Psychological therapies

The term ‘psychological therapy’ refers to a range of interventions to help people understand and make changes to their thinking, behaviour and relationships to relieve distress and to improve their functioning, well-being and quality of life. The most common psychological therapy modalities include cognitive behavioural therapy (CBT), psychodynamic psychotherapy, interpersonal therapy, arts therapies (including art, music and drama therapy), counselling, and family and couple therapy.

Psychological therapies are recognised as effective treatments for a wide range of mental health needs, with an increasing evidence base demonstrating the effectiveness and economic benefits of psychological interventions. The National Institute for Health and Clinical Excellence (NICE) recommends that psychological therapies be made available on the NHS as first-line interventions for a number of conditions.

Delivery of psychological therapies in the NHS may involve several different groups of staff, including clinical psychologists, nurse practitioners, psychotherapists and counsellors. In addition to staff directly employed by the NHS, psychological therapy may also be provided by therapists working for private, independent or voluntary sector organisations.

Staff may join the psychological therapies workforce from a range of different occupations and training routes. Some enter from specific training within the NHS, such as clinical psychology. Others may be trained in core professions such as nursing or psychiatry and then develop specific competencies in psychological therapy. Others may train directly in counselling or psychological therapies, often completely outside the NHS.

A number of economic and social factors may be increasing demand for psychological therapies:

The current economic climate, including unemployment, personal debt, home repossessions, offending and family breakdown may lead to a rise in mental health need. A survey for the mental health charity Mind (2010b) Workers turn to anti-depressants as recession takes its toll, found that since the last recession, one in ten workers sought support from their doctors and 7 per cent started taking antidepressants for stress. Additionally, their mental health needs were directly caused by the effects of the recession on their workplace. The findings, which launched Mind’s campaign Taking Care of Business, coincided with Government statistics showing the biggest rise in antidepressant prescriptions ever, with a record 39.1 million issued in 2009, up from 35.9 million in 2008.

Demographic changes – including the ageing population and the increasing longevity of those with long-term conditions and complex needs – may also increase demand for psychological therapies. According to the Office for National Statistics (ONS, 2010a), the population in England is estimated to increase from approximately 52.7 million in 2011 to 60.8 million in 2031, an increase of approximately 15 per cent. The ONS estimates that the number of people aged 65 and over is likely to increase from approximately 8.8 million in 2011 to 13.2 million in 2013, an increase of approximately 51 per cent. Traditionally, those aged 65 and over have been low users of psychological therapy services, despite evidence supporting their effectiveness. One of the objectives in Talking therapies: a four-year plan of action is to ensure appropriate access to psychological therapy for people over 65 to address the current significant under-representation of those in this age group in IAPT services.

Changing public attitudes and behaviour towards mental health, supported by campaigns such as Time to Change, and a reduction in the stigma associated with mental health issues could lead to people becoming more willing to seek help and access the services they need.

Access to work policies are increasingly being promoted. The aim is to improve social and economic participation by tackling unemployment, by encouraging and providing access to services, including psychological therapy, for those with mental health issues to assist them to gain employment or return to work.

The potential of innovation and information technology to transform mental health services – for example through the increasing exploration of online solutions and e-therapy – may also increase demand for psychological therapies.

Trauma and abuse are becoming recognised as a major cause of a range of mental health problems, including psychosis, depression, self-harm, substance misuse, eating disorder. It may complicate recovery so that those people with long term mental health problems, those who have longest hospital stays, are more risk, have more interpersonal problems, may have more severe trauma. National inquiries, e.g. Rotherham, are making it clear that statutory services need to be able to respond to survivors. One of their needs may be for psychological therapy.

Cognitive Behavioural Therapy (CBT)?

CBT is a psychological talking therapy that helps people look at how they are thinking about themselves, the world and other people (the cognitive bit), and how what they do (the behavioural bit) affects how they are feeling. CBT does not ignore early childhood experiences but it is more concerned with the here and now.

An important part of CBT is to try and solve problems and learn self-help to maintain improvement after therapy has finished.

