To have concerns about counselling

[navymack]

This isn’t about individuals who I am sure mean well and genuinely want to help. But AIBU to worry that some of the treatments offered, at great personal expenditure, are ineffective or even counter productive in some cases?

The costs are really concerning to me - it seems that a lot of money goes into this with universities offering degrees in counselling and individuals charging anything between £30 and £70 per hour.

I have seen over the years people raise concerns about inappropriate things counsellors say to them, and the fact that it isn’t recommended for those in abusive relationships makes me wonder if in fact it is the solve-all it is often presented as being?

I know that individuals will state counselling was helpful to them, but what specifically is so helpful? Is it just having time and impartiality?

Yes matilda but nonetheless, for some people, it doesn’t work, as in, it is ineffective.

For still others, it is actually counterproductive.

I do think there is another dimension to this as well - and that is that for many people who seek therapy, their family or social circle aren't on board with it - but not for positive reasons.

These are people who don't necessarily want the person seeking therapy to address longstanding historical issues or current ones. So they might well spend a lot of time ridiculing it, saying it doesn't work / isn't working quickly enough, or that counsellors are charlatans and so on.

In many cases people seek therapy because of damaging people in their lives. Those people are often not at all motivated to support the person going to therapy for obvious reasons.

So that's a tricky one too - how to know the person discouraging you form therapy is doing it because they genuinely have concerns for you, or because they are concerned about themselves?

My view is that talking things out, thrashing them through, noting patterns and potential problems is a good thing.

Do I think this is something that requires a degree and quite high costs? Honestly, no, I don’t. I recognise my saying so may invite criticism but it is what I think.

YABU. If people want to pay for it let them.

Some therapists can seem to claim it works. This is problematic as the evidence is very low-quality to make this claim for lots of reasons.

I think it is more accurate for a therapist to be upfront and say "We can have a bash at this together. It might help but it might be terrible! We will need to work hard and despite both of our best efforts it still might leave you worse than when you started. On the other hand if we can stick with it there could be more healing than you ever thought possible. Quite likely we will end up somewhere in the middle. Are you sure you want to do this?" And then continually reviewing the process as you go is important too.

@continuallychargingmyphone I don't think that is particularly provocative. It is one of the reasons I plan to invest in a pet cat to talk to. (I am not joking.)

(I do also have a therapist.)

Another issue I have is the lack of clarification over what hard work means in terms of counselling.

@continuallychargingmyphone That's a great point too. Perhaps it's different for different people and therapy styles as well?

I wouldn’t personally discourage anybody from therapy. However, if they were to say to me ‘I’m not sure this is working’ I would not urge them to continue doing so.

Effectiveness can be measured with lots of different scales of the client's experience but not all counsellors or psychological therapists evaluate their practice. Accessing a counsellor through the BABCP or BACP or a psychologist through the BPS ensures a level of training and CPD and governance.

I work for a charity but it's the same in my NHS role and all good therapists will have the belief that counselling is not effective for everyone at all times as it has to be the right time, right therapist and right circumstances. Our clients are sometimes not offered counselling until or unless certain circumstances have begun or ended. This is partly about the safety of the client and partly because of our knowledge of the factors that diminsh the effectiveness of counselling.

The problem is, Navy, we can’t know if it will work or not unless we try it.

My parents were dead against counselling (and they are Psychiatrists!). They absolutely believed it made people worse, could offer loads of anecdotal evidence that it did. They denied me counselling as a child when school and the GP alerted authorities and on several occasions that they were concerned about me. I felt trapped as I knew I needed help as an adult, I knew a pill wouldn’t fix my past and didn’t know where else to turn.

Thank goodness I, in desperation, googled counsellors and found mine. It’s been hugely positive as I’ve already said...life changing.

My friend who’d had a similar childhood to me had free counselling for several years and stated “counselling doesn’t work” when she knew I was going. She spent 1000s on EMDR and I eventually had to step away from the friendship because after she started EMDR she became constantly anxious, angry and eventually aggressive, jokingly talking about murdering people, wishing people dead, threatening suicide if she didn’t get her way and just becoming quite psychopathic in general. I’d known her for years and it was only after about a month of EMDR weekly that this started happening and she started having panic attacks and disturbing nightmares almost immediately. She also developed delusions about having abilities she didn’t posses and would become aggressive if you didn’t agree that she could do the things...she was perfectly sane before she started the therapy. She would often say she thought the EMDR was making her worse but then quickly changed her mind because, I think, she couldn’t bear the truth of facing the fact that she had spent so much money on something that had damaged her even further.

