Talking treatments (psychological therapy)

Transcription

1 Talking treatments (psychological therapy) RET0129 Key points Psychological therapy is a treatment for mental illness which involves talking through your problems with a trained therapist to work towards recovery. There are many different types of therapy. The main ones are cognitive behavioural therapy, psychoanalysis and counselling. Therapy can be accessed through referral within the NHS but there can be problems with access such as waiting lists. Therapy can also be paid for privately but it is expensive and less well regulated. NICE have made a series of recommendations for therapy for different illness and you should expect to be offered therapy in line with the recommendations What is psychological therapy? Many people find that psychological therapies, sometimes referred to as talking treatments, counselling or psychotherapy, are useful for the treatment of mental illness. Therapy can either be used on its own or combined with medication. According to the Department of Health, psychological therapies have an important role to play in helping people with mental health problems 1. Psychological therapy can help towards reducing distress, symptoms and risk of harm to self or others 2. Therapy has more commonly been used to deal with mild to moderate conditions such as depression and anxiety but research has indicated that some psychological therapies can be effective for more severe illnesses such as schizophrenia 3. With the help of a trained professional, clients are encouraged to talk through the problems associated with their mental illness with the aim of improving their quality of life. This may be done by assisting a person to manage the symptoms of their illness (such as voices or anxiety), or look at ways of tackling negative thinking that can lead to depression. Therapy can also allow you to explore the factors involved in making you ill in the first place and what keeps you from recovering. Therapy can also help a person deal with a specific traumatic experience such as bereavement. Therapy is usually undertaken though one-to-one sessions with a trained therapist or can be held as a group. There are also non-talking based psychological therapies such as art therapy. The number of sessions required depends on the type of therapy, the nature of the illness and what is available if the therapy is accessed on the NHS. Different types of psychological therapies. The most common psychological therapies will be summarised in this section. For more detailed information on how the different therapies work you may wish to visit the websites referenced in this factsheet - 1 -

2 Cognitive Behavioural Therapy (CBT) CBT can help you to change how you think ("cognitive") and what you do ("behaviour)". These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the problems and difficulties in the "here and now" instead of addressing the causes of your distress or symptoms. CBT looks for ways to improve your state of mind by exploring how you currently think about yourself, the world and other people and how that affects your reaction to situations. 4 Strong data exists that CBT is as effective as antidepressants in reducing depression symptoms by the end of treatment 5. The National Institue for Clinical Excellence (NICE) recommends CBT should be offered to a patient when they are diagnosed as having mild to moderate mental illness such as depression and anxiety and also more severe illnesses such as schizophrenia 6. (for more information about NICE recommendations see below). CBT is usually provided by a psychologist but doctors, nurses, counsellors and Social Workers may also be able to do this. You should check that the person you are referred to (or have chosen) has been trained in CBT. Sessions are usually weekly and last an hour. An average number of sessions is You can pay to see a psychologist privately for behavioural or cognitive therapy. CBT is also available via computer programmes which you can use at home (CCBT). Research has shown some CCBT programmes are effective in mild symptoms of depression and anxiety and are therefore recommended by NICE 7. ICCBT is available on the NHS or can be purchased privately by individuals. If you would like more information go to for depression treatment or for anxiety treatment. Psychodynamic psychotherapy This is one of the longest established therapies and is a term that covers therapy of an analytical nature. It is it is a form of in-depth which focuses on the unconscious and past experiences and their effect on current behaviour and thinking. The client is encouraged to talk about childhood relationships and experiences during the sessions. The aim of the therapy is to help a person to understand how experiences in the past can unconsciously affect their behaviour and thinking. The therapist will keep his or her own personality out of the picture during the therapy session to allow the client space to explore their own thoughts and feelings. This type of therapy is very intensive and can take a long time to feel results. It is more likely to be accessed privately. Interpersonal Therapy (IPT) IPT is a type of therapy which focuses on helping a person understand how their difficulties may be connected to their relationships with others It is time limited and focused on relationship difficulties experienced by the clients. The aim of the therapy is to identify any relationship problems and their impact on the client..the therapist - 2 -

3 will assist the client to identify ways to cope with these difficulties and to strengthen their interpersonal relationships. 8. Counselling Although the term counselling is sometimes a term used generally to describe all types of therapy, it also refers to a specific type of therapy. Counselling allows a client to talk to a trained counsellor about a specific problem with the aim of helping the client to understand their problem more clearly and come up with their own solutions to deal with these difficulties.. The role of the counsellor is to listen and be non judgemental towards the client, providing them with a safe and confidential environment to discuss their difficulties.. Counselling tends to be provided on a fairly short-term basis and is available both privately on the the NHS. Family intervention Family intervention was originally set up to help families deal with a member suffering from drug, alcohol or gambling addictions, eating disorders or other self-destructive behaviour. Most recently the family intervention programme has been adapted to deal with families caring for someone with schizophrenia. Research shows that family interventions are effective at delaying, if not preventing, relapse for people with schizophrenia 9. Creative therapies Creative therapies use areas such as art and drama to increase self awareness, develop social skills, reduce anxiety and increase self esteem. Art therapy encourages clients to express emotion and explore their problems using a wide range of art materials. Art therapy can be helpful to people who may have difficulty expressing themselves verbally. Drama therapy involves the use of drama or theatrical techniques (such as roleplay, mime, story telling) to assist with personal development, insight and self expression. Dialectical Behaviour Therapy (for borderline personality disorder) Dialectical Behaviour Therapy (DBT) is form of CBT (see above) which has been adapted to the needs of people with borderline personality disorder 10. DBT works on the basis that some people do not have normal emotional reactions to things for a variety of reasons. Normally, the client attends both individual psychotherapy appointments and group therapy sessions 11. Other psychotherapies There are many other types of psychotherapy available and they are less likely to be accessed through the NHS. The list below was taken from The United Kingdom Council for Psychotherapy and more information about the individual therapies can be found on their website which is Attachment-based psychotherapy Behavioural therapy - 3 -

