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.
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.
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.
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.
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.
Adapted from Tees, Esk and Wear Valleys NHS Foundation Trust ‘What is cognitive analytic therapy?’
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. The psychologist 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.
Mindfulness Based Cognitive Therapy (MBCT)
Before we describe MBCT, we explain what mindfulness is.
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’.
It 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.
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.
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].