What are the recognised benefits and limitations of counselling and psychotherapy?
What are the recognised benefits and limitations of counselling and psychotherapy?
Research studies continue to indicate that for a significant majority of people counselling and psychotherapy is of benefit when tailored to their needs. Therefore, it is more likely than not that counselling and psychotherapy will be of benefit to people.
Benefits of Counselling and Psychotherapy
The benefits of having counselling and psychotherapy include, but are not limited to:
- increased understanding of the current issues being faced and how past experiences may be influencing how a person is impacted, resulting in a growth in self-awareness and awareness, including how a person sees and understands themselves, others and the world
- the provision of psycho education and support to enhance coping mechanisms and resilience, resulting in the reduced risk of recurrence of mental health issues
- growth of self-acceptance and self-regard through greater understanding of the situations and events that have contributed to psychological problems, resulting in better management of harmful patterns of behaviours for example self-harm and addiction
- growth in self-confidence and agency resulting in, for example, the resolution of specific problems, adoption of healthy coping strategies, the ability to make more fully informed choices and decisions, improved communication and ways of relating with the potential for healthier relationships and increased harmony with others
- growth in empowerment, which can result in an increased ability to seek justice, disclose historic issues, make positive life-choices and the sense of having a right to be heard
- improved mental health resulting in, for example, a reduction in the symptoms of emotional distress such as depression, stress and anxiety
- improved spiritual health through gaining awareness, understanding of how spiritual and religious issues and concerns impact on mental health issues and wellbeing and vice versa.
All of these benefits can also bring improvements in a person’s religious and spiritual life and relationship with God (or their sense of the divine)
There are also the often the reported but less tangible benefits of the experience of having a confidential and safe space to unburden and explore current issues, to be listened to and valued, and to process life events and their impact. This can be especially valued when people have suffered from adverse life events whether in childhood or as adults for example neglect, trauma, isolation, oppression, loss and bereavement. There is an emotional release from sharing with a professional counsellor or psychotherapist that which cannot be easily shared or communicated with others. Often, this process in itself can result in someone simply feeling more at peace in themselves.
The Therapeutic Relationship
The approaches that counsellors and psychotherapists take vary in emphasis and method and all of these well established and recognised approaches can be of benefit. Therapists are responsible for making sure that the approach that they offer is one that they are competent to work within and is suitable for a particular client’s presenting concerns and difficulties.
However, research consistently suggests that the single most important factor in counselling and psychotherapy is the effectiveness of the therapeutic relationship between the counsellor and the client. Therefore, it is important that a person considering counselling and psychotherapy has a choice about whom they
engage with, and has an opportunity to meet with the therapist initially to make sure that it is someone they feel safe and comfortable to work with.
All counsellors and psychotherapists are aware of the importance of this ‘fit’, so a person should not feel awkward or embarrassed when explaining to a therapist that they do not feel that they want to work with them.
Important Factors in Considering the Suitability of Counselling and Psychotherapy
- Engagement
Counselling and psychotherapy require a person to be able to engage with their therapist and be able to reflect upon themselves and what has brought them to therapy and explore aspects of their current life and personal history. Counselling and psychotherapy may not therefore be appropriate for:
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- those who are experiencing an acute mental health crisis needing specialist psychiatric care. However, such a person may at some point in the future have counselling and psychotherapy as part of an overall treatment plan approved by their psychiatrist or mental health team.
- anyone with significant cognitive impairment and/or any significant condition that hinder any form of verbal communication. People within this overall category may need a different form of therapy for emotional regulation and relief of symptoms of distress.
- Timing
Counselling and psychotherapy can involve revisiting painful memories and/or exploring difficult thoughts and emotions. Whilst a counsellor and psychotherapist will never apply pressure on a person to enter into an exploration of something that they are not yet ready to talk about, it nevertheless takes a degree of resilience to be able to enter into therapy in the first place.
Therefore, it is generally recommended that a person waits until there has been some time distance and initial recovery from the occurrence of an acutely stressful event such as an accident, injury, or traumatic bereavement before engaging with a counsellor or psychotherapist.
- Reliability and availability
Counselling and psychotherapy require commitment. A person needs to be able to attend therapy sessions regularly, often at a set time and frequency. Sessions generally take place at an agreed time, for a set duration (normally 50 minutes/1hr or more), at an agreed frequency (normally weekly/two weekly) and for a period of time (which can be weeks, months and when warranted even years). Counsellors and psychotherapists may be able to offer flexibility in the way sessions are booked and where they take place (on-line, over the telephone, in person in a counselling centre or the therapist’s consulting room),
This means that a person needs to have the time and space to commit to this pattern of engagement. Some life events or circumstances can make this very difficult.
