Counselling and other talking therapies for mental health
• what is counselling?
• being referred by the GP for counselling
• referral to other services
• counselling services at college and university
What is counselling?
Mental health issues can be treated in several ways, including with medication and talking therapies, such as counselling. Some people we talked to were referred for counselling by their GP. Others saw a counsellor at school, college or university. Counselling is about talking to someone who understands depression and other mental health issues and what can help. Counsellors are professionally trained to work with people on their personal and emotional issues, including anxiety, depression, eating disorders, and self-harm. All counselling sessions are confidential. The counsellor won’t tell the GP what has been said, unless they feel someone’s at serious risk. Being referred by the GP for counselling
Some GP practices (surgeries or health centres) have an onsite counsellor and people may be referred to them by the doctor, though waiting lists vary. If counselling or therapy isn't available at the surgery, the GP may refer the person to a local psychological therapies service. Aphra was referred for counselling by the GP and waited 3 weeks before her first appointment. She was also taking antidepressants. Before this, she’d had counselling several years earlier at school.
- Aphra works voluntarily to help improve cancer services in her area. She lives with her family. Ethnic background / nationality: White British.
When I'd finished with that therapist, because the only catch was is that it was limited to six sessions. And I remember thinking at the time going, 'Oh six sessions, I won't need all of those, I'll be fine in no time.' I was really kind of confident in that I would bounce back out of it all, and actually you know I'm on my second therapist. I'm just about to finish with her, and now I feel like I'm in control.
Did you…so you were seeing the GP, and the GP was prescribing the antidepressants?
And separately then you were seeing the counsellor?
Yeah. So the therapist I was seeing through the GP again stays confidential. So the GP only knows how many sessions you’ve had, or if they think there's a problem then actually they tell you, and it's up to whether you talk to your GP about it or not. Which came up after I'd had my six sessions with the first therapist. She thought I could benefit from a higher level therapist which would mean that I'd have to travel, but only into the town centre to their actual kind of head office as it were.
And that took a couple of months to come through, probably almost three months before I could see somebody there. But those sessions were every week and they were an hour long, so it's a lot more intensive and it's all cognitive behavioural therapy. So it feels really practical and like you're taking steps to fixing yourself as it were rather than just talking about how low you still are.
Was that how it was at the GP's surgery?
The GP's surgery had some cognitive behavioural therapy, but there was a lot more talking as well involved; it was a kind of mix of the two. And but those sessions were only half an hour and they were every couple of weeks, so there was a lot more time in-between. And I kind of see it almost like the ones I had at the GP's surgery was a triage kind of thing. So it was about making sure that I was eating and making sure I was sleeping and paying attention to what kind of activities I was doing.
- Sophie is at school and works part-time in retail. She lives at home with her parents. Ethnic background / nationality: White British.
The first time I kind of chatted to her [the counsellor], yeah, she was a very kind of like welcoming and she arranged an appointment with me. But because like my school is quite big and, because there were so many students, she had a waiting list for, I think it was like four weeks. So that was a bit disheartening because obviously you want to be seeing someone quite quickly.
So, yeah, that was kind of disappointing. So I think, you know, the schools need to be making kind of like a conscious effort to make sure that they’ve got enough counsellors for the amount of students they have.
So, yeah, that was the first time I'd ever met her, but then… yeah my first appointment. I mean it's difficult because it was… like counselling isn't for everyone and it's just kind of one way of, you know, being helped. And so I think at first I… I didn’t know what to expect. I didn’t really know how to respond because I… in my head I thought that’s the only way, like that’s the only kind of form of treatment really, where obviously I was really wrong. But so when it…when I found it wasn’t all that like effective for me and I just felt it was kind of just bringing up problems that I just didn’t want to be talking about.
I felt it wasn’t, it wasn’t really working for me but I…I think I should have known that there are other ways and it was alright if it wasn’t working for me. But, so yeah, I mean they were good in the sense of it was good to be able to have a space to talk to someone and know that if I did want to speak to her I could. But at the same time I think it was… it was difficult because it did feel a bit like it was either that or nothing, so yeah.
