The Job and What's Involved

Psychotherapists help people who are experiencing difficulties with relationships, bereavement, depression, anxiety, stress or other personal problems, and people who want to improve the way they handle everyday life.

They don't offer advice, but they do help people examine their options and explore their own solutions in a calm and confidential setting.

The work of a psychotherapist usually involves:

  • Agreeing a therapy 'contract' with their clients, outlining the issues that will be covered and how sessions will work.
  • Helping clients to talk about their behaviour and feelings, by listening carefully and patiently, making observations and asking questions.
  • Keeping confidential records of their work.

Psychotherapists in private practice may work with a range of clients with a variety of reasons for seeking help. Others may specialise in a particular type of problem, such as alcohol or drug use, or work-related issues. Their approach and techniques are based on a particular 'core model', and could be:

Psychodynamic - focusing on childhood experiences, dreams, the unconscious and the dynamics of the client-therapist relationship.

Cognitive-behavioural - rooted in the belief that damaging behaviours can be unlearnt or reconditioned and recognising the link between negative thoughts and habitual responses.

Humanistic and person-centred - based on self-development and personal growth.

Integrative or eclectic - a mixture of techniques drawn from the core models.

Therapy usually takes place in a one-to-one situation, but it can involve work with couples, families and groups.

Some people use the terms psychotherapy and counselling interchangeably, others distinguish between them. The UK Council for Psychotherapy (UKCP) says that counsellors can practise after relatively short training, although many do have extensive training and experience. Counselling is also generally accepted as being more short-term than psychotherapy, although some counsellors may see the same clients for years.

Psychotherapists generally work standard office hours, though some also work in the evening and at weekends. Sessions with each client usually last 50 minutes.

A high proportion work part time. In a full-time job, the profession recommends a maximum of 20 hours of client contact time each week, with the rest of the time being spent on administration, professional development and supervision.

Psychotherapists mostly work indoors, usually sitting in a quiet, comfortable room, in places such as health centres or colleges or a in a suitable room in their own home.

This work can be emotionally challenging, but all psychotherapists are expected to undergo supervision, which means having regular sessions with an experienced therapist, who can give support and guidance.

Starting salaries for full-time qualified psychotherapists are from around £17,000 (around £20,000 in the NHS).

With experience, psychotherapists may earn up to around £60,000 a year, and up to £95,000 in the NHS in the most senior positions.

Psychotherapists in private practice charge an average of £30 to £60 a session. Their income depends on the number of client sessions and the cost of providing the counselling room and their own supervision.

Getting Started with this Career Choice

Full- and part-time jobs may be available in schools, colleges, prisons, the NHS and the voluntary sector and with large employers. However, there are more part-time than full-time jobs, so psychotherapists may combine their counselling work with other roles. Many also work unpaid as volunteers with charities and support organisations.

Government investment in the Improving Access to Psychological Therapies (IAPT) programme means more people with anxiety and depression are being offered talking therapies through the NHS. As a result, the number of career opportunities is increasing for psychological wellbeing practitioners and high intensity psychotherapists who practise cognitive behavioural therapy (CBT). There is strong competition, though, especially for trainee places.

The British Association for Counselling and Psychotherapy (BACP) has around 30,000 members in the UK. The UKCP has 6,600 psychotherapists in its membership.

Jobs are advertised in The Guardian on Tuesdays and Wednesdays, on the NHS Jobs website and through specialist journals and websites.

Education and Training

There are proposals for all psychotherapists to be regulated in the future, but there are no specific entry qualifications at the moment. The professional bodies, though, do have voluntary membership or accreditation requirements and suggest that clients are more likely to choose a counsellor who holds a recognised qualification.

Many staff practising psychotherapy in the NHS are qualified and experienced clinical staff who have undergone additional training, including psychiatrists, psychologists, social workers, mental health nurses, occupational therapists and arts therapists. These staff are already regulated by bodies such as the General Medical Council (GMC), Health Professions Council (HPC) and the General Social Care Council (GSCC).

It would be unusual for someone to enter full-time psychotherapy work before their mid-20's, and most advanced counselling courses insist on a level of maturity and life experience. Most psychotherapists will have had experience as a volunteer in a trainee placement, perhaps with an agency such as Relate (relationship counselling), Cruse (bereavement) or Phobic Action.

Relevant qualifications include:

  • ABC Level 3 Certificate in counselling skills, and Level 4 Diploma/Advanced Diploma in the theory and practice of counselling.
  • AQA Level 2 Certificate in counselling concepts or counselling skills, and Level 3 Certificate in counselling or Diploma in counselling.
  • BTEC Award in introduction to counselling skills, Diploma in developing counselling skills and Professional Diploma in therapeutic counselling.
  • City & Guilds Level 3 counselling skills and Level 4 Higher Professional Diploma in counselling.
  • CPCAB Level 2 Award in introduction to counselling skills, Levels 2 and 3 Certificates in counselling skills and counselling studies, Level 4 Diploma in therapeutic counselling, Level 5 Diploma in psychotherapeutic counselling and Level 5 Diploma in cognitive behavioural therapeutic skills and theory.
  • NCFE Level 3 Award in counselling skills and theory.

The CPCAB (Counselling and Psychotherapy Central Award Body) also offers a part-time foundation degree in counselling, in partnership with the Open University.

Degrees in social sciences, psychology or human sciences may be a useful, though not essential, preparation for counselling training.

There are a wide range of postgraduate-level psychotherapy and counselling training courses.

To work with children or vulnerable adults, applicants may need to undergo checks through the Criminal Records Bureau and be registered with the Independent Safeguarding Authority.

A Few More Exams You Might Need

Most employers now require counsellors to have, or be working towards, a qualification recognised by a professional body, such as the BACP or UKCP.

Professional bodies also require counsellors to undertake a certain number of hours of supervised practice before they can be accredited.

Psychotherapists may take a postgraduate diploma or Masters degree. A degree isn't always required for entry, but substantial work experience is essential.

To do IAPT training, applicants need to get a trainee position, either as a psychological wellbeing practitioner or high intensity therapist. Vacancies appear on the NHS Jobs website.

Many private, voluntary and charitable counselling organisations have their own training programmes that focus on the particular needs of a specific group of clients.

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Skills and Personal Qualities Needed

A psychotherapist should:

  • Have excellent listening and observation skills.
  • Have empathy, patience, tolerance and sensitivity.
  • Be able to support clients emotionally and encourage them to express their feelings.
  • Be able to work with difference and diversity.
  • Be able to help clients question their attitudes and approach to problems.
  • Exercise self-awareness and regularly review their own practice.
  • Be willing to examine their own thoughts, feelings and values.
  • Respect client confidentiality.

Your Long Term Prospects

There may be opportunities for experienced counsellors and psychotherapists to move into supervision or training, depending on the size of the organisation.

There are courses for experienced counsellors and therapists who want to specialise in an area such as drug misuse, AIDS, bereavement, cancer or child abuse.

Counsellors and therapists may also set up in private practice.

Get Further Information

British Association for Counselling and Psychotherapy (BACP),
BACP House, 15 St John's Business Park,
Lutterworth LE17 4HB
Tel: 01455 883300

Counselling and Psychotherapy Central Award Body (CPCAB),
PO Box 1768, Glastonbury BA6 8YP
Tel: 01458 850350

NHS Careers.
Tel: 0345 60 60 655

UK Council for Psychotherapy (UKCP),
2nd Floor, Edward House,
2 Wakley Street, London EC1V 7LT
Tel: 020 7014 9955

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