You have a right to expect acceptance in psychotherapy. When you feel safe with and held by your psychotherapist, you may talk about some painful things. You should feel that your therapist will not pass judgement on you, or be repulsed by anything you say. You should feel that your psychotherapist or counsellor will not react negatively, even if you become enraged at the therapist. The counsellor should respond to you therapeutically, allowing all your feelings, good and bad, to be released in a therapeutic frame which is strong and secure enough to hold them.

You start to build a secure frame long before you start counselling. The process begins the first time you consider calling a psychotherapist for an appointment. How do you choose a psychotherapist to call when there are over 300 varieties of counsellors, psychoanalysts, counselling psychologists and psychotherapists in London?

Take into consideration the psychotherapist or counsellor qualifications.

The best referrals are from local London referrals: from a professional who knows the psychotherapist or counsellor professionally;

• your family doctor,

• a professional organization,

• a counsellor or psychotherapist whom you have consulted for the purpose of obtaining a referral,

• some similar person who is in a professional position to have general feedback that this psychotherapist's clients have worked successfully (and who is NOT themselves a client).

If you use a London psychotherapist or counsellor referral service or directory, especially those online psychotherapy services directories, keep in mind that most of them are commercial services. Unlike LACAP, they may not have screened the therapist; any psychotherapist or counsellor in London who pays for a listing could be included. In other cases, the psychotherapy or counselling service could be restricted to only one variety of therapy, giving you less of a choice.

When you get the psychotherapy referral, you may find out about the psychotherapist or counsellor education, training and experience, and, if you know you have a particular need, the therapists specialty, if any (i.e. alcohol/addiction, depression, family or couples psychotherapy etc.). London counsellors may have a particular “orientation” like psychoanalytic, psychodynamic, cognitive/behavioural, gestalt, solution-focused, etc. It can be traumatic just trying to understand all the various psychotherapies on offer, let alone decide what kind of therapist to see. The letters after a therapist's name cannot reliably be used as a rating system to distinguish between good psychologists and ones offering poor psychotherapy.

Since psychotherapy or counselling  is as much an art as a science, there is a degree of plain old talent required, which is difficult to define with credentials; not to mention human qualities of compassion, empathy and character. To be a competent therapist, one needs ALL of the following:

Start with a master’s or a doctorate in a mental health field  A good London psychotherapist or counsellor has completed an extensive training program (“clinical placement”). It may have been part of the psychotherapist’s academic degree, or it may have been a separate postgraduate program. Some PhD’s and MA’s have academic knowledge about psychological research or medication, but have never had actual training or practice in psychotherapy or counselling . In London, a supervised psychotherapy placement is where counsellors and psychotherapist's learn their trade. After placement, and supervised experience, the therapist has been pronounced worthy by an authority to which they will be accountable. If the therapist doesn’t have all this, find someone who does.

Likewise, research in London has shown that the “orientation” of the psychotherapist or counsellor, and the technique that the therapist uses, is not the biggest factor in psychotherapy or counselling  outcomes. As with credentials, therapists like to say that their techniques are the best. But research in psychotherapy suggests that it has much more to do with the counsellor’s relationship with you.

You've selected a therapist in London to call for an appointment. The hardest part is that first contact. Do judge the relative competence of your prospective therapist.

In your very first contact, you will probably encounter either an answering machine or (less likely) a receptionist if using a psychotherapy service. With either, you only need to leave the following information: that you want to talk to the counsellor, your name, telephone number, email. When you can be reached  At this time, it is not necessary to explain the reason for your call. You need never have to discuss the reason that you want to talk to the counsellor with anyone except the therapist. A receptionist is NOT entitled to know and should not ask.

You shouldn't have to convince the psychotherapist or counsellor to see you. It would be unusual that any London therapist in private practice would not agree to see you at least once, as long as they have time available. Don't feel that you have to "qualify" for the appointment by offering the counsellor a suitable reason. The psychotherapy service receptionist should call within a few hours, certainly the same day.

• The service receptionist or psychotherapist identifies him/herself.

• You say that you want to make an appointment for psychotherapy. You mention where you heard about the psychotherapist or counsellor.

• The London psychotherapy service proposes a day and time no more than a week away. You agree on a day and time.

• Note: you have to be flexible here; be aware that good psychotherapist or counsellor’s schedules is usually full, especially evening hours.

• The counselling service gives you clear directions to the counsellor’s office.

• You confirm the appointment, say goodbye.

Don’t barrage the psychotherapist with extensive details at this time. These are better worked on in session. Do clearly ask what the psychotherapist charges and fees are. In London, this can vary greatly. The psychotherapy or counselling services manner should be professional and to the point.

The Initial Consultation: The therapist should have private offices with a comfortable waiting room. In a good London psychotherapy or counselling service, the therapist comes out to the waiting room, introduces him/herself, and shows you into the consulting room. When you are settled, it's usually up to you to start; otherwise the therapist may prompt you with a general question such as "What brings you along for psychotherapy?" You can describe the problem you are having or anything else that comes to mind. Don't worry about whether you can tell the counsellor everything with absolute precision. The counsellor should be able to help you get it all out. In this first session with the counsellor, you can expect to do nearly all the talking. You can expect your psychotherapist or counsellor to listen actively. While you are talking, the therapist will be listening carefully, and deciding on possible treatment. In order for the therapist to do this, the therapist must listen to you, and not influence what you say. Beware of a psychotherapist or counsellor who talks more than you do in the first session, especially about himself!

Toward the second half of the session, the psychotherapist should indicate whether a psychotherapy can help you, whether the psychotherapist can refer you within the counselling group service to another psychotherapist or counsellor more qualified for your case. The counsellor should then propose a therapeutic structure: a schedule of appointments, a fee, and any other related details. Though you may think, consciously, that flexibility on the part of the psychotherapist or counsellor is desirable, the opposite is true. At this point, you need the therapist to be firm and consistent (like a good parent). Fees and times may seem incidental to the actual therapy; but consistency contributes to the work. The usual psychotherapy is once a week, though you and your psychotherapist or counsellor may decide to meet more frequently; in therapy twice a week is not uncommon. In cases of financial hardship, a therapist may agree to sessions every other week.

Psychotherapy or counselling sessions are typically 45 or 50 minutes. Your therapist will hold you to that time absolutely. If you arrive late, the counsellor will still must stop at the agreed time. Your absences and lateness for psychotherapy sessions, persistent silence with the psychotherapist, wanting to leave therapy, forgetting to pay the counsellor, are often symptoms of "resistance", or fighting psychotherapy. In most cases, you will be responsible for paying for any regularly scheduled counselling sessions that you miss or cancel.

At your first session, the therapist should propose a fee. What is a normal counselling fee? It varies enormously with the area, the psychotherapist or counsellor qualifications, and the psychotherapy services setting. London psychotherapists or counsellors in private practice, may charge anywhere from £25 per session in Neasden, to £150 or more in Mayfair. Non-profit counselling  centres and clinics with sliding scales may reduce the counselling fee significantly. You can ask your psychotherapist or counsellor not to take notes or record your session. If you choose to allow information to be released by the counsellor then your therapist should obtain a consent form from you. If your psychotherapy or counselling is provided as an employment benefit, there should be no requirement for the therapist to report back on the therapy to your London employer.  Many insurance schemes though now intrude on this right: discuss it through with the therapist if it happens. Lacap hopes this helps when considering a psychotherapy or counselling, and in choosing a psychotherapist or counsellor or counselling psychologist in London.