- Shane is at college. He lives with his mum and two younger sisters. Ethnic background / nationality: White British.
I always felt that I was helped when I left the doctors straight away, just because I had released some of the stuff that I was keeping to myself, which was a good point I guess. But I also felt wrong with myself in a way because, after the doctors, I made it a routine to go to the pharmacy directly afterwards. And later on I felt wrong in doing so because of the hospital incident, and I had to go and pick up medication with bandages on my arms for a mental health disorder in which everyone in the pharmacy could clearly tell it was for the self-harming and stuff.
If someone's in the same situation how could that have been easier because you went for counselling and then you went to the pharmacy.
Is there anything that could have helped there?
I guess with people in that situation actually having the pharmaceutical, I guess, goods in a way, having them with your doctor so at the end of your counselling or session or appointment, they can give you said medications and stuff like that, just because they…if they think it's good for you, they’ll give it to you. And if they don’t it…they won't, or at least talk to you about it. And just because they know you a lot better than the person behind a desk at the pharmacy.
So what the doctor was going to prescribe after she spoke to you, if she could have written the prescription, somebody could have fetched it while you wait in the waiting room or something?
Yeah just stuff like that so that it's a lot more like you're not being moved around in a sense.
So for five months you went to see her. Can you tell me what, you know, you said some of the good things was that sometimes you felt like you talked about things that you'd kept to yourself. Can you tell me the good points about going to see her, and then the things perhaps that weren't so good, please?
OK. Well one of the good points was the offloading and stuff, but also I guess the…it was the sense that I was finally beginning to help myself which, for me, was a rarity among anything just because, as I said, I prefer to help others than myself. So that was a good thing about it.
I guess also the fact that I…I felt like I was being I guess like specialised in a way because normal people have fifteen minutes and stuff like that, and I ended up with half an hour which I feel like I cheated other people in a sense just because I was given double their time, but also happy and glad because I had that extra time.
The bad things was probably I guess the moving around of doctors when she was not present I guess. So that was a bad thing. Another was with the going to the doctors I had – before the hospital incident – I was missing a lot of college days which brought me even further behind.
Other mental health professionals that a GP might refer a person to include a psychotherapist, clinical psychologist, and psychiatrist. Other services include Child and Adolescent Mental Health Services (CAMHS).
CAMHS is an area of the NHS dedicated to supporting children and young people with emotional, behavioural and mental health issues, in both in-patient (hospital) and out-patient (day-care) services. CAHMS offer assessment and treatment to young people up to the age of 16 or 18, depending on the local service. The most common way to get an appointment is through the GP, but teachers and school nurses might also be able to make a referral.
Lucy was referred to CAMHS by her GP because of anxiety. She started feeling anxious around the age of 13 when she was at school. She often had to leave lessons because of it and later found it hard to go to most lessons. Her teachers suggested that she talked to a doctor. Being used to 10-minute GP appointments, she was surprised when the counselling session lasted an hour, which she liked. She felt uncomfortable in one of her sessions, though, because her dad wanted to sit in with her and then talk to the counsellor alone. After five sessions of individual counselling, she tried adolescent group psychotherapy.
- Lucy is at college and lives at home with her parents. Ethnic background / nationality: White British.
I think at first I felt a bit uncomfortable cos of my dad going in there. And especially the time my dad was like, “Oh I just wanna talk to, you go outside for a sec.” Cos that made me think like, “Oh they’ve probably said something about me.” Cos I felt like I don’t want stuff about me to have been said if it, if I’ve said it to her confidentially. So that sort of bothered me. But then as soon as my dad stopped going in on the sessions, it was, it felt a lot better.
And there was this time, cos they moved buildings. And when they moved buildings, the first time I had to go there, I had to go by myself cos I didn’t, like my dad was doing something. I didn’t really have any idea where it was or where I was meant to get off the tram or anything like that.
