All About Talking Therapies

The content in this section has been adapted from the Department of Health’s booklet ‘Choosing Talking Therapies?’. Copies of the full booklet are available free of charge by writing to DH Publications, PO Box 777, London SE1 6XH; by fax on 01623 724524 or by e-mail. An audio version is available on request. The booklet is also available on the Department of health website at www.doh.gov.uk/mentahealth/choosing.htm This section provides the following information: What are talking therapies and could they help me? Who are talking therapies for? How and where can I get talking therapies on the NHS? Talking therapies: Different Approaches Do talking therapies work? What are talking therapies and could they help me? Talking therapies involve talking and listening. Most of us want somebody to talk to, who listens and accepts us, especially when we are going through a bad time. Sometimes it is easier to talk to a stranger than to relatives or friends. Some therapists will aim to find the root cause of you problem and help you deal with this, some will help you change your behaviour or negative thoughts, while others simply aim to support you. Therapists are trained to listen attentively and to help you find your own answers, without judging you. People go for talking therapies for a whole range of reasons. It may be that somebody has died or left, or that you have become depressed or isolated. You may be unable to sleep, or are having panic attacks. Perhaps you have had a psychiatric diagnosis and are already having treatment. Or you may be simply trying to understand yourself better. Talking therapies do not offer magic solutions, it can be hard work and progress can be slow or painful. It may not be the right time for you to talk, or talking about things may make you feel worse at first. What you feel able to cope with is the most important thing, and this can change over time. More research with service users is needed in order to understand which talking therapies people find helpful and why. Who are talking therapies for? Talking therapies are for all sorts of people. They can help if you are working class or middle class, old or young, heterosexual, gay or lesbian, black or white or from an ethnic minority community. They may also help if you are on medication, or have had a ‘psychotic’ diagnosis, such as schizophrenia or manic depression. You can ask your GP for talking therapy regardless of any diagnosis you have been given or any medication you are on. Most therapists will be happy tow work with you while you are taking medication. There is no reason why medication and talking therapy should not be used together. Some research has found that a combination of drugs and therapy works better then either on its own. In an ideal world, all mental health service users should be offered some form of talking therapy, or simply the opportunity to talk to someone, as a main part of their treatment. You should be given the option of talking therapy regardless of you diagnosis or your age, sex, social class or ethnic group. People with complex and long term mental health problems, and those whose troubles may appear less severe, have an equal need to talk. There is a stigma around talking therapy, and some people feel it is a sing of weakness to go for this type of help. Seeing a therapist doesn’t mean you are self-indulgent or going mad; don’t let these sort of prejudices stop you trying it. It can take strength to be prepared to look at yourself and your situation. How and where can I get talking therapies on the NHS? Talking therapies are available free on the NHS either at your GP’s surgery, at a hospital, or from a local community mental health team. What is available on the NHS will vary a great deal from place to place. There will often be a waiting list as NHS therapy is in short supply in some areas. Seeing your GP is the first step – you will usually need a referral letter to a NHS counsellor, psychologist, psychotherapist or psychiatrist. If your GP is unwilling to refer you for talking therapy, you may have to find out yourself what is available in your area and push hard to get it. Your GP may refer you to a local voluntary organisation for counselling or you can approach them yourself. Many voluntary organisations provide low cost or free counselling services. Some, like Cruse (bereavement care) or the Eating Disorder Association (http://www.edauk.com/) are focused on a specific problems, others like Mind (http://www.mind.org.uk) or Relate (http://www.relate.org.uk/ , can help with a wide range of difficulties. Some employers provide counselling for their employees, and student counsellors provide a service at many colleges or universities. Many talking therapists work privately. They can be expensive, but some will offer a sliding scale based on your income. Ask about this. Talk to several therapists before you decide which one is right for you. Make sure they are members of a recognised professional body such as the UK Council of Psychotherapy (http://www.psychotherapy.org.uk/), or the British Association for Counselling and Psychotherapy (http://www.bac.co.uk/). For detailed information about talking therapies available in your area ask your GP or visit your local service directory on this site and look under counselling. Talking Therapies: Different Approaches There are a number of different sorts of talking therapy. The most common in the NHS are counselling, cognitive-behaviour therapy and psychoanalytic or psychodynamic psychotherapy, but there are many others. Qualified professionals in the NHS who provide talking therapies include psychologists, psychiatrists, counsellors and psychotherapists. Social workers and nurses may also offer them. The following section describes the main types of talking therapies used in the NHS, and includes research evidence on specific problems they can help. If a particularly therapy has been found to work for your problem, it is worth trying that approach first, but bear in mind that there rare gaps in the research. A particular therapy might work for you even f there is not evidence yet, to back it up. What seems to matter most is your relationship with the therapists; if you feel you can trust and work well with them, it is more likely to help you. Counselling Counselling helps you to look at problems you are facing now. It may focus on a specific problem like bereavement or post-natal depression or on a decision, crisis or conflict. You are encouraged to talk about the feelings you have about yourself and your