How will I know if CBT is helping and I am getting better?

You and your therapist will work together to identify goals at the beginning of therapy. By doing this you can see if you are feeling less depressed, anxious or frightened. It’s important that you give feedback on how you are getting on, to help identify what works and what doesn’t work for you.

Alternatives to CBT

CBT is an evidence based treatment that is explicitly recommended by the National Institute for Health and Clinical Excellence (NICE) for the treatment of many conditions. However, there may be other psychological therapies that may be effective and you should discuss these with your referrer or assessor.

Risks

As with many other therapies and treatments, CBT is not without the possibility of risk and you may experience a slight worsening of your condition as you begin to address some difficult issues. There is, however, a very good support network in place to help you deal with these difficulties if and when they arise and your therapist will discuss this with you.

How does CBT work?

CBT breaks problems down into situations, thoughts, emotions, physical sensations and actions. All these areas can be connected. For example, how you think about something can make you behave in a certain way and how you feel emotionally can affect the way your body reacts or the way you think about yourself, the world, the future, etc.

Which problems can CBT help with?

CBT has been scientifically tested for over 20 years and has been proven to be highly effective. It can be used to treat a number of psychological issues including:

• depression
• anxiety disorders
• panic
• social phobia
• post traumatic stress disorder
• obsessive compulsive disorder
• bipolar disorder
• insomnia
• psychosis/schizophrenia
• eating problems
• sexual and relationship problems

Dialectical Behaviour Therapy

Dialectical behaviour therapy (DBT) is a psychological treatment to assist people diagnosed with borderline personality disorder or those displaying borderline personality traits in learning and applying skills to improve their life. It consists of both individual therapy and group skills training.

Alternatives to DBT

DBT is an evidence based treatment for borderline personality disorder that is explicitly recommended by the National Institute for Health and Clinical Excellence (NICE). However, there may be other psychological therapies that may be effective and you should discuss these with your referrer or assessor.

Risks

As with many other therapies, DBT is not without risk and you may experience a slight worsening of your condition as you begin to address some difficult issues. There is, however, a very good support network in place to help you deal with these difficulties if and when they arise and your therapist will discuss this with you.

Benefits

The evidence base for DBT shows that it is effective in reducing self-harm and self-destructive behaviours. However, as we address a variety of problems it may be that you benefit from it in lots of other ways.

How long does therapy last and what is expected of me?

DBT groups are usually held weekly in your local area. They normally last approximately 2 hours, will have 8-12 members at most, and are run by professional therapists. The whole programme is one-year long and you will be expected to commit for this length of time.

In addition to the weekly group sessions you will have regular one-to-one sessions with a therapist. You will be asked to put into practice what you learn in the groups and fill in diaries.

How do I know if I am suitable for the group?

Individuals who are referred for DBT will be offered an individual assessment with a therapist. This will allow you to assess whether this would be for you or not.

Psychodynamic Therapy

Psychodynamic therapy is rooted in bringing forth the unconscious drivers or defences that a person uses within their interactions. This form of therapy recognises that many of these unconscious interactions are from experiences the person has had in their early childhood. The relationship with the therapist may elicit transference or counter-transference which will unearth life issues and dynamics. Another focus within the therapy is that of ‘free association’ whereby internal conflicts and problems are expressed through the honest sharing of the trail of consciousness.

How it works

Often a therapist will meet with the person once or twice a week and through developing a relationship certain unconscious mental content will come to the foreground. Once the relationship is established the therapist can work with the person to develop insight into how their conscious or unconscious drives and defences are impacting on their ability to build and maintain relationships with others in their lives.

Person-Centred Therapy

Person-centred therapy is a talking therapy which allows clients to take more of a leading role in helping them develop and grow in their own way, discovering their own solutions. It aims to facilitate self-discovery, self-acceptance, and provides a means toward healing and positive growth. The therapist acts more as a facilitator as this therapy is based on a more non-authoritative approach. The therapist is there to listen without judgement and attempt to fully understand the client’s experience, thoughts and feelings. They will not try to interpret what is said but may ask for some clarification or help in truly understanding what the client meant so that the client feels that they have expressed exactly what they wanted to and they feel that the therapist understands this. A focus of Person-Centred Therapy is to help individuals deal with the ways they perceive themselves rather than how a therapist can interpret their unconscious thoughts and feelings. The therapist is there to encourage and support the client and to guide the therapeutic process without interrupting or interfering with the client’s process of self-discovery. Person-centred therapists work with both individuals and groups.

