Talking Therapies (Types)
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 your 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.
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.
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.
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 their surgeries and mental health professionals such as psychologists or social workers may also offer counselling. Voluntary organisations like Cruse and Relate offer low-cost or free counselling for specific problems.
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, postnatal depression, illness, disability or loss. Users 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 structured 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 10-15. You can pay to see a psychologist privately for behavioural or cognitive therapy.
WHAT IS IT FOR?
More research has been done on cognitive behaviour therapy than on other therapies and it has been shown 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 disorders, 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 thought. Psychoanalytic and psychodynamic therapy may often continue for a year or 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 group 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
On the NHS these 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 therapists.
What can I ask and expect from my therapist?
Therapists do vary. Some are simply better at their job than others, or they may be better for some people and some problems than others. If you have severe or complex mental health problems your GP should refer you to a skilled and experienced therapist.
NHS practitioners are likely to be qualified and belong to a professional body (with a code of ethics and practice, complaints and disciplinary procedures), although some will be in training or newly trained. They may be good at their job, but you may want to know about their experience. It is especially important to ask about the training and experience of private therapists as training courses can last anything from a week to several years. It is also important to check which professional body they belong to.
Your first one or two meetings should involve you and the therapist getting to know each other and deciding if you can work together. You may not be offered a choice of who you see on the NHS, but you can still ask questions. The more information you have about what to expect, the less likely you are to be disappointed. This can form an oral (or written) contract between you and your therapist. A good therapist will expect questions and be happy to answer them.
POSSIBLE QUESTIONS FOR YOUR THERAPIST
• What kind of therapy do you offer and what is it trying to achieve?
• How long is a session and how often are they held?
• How long might therapy last for and how does it end?
• How long before I should expect to feel some benefit from therapy?
• Can I contact you between sessions if I need to?
• What training have you had, how many years have you been practising?
• What professional organisation do you belong to?
• Have you had experience of working with people with similar problems to mine?
• Is therapy confidential and when might confidentiality be broken?
• In what circumstances might you refer me to another professional?
• How much do I pay per session, and is there a cancellation fee? (for non-NHS therapists)
You may have different questions. Always ask if something is unclear. If you feel uncomfortable asking your therapist directly, ask your questions in a letter.
There are risks: focusing on your problems can make you feel worse, and therapy can sometimes affect your relationships with your friends and family in a negative as well as a positive way. Strong feelings may come up in therapy and you may feel vulnerable or angry. You may become dependent on your therapist and have strong feelings of attachment to him or her. It is the therapist’s job to understand these feelings, to help you to deal with them as they arise, and not to take advantage of your vulnerability or neediness.
It is not unusual to feel worse before you feel better. But you should not consistently feel unheard, humiliated or used. Remember that therapy is supposed to be for your benefit. You can stop it if it is not helping you or if the approach is not right for you. A good therapist will regularly check that you are getting something out of it and will suggest ending therapy if you are not. Trust your instincts and feelings, and consider ending therapy if you continue to feel worse. Keeping a diary of your thoughts and feelings during therapy can help you to judge your own progress.
What to do if you have concerns
You may feel that your therapist doesn’t really understand or listen to you or that you can’t work with him or her. Try talking to your therapist – there may be real misunderstandings between you that can be dealt with. If this is not possible, ask your GP to refer you to somebody else.
Most people experience no problems, but there have been a few cases of therapists who take advantage of people emotionally, sexually and (for people who pay for therapy), financially. A sexual relationship between client and therapist is never right – it is the therapist’s job to make sure this does not happen. Other problems could include the therapist breaking confidentiality, seeing clients with problems outside their experience, being unreliable or imposing their own personal values on you.
COMPLAINING ABOUT YOUR THERAPIST
If you are seeing a therapist on the NHS you can use the NHS complaints procedure (see below). Your therapists’ professional body will also have a complaints and disciplinary procedure. If you are seeing a therapist privately, find out which professional body (if any) they belong to and complain to them.
NHS COMPLAINTS PROCEDURE
First discuss your concerns with the person concerned or other staff members at the practice, clinic or department where you are being seen – they should try and sort the problem out.
If you are not satisfied, ask to speak to the manager of the service
If the matter is not resolved, or if you prefer to complain in writing, write to the manager of the service or the Chief Executive (if it is a NHS Trust or hospital). They should acknowledge your letter promptly and investigate your concerns.
If you are still not satisfied, discuss the matter with your local
Health Authority.
If you have exhausted the complaints procedures open to you and are still not satisfied you can complain to the Health Services Ombudsman.
ENDING THERAPY
If therapy is abusive or damaging you should end it quickly. Otherwise, it is not a good idea to end therapy abruptly. Tell your therapist you want to finish therapy so that you can discuss it and have a positive ending. Your therapist should tell you in advance when your sessions will finish, or if they are leaving their job. They should help you prepare for therapy ending. This will usually include arranging a final goodbye session.
