Increasing Understanding of Mental Health, Trauma and Wellbeing Support to Enhance Informed Choice.

There are many kinds of support available when it comes to mental health, trauma and well-being support, so much so that it may be confusing for some to know who to turn to for the most effective, safe, and ethical support.

This article aims to raise awareness about the different types of support offered when it comes to this topic, so that clients have a better understanding and, as a result, can make informed decisions, which not only empowers a client at the start of their well-being journey but also facilitates support that is better suited to the individual needs of the client.

I want to highlight an important consideration: the titles therapist, counsellor, and psychotherapist are not legally protected titles in the UK (unlike psychologist and psychiatrist), meaning anyone without training can use them. Unfortunately, if someone requires therapy, they may assume that someone using such titles is qualified, even though this is not always the case. Despite the legalities, it’s unethical to mislead others who require qualified support for their best interest.

Many in the wellbeing space choose to support others because of their own past struggles, which, while helpful to some, cannot replace qualified support, when it is required.

Many people will turn to mental health support when they are at their most vulnerable, for example, when experiencing depression, anxiety, past trauma, or even whilst in an abusive relationship; therefore, many may not be in the right place mentally to constructively spend time assessing each practitioner that they come across, highlighting the need for transparency.

When mental health support or talking therapy is advertised, many may automatically assume that such a person is qualified to offer such practices (I know I did in the past). Sadly, this isn’t always the case. Moreover, as I am increasingly observing unqualified mental health support advertised in places like GP surgeries (in my local area), many may automatically assume that qualified professionals provide such support and not ask questions. So, I feel it’s vital to increase understanding of the different types of support commonly offered to enable informed choice. The client should be aware if their practitioner is qualified or not, to make an informed choice. When we are suffering psychologically, we need support urgently; thus, we may accept support from the first person we discover, without asking the right questions (or any).

For clients who require therapy due to trust issues, if they assume their practitioner is a qualified therapist/ counsellor when they are not, due to a lack of transparency, this could cause further psychological harm to the client.

Counselling

A qualified counsellor (often referred to as a therapist) has received appropriate training to support clients safely through emotional and mental distress. Counsellors usually support clients with anxiety, depression, attachment issues, relationship issues, self-esteem issues, and past trauma – this is not a comprehensive list. Counsellors are more “past and present focused”, supporting you to “unpack” and heal from psychological pain. A safe, confidential space is provided in therapy, enabling the client to open up at their own pace. Qualified counsellors are trained to listen actively, entering the client’s “world”, keeping their own opinions and beliefs outside of therapy.

The therapist is trained to manage dynamics, such as transference, and attends monthly supervision, which is vital to client safety. Additionally, a qualified counsellor has not only undertaken academic training but has also successfully completed at least one hundred hours of supervised counselling. Professional boundaries are essential in therapy; they maintain a professional relationship and ensure the safety of the therapist and client. Therefore, a counsellor would not work with someone they personally know or befriend. Continuing professional development is an important part of a counsellor’s role, as it ensures they stay up to date with the latest knowledge and research.

Counsellors have undergone training that includes self-reflection, along with monthly supervision, which aids self-awareness and highlights strengths and limitations. A counsellor should signpost a client to someone more suitable if they feel that they aren’t the best therapist for them; this is ethical for both. Counsellors should clearly inform you of your rights, clearly communicate how your data will be protected, and provide a contract and privacy policy.

Counselling in the UK is not regulated, despite this, many counsellors choose to be regulated with professional bodies, these include the BACP, NCPS and UKCP. If a counsellor is a member of one of these professional bodies you can be sure that they are qualified and follow ethical standards, including supervised practice.

Coaching

There is a huge difference between a therapist and a coach; both can have a positive impact on a person’s well-being, but the key is knowing the difference so we can make an informed choice from the start.

Coaches are more “present and forward-focused.” Coaches support clients in setting personal goals, such as career and health, goals; again, this is not a comprehensive list.

For clients who have no psychological distress and want to focus on clarity over achieving their personal goals, working directly with a coach would be beneficial and appropriate. Despite this, if a client does have emotional and mental distress, they should seek help from a qualified therapist first.