How it works

Rather than being seen as the expert and directing the therapy, the therapist offers unconditional positive regard, empathy and congruence to help the client develop and grow in their own way. These are vital to helping an individual feel accepted and better understand their own feelings – essentially helping them to reconnect with their inner values and sense of self-worth. This reconnection with their inner resources enables them to find their own way to move forward.

The three core conditions of successful therapy:

1) UNCONDITIONAL POSITIVE REGARD: therapists should be accepting, empathetic and non-judgmental to instill trust and confidence which encourages individuals to make their own decisions and choices.

2) EMPATHETIC UNDERSTANDING: therapists truly understand and appreciate their clients’ perspective.

3) CONGRUENCE: therapists are willing to be transparent and honest when relating to clients as opposed to an unconnected professional self.

What are the benefits of Person-Centred therapy?

Person-Centred Therapy can help people develop self-confidence in making their own decisions as well as develop a stronger sense of identity. It can also help improve people’s ability to build healthy relationships as well as ability to re-connect with their inner-self. One of the main strengths of this therapy is that individual feels more control over the sessions and they don’t need to worry that their therapist will be evaluating or judging them in any way.

Who can this therapy help?

Person-Centred Therapy can be used alone or in combination with other types of therapy and has been found to be helpful for people who have been diagnosed with or who are experiencing grief, depression, anxiety, stress, abuse, people who have difficulties managing emotions, eating disorders and alcohol addictions as well as some other mental health challenges. It can help individuals of all ages with a range of personal issues.

The client must do a lot of the work in this therapy therefore it is more likely to benefit those who are motivated to explore themselves and their feelings as well as those who want understand and change specific habits or ways of thinking.

Alternatively, ideas surrounding person-centred therapy can be transferred to areas other than a therapy setting including teaching and childcare. Many people use this to support them through work, relationships and day-to-day life.

Cognitive Analytic Therapy

Cognitive Analytic Therapy, also known as CAT, is a talking therapy that mainly focuses on relationship patterns.

It is based on the idea that our early life experiences influence the way we relate to other people and how we treat ourselves. This means that sometimes patterns of behaviour, or our expectations of other people’s behaviour, can develop into unhealthy or unhelpful repeating patterns, as well as those that are healthy and helpful.

Expecting or experiencing problematic relationship patterns can be overwhelming and can result in:

• repeatedly feeling let down, hurt or rejected
• experiencing depression, anxiety or low self-esteem
• avoiding things
• struggling to be assertive
• repeatedly finding yourself in vulnerable positions.

CAT involves working with a therapist to clarify and understand:

• any problems you may be experiencing
• unhelpful patterns of thinking, feeling and behaving.

The therapy work is tailored to your individual needs and to your own manageable goals.

How can CAT help me?

CAT is a safe, widely used therapy that is often used with people:

• living with depression, anxiety or eating problems
• who self-harm
• with personal or relationship problems.

During therapy you will explore how you manage your relationships and cope with feelings or difficult situations. This will involve identifying patterns of thinking, feeling and behaving. By looking at these patterns more closely, you will:

• clarify which ones are helpful or unhelpful
• understand how these patterns have developed
• discover what makes you keep repeating them
• find alternative, more effective ways of managing to stop negative experiences or feelings from recurring.

The aim of this is to minimise the distress you experience within your relationships with others and with yourself.

What preparation is needed?

You do not need to prepare for this therapy. However, it may help to think through what you feel your main difficulties are and what you hope to gain from therapy. You also need to make a commitment to attend regular weekly appointments.

What happens at the first appointment?