4 Body psychotherapy Brief therapy Cognitive analytical therapy Dance movement therapy (DMT) Eye Movement Desensitization and Reprocessing (EMDR) Existential psychotherapy Gestalt therapy Group analysis Group psychotherapy Humanistic integrative psychotherapy Hypnotherapy Jungian psychotherapy/psychoanalysis Neuro-linguistic programming (NLP) Object relations therapy Psychosynthesis Relational psychotherapy and psychoanalysis Relationship counselling Solution-focused brief therapy Systemic therapies Transactional analysis Transpersonal psychotherapy How Do I Access Therapy? The first step is to discuss how you are feeling with your GP, social worker, community psychiatric nurse (CPN) or other healthcare worker. He or she will then be able to refer you to the most appropriate service. Usually you will be seen first for an assessment and you will be given an opportunity to find out what you need to know about the therapy before you consent to the treatment. You may express a preference for the type of talking therapy that you would like to receive. This will be taken into account when a referral is made, however there may be times when the talking therapy that you would like is not available or not the right one for the problems you are experiencing. You will be given the opportunity to discuss the options with the therapist. You can choose to pay to see a therapist privately. The benefits of private therapy are increased choice; faster access to therapy and the flexibility to shop around if you are dissatisfied with your therapist. However the clear drawback is the cost as the average price of a session is Some therapists operate a sliding scale and offer a reduction for people on low incomes 12. However, some of the therapy available privately may not necessarily be the type recommended by NICE for certain mental illnesses, such as CBT by a trained psychologist (see below) It may also be possible to see a counsellor at a local mental health group such as MIND or Rethink without a referral but this depends on what services are available in your area. For more information go to or

5 NICE Guidelines on Therapy NICE (National Institute for Clinical Excellence) are a government body who advise the NHS on caring for people with specific conditions. The following section looks at what NICE recommends for some of the most common mental illnesses. If your condition is not listed below then discuss what options are available for you with your healthcare professional or contact Rethink for more information. Depression In both mild and moderate depression, psychological treatment specifically focused on depression (such as problem-solving therapy, brief CBT and counselling) of six to eight sessions over 10 to 12 weeks should be considered. Current research suggests that the delivery of CBT via computer (CCBT) may be of value in the management of anxiety and depressive disorders. CBT of at least sessions should be offered to patients with moderate or severe depression who do not take or who refuse antidepressant treatment. The option of Interpersonal Therapy should also be discussed with the patient and personal preference should be taken into account 13. Anxiety Disorders Psychological therapy should be offered and patient s preference as well as availability should be taken into account. CBT is considered to be more effective than medication in the treatment of anxiety however a combination of both should be considered 14 Schizophrenia You should be offered CBT for at least 16 sessions. If you live with your family or are in close contact with them you should be offered family intervention therapy. You may also be offered one of the art therapies. As there are other therapies available, your personal choice should also be taken into account especially if the other therapies are not available in your area 15. Bi-polar disorder NICE recommends that individual psychological therapy which focuses on depressive symptoms should be offered to patients who have not responded to medication and who have persistent depressive symptoms 16. Problems with accessing therapy on the NHS The main problem with talking therapies on the NHS is lack of access and long waiting lists. Rethink is aware that once a person has been referred for a particular therapy, the wait can be anything from 6 months to 2 years. This is because the cost of training and paying for a therapist is very high and so is the demand. For this reason your healthcare professional may be reluctant to refer you in the first place or you may not be able to get as many sessions as you feel you need

