Debt consolidation is a relatively broad term - it's a type of debt program that convert all your monthly unsecured debts into a single monthly payments. It often involves a credit counseling portion, where a credit counselor reviews your finances and help you determine which approach to managing your debt is right for you.
Generally, your options are personal bankruptcy (chapter 7 and chapter 13 most commonly), debt consolidation loans, debt management plans, debt settlement programs, or simple budgeting & repayment without a program.
Debt Consolidation Loans
Commonly advertised by credit card companies, a debt consolidation loan is a new line of credit that rolls all your other lines into it. While most people would get a higher rate to do this, by securing the loan with the equity in your home, one can get a more affordable interest rate, and the interest is often tax deductible as a home mortgage.
These loans may be interest-only home equity lines, or amortizing second (or first) mortgages, amortizing over 15, 20, 25, or 30 years. If your debts are from behavior that you have corrected, these loans are often the cheapest way to fully repay your debt without adverse effects on your credit score. However, if you get yourself back in debt, you have now "lost" your home equity and if you fail to make payments, your house can be foreclosed on.
Debt Management Plans
Commonly known as debt consolidation or consumer credit counseling, debt management plans are programs where the consumer enters the program and has a single payment to the debt management program. These programs are usually administered by non-profit companies, and the creditors have guidelines for negotiated rate decreases.
If you stay in the program, the simplicity of a single payment taken from your bank account via ACH, combined with the changes in interest rates and monthly payments, may help you get out of debt faster than on your own. However, if you drop out of the program early on, you will be ineligible for another opportunity for a year and you will be further behind because of the setup fees. This is much less risky than a debt consolidation loan, but adversely affects your credit.
These programs are good for people intending to reform their credit usage, but won't quite "bet the house" on it.
Debt Settlement Programs
If debt management doesn't work for you, your credit counselor may offer you debt settlement. With debt settlement you make a more affordable payment into the debt settlement program, and your creditors continue to assess fees.
Debt settlement programs work on the assumption that your creditors will eventually settle for the amount of money in the settlement account, because if they don't the other creditors will and they'll just be able to chase you into bankruptcy which they don't want. These programs often save you money, but leave your credit score badly damaged. If you can't afford a better option, these programs are the least costly up front.
Budgeting and Repayment
According to Todd Middleton who is head of content at 1-855-Jet-Debt, "if you aren't in awful financial shape your counselor will help you construct a budget that pays off your debts and live within your means".
The best time to choose one of the other programs is before you fall behind on your payments, but if you are handling your payments but simply stressed out about them, you may be best off tightening your belt and increasing your monthly payments. This will make your short term cash flow more difficult, but you will quickly see your balances go down, and most credit card companies will change your rates if you are making timely payments.
If this option seems hopeless, it may be a good first step. You might be able to change your balances and make clean payments for 24 months, which would alter the rate that you would pay on a debt consolidation loan. You may also be able to change your monthly minimums enough that you will be able to enter a debt management plan at an easier to afford level, making those few years without credit cards less painful.
Most consumers who file bankruptcy do so under chapter 7, full discharge of debt, or chapter 13, a court ordered payment plan. Until the recent bankruptcy reform legislation, chapter 7, the full discharging of all debts was most popular. Under the new laws, debtors are means tested before being eligible for chapter 7, and otherwise are placed under chapter 13.