The therapist or practitioner will ask you why you are seeking therapy and talk to you about what this involves. This session gives you the opportunity to:

• find out if CAT is likely to be helpful for you
• decide if you are happy to work with the therapist
• ask any questions you may have about the therapy.

What does the therapy involve?

You will work together to develop diagrams or “maps” that clarify both the problematic patterns and the healthy/helpful ones. This will involve thinking about the relationship you have.

Early therapy sessions will involve hearing your story and trying to understand if some of your problematic patterns may have been learnt in your childhood. The therapist does not need to know every detail and the work will be paced according to what you feel able to manage. With your therapist you will begin to piece together patterns that keep you feeling stuck in a negative cycle of emotions. Your therapist will write, with you, a letter describing your story and your patterns, to help you choose what you want to focus on in the therapy.

After the first session you will be asked to complete a questionnaire or psychotherapy file asking you what problems or patterns you commonly experience. You may also be given homework tasks such as monitoring your mood or behaviour patterns. This may help you to spot patterns in relationships with:

• yourself
• your therapist
• other people in your life.

The rest of the therapy is about trying to recognise and change the patterns that are causing problems.

You and your therapist exchange a “goodbye” letter at the end of the therapy. This will reflect on the therapy, how you feel about this ending and looking to the future.

How long does it last?

CAT is a ‘brief’ form of psychotherapy. Your therapist will tell you how many sessions are being offered at the beginning of your therapy. This is commonly between 16 and 24 sessions. Appointments are usually weekly and last for 50 minutes.

What follow-up is needed?

You will normally be offered a follow-up appointment in two to three months. This is to review how things have gone for you after therapy has finished.

What are the benefits?

You will:

• develop tools (e.g. letters, diagrams) that will help you understand yourself
• have a clearer understanding of your problematic patterns and the healthy parts of yourself
• work jointly with your therapist so you feel your voice/opinion is heard
• be supported by your therapist to help develop a positive therapeutic relationship.

This can help you feel you have more control in patterns of self-care, self-harm and relationships with others. It can also help you to make positive changes.

What are the risks?

As with any talking therapy, focusing on your problems may make you feel worse before you feel better. Talking therapy can also be challenging as you may decide to make changes in your relationships that are better for you but some people (friends and family) may not like these changes.

What are the alternatives?

There is a range of alternative psychological therapies which include, among others, interpersonal therapy, cognitive behavioural therapy, psychodynamic and psychoanalytic therapy. It may be useful to read the information leaflets available to help you decide which approach may be best suited to your needs.

Your care co-ordinator or lead professional can help you if you would like any further information about psychological therapies.

Adapted from Tees, Esk and Wear Valleys NHS Foundation Trust ‘What is cognitive analytic therapy?’

Share your views

If you would like to share your views around CAT, you can take part in a short, anonymous survey created by the Association for Cognitive Analytic Therapy (ACAT). The survey is open to all, but researchers are particularly interested in the views of people who are either curious about CAT as a therapy for themselves or someone they know, or have some sort of experience of CAT as a patient/client/carer.

Personal Experience of CAT

After several years of struggling with mental health problems and a repeated pattern of crisis admissions, I was referred for CAT therapy with a psychologist. I was originally offered 24, hour long sessions but we ended up working together for a longer period.

We used the first few sessions for me to explain some of the problems I had been having both recently and throughout my life and to talk about my understanding of them, or lack of it! After these initial sessions, the psychologist then wrote a letter which summarized my difficulties. She shared this with me to make sure she had understood properly. She was very empathetic and compassionate, I really valued the opportunity to be listened to and have my feeling validated. She wasn’t interested in the labels that I had collected from services but wanted to understand me and how I experienced things.

The focus of our work together was then to enable me to get a better understanding of myself; to think about how and why I repeatedly behaved in such a destructive way and where the hurt and the distress had come from. We used ‘maps’ to describe some of the patterns of thinking, feeling and behaving and talked a lot about how these ways came to be. I appreciated the space to reflect on the most difficult aspects of my past with someone who I trusted. However this work was hard and very emotional and I often struggled to cope between sessions.