- Affordability
Counselling and psychotherapy outside of the NHS is generally a paid for service, so it is important to consider its affordability.
Public provision of counselling and psychotherapy within the NHS is limited in terms of its availability and the breadth and depth of the service on-offer. Normally it is restricted to a set number of sessions, and approaches / models of therapy, the most common of which is Cognitive Behaviour Therapy (CBT). There can be long waiting lists in certain areas.
There are some counselling services outside of the NHS that offer low-cost options, and some counsellors and psychotherapists operate a sliding scale. There
may be support available from an employee assistance scheme or from a church supported service.
Having set out this real financial limitation for some people, it is helpful to focus on the benefits associated with counselling and psychotherapy, and to view it as an investment rather an expense. This investment can benefit not only the person receiving counselling and psychotherapy, but also others who care about them and/or they are in relationship with. Counselling and psychotherapy can also bring wider benefits to society in relation to restoring a person to health so that they are better able to contribute to their family and working life.
Limitations of counselling and psychotherapy
- Not a ‘cure all’
Counselling and psychotherapy are not ‘miracle cures’, and a persons present life circumstance such as financial problem, family crisis, losses or chronic physical illnesses will not ‘go away’ with therapy. Whilst counselling and psychotherapy may not be able to change the circumstances that a person finds themselves in, it may help them to change how they react and enable them to feel better able to cope with these adverse events.
- Unintended consequences
The growth of self-awareness, understanding and agency can result in a person embarking on positive and considered changes to their life. They may result in changes to relationships, priorities, career, life events and a person may choose to distance themselves from people who they experience as harmful. These changes can bring losses as well as gains, and its important a person works with their therapist to equip them to handle some of the more negative and difficult consequences of change.
- Can take time
Counselling and psychotherapy can be a slow and demanding process, and this may not suit people who are expecting the equivalent of a ‘quick fix’. It often involves working to acknowledge and explore feelings and emotions, including those that are re-awakened in the process. Whilst therapists are trained to help contain difficult emotions in the session, its nonetheless important for anyone in therapy to be willing to experience and re-experience uncomfortable thoughts, memories and emotions which can take time to unpack and understand.
Sometimes this ongoing process can lead to frustration at a ‘lack of progress’ and result in a person initially feeling worse because they are really exploring what is causing them emotional pain and distress. Expectations of what counselling / psychotherapy should solve may be unrealistic and not be met, which can result in a loss of trust in the therapist, and the person abandoning the counselling and psychotherapy. The person may feel more vulnerable and isolated as a result.
- Is not ‘immune’ from societal problems
Counsellors and psychotherapists are trained to recognise and reflect on the many and various issues of difference that impact on the therapeutic relationship. Irrespective of how competent and skilled they are in working with issues of diversity, people coming to counselling will nonetheless be coming with previous experiences of prejudice, misunderstanding, stigma, etc, that they may have experienced generally in society, in dealing with health professionals or from people who they see as being ‘like their counsellor or psychotherapist’. This may increase the risk of the client feeling vulnerable, fearing prejudice and misunderstanding and act as initial barrier to making progress in therapy. If this persists the outcome of therapy may be less effective.
Some people may continue to be impacted by stigma associated with having mental health problems within their community, or shame associated with adverse life experiences, which act as barriers to sharing within therapy, making the therapy less effective.
- Ethical and professional boundaries
A counsellor / psychotherapist cannot interfere or directly intervene in a person’s life to help them except in special circumstances when they have to report a safeguarding concern. They also are prohibited from becoming a friend or companion and will be alert to situations where a client may become overly dependent on the therapist, thus limiting the client’s ability to resolve issues moving forward on their own.
These are important differences and boundaries in what can otherwise be experienced as a very personally significant relationship can seem strange and sometimes even cause a degree of emotional hurt to a client. However, it is important that a therapist maintains these boundaries for several reasons, not least of which is to prevent exploitation of vulnerable clients.
- Not effective
For a small proportion of people counselling and psychotherapy may not be experienced as effective or helpful, and for some counselling has been experienced as harmful.
Although it is just the case that therapy does not work for some people at certain times, it is important to raise any specific concerns directly with a therapist if a person has experienced harm as a result of something that has been done. If the issue remains unresolved, then they are advised to raise a complaint with the therapist’s professional membership body. All professional membership bodies have complaints processes that uphold the standards of counselling and psychotherapy
If you would like to know more about the benefits of counselling and psychotherapy, please contact us at office@acc-uk.org.