Psychotherapy and counselling: what talking therapy is
What talking therapy actually consists of, the difference between counselling and psychotherapy, the formats it comes in, and what the research says about which parts do the work.
“Talking therapy” is the umbrella term the NHS uses for a family of treatments in which a trained person and a client work through difficulties in conversation. Counselling, psychotherapy, CBT, guided self-help and several other things all sit underneath it.
What it consists of
Stripped to essentials, most talking therapy involves:
- A regular, bounded meeting. Usually weekly, usually around fifty minutes, in a private room or by video or telephone. The boundedness is not administrative fussiness — the reliability of the frame is part of what makes it possible to say difficult things.
- A working agreement. What the work is for, how long it might run, confidentiality and its limits, and what happens if either party wants to stop.
- A method. What the practitioner does with what you bring: examine thought patterns, trace a difficulty back to earlier relationships, attend to what is happening between the two of you in the room, or something else again. See schools of therapy.
- Supervision, behind the scenes. Registered practitioners take their work to a supervisor. This is a professional requirement, not a sign of inexperience.
Counselling or psychotherapy?
In UK usage the words overlap heavily and are frequently interchangeable. The rough convention is that counselling tends to be shorter and focused on a present difficulty, and psychotherapy longer and concerned with patterns that recur across a life. But there is no legal definition of either, and plenty of practitioners do both.
That vagueness is a real problem for the public, and the professional bodies know it. BACP, UKCP and the British Psychoanalytic Council have spent years on SCoPEd, a shared competence framework that describes what training and practice standards sit behind each level of practitioner rather than relying on the label. It exists precisely because the two words do not reliably tell anyone anything.
Neither title is protected in law — see how therapy is regulated.
The formats
Individual. One client, one practitioner. The default.
Couples. Both partners and one practitioner, with the relationship rather than either person as the focus. NICE lists behavioural couples therapy among the options for depression where a relationship is central to the difficulty.
Group. Several clients and one or two facilitators. Group therapy is not a cheap substitute for individual work; it does something different, using the other members as the material. See group work and facilitation.
Online and telephone. Now routine rather than a fallback. Trials of remotely delivered structured therapies have generally found them effective, and NHS services deliver a large share of their work this way.
What people bring
Anything from a specific, nameable problem — panic, a phobia, a bereavement, a decision that will not resolve — to a diffuse sense that life is not working. People come with depression and anxiety, with the aftermath of trauma or abuse, with relationship difficulties, with the effects of illness or disability, with confusion about identity, and with problems at work.
You do not need a diagnosis to be a legitimate candidate for talking therapy, and having one does not oblige anyone to treat you as the diagnosis rather than as a person. Equally: therapy is not indicated for everything, it does not suit everyone, and for some difficulties other treatments have better evidence behind them. That is a matter for an assessment, not for a website.
Does it work?
For depression and for anxiety disorders, structured psychological therapies have a substantial evidence base and are recommended in NICE guidelines alongside or instead of medication depending on severity and preference.
Two honest qualifications. First, most of that evidence concerns specific, manualised therapies studied in trials — mainly CBT and a handful of others — rather than open-ended therapy as practised in private rooms, which is much harder to study. Second, the differences in outcome between well-conducted therapies are consistently smaller than the differences between having therapy and not having it. What the practitioner does matters, but so does the relationship, and the research has never cleanly separated the two.