Depression Counselling in Milton Keynes
In practice since 2013 + You don't have to be at rock bottom
The walls start to shrink. The world gets smaller, until it is about the size of the room you are in, and going outside it feels like more than you have got.
If that is roughly where you are, the rest of this page is written for you rather than about you.
Before Anything Else, See Your GP
This is the first thing I say to people, and I say it before I take any money from them.
I am not a doctor. When someone comes to me exhausted and flat, I want the biological ruled out first, because low mood and persistent tiredness can be symptoms of something a blood test would find. An underactive thyroid, for one, lists low mood, extreme tiredness and trouble concentrating among its symptoms. So does being short of iron. Neither of those gets better by talking to me.
To be clear, that is my own practice rather than an NHS rule. But it costs you one appointment to check, and if something physical is driving it, you have saved yourself months.
Worth knowing too that NHS Talking Therapies is free and you can refer yourself without going through your GP, as long as you are registered with one and are 18 or over, or 16 in some areas.
Depression and Tiredness Feed Each Other
Depression and chronic fatigue tend to travel together, and it is genuinely chicken and egg. Being depressed is exhausting. Being permanently exhausted will flatten your mood. Some of the medications prescribed for depression can add to the tiredness as well.
Which is why the biological question matters so much here. If part of the tiredness has a physical cause and it gets treated, that lifts some of the weight off the mood, and everything else you try gets easier.
What NICE Actually Says About Counselling
I want to give you the whole of this rather than the flattering half.
NICE, the body that sets treatment guidance for the NHS in England, published its current depression guideline in 2022. It lists a menu of treatments for adults and it says plainly that all of the options for less severe depression can be used as first-line treatments. Counselling is on that list, by name, for both less severe and more severe depression. NICE describes it as focusing on emotional processing and finding emotional meaning, to help people find their own solutions and develop coping mechanisms.
Now the part most counselling websites leave out. Those lists are ordered, and NICE says openly that the order reflects its committee's reading of clinical and cost effectiveness. Counselling sits tenth of eleven options for less severe depression, and sixth of ten for more severe. Guided self-help and CBT are above it in both.
So the honest sentence is that counselling is one of the first-line options NICE lists, not that NICE recommends it first. Anyone telling you otherwise has read the table and hoped you wouldn't.
NICE also says the choice should be a shared decision that takes account of what you want, and that you have the right to decline treatment.
Does It Actually Work
Two pieces of research matter here and they do not point the same way.
The largest look at real practice is an audit of 33,243 patients across 103 NHS services, which found outcomes for counselling and CBT for depression were comparable, and that the type of therapy was not a predictor of how people did. The authors add a line that belongs on this page as much as the finding does: it is of concern that half of all patients, regardless of the type of intervention, did not show reliable improvement.
The other is a randomised trial in NHS services comparing person-centred counselling with CBT. At six months counselling was as good as CBT. At twelve months CBT was significantly better. Both halves of that are true and you should have both.
Across the wider literature, roughly four in ten people respond to psychotherapy for depression and about a third reach remission, and relapse in the year after therapy ends is common. That is the real picture. It is better than nothing by a distance, and it is not a guarantee.
Two Things That Help, and What They Actually Do
Neither of these needs an appointment. Both are worth starting before you see anybody.
Get Moving, With Realistic Expectations
When you want to put your head under the covers and speak to nobody, the most useful thing is usually to get out into the world, so you can see it is bigger than the four walls closing in on you. That can be seeing people. If you cannot face people, go into nature instead. There are eight or nine lakes in Milton Keynes and you can walk round one without speaking to a soul.
Here is the honest part. If your tiredness is at a ten, I am not going to tell you a walk takes it to zero. It will probably take it to about a five, and a five is where you can start doing other things. That is what it is for.
Do the Basics, Badly If Necessary
Eat something. Drink water. Get outside. Sleep when you can. Move a bit.
None of that treats depression and I am not pretending it does. What it does is stop the physical side making the mood worse, which it will, quietly, if you let it go for long enough. Done imperfectly is fine. Done at all is the point.
You Do Not Have to Be at Rock Bottom
The most common thing that keeps people out of this chair is the belief that they are not bad enough to deserve it. That other people have it worse. That they should be able to manage.
Therapy is not really about the extremes. It is more about coping with the day to day and getting through things.
And if what you feel is not sadness but nothing much at all, that is worth saying too. When you go through pain, your mind protects you by numbing out. It is a defence mechanism, not a flaw. If so, you are not broken, you are just human.
What Working With Me Is Like
There is no reception, no team and no one else in the building. You send me a message, and I am the person who replies and the person you sit down with.
Early on we would look at all three levels together rather than only the one I am qualified in. The biological, meaning what your GP finds. The sociological, meaning your work, your money, the people around you and what is happening in your life. And the psychological, which is my end of it. They are all linked, which is why looking at one in isolation tends to miss the thing that is actually driving it.
I have been in practice since 2013 and I tutor counselling and hypnotherapy students at RQF levels 3 to 6, which mostly means I have had to explain this material to people who are going to be assessed on it, and that keeps you honest.
I will not tell you how many sessions this takes. Anyone giving you a number before meeting you is guessing.
If Things Are Worse Than That Right Now
Please do not wait for an appointment.
- If you or someone else is in immediate danger: 999
- NHS mental health crisis line for Milton Keynes, free, day or night: 0800 0234 650
- Urgent NHS help, choose the mental health option: 111
- Samaritans, free, at any hour: 116 123
- MK Crisis Cafe, run by Mind BLMK, open 5pm to 11pm every day: 01525 722 225
Common Questions
Should I See My GP or a Counsellor First?
Your GP, if you have not already. Not because counselling is second best, but because low mood and exhaustion can have physical causes worth ruling out, and because your GP can also refer you into free NHS talking therapy. Coming to me afterwards is entirely reasonable. Coming to me instead of ever seeing anybody is the bit I would push back on.
Do I Have to Come Off My Medication?
No, and I would not have a view worth having on that. Medication is between you and the person who prescribed it. Plenty of people do both, and the research suggests combining talking therapy with medication works better than either alone for more severe depression.
Is Counselling as Good as CBT for Depression?
In routine NHS practice across 33,000 patients, outcomes were comparable. In the one properly randomised UK trial, counselling matched CBT at six months and CBT was ahead at twelve. Honest answer: close, with CBT possibly better at holding the gains.
How Long Does It Take?
I don't know, and anyone giving you a session count before meeting you is guessing.
What If I Cannot Face Talking?
Then send a few lines in writing instead and we will go from there. Quite a lot of people find the first contact easier to type than to say.
Send me a message. Tell me as much or as little as you want, and getting in touch commits you to nothing.
Send me a messageIf you decide to go ahead, the first full session is half price.
Getting help when you need it is sensible, and it is not a sign you have failed.
David LloydCounsellor, psychotherapist and coach, Wolverton, Milton Keynes