Talking therapy sessions can take many different forms, depending on your needs, the type of therapy you have and where or how that therapy is delivered.
You will usually have a number of planned, regular sessions lasting for around 50 minutes. How often you see your therapist, and how many sessions you have, will depend on your individual circumstances.
You may see your therapist on a one-to-one basis or in a group, or you may speak to them over the telephone or online. They may go through specific exercises designed to help you with the problem you're experiencing. Or you might have more general discussions about how you're feeling.
What you talk about will vary depending on the problem you want help with and the type of therapy you are getting. It could include:
situations or events you find difficult
Your first session
Every therapist has their own way of beginning therapy. They may start by talking about what will happen in your therapy or they may begin straightaway by asking you what is troubling you. Either way is fine, but there are a few things your first session is likely cover:
Your therapist should spend a few minutes introducing themselves. If you’re not sure whether to call them by their first name or to be more formal, just do what you feel most comfortable with. If you feel the therapist is too informal in the way they address you, you should say so.
Your therapist may start by taking a history of the troubles you are experiencing. They might ask you to complete some forms, or go through information they have received about you, such as a letter from your GP. They may just ask you to ‘tell your story’. Whatever format the assessment takes, you should feel you have the opportunity to tell the therapist about the issues that are troubling you.
Your therapist should agree the terms, or contract with you, on how they will provide their services. This should include:
Your therapist should discuss with you the number and frequency of sessions you will have and how any fees will be paid. They should also explain what happens if you miss a session or are away on holiday.
Confidentiality and note taking
Your therapist should explain how they will protect your confidentiality and privacy. They will also tell you of any situations when they may be required to disclose information about you. Therapists will usually take notes or record the sessions in some way for their own professional use. They should tell you how they will do this.
During the first session, or at any time during your therapy, you can ask your therapist anything you want to know about their qualifications and experience. You can also ask them about your therapy and question anything you don't understand. Your therapist should encourage you to do this.
Your relationship with your therapist is very important. To get the best out of the process it’s important that you have confidence in them. Trust your instinct and if you’re unsure about the therapist, seek another one.
If no therapist seems suitable, you may want to consider whether you would wish to proceed with therapy or not.
Talking therapies can help with many difficult life problems - from coping with traumatic experiences and events, to dealing with depression and anxiety or managing harmful emotions and behaviours.
Here is an A-Z of issues and concerns which may be helped by talking to a therapist, this is by no mean an exhaustive list.
Abuse is when the way others treat you becomes harmful to you. Abuse can take many forms, including emotional, physical or sexual. Therapy can help you address how this has made you feel and work through your feelings so you feel better about yourself.
Attention deficit disorder (ADD) or Attention deficit hyperactivity disorder (ADHD)
ADD or ADHD usually begins in early childhood but can continue into adulthood. Those affected may be hyperactive, impulsive or find it difficult to pay attention. Cognitive behavioural therapy (CBT) or behavioural therapy can help to change these behavioural patterns.
Addiction happens when you become overly dependent on something, often when you’re trying to escape from other problems. You can be addicted to many things including:
Therapy can help you address the causes of your addiction to help you stop your addictive behaviour.
Being adopted can directly affect you in many ways. You may:
feel loss or rejection
be confused and have split loyalties
feel disappointed and depressed
be in turmoil over how you feel
In therapy you can talk through how being adopted affects you, understand what you are thinking and explore the issues that you are experiencing.
AIDS and HIV
HIV is the virus that causes acquired immune deficiency syndrome (AIDS). It weakens your ability to fight infections. Having HIV does not always mean that you have AIDS, and it can take many years for AIDS to develop. HIV and AIDS cannot be cured but there are many ways you can stay healthy and live longer. Therapy can help by supporting you in dealing with the symptoms and reactions.
Anger is a normal emotion, but it can become uncontrollable and create problems for you, your family and your personal relationships. Anger can stop you thinking clearly, make you act impulsively, or may make you aggressive and violent towards others.
If you find it difficult to talk about how you feel, you may suppress your anger or turn it inwards. This can lead to problems such as:
Therapy can help you find the cause of your anger and provide ways to control and change your behaviour.
Anxiety is common in mental illness or after extreme or distressing experiences. You may feel intense apprehension or worry, accompanied by acute physical signs such as:
Therapy can help you with anxiety, panic attacks and phobias by giving you ways of dealing with situations as they occur and exploring the cause of your feelings.