We worked towards the ending of our relationship and she again wrote a letter documenting some of the things we had worked towards. As I came to make more sense of myself I was able to let go of some of the shame. The focus was more what had happened to me rather than what is wrong with me. This process of exploring some of these issues really started my journey towards recovery and a deeper understanding of myself motivated me to make changes.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) uses and teaches mindfulness and acceptance strategies that help people develop psychological flexibility. It can help people recognise how trying to supress challenging experiences can cause problems. Instead it helps people accept their negative thoughts and feelings and become better at taking action towards more valued behaviours that support well-being. ACT encourages people to open up to challenging thoughts and feelings, helping them to not avoid situations where these may come up. This therapy is not intended to change unwanted experiences but instead it teaches people to develop a mindful relationship with them.

How it works

ACT is not a specific set of techniques however there are 6 core principles that are thought to help develop psychological flexibility.

1. COGNITIVE DEFUSION: This aspect of therapy aims to change the function of negative thoughts, emotions and memories that affect an individual.

2. ACCEPTANCE: This provides an alternative to avoiding unwanted thoughts and feelings. Embracing these without attempting to change them helps individuals to open up and implement newly learnt coping strategies

3. CONTACT WITH THE PRESENT MOMENT: This is about individuals being psychologically present, connecting with what is happening now.

4. THE OBSERVING SELF: This focuses on a person’s attention and awareness which may include developing mindfulness skills.

5. VALUES: Values give life meaning and purpose. They are used in ACT to develop therapy goals.

6. COMMITTED ACTION: This aspect of ACT involves establishing goals that are consistent with a person’s values so that individuals stick to them and carry them out responsibly.

Mindfulness is one of ACT’s most useful techniques promoting openness and curiosity. Developing mindfulness skills can help us see our experiences in the present moment without judgement. It helps us to detach and let go of unhelpful thoughts, allows us to experience painful feelings and feel connected to the present moment.

Acceptance techniques also play a significant role in ACT. By trying to get rid of pain and distress, we can in fact increase it. By accepting and acknowledging what we feel, we can learn to make room for these negative feelings so that we no longer have to fight to supress them.

Benefits of Acceptance and Commitment Therapy

ACT can teach a variety of skills that help to deal with distressing thoughts and feelings so that they have a much smaller influence on your life. It can also help in determining what is important to an individual and encourage you to change your life. Different to many other therapies that aim to make the individual feel better, ACT helps people become empowered to make themselves feel better.

Who can ACT therapy help?

This therapy has been found to be effective in helping people who have been diagnosed with or who struggle with anxiety, depression, obsessions and compulsions, the effects of trauma, substance abuse, eating disorders and distressing unusual beliefs and visions.

The mindfulness elements of this therapy are also very effective in many different settings including improving people’s athletic or business performance.

Mindfulness Based Cognitive Therapy (MBCT)

Before we describe MBCT we explain what mindfulness is.

Unhelpful habits of mind…

• Many of us spend a lot of time brooding about the past, worrying about the future and being hard on ourselves.
• These habits of mind are difficult to control and often leave us feeling stressed and low.

What is mindfulness?

• Mindfulness involves paying attention to exactly how things are in the present moment.
• When we’re tuned in to the present moment, the mind is less likely to get caught up in unhelpful patterns of thinking and feeling.
• Tuning in to the present isn’t easy, especially when we’re feeling stressed and unhappy… but with patience and practice, we can all learn to be more mindful more often.

What might be the benefits?

• Mindfulness helps us to become more familiar with the mind and to work with the mind in more helpful ways. The mind becomes a little more focussed and steady.
• As mindfulness develops, we become more aware of our thoughts and feelings, we learn to be more accepting of ourselves and we respond more wisely to difficulties and stress.