situation, and the counsellor helps you find ways to tackle them. Counselling on the NHS is usually short or medium term. Longer term counselling may go deeper and be more like psychotherapy. Many GPs now employ counsellors in the surgeries and mental health professionals such as psychologists or social workers may also offer counselling. What is it for? Counselling can help both ordinary problems of living and life crises. It can help you stay well and prevent mental health problems. There is evidence that counselling can help people who are adjusting to life events such as bereavement, post-natal depression, illness, disability or loss. User s say supportive counselling can help you through a difficult time, and it can help you become aware of and guard against too much stress in your life. Cognitive Behaviour Therapy Cognitive behaviour therapy (CBT) aims to help people change patterns of thinking or behaviour that are causing problems. Changing how you think and behave also changes how you feel. It is a structure approach – you agree goals for treatment with your therapist and try things out between sessions. Cognitive behaviour therapy is usually provided by an NHS psychologist, but doctors, nurses, counsellors and social workers may also use it. You may need to check that the person you are referred to has been trained in CBT. Sessions are usually weekly, and last an hour. An average number of sessions is 1-15. You can pay to see a psychologist privately for behaviour or cognitive therapy. What is it for? More research has been done on cognitive behaviour therapy than on other therapies and it has been show to work for a variety of mental health problems. This evidence doesn’t mean it is better than other therapies, but simply that others have not been studied so closely. In particular, it can help depression, anxiety, panic attacks, phobias, obsessive compulsive disorder and some eating disorder, especially bulimia. Some studies have shown it can help long term fatigue or pain. It may also help schizophrenia, other psychoses and manic depressive illness . Psychoanalytical and psychodynamic therapies These involve a therapist listening to your experiences, exploring connections between present feelings and actions and past events. It aims to help you understand more about yourself and your relationships. Therapists have different approaches and different styles of working – some may seem detached and analytical while others seem friendly and supportive. Some will take the lead with questions, while others will follow your train of through. Psychoanalytic and psychodynamic therapy may often continue for a year of more, but can sometimes be short term. It is usually one-to-one, but sometimes psychotherapy groups are available where a therapist aims to help groups members understand themselves and others better. NHS psychotherapists normally work in a hospital or clinic where you will see them as an outpatient. Private psychotherapists often work from home. What is it for? Psychoanalytic/psychodynamic therapy can help people get to know themselves better, improve their relationships and get more out of life. It can be especially useful in helping people with long term or recurring problems get to the root of their difficulties. However, some people, for example, those who feel vulnerable or who are experiencing psychosis, can find psychotherapy unhelpful or distressing. There has been less research on psychoanalytic psychotherapy, but there is some evidence that it can help depression and some eating disorders. Other therapies Other therapies on the NHS include cognitive analytic therapy, interpersonal psychotherapy and systemic therapy. Humanistic and experiential psychotherapies, art therapy, music and drama therapy are also sometimes available. Ask your GP for guidance. Even more therapies are available from voluntary organisations and private therapist. Most therapy will be on a one-to-one basis with just you and the therapist. You may be offered couple therapy if you are having problems in a relationship. Family therapy may be offered when the whole family is in difficulty. Group therapy is where 8-12 people meet together with a therapist. Conclusion: Do talking therapies work? You may find big changes have taken place in the way you think and behave as a result of talking therapies. You may understand yourself better or you may feel more able to deal with difficult times. Or, you might be disappointed, perhaps even feeling worse than before. Talking therapies are more likely to work if you feel comfortable and at ease with your counsellor, psychotherapist or group leader. So, finding the right person for you is as important as finding the right type of therapy. Users of talking therapies say that over and above just talking, they need to feel listened to, accepted and understood by their therapist. Felling safe and believed is also important. Many people say that talking therapies do not make their problems go away, but that they feel better able to cope with them. The Department of Health’s booklet ‘Choosing Talking Therapies?’ also gives detailed information about what you can expect from your therapist, the risks of talking therapies and what to do if you have concerns. Local organisations who can help: To access psychological treatments available on the NHS you must be referred by your GP or a mental health professional. More information can be found in your local service directory under Hospital Services. For details of local voluntary organisations providing psychological therapies, and private counsellors and psychotherapists look in the service directory for your area, under counselling and psychotherapy. Peterborough & Fenland Mind has a booklet that tells you what to look for when choosing a counsellor. National Organisations providing information about psychological therapies: British Association for Counselling and Psychotherapy Tel: 0870 443 5252 Fax: 0870 443 5160 Website: www.bac.co.uk e-mail: bac@bac.co.uk British Association for Behavioural and Cognitive Psychotherapies (BABCP) Tel: 01254 875277 Web address: http://www.babcp.com/ British Confederation of Psychotherapists (BCP) Tel: 020 8830 5173 Web address: http://bcp.org.uk Mind MindinfoLine: 08457 660 163. Open Monday to Friday, 9.15am to 5.15pm http://www.mind.org.uk/ Mind produces the ‘Understanding’ series of booklets which includes ‘Understanding talking treatments’ and ‘Getting the best from your counsellor or psychotherapist’. Mental Health Foundation Tel: 020 7802 0300 http://www.mentalhealth.org.uk/