Autism spectrum disorders (ASD)
ASDs are lifelong development disabilities, which can cause difficulties with social interaction or restricted and repetitive patterns of behaviour and interests. People can be affected in very different ways - some can live relatively unaffected lives while others need specialist support. Therapy can provide support for those living with autism and offer coping strategies. Cognitive Behavioural Therapy (CBT) is often a useful tool for people with Asperger's Syndrome.
It is normal to feel angry, sad or lonely when a loved one dies or leaves. Even the loss of a pet can have a major psychological effect. Working through your feelings with a therapist can help you come to terms with your loss.
Bullying is when other people have the power to cause you pain and distress through abuse, threats and intimidation. It can include emotional, physical, verbal and cyber bullying and can happen at all ages - in families, education and at work. Therapy can be helpful for both the victim and the bully.
If you have cancer, you may feel anxious and stressed about the changes in your body or the effects of your treatment. You may be angry and find it difficult to cope with feelings of loss of control. It can help to talk through these feelings with a therapist, as your friends and family may be too close to the issues to see them clearly.
You may benefit from career counselling when you are thinking about possible career movements or areas of study. A counsellor can help you set your personal goals and identify any factors likely to influence your decisions or affect your objectives. They will give you confidential guidance and help to ensure you are setting realistic targets for yourself and making positive career choices.
Child related issues
Children and young people, and their families, can sometimes need extra support if they are finding it difficult to deal with or understand their emotions or behaviour. Children can find it hard to express their worries, and unresolved problems may extend into their adult lives. More serious issues like abuse and mistreatment often require urgent specialist attention.
In our increasingly multi-cultural and multi-racial society, people may need help adjusting to their own and other cultures. Personal and professional relationships between different cultures challenge and put pressure on people to maintain their own identity and values which can cause:
negative self image
feelings of being different
Cultural counselling acknowledges the impact these issues can have on your wellbeing and may help you to cope with them.
If you are living with dementia, you may find it hard to make sense of what is happening to you and how your life is changing. You may feel angry, confused, afraid and anxious, and find it difficult to discuss your feelings with family and friends. If you are faced with dementia yourself, or for a close family member, you may find therapy allows you to speak frankly about your feelings and work out ways to live with the condition.
Depression can be a devastating illness that affects your body, mood, behaviour and thoughts. It is not a sign of weakness or failure, and it's not something that can be changed overnight. Without treatment, symptoms can be present for years, preventing you from functioning to your full ability. The National Institute for Health and Clinical Excellence (NICE) currently recommends a range of psychological therapies for the treatment of depression.
Therapy can help you get to know yourself better, clarify issues that matter to you and develop your potential. It gives you the opportunity to work in ways which promote your ability to resolve problems, or to develop coping skills for things which cannot be changed.
Eating disorders are extremely common and can be serious or even life threatening if not treated appropriately. People often use dieting, bingeing and purging start as a way to cope with painful emotions and to take control. But if these behaviours continue, they will damage your physical and emotional health and self-esteem. Therapy can be helpful in changing thoughts and expectations and in providing support and encouragement.
Sometimes simply sitting down with someone who can help you put your feelings into perspective can be beneficial. In counselling, you can explore personal difficulties or feelings of dissatisfaction, and talk openly about aspects of your life, in a way that may not be possible with friends or family. Therapy can help you discover what is important to you, so you can live the kind of life you really want and improve your health and wellbeing.
If you have financial problems, you should seek financial advice as soon as possible. But it can also be helpful to discuss the emotional difficulties that debt may raise with a therapist.
Health related issues
Therapy can help anyone who is generally worried about their health, or who needs help in coming to terms with being diagnosed with illness. Working through feelings such as 'why me?' can be beneficial to your quality of life.
Being unable to get pregnant, or having repeated miscarriages, causes many complex and painful emotions. Infertility treatments can also be physically uncomfortable, time-consuming and exhausting, placing great emotional demands on those involved. Talking to someone who is not directly involved can help you to come to terms with the situation.
