Melissa Powex • 17th October 2017
It’s often clear to me that a lot of people have no idea between different Psychological therapies and it shouldn’t be this way. It’s like chosing your grocery shopping – if you don’t know what an item is, you’re not going to buy it (most likely) – so why would you look into any form of therapy (which I think everyone should have at one time in their life) if they don’t know what they’re getting?!
Why have I chosen a picture of a chair in a street?! Because - you should be able to take your therapy around in life with you to help manage difficulty and address any challenges you may face in real life.
I thought it might be helpful for me to briefly discuss my ideas of what different therapies can help with and the ways I usually explain things to my clients
Talking therapies – there are many different talking therapies and they have different focuses where practitioners are trained in different ways – often based on their own personal beliefs and experiences. Most therapies have research and evidence base to support their use on patients in the NHS in the UK and the NHS (interestingly or not) normally commission (make sure there’s money for) therapies that have a lot of evidence to be effective.
What is effective I hear you ask – now this is exactly the problem with the question – different people need different things. Allow me to further explain.
CBT – Cognitive Behavioural Therapy – is a method where a set number of sessions is set out to commonly to help people with anxiety and or depression. This is an ‘active’ therapy in that you have to want to go and make a change and you are the person that brings the problem and works with the therapist to challenge your views, thoughts and feelings about this problem. An example I often use for CBT is if you have a fear of spiders. The fear can be over come by thinking about where the negative thoughts and feelings come from and what you can potentially change in your thought process to build a tolerance and reduce your fear of spiders. This can be done in 6-12 sessions (once a week) and you can rate your experience quite easily and almost ‘test’ whether you are able to be in a room with a spider or not at the end. This, my friends, is why CBT is funded by the government – there are lots of tick box rating scales to tell the business people that something is working. CBT can help people dramatically and can be a first experience of being in a room with a stranger, divulging personal thoughts and beliefs. However, my belief is that this is not the only therapy that should be funded as it will NEVER get you to understand the possible deeper issues.
Psychotherapy – On the complete other hand psychotherapy is a therapy that has much less ability to rate. It’s not straight forward and it DOES make you think about lots of past experiences. A longer term therapy (2 years and can be up to 5 times a week). The therapist is trained to understand and experience the ‘transference’ (the feeling in the room), the angry feelings that come out of the patient when talking about someone they don’t like or are having a particularly difficult time with. The therapist takes that feeling in and tries to unpick where its coming from and help you process the feeling and maybe separate it from what you think is going on. This takes time for the therapist to get to know you and a relationship to develop that you feel able to express your inner thoughts and feelings. However, (having had psychotherapy myself) it’s not easy and most people are not ready/able to address some of the deeper darker things in their minds. This is why, the government prefer to use plasters with CBT to make small fixes. Psychotherapy is where you are going to make the biggest changes. A space to offload difficult feelings where you won’t be judged, maybe not even responded to, a space where you can really be heard and understood.
DBT – Dialectic Behaviour Therapy – A mixture of CBT and Psychotherapy – as most people find it hard to dive into full psychotherapy and CBT is not enough – a middle ground where you can have an active approach and try to find ways to manage difficulties, but will last longer than a CBT approach.
IAPT – Improving Access to Psychological Therapies – this is likely what you will first hear about from your GP – a government initiative to do what it says on the tin – but, with the idea that short term, brief work with clinicians who are trained (but not to the same standard as a Psychologist or a Psychotherapist at Doctorate level). IAPT will plug in the hole for ‘enough’ help for people who the government feel need therapy. If you can’t tell – I’m not a huge fan of the IAPT model as I think the model is short sighted and limited in lots of ways and doesn’t offer the range of information that people need to decide for themselves what they might like to engage in. The IAPT approach is described as a ‘dynamic interpersonal therapy’ approach which is a brief psychotherapy intervention, but with CBT elements. I believe that the NHS should invest more in longer term therapies than IAPT – however as a starting point for someone that has no idea what they might need it is a good place to start.
Group therapy – an exposing experience yes, but actually can be very helpful for people who might be struggling with bereavement, relationship difficulties, anxiety, psychosis, OCD where people can relate to others experience and the experience can be normalised and shared rather than be located just in one persons understanding of their experience. Group therapy is not for everyone, but has its place.
Mindfulness – is a wellbeing type therapy which is based on spiritual histoy and is not based in religion. It is very much about learning to experience yourself in the here and now and stop things from always being in the future or the past (worrying about what you said last night, or thinking that you might be late for a meeting). By using mindfulness, you are able to check in with your bodily sensations and experience to be guided to notice when anxiety might be building up which in the long term after lots of practice will help you use strategies to manage anxiety before they feel overwhelming and possibly debilitating.
Counselling – is normally again around a specific problem – couples counselling, alcohol misuse counselling, bereavement counselling. Counselling can go on for longer than CBT so may be helpful for some, but does not have the depth that Psychotherapy has. Counsellors can offer advice and tips on how to make change – a bit like CBT – however, they may never dip into the deeper problems that might be present that will arise in Psychotherapy. It is more a reflective space to share thoughts and feelings with a professional who is trained to pick out themes that might help you move forward.
There are more sub groups of the above therapies, based on what particularly research or training the practitioner has had but you can explore these things by googling therapists background. This is not an exhaustive list of therapies as there are more (EMDR, narrative therapy, lego therapy, gestalt therapy....the list is quite long), which makes it a bit of a mindfield - but if you are prepared to find the personal trainer/nutritionist/body mind and soul expert to physically feel better, you should consider doing the same for your mind.
My advice when thinking about what you might need in terms of talking therapy is to ask questions. You may not know what you need and some therapists might convince you that their therapy is the right one – however, just like anything (even in the fitness world) – a good trainer and a good therapist will give you honest feedback and advice. If you see a psychotherapist for a consultation and tell them that you have a fear of spiders and want this addressing, they might ask you some questions and suggest that maybe a CBT approach is more suitable for you. Unless you tell a story whereby your mother was caught in a spider web when you were 3 and then your dad left and then your sister disappeared and you started panicking and you’ve never spoken about it. I mean – I hope that is no ones experience – but then you might need psychotherapy!
In the same way that with a personal trainer, you want to know what you are getting and that they can help you – you test things out maybe and see the people you like their style or think you can get on with their work rather than just use the only guy at the gym.
Test things out – try things – go and see a few different people before you decide on what feels right.
Reduced fee schemes are also available and if you don’t want to wait for the NHS queues and limited resources within our prescious services, just google ‘reduced fee scheme’. I will write a separate blog about reduced fee schemes as some might see them as not ‘good enough’, when actually there are pros and cons to these services.
Get in touch if you want more advice as I make these decisions every day, whether someone would benefit from a different type of therapy and offer elements of CBT and psychotherapy in my own day to day work.