How to choose a therapist

Hi I’m Sarah! I’m a Manchester psychotherapist, working worldwide via Zoom.

People are starting to talk about mental health in a new way and it's getting more exposure on TV or on the radio and other media. Whilst discussions are increasing in number and scope, there are still a lot of people who have never experienced therapy. This can leave them at a disadvantage when they are trying to get help as they may be dealing with terminology they don't understand.

In this post, I'm going to focus on some things to consider when choosing a therapist. 

I will cover:

What is a psychotherapist?

Who regulates therapy in the UK?

How long does counselling training take in the UK?

What is the difference between a psychiatrist, a psychologist and a therapist?

What is a psychotherapist?

In the UK, a psychotherapist should ordinarily have studied for 4 years at a postgraduate or masters level. Courses are often part time since therapists frequently become therapists as a second career and need to fit training in around work or other commitments.

Who is the UKCP?

The UKCP is a body which voluntarily regulates psychotherapists in the UK. The UKCP expects psychotherapists to have completed a 4 year part time course at masters level and among their requirements, to have 450 hours of client hours (working with clients).

They would ordinarily have been in personal therapy on a weekly basis throughout the duration of the course (and in some cases for several years thereafter whilst completing the necessary requirements for accreditation). This means that if you choose a UKCP psychotherapist (like me!) they have already checked that your therapist meets their standards. 

How long is counselling training in the UK?

Counselling training in the UK will often refer to different levels. Most qualified counsellors will be at least a level 4, which normally requires a minimum of  100 hours of client hours and several years training (depending on their background, they may have completed previous training or hours prior to this).

Who is the BACP?

The BACP is the British Association for Counselling and Psychotherapy. It’s one of the main voluntary regulating bodies in the UK.

Some, but not all, courses will also require personal therapy. Some counsellors are members of the BACP (a body which voluntarily regulates counsellors and psychotherapists in the UK). The BACP requires that you complete 450 client hours before becoming an accredited member and that you have trained for at least 1 year full time or 2 years part time. 

It is worth noting that the UKCP requires 4 years training to call yourself a psychotherapist whilst the BACP does not stipulate this. Some people use counsellor/psychotherapist interchangeably and using one title over another does not necessarily signify a higher level of training. If in doubt please ask your therapist about their training.

Is therapy regulated in the UK?

Therapy is not currently regulated in the UK.

Neither counselling nor psychotherapy is regulated in the UK. That means that there are no accepted standards as to what constitutes a psychotherapist, therapist or counsellor. It is therefore theoretically possible to have no training and call oneself any of these titles. Most therapists take their jobs and responsibilities very seriously and this is an unlikely but possible scenario.

What is a psychiatrist?

A psychiatrist is a doctor who has completed additional training in psychiatry. Psychiatrists are regulated (you cannot call yourself one unless you meet the specified criteria (you must have a medical degree and a specialism in psychiatry). Psychiatrists can prescribe drugs for mental health issues. Since they specialise in complex mental health issues, you may be referred to a psychiatrist for an evaluation or if your GP recommends that you seek additional help for your medication requirements. If your anti depressants are not helping for example, you may be referred to a psychiatrist for further evaluation on the best medication for you.

What is a psychologist?

A psychologist is somebody who has studied psychology. After a degree in psychology, it is common for psychologists to undertake additional training to specialise in a particular field.

Titles such as counselling psychologist, clinical psychologist, educational psychologist, forensic psychologist are also protected. A psychologist is not a protected title.  

You can also read my post The difference between a therapist, counsellor, psychotherapist, psychologist and psychiatrist.

Are qualifications important when picking a therapist?

It is worth noting that whilst qualifications are an indicator of the training a therapist has received it does not necessarily make them a good therapist and nor does it make them the right therapist for you.

Training is important but does not always reflect competence particularly in working with a specific population.

So you should treat it as relevant, but not all defining.

Don't try to convince yourself that a well qualified therapist that you don't get on with or feel comfortable with is your fault.

Find someone you want to work with who you feel can help you.

What is accreditation?

Accreditation is the assurance that your therapist meets a minimum standard of training.

As mentioned above, the UKCP voluntarily regulates psychotherapists and psychotherapeutic counsellors (who must have completed at least 3 years part time training) and the BACP voluntarily regulates counsellors and psychotherapists.

Both bodies expect ongoing supervision which means the therapist discussed their clients and their work with a qualified supervisor on an anonymous basis in order to gain support and insight into their work.

They also expect CPD which is continuous professional development and means the therapist has a responsibility to update their skills on an ongoing basis, including, reading, attending courses, training or conferences, and personal therapy.

Are all therapists accredited?

Because accreditation is voluntary, not everyone is accredited.

Some people do not yet meet the standards for accreditation set out by the bodies I mentioned.

Some people will be accredited by different bodies (there a number of bodies who accredit psychiatrists, psychologists and other types of therapists).

Some people will not want to pay to be accredited.

Some may be accredited by several organisations (you can join both the UKCP and the BACP for example).

Accreditation should be viewed in much the same way as qualifications. For example, I became accredited with the UKCP in 2018, and I was an effective therapist before I was accredited.

Some therapists may be working towards accreditation; that is they are still in the process of completing the necessary requirements to apply. It took me an additional 2 years on top of my 4 years training to meet the UKCP requirements; some people will be able to meet requirements sooner than this.

What is a licensed therapist in the UK?

In the UK, there is no such thing as a licensed therapist.

You can be accredited (as outlined above, and it is important to find out by whom) and you might be qualified (and it is also important to know what the training was, since training is not standard and the idea of being qualified is not regulated).

In the US therapists are licensed on a state level. This doesn't exist in the UK, so no UK therapist will call themselves licensed unless they are also licensed in the US. 

