Social illness

Questions people have when starting therapy

When we first start thinking about accessing therapy, questions can whizz around our brain and keep us up at night. It can be hard to know where to put them. We might not be sure how to ask and sometimes might not even be sure quite what it is we’re asking.

We’ve collected a bumper list of questions that we might have when starting therapy. Though we aim to answer each as generally as we can, it’s important to check with individual therapists, centres, and services for more specific, personal advice.

Is a therapist the same as a mental health nurse?

People in jobs that require talking to those who need mental health support and/or therapy, come from a wide range of backgrounds. This could include counselling, social work, nursing, mentoring, coaching, art therapy, music therapy, drama therapy, dance therapy, occupational therapy, speech and language therapy, and more.

Here, we use ‘therapist’ as a catch-all term.

What do all the acronyms mean?

The world of therapy contains many acronyms. Thankfully, we’ve jargon-busted a lot of them in a handy downloadable e-book.

What happens if I don’t know what I need?

Sometimes we don’t know what we need, we just know that something is wrong. We can’t ask for what we need when we don’t know what it is we need other than ‘to feel better’.

Not knowing exactly what we need is more common than we might think. Being open with our therapist about it can help them to understand where we’re at, and as our therapist gets to know us, they should be able to help us to unpick some of our challenges.

Can I access therapy without leaving the house?

Yes. We might not have as much choice as if we did leave the house, but many NHS services and other therapy services now offer online appointments. Alternatively, some will even come to our house.

One thing it is worth being cautious of, though, is considering whether we’re avoiding something that we want to work on. If that sounds familiar, then it’s worth raising it with our therapist.

Will everyone know I’m having therapy if they see me walk into the building?

This really depends on where the building is, how obvious the signage is, and whether there are other things in the same building.

Some buildings are hard to find, but that makes them fairly anonymous. Sometimes, different services will share the same building, so it may not be clear why we’re popping in.

If someone spots us and we’re uncomfortable with them knowing that we receive therapy, we can always be very vague if they ask us about it. Please remember, though, that there is absolutely no shame in needing support.

Can I get time off work to go to therapy?

This depends on our job. Some workplaces do allow some paid time off for medical appointments. Others will operate a flexitime policy whereby we’re allowed to take the time we need but will need to make that time up.

Some employers aren’t at all flexible. Sometimes this is because they can’t be, sometimes it’s because they don’t want to be. Speaking to our HR team and asking for an occupational health appointment might help us to find out more about our rights and what our employer may or may not be able to offer. If we have a contract or intranet, they might also explain our employer’s position.

If we’re really struggling then we could use our annual leave (although we shouldn’t have to!) to take the odd afternoon off. We could also speak to our therapist – they might offer evening or weekend appointments.

Do I have to lie on a couch?

We’ve all seen the films where people walk into a therapist’s office, (which usually has dark wood panelling and many many books) and immediately lie back on a ‘couch’ and pour their heart out.

The reality is that more often than not we’ll either be sitting on a chair or doing an activity. There might be instances where we’re offered the opportunity to lie down if that’s what we want to do, but usually, it’s up to us to choose how we’d like to be.

Someone told me that their therapist gives them homework. Do all therapists do that?

Sometimes, therapy involves reflecting on, tracking, or trying different things. Some use worksheets, others don’t. It really varies according to the type of therapy we’re accessing, and the way our therapist works.

If this is something we’re concerned about, the best thing we can do is to ask our therapist about it.

How do I know which therapy is right for me?

With so many different types of therapy out there, it isn’t surprising that they will work differently for different people.

Some therapies are more suitable for some diagnoses than others. The National Institute for Health and Care Excellence (NICE) offers guidelines on treatments for different diagnoses. It can be helpful to discuss our options with our GP or a potential therapist, too.

Sometimes, we have a specific goal which may link to a specific type of therapy. We need to discuss this with a therapist to ensure that we receive the right support. Sometimes, the therapist we speak to may tell us that they’re not a specialist in an area, but they know someone who is.

Unfortunately, sometimes it’s a case of trial and error. We’re all different. We have different needs, communication styles and goals, so it makes sense that we need slightly different types of therapy.

Can I choose different types of therapy through the NHS?

