if you’re struggling with your mental health, it’s worth doing so. Here are some tips for tackling the appointment:
Before the appointment
We asked Dr Zirva Khan what people should think about when approaching the appointment. She recommends making a note of your thoughts, concerns and expectations before the consultation, so you don’t forget to discuss what’s most important to you. You might like to think about the outcome you want from the appointment – for example a referral to therapy – if you know. If you’re feeling nervous or worried about the appointment, it could help to have someone you trust there with you.
During the appointment
It’s important to be honest and describe how you’re feeling as best you can. The GP will ask you some personal questions and might get you to fill out a questionnaire to get an idea of what kind of support might best suit you. Your GP should be able to give you individualised advice on what to do next. They might suggest further monitoring of your situation, refer you to therapy or counselling or offer medication. The right course of action differs from person to person – it’s highly individualised. The GP should consult with you on what options you feel comfortable with. If you need time to think about it or have any follow-up questions, don’t be afraid to ask these.
After the appointment
You should agree a follow-up plan with your GP, or they might arrange follow up with another organisation such as local mental health services. If after the appointment you’re not completely happy with how it went, or are uncertain about the proposed course of action, you should arrange another appointment or seek a second opinion to get an alternative perspective.
Accessing therapy or counselling on the NHS
Accessing therapy through the NHS is free and a good first port of call for many. The main downside is likely to be waiting times and slightly more restricted options.
You’ll usually be seen in less than six weeks, but this can differ by local area. Waiting lists can be much longer depending on the availability of types of therapy. One in five respondents to our survey had to wait more than 12 weeks for their therapy through the NHS.
What to consider
Your choice of therapist and type of therapy will be slightly more restricted on the NHS compared with going private, but there still are multiple types of therapy and counselling available. You’ll be assigned a therapist in the first instance, but it’s important to know that you have the right to ask for a different therapist, or a review of the treatment you’ve been offered, if you don’t feel comfortable.
Private therapy and counselling services
Private therapy offers greater variety of choice, but it can be expensive.
Waiting times Private therapy might be quicker to access than going through the NHS, depending on the therapist. In our survey, 61% of respondents were seen within four weeks (compared with 28% on the NHS).
Price Private therapy can be expensive and prohibitively so for some people. A session (usually an hour) can cost anywhere between £25 to more than £90. Some therapists offer reduced rates for people on lower incomes, so it’s worth contacting them to check if this applies to you.
What to know When seeking therapy privately, look for a therapist who is registered with a professional body, such as the British Association for Counselling and Psychotherapy (BACP). Many of these organisations have online directories you can use to find a therapist to suit you. In addition to the BACP therapist directory, there are specific directories for groups such as LGBTQIA+ people and different cultural or ethnic backgrounds. When choosing a therapist, don’t be afraid to ask them some questions up front, such as: How much the sessions will cost What happens if you have to skip a session or stop completely Whether they offer lower rates for people on low incomes (if applicable) What the sessions will be like If you’re worried about a specific issue, how they might deal with that.
Getting therapy through a charity or community organisation
These groups provide affordable therapy options and/or step in to fill gaps in NHS and mainstream routes to therapy.
Waiting lists for therapy through some of the larger mental health charities can be long, but again this will differ from area to area. In our survey, 41% of people getting therapy through a charity or community organisation were seen in less than four weeks.
Price It will vary depending on the organisation – some charities such as Anxiety UK offer subsidised therapy for members; some locally organised counselling or therapy sessions might be free or at a lower price. What to know One in 10 of our survey respondents said they were receiving mental health support from a charity, such as a local Mind or a community organisation. These grassroots organisations can be good for providing culturally specific therapy (see below) or support tailored to a specific community. The challenge for these organisation can be that demand often outstrips supply.