So I got off the tram and it was chucking it down. And I think I walked about a mile in the wrong direction. And then I had to walk back and it was just all really horrible. I was like crying. And so I had to phone them like three times to find out where it was. And I finally found it. And then the appointment that I was even going for wasn’t even meant to be with her. It was meant to be with the group of people, to make sure I was definitely gonna go.
But then she saw me. She was like, “Oh, God, are you all right?” And I was like, “I’ve just gotten lost and it was really horrible.” And so she like took me into her office, found a blanket and gave me that and made me a cup of tea. So I think from that moment I was like, “This one’s all right. I trust this one. She makes me tea. It’s fine.” But, yeah, before that, when it was just my dad going all the time, I was like, “No, I don’t like this.”
- Sophie is at school and works part-time in retail. She lives at home with her parents. Ethnic background / nationality: White British.
It was held in I think it was…it was like a mental health centre. I think it must have been about like twenty miles away from my house. I got the bus there. And it was…my first appointment I was…I was kind of nervous because I had no clue what to expect. But it was really friendly, really welcoming, and there were about seven or eight of us I think. And we did literally sit in a circle and we introduced ourselves. And there was two…two, no, three specialists there who were kind of, you know, encouraging us to speak and stuff. And I think it was just…it just worked really well in the sense of it was the first time I felt that I wasn’t alone in it and that there were other people out there who were kind of needing the same kind of treatment as I was.
So that was the group therapy; did your parents know?
And you went there. Was it mainly people of your age group, or different age groups?
Different age groups yeah that you…I think I was…I wasn’t the youngest but I was the second youngest and there were some older people there too.
So older people as in over twenty or something, over thirty?
Yeah, yeah, which I was surprised about because I thought, because it was through CAMHS [Children and Mental Health Services], well I thought it was through CAMHS, but it turned out I…if I wanted to do a CAMHS group therapy, I would have had to do a different thing. But I didn’t…I wasn’t fussed by the fact that it was…I thought it worked well because it was different age ranges – I thought that worked really well.
So, when you say different age ranges, so people…well you were the second youngest?
And then were there people over forty/fifty/sixty?
Yeah, I think no-one was…probably no-one over sixty, but yeah I'd say like there were some middle aged people there.
And you said the age group and the age difference – that helped?
Yeah [coughs]. I think it helped because it did just show that no matter who you are, you can struggle with the same things, you know, whatever your age you still might struggle with the same thing so.
And you said it helped you feel that you weren't alone.
So the very first time you went there, did you notice a difference at all in how you were feeling?
Yeah, it made me much more kind of open in the sense of I didn’t know these people but they were really understanding. And it kind of made me think that I was able to speak to other people in my life because, you know, they’ll probably be just as understanding. So, yeah, I think it really made a difference in that sense and the fact that I was…I then felt that way and the more I talked about it, kind of, the more people understood that it made things a lot easier.
- Lucy is at college and lives at home with her parents. Ethnic background / nationality: White British.
Then she [the counsellor] put me in the teenage psychotherapy group which, so I got put in that. And that was once a week and it was two hours I think. There wasn’t many of us. I think there was me and like four or five other people. And that was all right cos you didn’t always have to talk about serious stuff. And sometimes you could literally just go, have a bit of a break. And I quite liked that. And then she was like, “Oh, we’ll still keep on seeing you through this.” And I was like, “Oh, right, okay.” I think I went to the teenage psychotherapy group for about a year and didn’t have an appointment with her.
And then I think I really then ended up wanting an appointment cos I was feeling really like low and everything was like really bad. And sometimes like at the group thing, I ended up becoming sort of like the clown. Like, people were down, it was always me that had to cheer them up and I’d have to be the loud, funny one. It was like, yeah, so I never really felt like I could talk there. So this appointment, I think we had about two or three more appointments and that was really about it.
And in the psychotherapy group, were there other people with the same kind of issues, problems, issues that, did it feel comfortable being with people?
