Let’s just assume we’re all on the same page that everyone could benefit from a little bit of personal therapy. Probably couple’s therapy too. But we’ll hold that thought for the moment.

Whether you…

• struggle in relationships (be that with friends, family or romantic partners)
• have experienced addiction issues (substances, alcohol, sex, shopping, gambling, etc)
• have experienced eating disorders
• have lost a loved one
• have suffered from emotional or physical abuse
• have been through a traumatic event
• experience anxiety, depression, compulsive behaviours, intrusive thoughts, or quite simply feel overwhelmed in the social, political and economic landscape we find ourselves in…

… a little bit of support can’t be a bad thing.

But where do you start?

Searching “I need a therapist” online throws up hundreds – nay, thousands! – of options. From sponsored posts like Better Help to the NHS route of GP referral. The influx of information can be enough to stop you in your tracks.

First of all, let’s explain a few definitions…

Psychiatry, psychotherapy, psychology and counselling… what’s the difference?

Psychiatry, psychotherapy, psychology and counselling. A lot of similar sounding syllables. A lot of crossover in terms of practicalities, and how they look to the client or patient. And all can fall under the umbrella term of ‘therapy’.

But they’ve obviously got different names for a reason. So what exactly is the difference between them?

Psychiatry

Psychiatrists are medical doctors specialising in mental health problems. These are the people who diagnose conditions and disorders, and help work out how to best manage them.

You would see a psychiatrist when things are consuming, persistent, or severe. For example:

• if you are experiencing hallucinations
• have persistent thoughts of self-harm or harming others
• feel overwhelmingly sad or anxious, to the extent that it is affecting your day-to-day
• experience distressing intrusive thoughts, traumatic flashbacks or regular nightmares
• have chronic difficulty focussing or making decisions

Psychiatrists will help you work out your roadmap of treatment – whether that’s talking therapy, medication, or other – and will check in with you regularly to work out if anything needs tweaking. If you know something’s up but don’t know where to start, see a psychiatrist.

To make an appointment with a psychiatrist, see your GP who will be able to make a referral.

Psychotherapy

Psychotherapy is talking therapy which can be conducted as individuals, in couples, or in groups.

You would see a psychotherapist when you are struggling with any kind of problem. For example:

• depression
• anxiety
• relationship difficulties
• bereavement

You will talk about your issues together and build a picture of behavioural patterns and possible causes. Over time, self-awareness and resilience will develop, helping you to overcome difficulties, break problematic habits, suffer less and cope better.

You may work together for months if not years, delving in to the roots of your issues in order to alter your behaviour in the present day.

There are different types of psychotherapeutic styles and techniques (more on that later – see schools of thought), some of which may suit you better than others.

To make an appointment with a psychotherapist, there are a couple of options:

• Free therapy is available on the NHS via your GP, but waiting times can be long
• Some charities offer low-cost or free therapy – search your local area
• Some workplaces offer counselling via Employee Assistance Programmes (EAPs)
• Use an online register such as Counselling Directory for private therapists

Psychology

Psychology is the study of people; “the scientific study of the mind and behaviour”. Generally speaking, psychologists aren’t (medical) doctors; they cannot prescribe medication. Their job is to understand people, and apply this knowledge in arenas such as forensics, clinical, counselling or health psychology.

Their work can involve therapy but broadly speaking their focus is on research, assessments, and policy work.

For example:

• A forensic psychologist would use what they know about the human mind to work on criminal investigations (think Mindhunter). They would make assessments, work on treatment plans for rehabilitation, and act as expert witnesses in court.
• A clinical psychologist sits somewhere between psychiatry and psychotherapy. They work with patients to assess, diagnose and treat mental health conditions, without medication. So the difference between a clinical psychologist and psychiatrist is that they cannot prescribe medication. And the difference between a clinical psychologist and a psychotherapist is that they are able to diagnose patients. They will also have research and consultation aspects to their work.
• A counselling psychologist is similar to a clinical psychologist, except their focus would be more on the treatment side of patient care as opposed to diagnosis. Their day to day would look similar to a psychotherapist, except they have the additional knowledge and capacity to diagnose.
• A health psychologist would focus on healthy behaviours as a means to treat patients, such as healthy eating and exercise, alongside talking therapy.

You would see a psychologist when you are experiencing significant or persistent changes in your mood, thoughts or behaviours. Perhaps more serious than if you would choose a psychotherapist, but less consuming than a psychiatrist.