Mindfulness Based Cognitive Therapy

• A common way to get better at mindfulness is to learn mindfulness meditation.
• Mindfulness-Based Cognitive Therapy (MBCT) combines training in mindfulness meditation with elements of cognitive behavioural therapy.
• It is a group-based skills development programme which includes 8 x 2 ¼ hour sessions, normally over consecutive weeks, and one longer session.
• You will learn to use simple meditations, for example focusing attention on the physical sensations of breathing.
• The course demands considerable commitment and involves practising at home on a daily basis. It is important to attend every session and to complete all the home practice.

What’s the evidence?

• MBCT has been thoroughly researched and is recommended by the National Institute for Health and Care Excellence (NICE) for people who suffer from repeated episodes of depression.
• There is robust meta-analytic evidence for MBCT’s effectiveness in reducing symptoms of depression ( Goldberg et al, 2019) as well as for relapse prevention (Kuyken et al, 2016).
• There is a great deal of evidence that learning mindfulness can be very helpful for people who are stressed.

Anonymous quotes from attendees of mindfulness courses

The practices are making a clear, positive impact on how well I can cope with stress, depression, grief and pain. Patterns of thinking have been challenged and are gradually changing… I like myself more and am kinder to myself and have greater self-awareness.

I came to the course expecting a miracle cure that never happened but what did happen was more important. I found how to be myself again and not hide away from the world imagining things that are not true. This course was a godsend.  

At the beginning of the programme my mood was at rock bottom with no motivation to do anything. I felt my life was over and I had nothing to look forward to. Now, at this point in time, with regular practice, my mood is elevated, I feel hopeful about the future and I am motivated to do more with my life… I intend to keep the practice up as it has had such a great improvement in my life as a whole.

EMDR

EMDR is an acronym for ‘Eye Movement Desensitisation and Reprocessing’.

EMDR is a powerful psychological treatment method that was developed by an American clinical psychologist, Dr Francine Shapiro, in the 1980’s. As a Senior Research Fellow as the Mental Research Institute (in Palo Alto, USA), she published the first research data to support the benefits of the therapy in 1989.

Since then a wealth of research has been conducted demonstrating its benefits in treating psychological trauma arising from experiences as diverse as war related experiences, childhood sexual and/or physical abuse or neglect, natural disaster, assault, surgical trauma, road traffic accidents and workplace accidents. Since its original development, EMDR is also increasingly used to help individuals with other issues and performance anxiety. EMDR has been found to be of benefit to children as well as adults.

EMDR works for what kind of difficulties?

A wealth of research has been conducted demonstrating its benefits in treating a range of distressing experiences such as:

• Childhood sexual and / or physical abuse
• Childhood neglect
• Bullying
• Natural disasters
• Assault
• Surgical trauma
• Road traffic accidents
• Workplace accidents
• Bereavement
• Pain disorders
• Panic attacks
• Phobias
• Dissociative disorders
• War related experiences
• Body image disorders
• Performance anxiety

How does EMDR work?

When a person is involved in a distressing event, they may feel overwhelmed and their brain may be unable to process the information like normal memory.  The distressing memory seems to become frozen on a neurological level.  When a person recalls the distressing memory, they re-experience what they saw, heard, smelt, tasted or felt and this can be quite intense.  Sometimes the memories are so distressing that the person tries to avoid thinking about the distressing event to avoid experiencing the distressing feelings.  Some find that the distressing memories come to mind when something reminds them of the distressing event, or sometimes the memories just seem to pop into mind.

EMDR works because the alternating left-right stimulation of the brain with eye movements, sounds or taps seems to stimulate the frozen or blocked information processing system.  In the process the distressing memories seem to lose their intensity, so that the memories are less distressing and seem more like ‘ordinary’ memories.  The effect is believed to be similar to that which occurs naturally during REM (Rapid Eye Movement) sleep, when your eyes rapidly move from side to side.  EMDR helps reduce the distress of all the different kinds of memories, whether it is what you saw, heard, smelt, tasted, felt or thought.

What can I expect from my EMDR therapist?

EMDR is not simply the use of eye movements.  Rather it is a comprehensive therapeutic approach with principles, protocols and procedures with the goal of reducing distress in the shortest period of time.

