The Evolution of UK Counselling: Moving Beyond the Nodding Therapist

Writer: Sharen Dobson

A note from the writer: I'm dyslexic, so my writing journey takes a bit longer and sometimes looks different. I've done my best to check everything carefully, but if you spot any errors or anything unclear, please know it comes from a place of genuine care and effort. What matters most is that these words give you the warmth and understanding they're meant to carry.

Disclaimer

This blog post is based on personal experience and professional observations. It provides general information and is intended to offer insight into the evolving world of counselling. This information does not replace professional medical advice, diagnosis, or treatment. If you're in crisis or experiencing mental health difficulties, please get in touch with your GP, Samaritans (116 123), or your local emergency services. Always speak to qualified healthcare providers for support tailored to your specific situation.

There's this image that keeps coming up when people talk about therapy

You know the one. A stuffy room, a leather couch, someone with a notepad sitting across from you, nodding every so often, maybe asking "and how does that make you feel?" in this detached, clinical voice that makes you feel like you're being observed rather than heard. It's put so many people off seeking support. They think therapy is passive, impersonal, something you only do when you've hit absolute rock bottom. The reality of what's happening in counselling rooms across the UK right now? It's nothing like that stereotype.

Things Are Actually Changing

Over the past decade, the world of UK counselling has shifted massively. We're not just sitting back anymore, nodding along, keeping ourselves separate from the work. More and more counsellors are showing up as actual people in the room, having real conversations, bringing coaching into the mix, using proactive methods that actually help people move forward. This doesn't mean we've thrown out boundaries or stopped being professional. We haven't. What it means is that we've finally cottoned on to something important. Healing happens between people, in genuine connection, in conversations that feel like conversations rather than interviews.

The neurodivergent community has pushed this change forward in ways people don't always recognise. As we've started accepting that there isn't one "right" way to think, process information, or exist in the world, it's become obvious that there can't be one "right" way to do therapy either. Some people need to move whilst they talk. Others need to draw or make things with their hands. Some need direct, solution focused work. Others benefit from exploring existential questions about meaning and purpose. We've had to adapt. And honestly? It's made the work so much better.

The Tools We're Using Now

Talk therapy still has its place, but it's not the only option anymore. Not even close. EMDR has completely changed how we work with trauma. I've watched clients process things in a few sessions that they'd been carrying for years, decades even. It uses bilateral stimulation, which sounds complicated but really means we're helping your brain reprocess difficult memories without you having to talk through every painful detail. For people who've tried traditional talk therapy and found it either didn't work or made things worse, EMDR can be genuinely life changing.

Then there's polyvagal theory, which is essentially about understanding how your nervous system works. Your body isn't trying to sabotage you when your heart races, you freeze up, or you suddenly feel rage out of nowhere. It's responding to what it perceives as threat. Once you understand that, once you can recognise what's happening in your body and why, you can start working with your nervous system instead of fighting against it. I can't tell you how many times I've seen someone's whole face change when they realise their responses aren't character flaws, they're biology.

Existential therapy gets at the bigger questions. What makes life meaningful? How do we live with uncertainty? What do we do with our freedom to choose when that freedom feels overwhelming? Not everyone needs this type of work, but for people going through major transitions, questioning what they're doing with their lives, feeling disconnected from any sense of purpose, it goes deeper than trying to manage symptoms.

Art therapy and movement therapy recognise something we've ignored for too long. Words aren't always enough. Sometimes your body knows things your mind hasn't caught up with yet. Sometimes you need to create something, move in certain ways, express what's happening inside you through means other than talking. This is particularly true for neurodivergent people, trauma survivors, and anyone who struggles to put feelings into words.

Let's Talk About The Stigma

Even with all these changes, there's still this idea floating around that therapy is for people who are broken, who can't cope, who've failed at life somehow.