This varies hugely from place to place. Some services operate a very limited number of therapy options. Some offer ‘first line’ therapy to everyone through Improving Access To Psychological Therapies (IAPT) and only offer further therapy if they feel it’s needed. Others ‘triage’ people, which means they will offer one or more appointment(s) to assess our needs. Sometimes, some therapies are only available to those with particular diagnoses.

Lots of mental health trusts, Clinical Commissioning Groups (CCGs) and GP surgeries have sections on their websites explaining what is available in the area. If we feel that we need a specific type of therapy, then speaking to our local mental health trust or GP can help us to understand our options.

The therapy I need isn’t available through the NHS in my area – how can I get funding?

There are sometimes individual funding options for specific therapies if our needs differ from a ‘typical’ case and meet certain requirements. This varies depending on where we live. Sometimes, GPs can apply to our CCG using an ‘individual funding request’. Alternatively, our GP or mental health service may be able to refer us to an ‘out of area’ service who do offer the support we need. It will vary a lot from case to case.

Where do I find a therapist?

If we choose to access NHS therapy, then we could go through our GP or contact our IAPT service.

For non-NHS services in our area, our GP might have a list. Hub of Hope will show some local services but unfortunately might miss some. Our local Healthwatch might have gathered a list of local support services. We might have a local magazine that lists them. Other than that we may need to do some searching ourselves.

For an individual therapist as opposed to a service, the British Association of Counsellors and Psychotherapists (BACP) have a search tool to find a therapist in our area who covers the topic we need support with.

How do I know if a therapist is right for me?

Sometimes we’ll meet a therapist once and immediately know whether we’re going to be able to trust them, or whether our fight/flight mode is kicking in.

If we’re paying privately then we could first tell our therapist how we feel, if we want to, to see whether our concerns can be resolved. If they can’t, or we don’t want to discuss it with them at all, then it’s relatively simple to say “I’m afraid I don’t think we can work together” and try someone else. It can feel quite awkward to do that, but our therapist might have also picked up the same feeling as us.

With the NHS it can be harder to change the person we see as often we’re allocated the first person who has space on their caseload when we reach the top of a waiting list. In the first instance, it’s worth discussing this with our therapist if we feel able to. There might be concerns that they can alleviate. If we’re struggling to communicate our concerns or we feel as though they’re not being heard, then we could contact our local Patient Advice Liaison Service (PALS) who should be able to support us in communicating with the service we’re under.

I’ve been told I need to be sober to start therapy. But I need therapy to get sober. What do I do?

This is such a common story. It’s a catch-22 situation.

Firstly, we’d suggest speaking to those who told us we have to be sober before we can get therapy. They may be able to suggest a service we can get some support from to work on our sobriety. We will not be the first person in this position.

Our GP might be able to recommend a service and there may be a drug or alcohol service in our area. We could also try support such as Alcoholics Anonymous, Gamblers Anonymous or Narcotics Anonymous.

I’m neurodivergent, do I need to tell my therapist?

As neurodivergent brains process information differently from neurotypical brains, the type of therapy we need might differ. Sometimes therapy will need to be adapted to suit our processing, so it’s often helpful to tell our therapist of our diagnosis (or self-diagnosis). However, we don’t have to if we choose not to. Although it’s worth being aware that if it is on our NHS records, and we’re seeing an NHS therapist, then our diagnosis may be communicated when a referral is made.

When choosing a therapist, if we are self-funding, we can absolutely ask them about how much experience they have in working with neurodivergent clients. If we specifically want to work with a neurodivergent therapist, then the Association of Neurodivergent Therapists can be a good starting point.

I have a physical disability or chronic condition, do I need to tell my therapist?

Again, this is very much up to us, although if we’re receiving NHS support it may have been included in our referral.

If we’re seeing our therapist in person, and our disability or illness affects our mobility, then we may need to check that the building is accessible.

Otherwise, it’s worth considering whether our condition interacts with our mental health. For example, if diagnosed with asthma but it’s generally well-controlled, it might not be something we want to raise. If we have significant fatigue and are always in pain, both of which impact our mood, then it might be worth mentioning.

If we choose to see a private therapist, then we are well within our rights to ask them how much experience they have in working with those experiencing long-term health conditions.

Do I have to talk about things I don’t want to talk about?