Therapy can help you identify the skills and capabilities that you have, and use them to the best of your ability. It can make you better able to change things to:
make your life run better
fulfil your potential
be more successful
be less stressed
become more peaceful, sociable or fun
Loss is not just about death; you could also lose a relationship, a job or your health. Losing someone or something you love is very painful and you may experience many difficult and surprising emotions, such as shock, anger, grief and guilt. Therapy can help and support you through this difficult period of your life.
Obsessions and obsessive compulsive disorder (OCD)
Obsessions are usually unpleasant thoughts, pictures or impulses which come into mind when we don’t want them. Compulsions are the behaviours used to ‘put right’ or act on the obsession.
Most people have occasional intrusive, troubling thoughts, such as worrying that you've left the oven on, but some people can’t get rid of them. If you have OCD, you may have repeated obsessions and compulsions that seem very important and make you feel anxious. Therapy can help you put things in perspective and develop coping mechanisms to deal with the triggers of OCD.
Therapy can help you use knowledge, skills and experience to develop your self-esteem. This enables you to take responsibility for things like your:
A phobia is an irrational, intense, persistent fear of certain situations, activities, things or people. Therapy can help you manage these thoughts and put them into perspective.
Post-traumatic stress disorder (PTSD) is a psychological and physical condition caused by a very frightening or distressing event. With PTSD, you often relive the event through nightmares and flashbacks. You may have problems concentrating and sleeping, and feel isolated and detached. The symptoms are often persistent and severe enough to have a significant impact on your day-to-day life. Several therapies can be helpful in coping with PTSD, including:
eye movement desensitisation and reprocessing (EMDR)
cognitive behavioural therapy (CBT)
rational emotive behavioural therapies
Pregnancy related issues
The experience of pregnancy, whether planned or unplanned, can be confusing and stressful, and may cause mixed feelings. For example, you may have concerns about how it could change your relationships. Therapy can help you understand your feelings towards your pregnancy, or explore difficult emotions following a miscarriage, stillbirth or termination.
Redundancy can lead to feelings of loss and confusion, as well as concerns about how to pay your bills. Therapy can help you work through issues of self-esteem and confidence, and the practicalities of redundancy.
Relationship counselling can help improve the way you relate to those around you and allow you to break free from old patterns of behaviour. This can cover all relationships, including couples and families.
If you have low self-esteem, you may view life in a negative way which makes things seem hopeless or pointless. You might think you are worthless, and that other people are better than you. You may have difficulty saying what you really feel, or you may lack the confidence to be assertive. As a result, you may feel that people take advantage of you and treat you badly. Therapy can help you explore the way you feel and change your view of yourself and others.
Self-harm can be a way of coping with painful and difficult feelings and distress. You may harm yourself because you feel overwhelmed and don’t know how else to deal with things. Therapy may help you discover and deal with the feelings that are causing you to self-harm.
Sex related issues
Sexual difficulties can occur at any time, especially during times of stress and change. If sex used to be exciting but no longer seems so, therapy can help you look at why the change happened. In a good relationship, getting help should give you an opportunity to find some answers.
Sexual abuse is when you are pressured to do something sexual against your will. It can include unwanted touching, photographs or rape. Some people blame themselves and do not report the abuse. Or they may have been influenced to trust the abuser or feel they will be punished for reporting it. Childhood abuse is not always addressed until sexual problems emerge in adulthood. Talking to a therapist can help.
Working out whether we are more comfortable in same sex or opposite sex relationships is part of our sexual identity. You may feel really sure about your sexual identity or it may be more fluid and changeable. Talking to a therapist can help you explore these feelings.
For many people, coming to terms with their sexuality can cause a lot of anxiety and heartache. You may know from an early age that you are lesbian, gay, bisexual or transgender . Or you may feel confused about your sexuality and take longer to work out what seems right for you. Therapy may help you come to a decision or to deal with a decision that you have already made.
Spirituality is about how you make sense of the world and find meaning in your life. It can, but does not necessarily, involve specific religious beliefs. Therapists who are experienced in spirituality can help you find inner peace and a deeper sense of meaning and belonging.
Stress can be a positive thing and help you achieve your goals. But too much stress can put your health at risk and lead to physical, mental and emotional problems. Therapy could help you to manage your life differently or support you in developing coping strategies.
Many kinds of emotional pain can lead to thoughts of suicide. You may reach a point at which you feel you can no longer cope. You may not truly wish to die, but you may need help at that moment. Therapy could help by allowing you to share your thoughts and feelings and work on ways to transform negative thoughts into more positive ones.
