Therapist

Therapists work with people on difficulties they cannot solve alone: anxiety, low mood, loss, trauma, relationships. The work is done in structured conversations, usually weekly, held within clear boundaries about time, confidentiality and what happens if someone is at risk. Different models suit different problems, so most therapists train in one approach and add others later.

What the job actually involves

• Assess what a client is bringing and whether the therapy you offer is the right fit for it.
• Agree a contract covering session length, cost, cancellation and the limits of confidentiality.
• Hold regular sessions and keep the focus useful without pushing your own agenda.
• Assess and record risk, and act when someone is in danger from themselves or another person.
• Write concise notes that protect the client and would stand up if they were requested.
• Take your own work to clinical supervision, which is a requirement rather than an option.
• Refer on when a client needs medication, specialist trauma work or crisis support.
• Keep up continuing professional development to stay registered with your professional body.

On a normal day

• A first session opens with a long silence, and you let it run rather than filling it.
• A client says something in the last two minutes that reframes the whole hour, and you have to decide what to do with it.
• You spend ten minutes between clients writing notes and resetting, so the last session does not leak into the next.
• You take a case to supervision because you noticed yourself wanting to rescue someone.
• You end a piece of work well, which means naming the ending several weeks before it arrives.

Pay and hours

Starting

£25,000 a year

Typical

£36,000 a year

Experienced

£48,000 a year

Source: National Careers Service (counsellor profile), checked 2026-07-29.

Usually 35 to 40 hours a week, regular pattern. Evenings are common.

Skills that matter

• Listening for what is not said. Clients rarely open with the real problem, and the shift in a session usually comes from something noticed rather than something asked.
• Holding boundaries. The frame of time, fee and contact between sessions is not admin, it is what makes the relationship safe enough to be useful.
• Tolerating discomfort. Sitting with distress without rushing to fix it is the hardest thing to learn and the thing clients most need.
• Risk assessment. You have to be able to ask directly about self harm and suicide, calmly, and know what you will do with the answer.
• Self awareness. Your own reactions carry information about the client, and if you cannot see them they steer the work without you noticing.
• Record keeping. Notes are legal documents, and they need to be accurate and brief enough to be safe if a client or a court reads them.
• Working within a model. Structure gives both of you a way to tell progress from drift, which is why training is in a specific approach.

How people get in

• College course (Level 2 to Level 5). The standard ladder runs from an introductory certificate through counselling skills to a Level 4 or 5 diploma in therapeutic counselling, which includes a supervised placement. Usually 3 to 4 years part time.
• University (Degree or postgraduate diploma). A degree in counselling or psychology followed by an accredited postgraduate qualification is the route into psychotherapy and into most NHS posts. Usually 4 to 7 years.
• Salaried training programme (Level 6 or 7). NHS talking therapies services train psychological wellbeing practitioners and cognitive behavioural therapists on paid programmes with university study alongside. Usually 1 to 2 years.
• Charity training scheme (Varies). Bereavement and relationship charities train volunteers in their own model, which many people use as a first step and as a source of client hours. Usually 6 to 18 months.

Experience that helps

Training courses expect life experience and want to see you have worked with people in difficulty, so most entrants arrive in their late twenties or later. Volunteer counselling with a helpline or a bereavement charity is the usual starting point, and it also gives you the supervised client hours that accreditation requires.

Who employs therapists

• NHS talking therapies services
• Mental health and bereavement charities
• Schools, colleges and universities
• Employee assistance providers
• Private practice
• GP surgeries and primary care networks

Where the work happens

Consulting rooms in a clinic, GP surgery, school, charity or your own practice, plus a large amount of video work. Sessions are usually fifty minutes with a gap between them, and the diary is booked weeks ahead. The work is quiet and sedentary, and emotionally heavy in a way that most jobs are not.

Where it leads

• Accreditation with a professional body, which employers and insurers treat as the real qualification.
• Private practice alongside or instead of employed work.
• Specialising in trauma, eating disorders, children and young people, or couples.
• Clinical supervision of other therapists, which needs further training.
• Service lead or clinical manager in an NHS talking therapies or charity service.

Common questions

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