It’s a huge risk.

The comment about not putting the work in has an element of truth. My friend admitted she’d often lie to her counsellor, didn’t open up properly and didn’t take action where she should have and so she decided EMDR might work instead...she didn’t want to spend another two years “just talking to someone”.

Initially, it would have appeared counselling “made me worse”. I was very angry at family and pushed them away for a few weeks. I sobbed until I thought I would break. I was suicidal on one occasion. But my counsellor had equipped me with the knowledge that it would be painful and gave me methods of coping - “if you feel angry towards x this week, it’s understandable given what you’ve shared, but I need to know what you steps you will take to keep both of you safe. What will you do? Tell me.” and we’d develop a plan. I know if I’m ever suicidal, I can call her. I know emotional pain can’t kill me...that doesn’t make it awful to experience but I don’t run away from it or shut it off. It is work. And I can see why, in the short term, in can be easier to not do the work.

Sometimes it’s a case of having a terrible therapist. Sometimes it’s a case of not willing to be open enough or allow pain to be felt in order to release it. It’s deeply individual. And I’d agree there can be many risks but there can also be rewards.

The scary part is not knowing what’s going to happen!

I also think that those scales themselves have lots of limitations, and that checking in and being honest about what is and isn't helpful is equally or more valuable.

@Haireverywhere your charity sounds thoughtful. Maybe working in a team like a charity is helpful as it gives a certain amount of oversight compared to therapy in private practise.

I agree Hair, my counsellor said to me that counselling doesn’t work for everyone and that timing etc can make a huge difference. She also frequently checked in with me about goals and targets and was respectful of when I needed a break or change of focus.

My point really isn’t the massively contentious one people believe it to be. It is simply that I think people struggling or suffering are not always best placed to be ‘cured’ with counselling

But what would you do with distressed or confused individual then?

Is counselling about ‘curing’? Surely it’s about making people feel better, or more in control, or less distressed/less confused. That’s not curing.

I think there’s a discussion to be had around access to taking therapies and that CBT isn’t the answer to everything (much as the NHS might like us to believe). Think there’s also a discussion to be had around quality of training - which varies enormously & accreditation.

But if you are not always recommending counselling then what are you suggesting?

Then are you saying devilish - well, we have to do SOMETHING - let’s send them for counselling?

No, I am sure you aren’t. As I have said, I am not anti it as a possibility. I am anti it as ‘get counselling’ as the solution to all emotional distress and MH problems.

Medication is one possibility, sure. Other times it is just good old time - if someone has gone through something distressing it might take a while for it to settle down. I was on here two years ago or so when a woman was on holiday with her toddler. The little boy had a nasty fall and initially people were supportive to her. She posted about it again a few weeks later and was told to ‘get counselling’ (I’ll see if I can dig it out, although it just might have been in chat.) IMO, that woman didn’t need counselling, she just needed a bit of time for her heart to return to normal!

Grief is another one. Losing someone sucks. If someone feels they need extra support, fine, but still it is going to suck.

One of my friends loves mindfulness - never done it myself but if it’s helping her it’s all good.

There are various options and ONE of those options is ‘wait it out.’ I had a horrendously stressful experience two years ago and all the counselling in the world wouldn’t have helped. I just had to wait it out!

Someone upthread says that NICE recommends counselling for depression.

It doesn’t. It recommends CBT, IPT, relationship counselling in certain very specific circumstances, and MBCT. And says that for adults with persistent sub clinical depression counselling might be helpful, but that the referring professional should discuss with the patient the lack of evidence that it helps before advising it.

In general NHS services only use counselling (as opposed to evidence based psychological interventions) as a last resort for people with persistent mental illness who could benefit from a listening ear and someone to keep a general eye on them. It’s not a recommended treatment for any condition.