Do I need a male, female, NB therapist?

Some people are not sure who to pick and may wonder, does it even matter?

It is about personal preference as to who you pick. If you feel more comfortable around a specific type of therapist, you can choose to work with that type of therapist. Alternatively, you might choose to work with someone you don’t feel comfortable with to try and work through why you have difficulties with them.

So if you had a difficult relationship with your father, you might choose a male therapist to try and understand this better and learn how to have good relationships with men. It’s not necessary that your therapist be a man, but a male therapist might trigger memories of your father or remind you of other men in a way that a female or NB therapist does not.

In the UK there are far more female psychotherapists, therapists and counsellors than there are male, NB therapists. So it may be difficult to find a male or NB psychotherapist if that's what you’re looking for.

Some directories such as Psychology Today allow you to select for therapists who are allied to certain populations or who have lived experience of specific identities. You can also search the Pink Therapy directory for gender and sexual diverse therapists.

Is your personal history relevant when choosing a therapist?

If you have been abused in any way, please consider how safe you will feel if you have face to face therapy (or even online therapy) with a male or female therapist. How comfortable will you feel talking to them? Do you find it easier to get on with women or men in general?

It is also possible that you might want to work on issues about a particular gender or relationship you have experienced and whilst this can be possible with any therapist you might want to specifically seek out a man if you have issues with men or a woman if you have issues with women.

In any case, you should still pay attention to your feelings around this therapist; do you feel comfortable or threatened? Is this because of something the therapist does or because of your background? Does your therapist listen to you, accommodate your requests or fears and respect your boundaries for working with them e.g. not sitting too close to you, using appropriate touch, allowing you to sit by the door if you need to etc. 

If you are transgender, genderqueer or gender fluid, it might be important for you to find someone who can identify with your background. Some therapists specialise in working with transgender or non gender conforming clients.

You may also be able to get what you need from a therapist who does not specialise in this area and who is willing to educate themselves where appropriate, particularly if they specialise in an area which brings you to therapy.

Is your sexuality relevant when choosing a therapist?

If you have a history of being marginalised for your sexuality, you might want to find a therapist who can relate to you on more than a theoretical basis. There are LGBTQIA+ therapists who will be happy to work with you and who share your lived experience. There are also therapists with whom you might connect who are happy to learn about issues they don't know from a personal basis. It is your choice as to which feels right for you. 

If you are polyamorous, in a non monogamous realtionship or asexual you may want to mention this to your therapist so you can gauge their response. Whilst I would hope that all therapists are open and accepting of different backgrounds and approaches to relationships this is not always the case in practice.

Therapy should be as far as possible a safe space for you and you don't want to be caught unaware by your therapist's ignorance or intolerance when you need their support. 

Is your religious or cultural background important when choosing a therapist?

If your religious or cultural background is central to your life (or your issues) you probably need someone who can understand this from their own experience.

In the UK, psychotherapists and counsellors are usually open to working with different religions and cultural backgrounds, of course this cannot guarantee cultural competence or remove bias. It is not your job to educate your therapist and you have the right to find someone who will understand you.

Opportunities to work with therapists of a particular religion, nationality or background can be more limited but are available.

If you need help finding someone, such as a therapist who speaks your mother tongue or someone who shares your cultural background, I'm happy to try and point you in the right direction or find you someone who can better help you get the right match. Again some directories enable you to select religions, languages or ethnic background.

How do I find an anti racist therapist?

With the increase in awareness that followed the death of George Floyd many therapists have increased their efforts to educate themselves on the importance of anti racism work as an ongoing form of CPD (continuous professional development which is a requirement for therapists). Of course this does not guarantee that your therapist will understand your experiences and the majority of counsellors and psychotherapists in the UK are still white. If your therapist is not willing to listen to any complaint that you may have about how you are treated, please consider making a formal complaint. Of course, it is not your responsibility to complain and you may decide not to do so.

How do I find a Black or Asian therapist?

To find a Black or Asian therapist please visit BAATN. It is not your job to educate your therapist and you have the right to find someone who will understand you.

Will my therapist have personal experience of mental health issues?

It’s pretty common for therapists to train after seeking therapy themselves and discovering how much it has helped them.

Many clients are relieved when I tell them I have suffered with depression and that's why I started therapy and eventually trained as a psychotherapist.

It is not necessarily the case that your therapist needs to have had every experience possible to be able to help you.

I do believe however, that there needs to be a capacity to empathise from their own experience. If you would like to know if your therapist has had professional or personal experience of your particular issue, you should ask them. They may not want to answer, and some types of therapists do not believe clients should have any information about them or their history.

In the type of therapy that I practice, I am happy to answer brief and relevant questions about my history and background. 

I would also include with this; have they had their own therapy? I would want a therapist who has had lots of their own therapy. This will help them to keep their own issues separate from yours and ensure that they have your best interests at heart. It also means that they are actively working on their own issues and to understand their own blocks and struggles.

How do I find a therapist that’s a good fit?

Your therapist should respect you as an individual and what that means for you.

When I work, I don't intend to create clones of myself with my values. I'm happy to respect your values and beliefs as long as I feel we're compatible and I'm able to help.

I want you to be able to steer your own life and make your own decisions. I don't want to be another person that tells you what to do or controls you.

I don't want to be another person that you feel you have disappointed. We will work towards strengthening your own sense of self, which means helping you to discover what is important for you and how to weather the different opinions, thoughts and option you hear from other people and stick to your own way.

Sometimes you might want to take what others say into consideration too, this is not about being blinkered and inflexible, but we do need to create a filter so that you can weigh up what is useful to you and what is not. 

Ultimately, you should be the one who gets to decide who you are.