Well, I dunno, cos I didn’t really fully know their problems. It would sort of be more like one week someone would have a bad week. Like, someone’s nan would die and then they’d talk about that and they’d be really upset. And then, I think for me one week like my dad was ill, so I was upset about that. But you never really, you never really knew why people had started CAMHS [Children and Adolescent Mental Health Services] and stuff like that.
Was there someone leading the group?
Yeah, there were two members of staff and they were really nice.
Auberon was referred to CAMHS by his GP too. When he turned 18, though, he had to move from CAMHS to adult services and had a long wait for CBT (Cognitive Behavioural Therapy). He was also under the care of a psychiatrist and only saw his GP when he needed to talk about his medications or get a repeat prescription:
- Auberon is a student and lives at home with his parents. Ethnic background / nationality: White British.
Regarding my mental health issues, I was in the hospital for a month which is where I was first diagnosed with mental health problems and all my diagnoses took place. And then…But before then I was seen under CAMHS [Children and Adolescent Mental Health Services] just as a counselling service, if you know what I mean; just as like a support and just talking service. But then after I'd been put into this hospital for a month, then I'd been referred to the adult mental health service team, so yeah.
Was there a big difference between that transition to the adult mental health team from the, you know the children's or young people's?
Yes, it was, because I was getting cognitive behaviour therapy at the time, and unfortunately my therapist got ill and unfortunately she couldn’t do it anymore. But they said they would…they said as it was so close to that change…between that period of change over, between the CAMHS and the adult, they said that…they said it would automatically start up again when you come in the adult. But things didn’t work out and I'd been on the…I'd been in the adult mental health services for almost two years and I'm finally getting my first CBT appointment next week.
So you’ve been waiting for a good…?
Two years, almost two years yes.
Have you been able to access any similar services at all in any other way?
I've been …no, not really. I've been…my care co-ordinator's great, but she's not a therapist really. She's just like a care co-ordinator because she gives more practical advice on what to do and how to cope and stuff, but therapy is, I think, everyone says it's a way forward, so yeah, so...
So the care co-ordinator – is this through the GP or the hospital?
It's through… I first start…well I was in a CAMHS mental health unit when I was in hospital, so then I was diagnosed, so I had a formal psychiatrist up there, and when I got out and everything. But then my psychiatrist switched me to adults because I was over eighteen, I was getting to the age of eighteen, and so yeah so....
- Siobhan is doing her A Levels, and voluntary work in her free time. She lives with her parents. Ethnic background / nationality: White British.
And you mentioned that, was it through the doctor that a counsellor got in touch with you and said, “Do you want to do the online CBT (Cognitive Behavioural Therapy)?”
Yeah, the doctor said that there’s an onsite counsellor who they were gonna send me to. But that took a few weeks to get the appointment cos she only works Tuesdays till like 4 o’clock and I have school. So I had to book it for holiday times. And I went to see her and she like gave me the leaflet about IAPTs [Improving Access to Psychological Therapies] and what options there are and stuff like that, about what I can do. And just told me about different types of CBT, like face to face, online, like workshops that you can do in town and things like that.
Did you only see her the once then?
Yeah, I’ve not seen her since.
So she just told you about all the different options?
Yeah, then she just called me to ask me what I wanted to do.
And you felt that the online would be best for you?
Would you like to try any of the others? Or do you think, “No, this is the one that’s best for me”?
I think the online one’s one of the better ones for me. Cos I’m not very good at just like when people go, “And how did that make you feel?” I’m like, “Well, I don’t know.” So, and like with the workshops, it’s a big group and having to just blurt it out. It would be like, “No, I’m not going to a support group. I’m not going to bloody ‘self-harmers anonymous’.”
And the online, can you do that any time or..?
Yeah, as long as I’ve got an Internet connection I can do it. But you’ve got to have headphones cos it talks. But it takes like about 40 minutes, so obviously I’ve got to have that chunk of time free.
- Fran is an NHS trainer and lives on her own. Ethnic background / nationality: White British.
