It depends on the therapist and your issues.
I've been on-and-off from therapy for a while. Here in the USA, if you have bad insurance or are poor, you tend to get worse clinicians. They are overworked and can't spend much time on you, or have checked out and lack consideration for their patients, which is why people have lots of stories of their therapist running errands during sessions, texting, or venting about their own problems.
I'm not sure if it's easy to change your psych in the UK, but some red flags are:
- Therapist seems clearly disengaged. be careful with this -- I have social anxiety disorder so I always think people are bored out of their minds when I speak. Some obvious, non-negotiable ways to tell are: therapist does not remember significant things you told them in previous sessions (e g.: you mention that you don't get along with your mom but they always recommend asking to your mom for advice), texting or staring at the clock during sessions, rolling their eyes or refusing to continue talking to you when you cry/get upset, or not having anything to say, consistently late/ending sessions early
- Therapist does not have a plan for your treatment. They might be adamant that you do CBT or narrative therapy or some other mode even if you say that it's not helping. The bad therapists usually *love* psychodynamic since it does not require them to do any work at all. They will just ask you to vent, say nothing of use the entire time, and ask you to come back next week and repeat it all again. Your therapist should set goals with you that are consistent with your own personal goals. They need to be focused too, lots of people veer off-track during setbacks and it's important that your therapist doesn't do this.
- They make you feel bad, uncomfortable, or upset, in a way that would make any other reasonable person upset. It's important for a therapist to challenge you, and sometimes that involves some discomfort. For example, a therapist may ask you to talk about your family. It may be a difficult topic, maybe they abused you in the past. A therapist understands your discomfort, and helps you get through it. They do not force you into disclosing, or guilt-trip you if you aren't ready. Or, if you have an anxiety disorder, they should not call your concerns silly, dramatic or dumb. They might instead use CBT techniques to help *you* come to the conclusion that your fears might be a bit blown oit of proportion. They also do not violate your privacy, make sexual advances on you, or criticize/demean you.
- They have boundaries and respect yours. If you do not want to talk about romance or family, they shouldn't push it until you're ready. Similarly, they should have boundaries and not allow you to contact them inappropriately (e.g.: "you can text me whenever you feel lonely"/"how about I go to the party with you?"). In special situations, such as exposure therapy for extreme phobias, it's a bit different, but usually it should be heavily outlined what you will be doing and why. Exposure therapy is not going partying or eating dinner with your therapist -- it'd be walking outside and talking about your feelings on a bench, or going on an elevator and doing mindfulness exercises throughout. The activities are also related to your specific phobia (e.g. if you are going in for severe fear of heights, you might go to high places like a public stairway or the hospital elevators. But not to events, the bowling alley, the therapist's home, or the mall). Also, if you don't have issues with phobias/anxiety they shouldn't suggest doing things with you outside the office, it's completely inappropriate.
Therapy can be very helpful but you need to put in the work too. If you are stubborn or unwilling to try things/do homework, it will be a waste of time and money.
I think therapy is most effective for issues that can be treated with CBT/DBT which are pretty much the only scientifically proven therapies out there. So, situational depression, anxiety disorders like OCD, body dsymorphia or SAD, borderline personality disorder, PTSD and other trauma-related disorders.
If you have some other issue it can be hit-or-miss. Typically, if you have a lot of insight (basically you are aware you have a problem and that your thinking/behavior might play a part in it) you'll fare better than those who don't.
Also, some mental illnesses have a big genetic/chemical/mystery component that therapy can never target. Sometimes you need medication or other supplements to help you get to that extra mile. like a lot of people with anxiety disorders might need meds to reduce the physical symptoms of anxiety before they can make progress in therapy. Or someone with seasonal depression might need vitamin D supplements and a day light and no therapy at all.
it's not an exact science yet. so it's mostly a matter of triak and error unfortunately. Just don't say that you will definitely kill yourself within the next few months or that you have a note/supplies/etc ready. Be vague until you read the atmosphere and determine how sectioning-happy your therapist is.