When you first meet with your EMDR therapist, your therapist will spend time getting to know your history.  This generally includes the kind of distress you are experiencing, the kind of difficulties you have experienced, if you have physical problems, if you are taking medication and explore the support you already have.   If your therapist feels EMDR is suitable for your difficulties then they will describe the EMDR model and explain the theory to you.  You can ask your therapist questions and express any concerns you may have.  Your therapist will spend some time doing some relaxation exercises with you, which could include ‘safe or pleasant place’ exercises, guided visualisation, deep muscle relaxation, breathing retraining etc.  Once you and your therapist feel that you are sufficiently prepared, you can then target a distressing memory with the eye movements or other forms of left-right alternating stimulation, such as sounds or taps.

Your therapist will ask you to select an image that represents the distressing event.  You will then be asked to think about negative and positive thoughts, your feelings, the amount of distress you feel and where you feel it in your body.  Your therapist will then begin the eye movements while you hold the image in mind.  After each set of eye movements your therapist will ask you what came to mind or what you noticed during the eye movements.

Family Interventions/Therapy

What is family therapy?

Family and systemic psychotherapy – also known as family therapy – can help those in close relationships to better understand and support each other. It enables family members to express and explore difficult thoughts and emotions safely, understand each other’s experiences and views, appreciate each other’s needs, build on family strengths, and work together to make useful changes in their relationships and their lives. Every family is a bit like a human body. Sometimes it feels great, and things work well. Sometimes even small things can feel like a huge challenge. When we hurt one part of our body, every part can be affected in some way. But all the parts of the body can work together to help if a bone gets broken, or if there’s an infection. So family therapy helps family members to work together when something is hurting, or just feeling out of sorts.

Family life isn’t always easy…

Families can be very complicated because everyone is unique. Each person thinks and talks about things in a different way, and each person has different ideas, feelings, worries and strengths. All kinds of changes can make family life more stressful, such as an illness, unemployment, moving home, new family members, getting older, divorce, death and trauma. Some families find their own ways to manage these changes, and some families find it much harder, for all kinds of reasons. Family therapy can help families when they’re feeling overwhelmed, sad and angry; when they’re not sure what to do for the best; or when they feel stuck in repeating patterns of hurtful or harmful behaviour.

What does ‘family’ mean?

Family therapists understand that different people have different ideas about what ‘family’ means. So ‘family’ is used to describe any group of people who care about each other and call themselves a family. As well as parents and children of all ages, they may also involve grandparents, brothers and sisters, uncles and aunts, cousins, friends, carers, and other professionals. They try to include whoever is important to the family. Family therapists respect the importance of each person’s beliefs, culture, and life experiences. They will adapt their approach and activities to suit the ages, needs, and preferences of each family they see.

How might family therapy help me and my family?

Family therapy helps family members and friends to understand and support each other. Family therapists try to help everyone to feel safe so they can talk about their difficult thoughts and feelings, understand each other’s experiences and views, appreciate each other’s needs, build on family strengths, and work together to make useful changes in their relationships and their lives. Some family therapists work in teams, because it’s useful to share lots of ideas for families to think about together. Others work on their own. But they will all help families and individuals to talk about their hopes, and to work towards their own goals as a family. Sometimes it only takes a few sessions to help a family find their way. Sometimes difficulties are more complicated, and families may need longer to find the solutions that work best for them.

What do family therapists do?

Here are some of the things that a family therapist might do with a family:

• Talk about each person’s hopes for their family.
• Encourage everyone in the family to talk about their experiences, and to listen to everyone else.
• Respect and clarify each person’s beliefs, values, needs, hopes and assumptions to help them understand each other better.
• Help families to stop blaming each other and to begin exploring how everyone can work together to make things better.
• Help people to understand the effect their words and actions have on everyone else in the family.
• Explore what each person in the family does well, and what they are most proud of.
• Draw a kind of family tree, called a genogram, to help people think about the different relationships in their family.
• Help families to talk about the challenges they are facing
• Support families as they work towards their own goals.

Personal Experience

If you would like to share your experiences of any of these therapies – either as someone using them, or as a professional – please get in touch at [email protected].