No. Nobody can force us to talk about anything that we don’t want to talk about. Sometimes it can take a really long time to feel able to discuss something (if we ever do). We can simply say “I don’t want to talk about “.

If one of our aims of accessing therapy is to work towards discussing difficult things, then we might find it helpful to tell our therapist that there’s something we’re not comfortable talking about yet, but we want to work up to doing so.

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Do therapists work with people in crisis?

Some therapists don’t work with those who may present a risk to themselves. That’s not because we’re bad people or we don’t deserve support. It’s often because they aren’t able to give us the support we may need, and can’t easily escalate any concerns they might have. If we have concerns about this, it’s worth discussing them with our therapist.

What happens if I need my therapist outside of working hours?

This is something our therapist should discuss with us when we first start seeing them. Different therapists and services might have slightly different boundaries and systems.

Outside of working hours, there are always helplines available. We are never alone.

If I tell my therapist that I’m suicidal, what will they do?

Normally, our therapists are bound by confidentiality unless they feel we are a danger to ourselves or someone else. If they feel that we are a danger to ourselves, they can escalate their concerns. This may involve contacting other staff or services.

They should keep us informed every step of the way, and should be working in, what they feel, are our best interests.

It’s also worth noting that there’s a difference between being actively suicidal and passively suicidal. Our therapist should be able to discuss this risk with us.

What happens if I open up and then run out of sessions?

This is a real concern for many. Often NHS services and charitable organisations will only be able to offer a set number of sessions due to funding. If we’re self-funding, then we might only be able to afford a set number of sessions.

This will vary hugely depending on the service and our needs. The first step is to tell our therapist and make them aware of our concerns. They can then support us with any choices or decisions we need to make.

In some circumstances, there may be an option to have a second ‘block’ of therapy with the same therapist. Alternatively, we might be offered something else with the same service. Occasionally, a service might apply for funding specific to our needs.

Sometimes, we could decide, with our therapist, that there are certain things it wouldn’t be safe or ethical to delve into in the time we have.

If paying privately, many therapists offer stepped pricing. Those on low incomes pay less per session. Speaking to them to find out the options available to us enables us to make informed decisions.

Can I pause therapy if I need a break?

Usually, yes. Life can be unpredictable and sometimes “stuff” happens and we have to shift our focus for a while. If we are in a position where we have too much going on for therapy to be helpful then our therapist might even suggest a break to us. This might vary between services or individuals, though, so it’s always worth asking to double-check.

What do I do if I’m concerned that my therapist is wrong about something?

This can be a really difficult situation to manage.

In the first instance, if we’re able to, it’s often helpful to have a conversation with them. They might have misunderstood something, or we may have misunderstood something. There could be some confusion around wording, or even regional language differences.

If we’re unable to talk to them about it, or we try to talk to them but still feel that they are wrong or aren’t listening to us, then it can negatively impact our therapeutic relationship. Sometimes it’s tricky to know how to handle that.

When receiving therapy through the NHS, we could contact the service we’re under or use PALS if needed. If we’re under another organisation then they should have a ‘things have gone wrong’ procedure.

With a private, individual practitioner, it can be harder to know what to do. If we feel that our therapy relationship is irreparable, then we can stop seeing the person. We could explain why and ask if they can advise another therapist. Alternatively, we could just let them know we won’t be returning.

It’s important to remember that this isn’t just on us. Our therapist has as much of a responsibility to address any relationship fractures as we do, if not more so as they’re the professional.

What do I do if my therapist says or does something that harms me?

Unfortunately, there are cases where a service or therapist harms us. This might fall under iatrogenic harm.

In some circumstances, this is unavoidable. A service has to do something to keep us safe, even though it’s traumatic. However, they should always take the least-restrictive option(s) and should always inform us of our rights and explain what’s happening.

Often, harm is avoidable and someone is acting in a way they shouldn’t.

If we want to complain and we’re using an NHS service, we could contact the complaints team or even the CCG. All other services should have a complaints procedure that we can follow.

The British Association of Counselling and Therapy have a whole page dedicated to supporting those in therapy who have concerns. They will have dealt with similar situations to ours before.

Finally, if we’d like an impartial ear to listen to our concerns but not necessarily as part of a formal complaint then a range of charities and helplines offer support.

Please help us to help others and share this post. You never know who might need it.

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