It’s often clear to me that a lot of people have no idea between different Psychological therapies. It shouldn’t be this way. It’s like choosing your grocery shopping, if you don’t know what an item is, you’re unlikely to buy it. So why would you look into any form of therapy if you don’t know what you’re getting?!
I have a strong belief that everyone needs therapy, whether they think so or not. Similarly, I think that everyone should have access to the right therapy, not just what their local services fund.
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. Therapy should help you manage difficulty and address any challenges you may face in real life.
I thought it might be helpful for me to briefly explain what different therapies can help with. I assess patients and what they need as part of my job every day. Normally I meet a new patient for an hour, collect information from what I am told and I work out which therapy might be best suited for someone. My long term patients have complex needs and normally are unable to access therapy in an easy way. My job is often to build that therapeutic relationship to prepare someone for therapy. Maybe I can help you think about your needs? This is how I usually explain things to my clients:
Talking therapies –
There are many different talking therapies with different focusses. Most therapies have research and an evidence base to support their use within the NHS and across the world. The NHS commission (fund) therapies that have a lot of evidence to be effective.https://www.nhs.uk/conditions/stress-anxiety-depression/free-therapy-or-counselling/. But does that mean that the therapy with the best ‘results’ are the best therapy for your individual circumstances?
Private therapists have a specific training and believe in the model that they work in. They will asses whether you are in the right place for their type of therapy. However, even if you are assessed to be ready to access therapy, it can be really tough and you may want to stop.
What is effective I hear you ask –
Now this is exactly the problem with the question – different people need different things.
CBT – Cognitive Behavioural Therapy –
A therapy where normally 6-12 sessions are set out, most commonly addressing anxiety and depression. This is an ‘active’ therapy in that you have to want to engage and make change. You are the person that brings the problem and works with the therapist to challenge your views, thoughts and feelings. An example I often use for CBT is if you have a fear of spiders. The fear (associated with anxiety) can be overcome by thinking about where the negative thoughts and feelings come from. You can potentially change your thought processes to build a tolerance and reduce your fear of spiders with CBT.
You will rate your experience at the beginning and end of the treatment to see whether you are able to be in a room with a spider. This, my friends, is why CBT is funded by the government. Your ratings are likely to improve with CBT. It is very likely that if you take the advice and do the homework, you will feel better using CBT strategies. This gives numbers to the big NHS commissioners to continue funding it. I refer people for CBT all the time, it is a therapy that I have a lot of experience in delivering myself. Sometimes, CBT is the perfect start to offer someone a first experience of being in a room with a stranger, divulging personal thoughts and beliefs. It is a structured therapy where you can unpick where your anxieties may come from and support self improvement.
CBT is great for treating issues that seem to be quite simplistic on the surface, however, my belief is that this is not the only therapy that should be funded as it will NEVER get you to understand possible deeper issues that you are unaware of.
I myself have done extensive training in this therapy. I have a long term goal of training as a psychotherapist and I have first hand knowledge from training and experience of having psychotherapy myself. Psychothearpy is the complete opposite of CBT and is much less ‘rateable’. This therapy DOES make you think about lots of past experiences. Psychotherapy is a longer term therapy which can be for a lifetime but often with the aim of at least 6 months of work, sometimes up to 5 times a week. The most intense cases I have worked with in mental health have involved 2 years of 3 times a week therapy. Some people have psychotherapy for life, including psychotherapists!
The therapist has an interest and training in psychodynamic theory and understanding, yes, Freud. But there are many other brilliant psychotherapists in history to learn from. The therapist is trained to understand and experience the ‘transference’ or the feeling in the room. The feeling in the room may not be the thing that you are talking about and this is what makes psychotherapy very unique and hard to rate. The angry feelings that come out of the patient when talking about someone they don’t like for example may be expressed in a passive or ‘I’m ok with this’ way. The therapist takes that feeling in and tries to unpick where its coming from and help you process the feelings. A psychotherapist will separate what they feel in the room to what you report is going on. This takes time for the therapist to get to know you and the relationship that develops enables you to express your inner thoughts and feelings.
This is not an easy therapy and most people are not ready/able to address some of the deeper darker thoughts. Many people like to mask that things are ok when they really aren’t. So if a therapist highlights this to you from the feeling in the room, this can bring up some quite disturbing feelings. Who wants to feel disturbed or angry from talking? Not most people I can tell you! Psychotherapy is where you are going to make the biggest changes if you feel that your ‘journey’ in life has been tough. If you have struggled to move move past certain issues, this may be the therapy for you.