A start would be ‘are you feeling better’, surely?

When? At point do you ask that, after how many sessions? And would the number of sessions depend on the person, their issues, their reason for being there?

And what's better? Define that? If you are going to track outcomes and effectiveness it's needs to be fact base.

Some people don't realise counselling has been beneficial for a while. My mum didn't. So do you wait for a cooling off period? But some people will self sabotage in that time. So how do you account for them?

And what if you have something, that the stats show counselling isn't effective for, so you don't try it but you were one of the few that it would have worked for.

Or do you split it into personality types?

A great counsellor isn't great for everyone, so grading counsellors on their positive outcomes won't work either.

You have this idea, that regulation isn't enough, and would like to see outcomes shown but no idea how that would work.

I am anti it as ‘get counselling’ as the solution to all emotional distress and MH problems.

No one ever says this.

Have you ever had counselling navymack? I was forced to have some as part of a therapy ds1 was doing. I didn’t feel I needed it tbh but it was incredibly helpful.

If someone is seeking support and lands in their GP’s then I personally would rather they were offered counselling than a prescription. Of course if someone is chatting to friends then they may get a different response (exercise, night out as well as anything else). But if someone has got as far as seeking medical treatment then surely THEY are asking for something. If it’s suggested as part of a thread then I guess it can be ignored alongside any other suggestion.

I have had counselling suggested to me because we are going through the most horrendous time at the moment (& for the last year) and a lot of friends are concerned by how much we have to deal with. Now I don’t feel counselling is right for me at the moment because the trauma (and it is trauma) is ongoing and too raw and I need to just deal with things at the moment. People have also suggested antidepressants (which I don’t want). They’re just suggestions - and ones that I don’t think are right for me at the moment (I may well look for counselling when things are settled because I know that the events are enormous and I want to ensure I have dealt with them).

But anyhow point being for now I appreciate the concern but don’t follow those particular suggestions. However if I was sat in my GP’s office asking for support then I would rather he suggested/referred to counselling (or maybe exercise - some places doing that now ?) than reached for a medication.

My answers are based on people actively asking for something - not people exploring the way they feel amongst friends or internet sprites.

Not quite.

I recognise regulating isn’t always possible.

Put simply, I think we have to ask ourselves:

What specific problem or problems are we addressing?
In what way will counselling help with these?
Where is the evidence that counselling will help?

I think we’d discover that some of the problems people present with aren’t being helped by counselling.

To give a ‘for instance’ although I have tried to veer away from personal anecdotes, I had to have counselling before I had fertility treatment. I was quite - very - pissed off about it but why did I have to have it? Because IVF can be emotional? I know. Because I had to be prepared for disappointment? I was. Because the fertility clinic wanted to make yet MORE money .., I suspect so

Well I would rather that too devilish

However, I have been to my doctor and just refused counselling. It really isn’t for me, and I have tried.

I do think amongst friends and the ‘net, sometimes “get counselling” is used to try to shut people up a bit!

And people suggesting counselling to friends/ internet poster sare presumably doing so because it has been helpful for them - they’re just sharing an idea. I’ve been known to suggest it because I did find it helpful in the past as it changed my way of thinking about things. The positive effect has lasted years.

But if someone makes a suggestion - whether it’s have a cup of tea, try a medication, alternative therapy or counselling they’re just suggestions. Maybe if counselling has been suggested a lot it’s because people have found it helpful.

Yes but devilish there’s the difference:

I have tried this and it was helpful. Have you considered it?

You’ve tried it and it didn’t work? You clearly weren’t ready for it.

You must have had a counsellor who was a bad fit.

Find another counsellor (not ‘is it definitely for you’?)

Do you see what I mean?

Well we can refuse any treatment we want to (I refuse nearly every medication - that may change as my health changes). But I’d personally still rather see the NHS offering alternatives to medication (when appropriate) in the first instance.

In reality you usually have to pay for any decent talking therapy (I won’t even bother going to my GP when I decide it’s time for some therapy) so it’s all largely theoretical but I won’t be going to be ‘cured’ - more going with acceptance and as way to offload my (understandable) anger. I still think that is better achieved via counselling than medication.