To make an appointment with a psychologist:

• Self-refer via the NHS website
• Speak with your GP
• Use an online register such as The British Psychological Society and use their find a psychologist tool.
• Your employer may offer access to services via Employee Assistance Programmes (EAPs)

Counselling

Similar to psychotherapy, counselling is talking therapy which can be conducted as individuals, in couples, or in groups.

You would see a counsellor when you need immediate support and coping strategies for short term and specific issues. For example:

• Stress, e.g. exam anxiety, changes in your sleeping or eating habits
• Dealing with a difficult boss or teacher
• Feeling ‘flat’ or ‘stuck’
• Going through a breakup

It is similar to psychotherapy but generally speaking less in depth, and for a shorter period of time. For example you may see a counsellor for 6 weeks after being made redundant, or in the lead up to Christmas if you’re worrying about family dynamics.

Counsellors are trained to a lower academic standard than psychotherapists and would need to signpost clients with more serious problems on to the appropriate level of care.

You would make an appointment with a counsellor in exactly the same ways as you can reach out for a psychotherapist – scroll up.

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Schools of thought

When it comes to talking therapy (i.e. treatment via speaking to a professional, with no medication involved), there are different styles and techniques that inform the way the therapist (counsellor, psychotherapist, psychologist) approaches your care.

It’s not up to you to learn about every school of thought in order to choose a therapist. But there might be a style that particularly works / doesn’t work for you.

Three of the main therapeutic approaches are:

• Psychodynamic
• Humanistic
• Cognitive / behavioural

The psychodynamic approach is all about looking back; combing through early life to try and work out what lies beneath. Theorists include Freud, Erikson and Bowlby, who all believed our early experiences shape the way we behave in the present day. You may have heard of Attachment Theory – read my overview here – which is an example of how your experiences as a child impact relationships throughout life.

The humanistic approach is more rooted in the present. It takes your past into consideration but is more concerned with your potential for growth. Theorists include Rogers and Berne, and there’s a general belief that we have what we need inside of us we just might need some help to see it.

CBT is all about how we think, feel and behave. It examines the links between them and aims to catch and readdress irrational beliefs that influence our behaviour and choices.

Different therapists will have trained under different schools of thought – whatever chimed with them, basically! – and will have a different approach to treating their clients.

Integrative therapists use a little bit of everything in their approach.

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Choosing a therapist

There’s a lot of information to try and take in once you’ve made the brave decision to engage a therapist.

You have to consider practical decisions like the merits of in-person vs. online. Drop down menus that list dozens of types of therapy to choose from. Then there’s the blurbs + photos to look at that make it feel like you’re weirdly on some sort of dating app…

Here’s my practical advice:

Online vs in-person

Online therapy is just as productive as in-person. If it makes it easier for you to commit to a time without having to travel, try online first. If you have a busy home and won’t feel like you’re in a private or safe space, go in person.

What’s worrying you

Don’t overthink it, you don’t have to be exactly right and you won’t be held to it. If you’ve said you want to talk about relationship issues and you delve in to disordered eating, you haven’t done anything wrong. Go with it.

Type of therapy

If in doubt, choose integrative. This means they have an understanding of many different techniques (e.g. psychodynamic, humanistic, and CBT) and can pull on different tools and resources to tailor your care.

Professional body

Therapy is an unregulated profession. This means that anyone can technically call themselves a therapist, psychotherapist, coach or counsellor; it’s not illegal for them to do that (just extremely unethical). Qualified practitioners register with a membership organisation which is as close as the industry comes to being regulated. In my opinion, the highest professional standard therapist will be registered with UKCP, the BACP, or the BPS. There are a couple of other decent ones but I personally prioritise them.

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Summary

If you’re thinking about trying therapy for the first time WELL DONE YOU! It’s brave, it’s responsible, and it will change your life for the better.

It’s also extremely confusing and overwhelming to know where to start. Don’t let that put you off! Hopefully this guide can help you through some of the initial choices there are to be made.

Please make sure you do your own research. I am not in a position to advise medical or health care. I am someone who is interested in the human condition, with 2 years of counselling studies under my belt and a one-day-MA in psychotherapy in my mind.

I am not a professional, this is only meant as a helpful guide.

If I’ve got anything wrong, please let me know in the comments. If you’ve tried certain paths and are willing to share your experiences, I’m always really interested to hear about it.

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Living Intentionally is a warm and irreverent guide to modern mindfulness.

I write about themes of happiness, purpose, joy and meaning 🌿

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