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How Does Therapy Work?

Updated: Jul 20, 2021


What is Counselling and Psychotherapy?

Counselling and Psychotherapy are both types of talking therapies, although the terms can often be used interchangeably and mistaken for one another. That's why I tend to use the term 'therapy' to help avoid confusion.

It's not hugely important what type of therapy you go for, in the sense that it doesn't have any implications on the effectiveness of the therapy. It's mostly down to any personal preference you may have. The most important consideration is the relationship you have with your therapist, so if you can, try to gauge in your first session whether you feel the therapist is someone you could see yourself opening up to.

Broadly speaking, both counselling and psychotherapy refer to the same process of speaking with someone who is trained to offer a safe and non-judgemental space for you to talk about whatever is troubling you, and to facilitate exploration of the issues you bring and help you to identify changes you may wish to make in different areas of your life.

Therapists train in different modalities or schools of therapy (e.g. Psychodynamic, Person-centred, Gestalt, CBT) that influence how they work. I work from a Pluralistic perspective, which essentially means that I don't limit myself to the use of one modality. I incorporate elements from different types of therapy depending on my client's needs and preferences.


What can Therapy Help With?

Anyone can come to therapy and bring anything that may be troubling them or causing difficulties in their life. A common worry new clients have is that what they are bringing is 'not enough', that they are not struggling enough to come to therapy, and that they don't deserve to take up space in the therapy room. I would like to encourage anyone thinking of coming to therapy to do so, no matter where you may go or who you may choose to see. You matter just as much as the next person.

Some common reasons why people may choose to come to therapy include:

  • Addiction

  • Anxiety

  • Bereavement

  • Difficult Emotions

  • Difficult Life Events

  • Depression

  • Issues about Sexuality

  • Eating Disorders

  • Experience of Trauma (e.g. childhood sexual abuse, domestic abuse, accident, assault, witnessing traumatic incident)

  • Low Mood

  • Low Self-Esteem

  • Physical Health Problems

  • Relationship Difficulties and Breakdown

  • Self-harm

  • Stress

  • Struggling to Cope

  • Work Problems


What to Expect from Counselling

Length of Therapy

The length of counselling varies, and tends to be either short term or long term. Some people feel they need only a few sessions, while others prefer to extend their counselling for much longer, working with therapist over a course of years. Much depends on what the client feels they need, and a skilled therapist will encourage you to review your therapeutic progress from time to time. Appointments usually take place for an hour each week, but again therapists can be flexible with this if the client wishes. Some clients may prefer to come for shorter appointments twice a week, while others may prefer longer appointments on a fortnightly basis. Some may also opt for an appointment once a month, although this is usually when a client has been working with a practitioner for a number of years, and wishes to have a space they can go to once a month to check in with themselves (and their therapist) and for self-reflection.

Initial Appointment

Most practitioners will offer a telephone consultation or face to face appointment before you commit to longer term therapy with them. This first appointment gives both you and your counsellor the opportunity to decide whether counselling with them is right for you. You will have the opportunity to talk with your counsellor in a safe space about yourself and what has brought you to counselling. Your counsellor may also answer any questions you may have, the way in which they work and what you can expect from counselling with them. This is a chance for you to explore whether you feel this is the right therapist for you, what you want to gain from counselling and what changes you may wish to make in your life.


Once a client decides to go ahead with therapy, the practitioner will usually take them through a 'contract'. This is to create clear boundaries for the relationship. Contracting will usually involve a discussion around session times, length, confidentiality, data protection, cancellation policy and payment (if applicable).


It is up to the client to bring whatever material they wish to bring to the session. Having said that, if the client is unsure of what to bring, a skilled practitioner should be willing and able to encourage the client to open up, and help them to discover whatever it is they want to explore in their sessions. In your sessions, your therapist should listen to you, and support you in finding solutions to your own problems. However, they won't tell you what to do or give you advice.

It can take a while for you to feel that therapy is 'working', and initially as emotions and feelings that may have been buried come up, you may feel overwhelmed.

Therapy can take place individually or in a group, face to face, online, email, live chat or videocall or via telephone. With the global pandemic, many practitioners have taken additional courses to further their online therapeutic skills, which widens clients' ability to find a practitioner who really speaks to them.

Ending Therapy

Once you begin to feel that you've gained what you wanted from therapy, it's a good idea to raise this with your therapist. It's up to you when you wish to end therapy, and you shouldn't feel pressure to continue any longer than you view necessary or beneficial. A good therapist shouldn't encourage dependency, and will gladly explore a therapeutic ending with you. It's important to leave enough time and space to process the ending. Usually the therapist will suggest at least a few sessions in between mentioning an ending and the last session. The therapeutic relationship is an important one, and it can be hugely beneficial to be able to process the ending in the way you wish. Often we have endings that we can't control, for instance with bereavement, relationship breakdowns. Having a satisfactory ending that you can control can be hugely therapeutic within itself. You may want to co-create a letter with your therapist that you can take with you once you leave. You may wish to create a piece of artwork, or find another way of summarising your therapeutic journey.


Take Care,


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