My psychiatrist, he’s, he’s not, he’s a really arrogant man. He’s just like so arrogant. And it’s like he thinks he’s right.... And it’s almost like, he’s got this smirk like, “I’m not here to help you. I’m here to fill my bank account.” It’s like, “Then why are you, can’t you go and do something else to fill your bank account and like not mess with . . ?” yeah. Psychiatrists, I’ve had a couple of good ones. I’m not a massive fan of them.
What were the good ones like?
Kind. And really like, it’s like there was a doctor called Dr [remove name] and it’s when I was on the ward. And I couldn’t really talk to like anyone. I was, and I used to go out and smoke and he used to come out and smoke his pipe with me and just have a chat. And I was like, I’ve never had a grandad. And he was like this proper, he was that old, he was like a proper, really sweet grandad. Like he just really engaged with his patients.
And I’m not sure, like I’m never really sure what the role of a psychiatrist is, to be honest. Cos it seems to be the psychiatric nurses do all the work. Probably the psychiatrists just have such big caseloads or whatever. But he was just really nice and jolly. And he sat down with me and he was like, “All I need you to do is explain what’s going on in your head.” And I did that. And without really, so, yeah, he was an exception.
Counselling is usually available free of charge to students who are at college or university. When Susan found out about university counselling services, she was pleased that she could see a counsellor quickly and didn’t have to pay for it. Like Vinay, she was reluctant to see a GP about mental health as she didn’t want to speak to a different doctor every appointment. Being a medical student, she was wary of what other health professionals would think about her having counselling. She also felt that GPs weren’t the best professionals to talk to about mental health. Counselling turned out to be very different to what Susan had been expecting – she thought she’d be talking about the stress caused by an eye condition she’d had but ended up discussing many different things:
- Susan is a medical student and lives in a shared house. Ethnic background / nationality: White British.
It was quite a weird experience, I didn’t…it wasn’t quite what I expected actually. So I had quite a few things in my childhood that were quite tough, but I'd never realised they'd affected me. And that was almost the first thing she talked about, and I had gone in wanting to talk about how stressed I'd been at university and how I'd had this awful condition in my eyes. And this was all making me sad. And that’s what I'd been expecting to talk about, and it wasn’t quite that.
And it was really hard to realise kind of how things in the past had affected you. And so yeah it surprised me, and part of me felt very uncomfortable with it. But once I'd overcome that initial phase, it just made such a difference, yeah it was amazing actually.
So would you recommend counselling to other people around your age group who are feeling anxious, stressed, maybe not talking about it, keeping busy?
Definitely, because I mean, I thought that I had a…I thought I was fine and I thought that there was no need for it, and that I was just being silly. And actually it helped me so much.
Can you talk about some of the ways it helped?
Yeah. So I think the main thing was just admitting to myself that there was something wrong. Because I was in denial for a long time and you just kind of live with it, and you think, 'No, this is normal, you know it's OK, I can carry on like this.' And every time you kind of reach almost a crisis point you think, 'That’s it I'm going to do something.' And then it passes and you think, 'No, no it's nothing, I'm fine.' So I kept putting it off, I kept telling myself I was fine, yeah.
But talking to her, looking at things in a different way.
How did the feelings of anxiety, were they there still a lot more at first, or how…you know, because you weren't expecting to talk about some of the things, how did it go over the sessions – were you allowed to have as many as you like, or was it like six or?
Yeah, so she was very good, she said I could have as many as I'd like. And actually she never really said the number of sessions, it was more like, she would leave me after a session and just let me get in touch. And I felt that was really good because it did take a long time, and it was not a quick fix at all. And I think just realising that early on that actually you're not going to go in and feel great after the first one. It really takes a long time and I think she gave me kind of bite sized amounts of things that I could do to make things better.
And that was all I could really cope with, and I think just changing that expectation to, 'OK, I'm just going to do these small bits at a time.' And gradually just I changed things about my lifestyle. Things, the way I saw things, and it does give you strategies, and I feel like they’ll stay with me forever. And I, maybe I'll slip into bad things in the future but I think now I'm so much more aware, I won't kind of put them to the background, yeah.
More young people talk about their experiences of low mood and depression here.