6 If you are going to seek therapy from the NHS and have been put on a waiting list there is usually little you can do to speed this process up. However, do not be put off and ensure that your name is placed on it. Some therapies are not available equally throughout the country. If you have mild mental health problems and you are not offered therapy then you could ask to see an alternative GP at the surgery who has a better understanding of mental illness. If this does not work then you should write to your surgery referencing the NICE guidelines and ask for a good reason why you are not being offered the recommended therapy. You could contact the PALS (Patient Advice and Liaison Service) or consider putting in a complaint. Rethink s National Information & Advice Service may also be able to help you with this and our contact details are at the end of this factsheet. If you have a serious mental illness and have been referred to the Community Mental Health Team under the Care Programme Approach (CPA) according to NICE guidelines you should also be offered CBT sessions. When you have a CPA assessment you should express your need for talking therapies and ensure this is included in your care plan. If therapy is written in your care plan but you are unable it due to lack of availability you may consider putting in an NHS complaint. If your care coordinator or psychiatrist do not recommend therapy you could ask for a second opinion or a re-assessment. You may find it helpful if an advocate accompanies you at the re-assessment with you to help you express your need for talking therapies. The Rethink National Information & Advice Service has further information in our factsheets on Complaints, Advocacy and Second Opinions which are available to download at or by contacting us directly. Our contact details are at the end of this factsheet. How do I choose a psychological therapy? Which therapy you choose depends on what you wish to gain from therapy and also which is the most suitable for your illness. However, due to the problems highlighted above, your choice may be restricted if seeking therapy on the NHS. If you are considering seeing a therapist privately you should take into account: The effectiveness of all types of therapy depends on you and your therapist forming a good working relationship. More severe or complex mental health problems should receive secondary, specialist support. Therapy is not recommended as the main intervention for severe and complex mental health problems. Ensure that they are members of registered bodies and have appropriate qualifications.. Regulation and Accreditation - 6 -

7 If you are considering a private therapist, it is important to look into their qualifications and understand how accreditation works in this field. Statutory regulation of psychotherapy is not currently implemented which means that is possible to offer services as a therapist without being monitored. Regulation is voluntary and operated by accreditation bodies. It is important to check that your therapist is registered with an accreditation body as all accredited therapists must show that they meet certain standards such as: They should be appropriately trained and qualified, They should work to a code of ethics, They should be subject to a complaints procedure 17. In the UK, the main accreditation systems are: BACP (British Association of Counselling and Psychotherapy), UKCP (UK Council for Psychotherapy) and UKRCP (UK Register of Counsellors and Psychotherapists). These organisations also hold list of accredited therapists and details of their websites can be found below. Are there any risks associated with talking therapy? There are some risks. Focusing on your problems can make you feel worse and therapy can sometimes affect your relationships with your friends & family in a negative way as much as in 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. It is not unusual to feel worse before you feel better. You should not feel consistently unheard, humiliated or used during therapy sessions..it is important to remember that therapy is supposed to be for your benefit. You can choose to stop therapy if you feel that 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 the therapy if you are not. You should trust your instincts 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. Organisations with lists of private therapists: UK Council of Psychotherapy UKCP 2 nd Floor Edward House 2 Wakely Street EC1 7LT Web: Tel: fax: info@psychotherapy.org.uk - 7 -

8 British Association for Counselling & Psychotherapy. BACP House Unit 15 St John s Business Park Lutterworth Leicestershire LE17 4HB Web: bacp@bacp.co.uk Tel: British Association of Psychotherapists. 37 Mapesbury Road NW2 4HJ Web: mail@bap-psychotherapy.org Tel: Fax: British Psychological Society. St Andrews House 48 Princess Road East Leicester LE1 7DR Web: enquiry@bps.org.uk Tel: Fax: British Psychoanalytic Council. Unit Wedmore Street N19 4RU Web: mail@psychoanalytic-council.org tel: Fax: British Association for Behavioural & Cognitive Psychotherapies. Victoria Buildings 9-13 Silver Street Bury BL9 0EU Web: babcp@babcp.com Tel: British Association of Art Therapists BAAT White Lion Street N1 9PD Web: baat@ukgateway.net Tel: Fax:

9 Further information: The Rethink National Information and Advice Service produces a number of fact sheets on a range of different issues that affect people with mental illness. They are also able to give confidential, impartial, practical advice on all aspects of mental illness. They can be contacted at: Rethink National Information and Advice Service 15th Floor 89 Albert Embankment SE1 7TP Tel: or , Monday to Friday 10am 2pm advice@rethink.org The National Information & Advice Service welcomes your feedback on whether this information was helpful to you. You can provide feedback in the following ways: By Please your feedback to us at feedback@rethink.org. By post: You can write to us at the following address: National Information & Advice Service Rethink 15th Floor 89 Albert Embankment SE1 7TP. Last updated 02/10 By telephone: You can call us on or National Service Framework for Mental Health, Department of Health, Treatment Choice in Psychological Therapy and Counselling, Department of Health, Recent Advances in Understanding Mental Illness and Psychotic Experience; The British Psychological Society, Depression in Adults: The treatment and management of depression in adults. National Clinical Practice Guideline 90, National Collaborating Centre for Mental Health, NICE Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary and secondary care, NICE

10 7 Depression: The treatment and management of depression in adults. Clinical Practice Guidance 90, NICE Depression: The treatment and management of depression in adults. Clinical Practice Guidance 90, NICE Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care, Clinical Guideline 38, NICE Understanding Personality Disorder: A report by the British Psychological Society, Depression: The treatment and management of depression in adults. Clinical Practice Guidance 90, NICE Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care, NICE Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care, NICE Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care, Clinical Guideline 38, NICE hp