More people are accessing therapy now than ever before. This is good news, not something to whisper about. But we've got to shift the conversation further. Therapy shouldn't be the thing you do when everything's fallen apart. It should be something you can access before you hit crisis, as a tool for growth, prevention and understanding yourself better. Think about how ridiculous this is for a second. You don't wait until your teeth are literally falling out of your head before you see a dentist. You don't wait until you've had a heart attack before you think about exercise or what you're eating. Yet somehow we've decided that struggling alone with your mental and emotional wellbeing until you're absolutely desperate is what you're supposed to do. Why? Life is draining. Can we just be honest about that? The demands never stop. You're meant to be constantly available, perform well at work, be present for your family, maintain friendships, look after your health, stay informed, and be productive.

The pressure is relentless, and despite being more "connected" than we've ever been, people are lonely and isolated. There's no medal for suffering in silence. There's no virtue in waiting until you're drowning before you ask for help.

Business Owners Need Therapy Too

I work with quite a few business owners and executives, and I'm going to say something that might surprise some people. They often need therapy more urgently than they realise, but they're the last ones to seek it out. Running a business is lonely. Holding a leadership position is lonely. You're expected to have answers you don't always have. You're meant to project confidence when you're terrified you're making the wrong call. You make decisions that affect people's livelihoods, their mortgages, and their families. That weight sits on you constantly. Who do you talk to about that? Not your employees, they need to believe you know what you're doing. Not your clients, they need to trust you're in control. Often not even your family, because they're already worried about you working too much, or they don't understand the pressures, or you don't want to burden them further.

Where do you process the fear, the exhaustion, the guilt about missing your kid's school play again, the anxiety about cash flow, the burnout that's creeping up on you? A therapist gives you that space. Someone who isn't affected by your decisions, who won't judge you for having doubts, who can help you develop actual strategies for managing the load you're carrying. I've had business owners tell me they felt guilty "taking up therapy time" when they weren't in crisis. Then they realised that having somewhere to talk regularly, somewhere to work through challenges before they became disasters, actually prevented them from reaching crisis point, prevention, not just reaction.

What Actually Happens When You Work With Me

People ask me what my sessions look like, so I'm just going to tell you straight.

We start with an introduction call. It's informal. I tell you a bit about myself, you tell me a bit about yourself, and we see if we could work together. No pressure. No commitment. Just a conversation. If you want to go ahead, we can do an assessment session. This matters more than people realise. I need to work out if I'm the right person to support you. I do a risk assessment, we talk about your daily life, what support you've already got in place, and what you're hoping to get from therapy. A good therapist knows their limitations. I know mine.

I don't work with eating disorders. I don't work with clinically diagnosed schizophrenia, bipolar disorder, alcoholism, or treatment based OCD. Not because there's anything wrong with people dealing with those things, but because they need longer term, more specialised clinical support than I can provide. If that's what you need, I'll signpost you to the right services. That's not rejection, that's me being responsible about what I can and can't do.

After the assessment, the first few sessions are about getting to know each other. We talk about your life, what's going on, what's bothering you. This helps me understand how you think, how you process information, what might work for you and what definitely won't. It also helps me identify which therapeutic approaches might actually be useful for your specific situation.

Here's the bit you need to know about how I work. I'm proactive. I'm interactive. I don't do the sitting back nodding thing. I don't do long awkward silences where you're desperately trying to figure out what you're supposed to say next. I want an actual conversation. Back and forth. Questions and answers. I'll challenge you when I think you're being unfair to yourself or when what you're saying doesn't match up with reality. I'll push back gently when I need to.

I use coaching techniques alongside counselling. That means solution focused work, motivational interviewing, helping you uncover what's actually getting in your way, challenging how you see your world and your relationships, working out what you actually want rather than what you think you're supposed to want. My job is to help you become empowered, to find your own answers, not to sit there like some guru telling you what to do with your life.

My main thing, the area I'm best at, is communication. How do we advocate for ourselves? What boundaries do we need, and how do we actually maintain them? How do we talk to ourselves, because that internal dialogue is often far harsher than anything anyone else says to us? Most issues people bring to therapy, when you dig down into them, have communication at their core.