Counsellors and coaches both have their place within wellbeing; however, there are key differences that are vital to acknowledge, as they serve different purposes.

Mental Health and Wellbeing Support Groups

In my local area, Stoke-on-Trent, I have noticed that many mental health and well-being support groups are becoming increasingly popular. These include (but are not limited to) women’s circles, men’s groups, and mental health support groups. Well-being groups are, of course, very needed and can offer great support for lonely individuals and/or individuals who desire connection and psycho-education. Despite this, I feel that the issue comes when groups are being used as a replacement for therapy. From my personal and professional experience, I feel that mental health and well-being support groups should not be used as an alternative to personal therapy.

Over the years, awareness and perceptions of mental health have greatly improved. Despite this, mental health and trauma support should always require ethical, confidential and qualified support; this by no means implies stigma only safety. Yet, some may prefer mental health and trauma support through support groups; the choice is, of course, up to the individual. However, without understanding the differences, informed choice is limited, which is the need this article addresses.

As a counsellor and from my own personal experience, I feel that encouraging others to speak about personal trauma and delicate mental health concerns in any setting other than therapy (or with a qualified professional) is not only unethical but is unsafe for everyone involved. I will further discuss the reasons why.

Many will seek mental health/well-being support groups when they are struggling; therefore, listening to other people’s struggles when they are vulnerable themselves does not make logical sense, as this may add to psychological distress, and could also carry implications depending on what others share. Many clients may take home other people’s emotional baggage as well as their own, leaving them carrying more distress than they began with. People who are struggling with trauma and/or mental health conditions need more than connection and sharing experience; they require confidential, safe, qualified support to guide them through it.

Some people may feel brave enough for the first time to unleash the biggest trauma of their life in front of a group of strangers. This is not appropriate for anyone involved, as there is no room, time, or privacy to delve into any trauma, no matter how big or small. This also questions the impact that hearing someone else’s trauma may have on the rest of the group. Furthermore, if someone is feeling suicidal or discusses self-harm, this could potentially have a dramatic impact on the other group members.

Moreover, we cannot control other people’s reactions or responses; people may be vulnerable, and other people’s opinions and/or advice are not the appropriate way to support and could potentially have an unintentional negative impact. Additionally, there is no guarantee of confidentiality, as there is no legal requirement, causing major ethical concerns, especially for victims of abuse.

Well-being-focused groups can be a great place for personal development and connection, especially if you’re trying to meet like-minded people. Although they should in no way be used as a replacement for therapy. Unfortunately, I feel that sometimes (and often unintentionally) they can lead to a “mini therapy session”, without the safety of a 1.1 therapy session. I say this from personal experience of attending women’s circles over the years, before my training, with no understanding of why the differences mattered for the safety and mental wellbeing of all involved. I view my younger self with compassion. I was reaching out for support and wasn’t aware of the limitations of group sessions. I hope my article can prevent others from experiencing such outcomes.

I’ve been to many women’s circles in the past, and although they seemed supportive, looking back now as a qualified counsellor, none were actually safe or ethical. I was encouraged to open up about past trauma, which I instantly regretted, and I left with past trauma wide open, putting me at risk. Women’s circles (and other groups) are obviously more affordable compared to one-to-one therapy sessions, so to people who cannot afford to pay for private therapy, circles and/or groups may seem like a legitimate alternative. This is why the facilitator needs to explain that this is not a replacement for therapy, and why, as not everyone will understand the differences and importance of such.

I have included a table to demonstrate some vital differences between 1.1 therapy and support groups and why this matters for clients with trauma, attachment, and mental health conditions. The differences highlight why support groups cannot replace therapy,

My personal experience of an online well-being training group demonstrates how comparison, fear of judgment and group dynamics can be problematic for clients who have not processed their past pain.

A few years ago, I attended an online group session for parents who had children with a visible difference. This training focused on helping parents deal with comments in public. I often got comments from strangers when out in public with my son, and I really struggled with them. I didn’t understand why strangers would ask questions. I was so worried about how these comments would affect my son, especially as he got older and his understanding grew. As a result, I often replied rudely.

I assumed the online course would be beneficial for me; I wasn’t sure exactly how it would help, but I was eager to learn. To my surprise, the course left me feeling worse, invalidated and angry. This is because they missed (what I feel) is the most important step: they assumed we were all happy to answer strangers in public about our children’s visible difference. I wasn’t, and at that time, I didn’t want to. This was not even considered.

Because I was in a group, I felt like I couldn’t speak up. I felt there must be something wrong with my thinking process, because no one else was thinking like this. I also felt a fear of judgment. I didn’t really take much of the course in as I was feeling so irritated about the lack of autonomy to begin with.

Now, after years of my own personal therapy and as a qualified therapist, I know that my reaction to a stranger’s comment held a deeper meaning. Every comment triggered a deep level of unprocessed pain, which caused a physiological reaction of anger and pain within me. The comments were connected to deeper unprocessed pain, which consisted of fear about my son’s future, worry about upcoming surgery, and anger that my child has to suffer. It was my unconscious that was in control; no amount of training would change this.

In therapy, we would explore what feels right for the parent at that stage and at their own pace (usually, these changes depend on where the parent is at that time).

Of course, this training course did not have the means to explore unprocessed pain, but this is what I needed before any training. Because if we have unprocessed pain at the foundation, no amount of training will make a difference, and in my case, it left me feeling worse.

This example can be applied to other group settings, especially those centred on sensitive topics, such as abuse. A person must process their past with a qualified therapist to avoid unhelpful defences and triggers that control us.

A Summary of Risk, If Not Managed

We cannot eliminate every risk, but it is the practitioner’s responsibility to put appropriate measures in place to minimise risk, increase understanding and transparency, and utilise groups or sessions for an appropriate purpose.

1 Some may assume well-being groups are equivalent to “mini therapy sessions”; this can be appealing for many who cannot afford 1.1 therapy. This may seem like a solution to a financial barrier.

2 No support to process trauma, resulting in clients going home with their trauma wide open, putting clients at risk.

3 Hearing others’ trauma can trigger your own, and/or you may take the emotional weight of what others may share.

4 Confidentiality: There is no guarantee of confidentiality.

Steps to Safely Manage Group Support Sessions

1 There should always be a transparent approach to the purpose and limitations of group settings.

 2 Preparing worksheets/ presentations and staying on topic can help the session stay on track.

3 Clients should not be encouraged to share their past trauma or deep wounds; it is not appropriate or safe for anyone involved. If anything, such as trauma, does come out, the client should be gently debriefed after the session and signposted to qualified support.

4 Confidentiality should be encouraged, but the limitations should be highlighted to group members.

Group settings are great for connection and education but are not designed to replace therapy; if used for that purpose, they can pose a risk to all involved.

Good Practice

I am not opposed to wellbeing-type groups; careful consideration of client safety and ethical concerns should be emphasised and effectively managed, as outlined above. Taking these ethical actions will prepare clients by informing them of the nature and objectives of wellbeing groups, thereby helping safeguard their psychological well-being.

If someone is self-harming or suicidal and attends a support group in the hopes of affordable support, but then leaves with trauma wide open, this could lead to detrimental consequences for that individual. As practitioners, both qualified and unqualified, we have an ethical responsibility to consider these kinds of situations and to do what is possible to reduce the likelihood of negative consequences.

Conclusion

This article explores the different modalities of mental health and well-being support, so that individuals can make decisions regarding support that reflect their individual needs. Safety is essential, and for issues such as attachment, trauma, and/or layered emotions, working with a qualified counsellor/therapist is essential. Sometimes qualified counsellors will signpost clients on to professionals such a psychologist or psychiatrist if mental health needs are complex.

Having the awareness of the difference between therapy, coaching and support groups can help clients to make informed decisions about their mental health, seek the appropriate support, and limit any potential issues associated.

Group settings and coaching can be extremely valuable for clients, especially if they seek social connection and/or want to work on their personal goals. The key is knowing the purpose and limitations of each to enhance informed choice. Each type of support should be used for its true purpose. Education, awareness and transparency of service providers are all factors that will enhance client understanding, Of course, the choice is always up to the client, but without the correct information, an informed choice is not possible.