Emotional and psychological trauma can be the result of extraordinarily stressful events that shatter your sense of security, and make you feel helpless and vulnerable in a dangerous world. Trauma can be caused by a one-off event, such as a bad accident, a natural disaster or a violent attack. Or it can result from ongoing, relentless stress, such as living in a crime-ridden neighbourhood or struggling with major health issues. Talking to a therapist could help you.
Work related issues
The average person spends almost a quarter of their adult life at work. It can give you a sense of purpose, structure and satisfaction while also providing the means to finance daily life. It can also cause stress, frustration, poor health and self-esteem issues. If you start to lose sleep, constantly dread work or drink heavily, it may be useful to seek help from a therapist.
How to offer support and where to get advice
If someone you know is going through a difficult time, it can be hard to know how best to help them. You may feel that they need support and assistance beyond what you can provide. Here’s some ways you can give support and find the right kind of help for them.
Start a conversation
Starting a conversation about offering help can be difficult. You could try asking simple questions, such as:
I’ve been worried about you. Would you like to talk?
I care about you and want to help. Is there something I can help with?
it seems like you’re going through a difficult time. Maybe I can help you to find the right help?
Talking with someone they trust and sharing their problem can be a really positive experience. It can help them feel less alone and give them a different perspective on the problem they are facing.
If a friend or relative is struggling with a problem, it can have a big impact on your life. Supporting them and letting them know you are there to help can bring you together. You could try:
expressing your concern and reassuring them that you care
asking questions, listening to their ideas and being responsive when they talk about their problems
reminding them that help is available and that problems can be solved
finding out what they feel would help and helping them to get any care they want
offering practical help such as making a telephone call or by going with them to their GP
Maintain their trust
Though it may be obvious to you that someone you know needs professional help, there are many reasons why they may refuse or be reluctant to seek help. You may feel frustrated if you think they’re not trying hard enough to get well, but try not to make assumptions about how they feel. When talking about their problems, try to remember to:
treat them with respect, compassion and empathy
keep yourself and them focused on positive things and day to day realities
discuss the topic when and where they feel safe and comfortable
watch for reactions during the discussion and slow down or back up if the person becomes confused or looks upset
Therapy is time set aside by you and the therapist to look at what has brought you to therapy. This might include talking about life events (past and present), feelings, emotions, relationships, ways of thinking and patterns of behaviour. The therapist will do their best to help you to look at your issues, and to identify the right course of action for you, either to help you resolve your difficulties or help you find ways of coping. Talking about these things may take time, and will not necessarily all be included in one session.
Usually individuals choose to have therapy because they are experiencing difficulties and distress in their lives. Sometimes people can be isolated but at other times, even where an individual has the most supportive family and friends, they can find it difficult if not impossible to explain why, for example, they may be feeling anxious and/or depressed. Or it may be easier to talk about personal, family, or relationship issues with a person who is independent of friends and family. Other life issues and events
which can be very difficult to deal with include bereavement, divorce, redundancy, health issues, bullying and so on. However, you do not have to be in crisis or on the verge of it, before choosing to have therapy. You may be experiencing underlying feelings of dissatisfaction with life in general, or be seeking balance in your life and spirituality. All of these reasons and more will bring individuals to therapy.
Therapy is not advice giving or persuasion orientated to the therapist’s point of view... although therapists may offer information and some therapeutic approaches may ask you to do homework as part of your therapy. Nor is it just a friendly chat discussing the week’s events as you would with a friend. Talking with a therapist is not the same as talking with a friend, a parent or sibling, who would probably have an opinion about the issues discussed. The therapist is an impartial professional, who is able to listen to you non-judgmentally and to work with your emotions and not get emotional themselves. The therapist helps you to develop understanding of yourself and others and to find your own solutions, making no demands upon you except for the terms agreed in your therapeutic contract.
Therapy sessions are normally regular and not held at random, for example, two sessions this week, one next week and then ‘see how we go’. Some therapy models allow some flexibility in the spacing of sessions. Sessions should not be held in cafés, bars, hotel reception areas, works canteens, or any place where client and therapist can easily be overheard and with the possibility of being recognised and interrupted by family, friends or colleagues.