What is Counselling?
Counselling is a support process that helps a person deal with specific problems, difficulties or decisions of everyday life (career guidance, relationships, stress management, life crises), drawing on their own resources and strengthening their problem-solving skills. It usually has a more focused and short-term character.
What is Psychotherapy?
Psychotherapy addresses deeper and often longer-standing psychological issues (such as depression, anxiety disorders, trauma or dysfunctional patterns of thought and behaviour), with the aim of understanding and changing them more fundamentally. In practice, counselling and psychotherapy are not two strictly separate categories, but function rather as a continuum (spectrum), with considerable overlap in methods and techniques.
How effective is psychotherapy?
The scientific evidence for the effectiveness of psychotherapy is now extensive. An extensive umbrella review (review of reviews) by Leichsenring and colleagues, published in 2022 in the journal World Psychiatry, brought together data from 102 meta-analyses comprising 3,782 randomised controlled trials (RCTs) and a total of 650,514 patients. The findings showed a statistically significant benefit of psychotherapy over placebo intervention (SMD=0.34), with no significant difference in effectiveness compared with pharmacotherapy (SMD=0.11). About 50% of patients show improvement by the 8th session, and this rate rises to about 75% by the 6th month of therapy. Research also shows that a large part of the therapeutic outcome is attributable to common factors, the most important being the therapeutic alliance — the relationship of trust and cooperation between therapist and client.
Main evidence-based therapeutic approaches today
- Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT): they focus on the relationship between thoughts, emotions and behaviour, with strong research evidence for anxiety, depression and other disorders.
- EMDR (Eye Movement Desensitisation and Reprocessing): a widely evidence-based approach for processing traumatic experiences.
- Interpersonal Therapy (IPT): it focuses on interpersonal relationships and their role in mental health, with particularly well-documented results in depression.
- Systemic / Family Therapy: it approaches the individual within the context of their relationships (family, couple), focusing on the interactions and dynamics of the system.
- Psychodynamic Therapy: it explores unconscious processes and patterns shaped by early experiences, aiming at deeper self-knowledge.
- Humanistic / Person-Centred Therapy: it places self-actualisation and unconditional acceptance at the centre, fostering the personal growth of the individual.
How do I choose the right professional?
The choice of the right mental health professional should take into account three key factors: the therapist's formal qualifications and licence to practise (a Psychologist or Psychiatrist holding a Licence to Practise as a Psychologist or a Psychiatry Specialty Licence), the therapeutic approach they follow and their experience with the specific issue, and — equally important — the personal “chemistry” and sense of trust (rapport) that develops between therapist and client, which research shows to be a decisive factor in the success of therapy.
The therapeutic alliance: why “who” provides therapy matters
Beyond the specific therapeutic approach followed, much of the research of recent decades focuses on what are called the “common factors” of psychotherapy. The researcher Bruce Wampold, in a review published in 2015 in the journal World Psychiatry, argues that the therapeutic alliance — the quality of the relationship, the cooperation and the agreement on goals between therapist and client — explains a large part of the improvement, in many cases as much as or even more than the specific technique used. This does not mean that the method does not matter, but that choosing a professional with whom you feel comfortable and whom you trust is just as crucial as choosing the “right” therapeutic school.
What to expect from the first session
The first meeting with a psychologist or psychotherapist usually takes the form of an initial assessment (intake session): the professional gathers information about your history, your request and your goals, explains their way of working and the framework of the collaboration (frequency, duration, cost, limits of confidentiality), and together you form a first picture of how therapy might develop. It is perfectly legitimate to ask questions about the professional's training, specialisation and therapeutic approach before committing to a long-term collaboration.
Read here about Online Counselling and Psychotherapy.
Bibliography
Leichsenring, F., Steinert, C., Rabung, S., & Ioannidis, J. P. A. (2022). The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: An umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry, 21(1), 133–145. https://doi.org/10.1002/wps.20941
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238