Trueform Therapy

Tag: myths

  • Can Counselling Really Help? An Honest Answer

    “Can counselling really help?”

    It’s one of the most common questions people bring to a first session, sometimes before they’ve even sat down. Often it comes with other questions underneath it. What if I don’t know what to say? What if talking to a stranger makes things worse? What if I’m not the kind of person it works for?

    I understand those doubts, because I had them too. I’ve been a client myself, and I was sceptical about whether talking to someone could really make a difference.

    So I want to give an honest answer to that question. Not a sales pitch, and not a list of reassurances, but what the research and my own experience actually say.

    The Short Answer

    For most people, yes. Counselling helps.

    The research on this is large and fairly consistent. For depression, talking therapy and antidepressant medication have broadly similar effects in the short term. A 2013 review led by Pim Cuijpers, who has spent much of his career comparing treatments for depression, also found that people were less likely to drop out of therapy than out of medication. And people who had CBT were less likely to relapse afterwards than people who stopped taking medication. The changes people make in therapy seem to last after it ends.

    There’s also UK research that matters particularly for counsellors. In the PRaCTICED trial, published in The Lancet Psychiatry in 2021, researchers in Sheffield compared person-centred counselling with CBT for 510 people with moderate to severe depression in the NHS. At six months, counselling was found to be no less effective than CBT. At twelve months, CBT had a small edge. It’s a reminder that different approaches can work, and that the full picture is rarely as simple as one therapy being “the best”.

    That said, “most people” isn’t “everyone”, and I’ll come back to that.

    What Actually Makes It Work

    If you ask people what makes therapy work, they often guess it’s the technique: the right method, the right exercises. Technique matters. But one of the most consistent findings in therapy research points somewhere else.

    An international task force led by Christoph Flückiger at the University of Zurich looked at almost 400 studies of the relationship between client and therapist, sometimes called the therapeutic alliance. Across different approaches, problems and countries, the quality of that relationship predicted how well therapy went. In other words, feeling understood, trusting the person you’re working with, and agreeing on what you’re working towards are not just pleasant extras. They’re part of what makes change possible.

    There’s another finding I find important, and it comes from the research behind the approach I trained in. Mick Cooper, who helped develop pluralistic counselling, worked with colleagues on a review of 51 studies involving around 16,000 clients. They found that when people received the kind of therapy they preferred, they did a little better, and they were almost half as likely to drop out early.

    That means your preferences matter. If you know you want practical tools, or space to talk without being steered, or to understand where your patterns come from, that’s useful information, not something to keep to yourself. A good counsellor will want to know.

    The Part People Don’t Talk About

    Here’s something that rarely appears on therapy websites: counselling doesn’t help everyone. In clinical trials, an estimated 5 to 10 percent of adults end therapy feeling worse than when they started. In routine care, the figures for people who don’t improve are higher still.

    What’s striking is how poorly therapists notice this. In one well-known study, therapists were told how often clients in their clinic usually got worse, and then asked to predict which of their own clients would. Out of 550 clients, they predicted just three.

    I’m not sharing this to put anyone off. I’m sharing it because it changes something important: if counselling isn’t helping, it’s not a sign that you’re failing at it. It might be the wrong approach, the wrong timing, or simply the wrong fit. The most useful thing you can do is say so. Any good counsellor should welcome that conversation. And if it still doesn’t feel right, it’s completely acceptable to try someone else.

    What Counselling Isn’t

    A few ideas tend to put people off before they start.

    It isn’t only for people in crisis. Many people come to counselling not because everything has fallen apart, but because something feels stuck, or heavy, or not quite right. You don’t have to wait until things feel unbearable.

    It isn’t a quick fix, but it isn’t endless either. Change usually takes time, and it isn’t always a straight line. Sometimes things feel harder before they feel easier. But it also shouldn’t feel like years of going round in circles. It’s reasonable to talk with your counsellor, from time to time, about how things are going.

    Your counsellor won’t tell you what to do. The decisions about your life stay yours. That doesn’t mean sitting in silence, though. Depending on what you want, a counsellor might offer ideas, share something useful about how the mind works, or suggest something to try. The point is that it’s collaborative, and you’re in charge of the direction.

    My Own Experience as a Client

    When I first went to counselling, I felt overwhelmed and unsure how to make sense of my own emotions. I didn’t expect much.

    Slowly, I began to understand the patterns underneath the anxiety and self-doubt I’d been carrying. My counsellor introduced things like mindfulness and journaling, which helped me step back and see my feelings more clearly. The changes were small at first: feeling calmer in situations that used to set me off, being able to say what I needed, reconnecting with friends and family in a healthier way.

    It wasn’t always easy. But by the end, I felt more in control of my life, and kinder towards myself than I’d been before. Those changes didn’t disappear when the sessions ended, either. I still draw on them today.

    What the First Sessions Are Like

    The first session or two are mostly about getting to know each other. Your counsellor will ask what’s brought you, a little about your life and history, and what you’d like to be different. You don’t have to tell your whole story at once, or know exactly what you want to work on. It’s fine to say “I’m not sure”, and to start there.

    It’s also a chance for you to decide whether this feels like someone you can work with. You’re allowed to ask questions too: how they work, what they’ve trained in, what happens if something isn’t working.

    Your counsellor will also explain confidentiality. What you share stays private, with a small number of exceptions, such as when there’s a serious risk of harm to you or someone else. A good counsellor will be clear about exactly where those limits are, so there are no surprises.

    Starting Where You Are

    Deciding to try counselling can take a long time. If you’ve been wondering whether it could help, that wondering is worth paying attention to.

    At Trueform Therapy, I offer one-to-one sessions in person in Cardiff and online across the UK and EU. My training is integrative and pluralistic, which means we’ll shape the work around what helps you, rather than fitting you into a single approach. If you’d like to find out whether we’d be a good fit, you’re welcome to get in touch for an initial conversation.

    You don’t need to have the right words. You can start exactly where you are.

    If You Want to Explore These Ideas Further

    If you’re curious about what research says about how therapy works, Mick Cooper’s Essential Research Findings in Counselling and Psychotherapy is the clearest summary I know of. It’s written for practitioners, but it’s readable and honest about what we do and don’t know.

    For a view from inside the therapy room, Irvin Yalom’s The Gift of Therapy (2002) is a short, warm collection of reflections from one of the most respected therapists of his generation.

    And if you’d like to know what therapy feels like from both chairs, Lori Gottlieb’s Maybe You Should Talk to Someone (2019) follows a therapist who goes to see a therapist herself. It’s funny, moving and surprisingly honest.

    And if you’d like to look at the research directly: