Does the setting of therapy matter?

Recently I decided to seek private counselling. I made this decision because I felt it was something I desperately needed to break the cycle of being unwell mentally, and to address a number of issues that have built up over the years. I decided to seek a private counsellor for the following reasons:

  • The waiting period for an NHS appointed counsellor, if you qualify, is 6- to 12-months, and I’m not willing to wait.
  • NHS treatment is often limited to 6 sessions maximum and focussed on CBT, a treatment I have had several times which has only helped in the very short term.
  • The counsellor you see may not be a good fit for you, but you don’t get a choice, you have to work with that person or go back on a waiting list.

I wanted to be sure that I felt comfortable with a counsellor and wouldn’t be forced down the CBT road nor be limited to 6-sessions which causes all sorts of anxiety if you’re not feeling like you’ve made progress. Going private is an expensive option, but one I think is worthwhile because it’s my health at the end of the day and can you really put a price on that?

But this actually got me thinking, again, about something I’ve thought about before. Does the setting of these type of talk therapies, CBT included, make a difference to how well the treatment works or how comfortable someone feels in opening up and being involved in their care?

In my experience, with NHS treatment you are generally seen in quite a clinical setting. You’re sat in very uncomfortable chairs in a room normally used by a GP so there’s an examination bed/couch, a desk and computer, scales, and all manner of books, leaflets, and other information notices. Even when I’ve had CBT and brief counselling through my employer’s occupational health service, the setting isn’t much different to that of the NHS.

Privately, the setting is very different. It’s much more like sitting in a friend’s lounge on a sofa and having a chat over a cup of tea. There’s nothing clinical about this environment, it’s nicely decorated and comfortable. It just feels better, more relaxed.

So I’m wondering, does the physical setting make a difference in how people interact with talk therapies? Do you relax more and feel more comfortable in one or the other? Does it make a difference to whether they make progress or not? I’m genuinely curious. I don’t know if this is actually measurable, though I’m sure there’s plenty of anecdotal evidence.

What are your thoughts? Have you experienced any type of talk therapy in these different environments? If so, do you feel one was better than the other or is it more down to all the other things like the person you’re talking to, the type of treatment, the issue at hand?

NB I’ve left out group therapy as that’s a different thing altogether, and I have no personal experience of it so don’t feel I can comment.

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