Psychotherapy offers 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. But it is also a very difficult space if you don’t like feeling uncomfortable or the sound of silence.
DBT – Dialectic Behaviour Therapy –
As a trained DBT therapist, I can speak very highly of this therapy. However it is for a particular person who needs an extensive therapy package. It’s basis is a mixture of CBT and Psychotherapy. The full programme lasts 24 weeks and there are different components to the full package. Individual sessions, group sessions, phone calls, homework, family work. It is a full on therapy, normally attached to a diagnosis of personality disorder. However, there are techniques that anyone can use to manage anxiety and low mood. Mindfulness is a big part of this therapy and this can be used by anyone.
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, the key aim is to provide short term, brief work with trained clinicians. The clinician may not be a Psychologist or a Psychotherapist at Doctorate level, which can make a difference to some people. IAPT is a CBT model and is often what you will be referred to in the first instance from a GP. I’m not a huge fan of the IAPT model as I think the model is short sighted and limited in lots of ways. It 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 great to give people an insight into what therapy is like and make a start on tackling difficult things. However, I think all IAPT therapies should be seen as an introduction and a starting block to a longer journey for most people. If you have had an experience of IAPT, I hope that you are curious about what is next for you and that you were given recommendations. If you feel that you need more than what IAPT offered you, you should be able to discuss this with your therapist or the service.
Dynamic interpersonal therapy –
16 sessions of CBT/psychotherapy. This looks a 4 areas of possible difficulty. The patient decides which area they want to focus on, ‘stress’, ‘social’, emotional processing’, interpersonal skills’. For example, trauma, interpersonal relations, low mood, anxiety. In depth talking around one of these defined areas and CBT tools (worksheets and homework) is given to support the patient outside the session.
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. Their experience can be normalised and shared rather than be located just in one person. Group therapy is not for everyone, but has its place. If you need a starting block, speak with the group therapist first to see if they are your kind of person before jumping in to the group. The person running the group is as important as the people that you might meet there.
A wellbeing type therapy which is based on spiritual history 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. Mindfulness helps you learn to check in with your bodily sensations and experience where anxiety or other emotions might build up. In the long term after lots of practice, mindfulness will help you use strategies before feeling overwhelmed and possibly debilitated. Mindfulness can teach you how to identify different emotions before they happen because you become more attuned with how your body reacts to different emotional states.
Normally 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, however it 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.
Lots of options and saying no –
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 mind-field. If you have paid for a personal trainer/nutritionist/body mind and soul expert to physically feel better, do the same for your mind?
Different people will have an affinity or interest in one way or another with therapy. Just because you may have tried counselling once, it doesn’t mean therapy isn’t for you if it didn’t work out. I sought out bereavement counselling when I lost a significant person in my life. My experience as a ‘service user’ within the NHS at that time was shocking. The organiser of a bereavement group told me that I was angry and I needed to deal with that. This response made me feel attacked and as if there was zero understanding of grief. See you later, I never went back. I looked in to different options and none quite fitted what I wanted, without a price tag that I couldn’t afford. So I have waited to find the right way back in to therapy with the right person. However, I was not in crisis, I was able to use my work and previous therapeutic experiences to know what I needed. If you don’t have a clue what you need and it doesn’t feel right, keep looking.
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. A good therapist should give you honest feedback and advice. This applies across different professional services, even in the fitness world. I have been told at different times by people I trust and believe that ‘now isn’t the right time for…’. and I listen.
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. That’s ok!
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 and maybe watch people, look for recommendations. You don’t just use the only guy at the gym because he is there.
Test things out – try things –
Go and see a few different people before you decide what feels right for you. Have various consultations. Ask questions about what they are about and why they do what they do. You should not feel obliged to see a therapist and possibly pay for them out of feeling its what you ‘should’ be doing.
Reduced fee schemes
If you don’t want to wait for the NHS queues and limited resources, google ‘reduced fee scheme psychotherapy’. I will write a separate blog about reduced fee schemes as some might see them as not ‘good enough’. There are pros and cons to these services.
Get in touch if you want more advice as I make these decisions every day. Maybe I can advise you on where to look for your therapy beginning?