I've worked with all sorts at this point. School kids dealing with friendship drama and exam stress. Consultants burning out and feeling like frauds despite their success. Police officers processing things they've seen that you can't unsee. Families trying to navigate grief after losing someone to homicide. People who've survived a loved one's suicide carrying impossible guilt. Business owners stretched so thin they don't know how they're still functioning. Every person is different. Every session is different. That's exactly how it should be.

The Myths That Keep People Away

There are some persistent myths about counselling that stop people from getting help they'd actually benefit from. Let me address them directly.

Therapy is only for people with serious mental illness.

No. Therapy is for anyone who wants to understand themselves better, navigate something difficult, process emotions, improve relationships, and develop better stress management. Most of the people I work with are functioning perfectly well in their daily lives. They just want support with something specific, or they want to grow as people.

A good therapist just listens and never gives advice.

Sometimes yes, sometimes no. Different things work for different people. Sometimes you need someone to listen and reflect back what they're hearing. Other times, you need psychoeducation, practical strategies, and direct feedback. A skilled therapist knows which is needed when. There's no one right way to do this work.

Once you start therapy, you'll be in it forever.

The length varies massively depending on what you're working on and what you want to achieve. Some people do short-term focused work over a few months, and that's exactly what they need. Others find ongoing support valuable long term. You're always in control of when it ends. Always.

Therapy means dredging up the past and reliving trauma.

Understanding patterns from your past can be helpful, but you don't have to relive painful experiences in detail. Modern trauma-informed approaches prioritise keeping you safe. We can work with difficult experiences without retraumatising you. That's actually the whole point.

If you're not crying, you're not doing it right.

Therapy can involve tears. It can also involve laughter, problem solving, learning practical skills, quiet reflection, anger, relief, all sorts of emotions or sometimes no strong emotion at all. Crying isn't the measure of whether you're doing meaningful work.

Where We're Heading

The evolution of counselling in the UK is part of a bigger cultural shift. We're slowly moving away from the stiff upper lip mentality towards something more honest, more human. It's not fast enough, but it's happening.

This doesn't mean everyone needs therapy, or that therapy is right for everyone. What it means is that for those who could benefit, the barriers should be as low as possible. Money is still a massive barrier, which is why having services at different price points matters. NHS access, where appropriate, matters. Making it clear that seeking support isn't shameful matters.

Some of the strongest, most resilient people I know are in therapy. They understand that strength includes knowing when to ask for help. They realise that self awareness means looking at uncomfortable truths about yourself. They understand that growth is ongoing, lifelong, never finished. If you're reading this and wondering whether therapy might help, ask yourself these questions. Are there patterns in your life you'd like to understand better? Do you feel stuck anywhere? Are your relationships as fulfilling as you want them to be? Do you communicate your needs effectively? Are you living according to your actual values or just going through the motions? Do you have any space to talk honestly about your experiences without being judged or given unwanted advice?

If any of that resonates, it might be worth exploring. Not because there's something wrong with you. Because you deserve support in living the fullest, most authentic life you can.

The therapist's chair isn't about someone sitting back, nodding, staying detached anymore. It's about two people in a room having a genuine conversation, working together towards understanding, growth, change. That's what counselling has evolved into, and it's making support more accessible, more effective, more human than it's ever been.

If you're thinking about counselling and want to explore whether we might work well together, have a look at my website at sdobsontherapyservices.com or reach out via social media. I offer a £10, 20 minute consultation call where we can talk openly about what you're looking for and whether I'm the right fit for you. Sometimes starting the conversation is the hardest part.

Sharen x

Resources:

The Counselling Directory: www.counselling-directory.org.uk

BACP (British Association for Counselling and Psychotherapy): www.bacp.co.uk

NCPS (National Counselling & Psychotherapy Society): www.ncps.com

For crisis support:

• Samaritans: 116 123

• Mind: 0300 123 3393

• Your GP or local NHS services