Counselling

What is counselling?

Counselling is a talking therapy. You meet a trained counsellor, in person or online, and talk about what is troubling you. They listen without judging and help you find your own solutions.

That last part matters. A counsellor will not give you advice or their opinion. They help you see the situation more clearly, so the next step becomes yours.

Counselling is one of the most widely offered talking therapies in the UK. The NHS provides it, and many counsellors work privately or through charities.

Sources: NHS: counselling, BACP: counselling

How it works

Most counselling grows from the person-centred tradition. The idea is that being heard, fully and without judgement, changes how you relate to yourself. Difficult feelings become easier to look at when someone is looking at them with you.

Counselling usually stays close to the present. You talk about what is happening now, what it brings up and what you want to change. Where the past comes in, it comes in because you brought it.

Many counsellors are integrative. They keep the listening at the centre and add tools from other approaches when a tool would help.

Source: BACP: counselling

What sessions look like

A session usually lasts about an hour, and most people meet weekly. The first session is for both of you to see whether it feels right. You can start with whatever is on top.

There is no homework and no set programme. On the NHS you would usually have up to 16 sessions. Privately, some people come for a handful around one event and others stay for months.

You and your counsellor agree the shape together, and you can review it at any point.

Source: NHS: counselling

Who is it best suited to?

The NHS lists counselling as help for a wide range of difficulties, among them:

• Difficult emotions, such as stress, low mood, worry or anger
• A life event, such as an illness or a bereavement
• Problems in a relationship, at work or at school

It suits you if you want a steady space to talk, at your own pace, without being handed a worksheet. It suits you less well if you want a structured programme for one specific problem. For that, read on.

Source: NHS: counselling

How it differs from CBT

CBT is structured. It sets goals, teaches techniques and gives you tasks between sessions.

Counselling is open. It follows what you bring and trusts the conversation to do the work.

Neither is better. CBT has the deeper evidence for some specific conditions, such as panic and OCD. Counselling often fits better for grief, a relationship ending or a stretch of life that has become too much.

Counselling or psychotherapy?

In the UK the two words overlap, and the same professional often uses both. Counselling tends to be shorter. It stays with a present difficulty, where psychotherapy runs longer and looks further back, as psychodynamic therapy does.

Neither title is protected by law in the UK. Anyone can call themselves a counsellor. So the register matters more than the word.

Look for a counsellor on a register accredited by the Professional Standards Authority. We check that every professional on ViaCara holds current membership of a recognised register.

Sources: POST: professional regulation, PSA: accredited registers

Group therapy

Group therapy is a talking therapy given to several people at once. The group is a setting, not a school of therapy.

NICE lists group CBT among its first options for a new episode of less severe depression. It describes a course of eight regular sessions, led by two practitioners.

Group size depends on the course. NICE puts about eight people in that group, and about twelve per therapist in an anxiety group.

For generalised anxiety, NICE describes psychoeducational groups. They are built on CBT principles, and run six weekly sessions of two hours.

NHS Talking Therapies runs these courses in groups as well as one to one. Its manual says a group should run the full course NICE recommends. It adds that NICE does not support a single-session group.

A therapy group is not a support group. Mind describes a support group as people with a shared experience supporting each other.

In a group, confidentiality is shared rather than held by your counsellor alone. The BACP asks your counsellor to tell you who is inside that circle.

It also asks them to set out the limits before you start. The group agrees its own ground rules on top of that.

Burlingame and colleagues found 67 studies that set the two side by side. They found no difference in outcome, dropout, remission or rate of improvement.

Barkowski and colleagues reviewed group therapy for anxiety. They found it better than no therapy, and no different from one-to-one work across seven comparisons.

Sources: NICE NG222, NICE CG113, NHS England: talking therapies, NHS England: talking therapies manual, Mind: therapy and counselling, BACP: confidentiality, Burlingame et al. 2016, Barkowski et al. 2020

Counselling shaped by identity, culture and faith

Some counsellors describe their work by a client's culture, faith, sexuality or relationship style. These name a focus and a skill, not a separate therapy.

Intercultural therapy is a named British tradition. Jafar Kareem set up intercultural therapy as a way of working.

It takes in your wider life as well as the account you bring. It attends to race, culture, belief and language. It also attends to realities such as racism.

The tradition does not hold that your counsellor must share your ethnicity. Guidance BACP publishes reports better outcomes when a client's preference is met.

The same guidance says clients rate cultural humility above a shared background.

Affirmative therapy holds no sexual orientation or gender identity to be preferable. BACP sets that standard without using the label.

Its framework asks members to challenge any claim that one is preferable. It rules out any attempt to change or suppress either one.

That ruled-out practice is conversion therapy. Signatories to the UK Memorandum of Understanding call it unethical and potentially harmful.

The memorandum still leaves room to question. It says the position does not stop anyone with uncertain feelings from seeking help.

BACP, the British Psychological Society and NHS England have signed it. The UK Council for Psychotherapy withdrew in 2024, and still tells its members not to practise it.

Feminist therapy is a counsellor's own description, not a British credential.

Faith-based counselling includes Christian counselling. The Association of Christians in Counselling and Linked Professions holds a register the Professional Standards Authority accredits.

It has signed the memorandum as well. Religion or belief and sexual orientation are both protected characteristics.

Kink-aware is a counsellor's own description, not a British credential. The term comes from an American directory, which says it does not verify or screen anyone it lists.

The World Health Organization draws the clinical line. An arousal pattern between consenting adults is not in itself a disorder.

Whatever the label, the register is the check. The Professional Standards Authority lists the registers it accredits.

Sources: Nafsiyat: intercultural therapy, Ababio 2019, BACP: what works in therapy, BACP: respect, CACT: conversion therapy MOU v2, BACP: conversion therapy MOU, UKCP: conversion therapy update, PSA: ACC register, UK Parliament: Equality Act 2010, NCSF: kink-aware directory, WHO: ICD-11, PSA: accredited registers

Counselling for children and young people

ViaCara works with adults. Our page for under-18s carries the services built for them.

Two things change when the client is under 18. Consent may rest with the young person or with a parent, depending on their understanding.

That test comes from the Gillick case, decided by the House of Lords in 1985. It runs decision by decision, not as a fixed status. Scotland has its own test in statute.

Confidentiality has a harder limit. A safeguarding concern is passed on whatever the young person wants.

BACP asks counsellors to weigh a young person's capacity to consent. It asks them to know the law that applies as well.

NHS services for children and young people usually run to 18, and some reach 25. In England, NHS Talking Therapies takes self-referrals from age 18. In some areas it takes them from 16.

Sources: NSPCC: Gillick competence, UK Parliament: Scotland capacity 1991, BACP: respect, NHS: children's mental health, NHS: find talking therapies

The evidence

NICE lists counselling among the treatments for depression, for less severe and more severe forms alike. NHS Talking Therapies in England offers it as a named treatment for depression, in the person-centred experiential form.

The largest UK trial compared that form of counselling with CBT for 510 people in NHS services. At six months the two produced similar improvements in depression. At twelve months CBT held its gains better, and the trial reports that plainly.

The finding fits what research across every approach keeps showing. The relationship between you and the professional does most of the work, and counselling puts that relationship first.

Not sure whether counselling or another approach fits? Our guide to the different approaches starts from what you want, not from the name of a therapy.

Sources: NICE NG222, NHS England: talking therapies manual, Barkham et al. 2021