Culturally specific therapy
Culturally specific therapy is where the therapist works with the full cultural background of the person, of which they themselves have a good understanding. It can be helpful to talk to someone who understands the role that your cultural or ethnic background plays in your experiences and identity. But it isn’t as easy to access as it should be. In our survey, one in four people who would’ve preferred culturally specific therapy didn’t receive it. At the moment, it’s easier to access culturally sensitive therapy through private routes than on the NHS. The NHS has started referring people to culturally specific therapy run by charity organisations, but this isn’t standard and is for now mostly concentrated in larger cities.
Types of therapy and counselling services
There are a wide range of different therapies out there. A few of the more common types are explained below, with information from Mind, BACP and the NHS. Not all therapy is individual – you may also seek therapy with a family group, as a couple or in a group of people experiencing similar issues.
Cognitive Behavioural Therapy (CBT)
CBT is a type of talking treatment that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches coping skills and practical solutions to help you feel better. It’s usually done over a set time period of six to 12 weeks. It can help with depression, anxiety stress, phobias, eating disorders and self-management of long-term conditions. This is likely to be one of the first talking therapies you’d be offered on the NHS and can also be sought privately. There is also mindfulness-based cognitive behavioural therapy (MCBT), which combines CBT with mindfulness techniques such as meditation and breathing exercises.
This a broad term that the NHS defines as a talking therapy, and involves a trained therapist listening to you and helping you find ways to deal with emotional issues. The therapist will not usually give you advice or tell you what to do, but help you get to a point where you are able to understand your feelings and thought processes and make those decisions. It can help with depression, anxiety, eating disorders, physical conditions such as infertility and difficult life events such as bereavement.
This is where you work through a self-help workbook or online course with the support of a therapist. Some online tools offer live therapy via instant messaging with a therapist, or anonymous forums with others experiencing similar mental health problems. It’s recommended for depression, anxiety and panic disorder, and can be accessed on the NHS or privately.
Eye movement desensitisation and reprocessing (EMDR)
This is a talking therapy that helps the brain reprocess memories of traumatic events so you can let go of them. It’s aimed towards people with post-traumatic stress disorder (PTSD). While many people find this helpful, the NHS recommends having a support network around you if you plan to try it, as it can bring up intense emotions in the healing process. It can be offered on the NHS and privately.
Interpersonal therapy (IPT) IPT
is a talking therapy that focuses on relationships and usually runs for about 16 to 20 sessions. It can help people with depression identify and address issues in their relationships, as depression can arise from challenging personal relationships or make maintaining your relationships challenging. You can access IPT privately, and you may be offered it on the NHS if you have severe depression or depression that hasn’t responded to a more common talking therapy such as CBT.
Person-centred therapy deals with the way people view themselves consciously, rather than how a therapist interprets unconscious thoughts or feelings. It takes more of a collaborative approach between you and the therapist, rather than the therapist directing sessions, it’s based on the idea that you have the capacity for your own personal growth.
Discussion groups or healing circles
It can be helpful to seek support among people who share similar experiences. You may seek group therapy or counselling through a therapist directory or the NHS. An example is depression support groups specifically for carers, or group therapy for those experiencing addiction. It can also be accessed through grassroots community organisations, which may offer more of a variety of choice and level of cultural specificity than you would find on the NHS or through traditional routes. For example, emotional emancipation circles are self-help support groups run by Black people to overcome and heal from anti-Black racism, while delving into Black histories and stories.
What about medication?
Depending on your situation and preference, medication might be appropriate. Medication can help for acute issues in the short term, or be prescribed as a long-term treatment. Many people find it takes a bit of trial and error to get the right medication for them. The right type, dose and duration of drug treatment is specific to each person, so it’s best to discuss this with your GP or a psychiatrist. More information can be found through the NHS or charities such as Mind.
Mental health and wellbeing apps
There are many apps designed to help keep you on track with your mental health. For example Catch It and SilverCloud, both on the NHS mental health app library, guide you through CBT techniques. There are also mindfulness apps such as Calm and Headspace, which teach you meditation and breathing exercises that may help with anxiety and insomnia. While these can be useful for many people, they’re not a substitute for therapy or counselling. They may be helpful for supplementing or maintaining techniques you’ve developed during therapy.