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Firstly, does counselling work?
There have been countless studies over the years, which give a very clear answer to this – it does. When researchers look at wellbeing measures before and after therapy, wellbeing tends to be higher afterwards. Clients also, on average, report themselves as being less distressed after therapy. Both of those types of research are correlations, so they don’t actually show that therapy was the reason clients improved, just that their scores were better after therapy. So you could argue maybe it was just time going by or other factors that helped them. However when you compare people’s distress before and after therapy with a control group who did not have therapy, the group that received therapy generally scores better. This makes it pretty clear that yes, on average, therapy does work.
Ok so it works, but why?
When researchers investigate the main factors that account for the effectiveness of therapy there is one that stands out above all – the relationship between client and counsellor. The main types of therapy are all found to be as effective as each other be that humanistic (which I practice), psychodynamic, or CBT (cognitive behavioural therapy). So whenever someone asks me the most important part of therapy, I tell them it’s the quality of the relationship. But what does ‘relationship’ really mean here?
The aspect of the relationship between counsellor and client that accounts for the most effectiveness is empathy from the therapist. The other factors that have the most impact on the success of the relationship are the alliance or bond, collaboration, if the therapist and client have the same goals, and positive affirmation from the therapist. If the client is not making much progress, then collecting client feedback can also be very effective. This can simply be checking in with three questions from counsellor to client – How are you doing? How is the therapy doing? How are we doing?
Some of these concepts like empathy, alliance, collaboration, or goal consensus can sound quite similar. In fact it’s quite likely that they are, or at least that they overlap somewhat. They are difficult to define, but all seem to be important parts of the relationship which itself leads to positive change for clients.
Trusting your gut
Sometimes it can take a while to build up a relationship with someone new. Going to counselling can make anyone nervous, as opening up to a stranger is not always easy. My counselling training required us to see our own personal counsellor for the duration of the course. So to help pick someone I initially booked three different counsellors for a free (or half price) introductory session. The first person I saw just didn’t gel with me for whatever reason. The other two felt much more my kind of people – I ended up going with the slightly cheaper person! That initial gut feeling may be a good indicator of whether or not you’ll have a good relationship with your therapist. Changing your mind is also fine! If you start therapy and don’t get a good feeling about your therapist, you’re under no obligation to stay. A professional therapist will be open to discussing this with you.
For an example of the research into the effectiveness of psychotherapy, I would recommend Mick Cooper’s book Essential Research Findings in Counselling and Psychotherapy.
If you’re interested in starting counselling please feel free to contact me to find out more.