Psychotherapies
This leaflet is for anyone:
- who may have been offered psychotherapy
- who thinks that they might need
psychotherapy
- who just wants to know more about
psychotherapy.
It includes:
- what is psychotherapy?
- what types of psychotherapy are there?
- how do I get psychotherapy?
- how does psychotherapy fit in the NHS?
- is psychotherapy available on the NHS?
What is psychotherapy?
There are different types, but they are all
'talking treatments' in which you talk with another person. It can
help you to overcome:
- stress
- emotional problems
- relationship problems
- troublesome habits
- problems, such as hearing voices.
The person carrying out the treatment is
usually called a therapist, while the person being seen is the
patient or client.
Most psychotherapies can be done one-to-one or
in groups. Some can now be done online on the internet.
What types of psychotherapy are there?
Psychodynamic (psychoanalytic)
psychotherapy
Psychodynamic psychotherapy gives you a
regular time to think - and talk – about the feelings you have
about yourself and other people (especially your family and those
you are close to). You discuss:
- what's happening in your life at the moment
- how you do things and the part you play in things going
right or wrong for you
- what has happened in the past
- how the past can affect how you are feeling,
thinking and behaving right now.
The therapist will help you to make these
connections between the past and the present. He or she will
often comment on what happens in the sessions as you talk together.
This can help to show how some of the things that you feel, do and
say are not driven by your conscious thoughts and feelings, but by
unconscious feelings from your past. And if it is happening in the
therapy sessions, it will also be happening in your day-to-day
life. When you understand these connections better, you can make
decisions based on what you want or need now, not what your past
experiences drive you to do.
Psychodynamic psychotherapy usually involves
regular, 50-minute meetings. These can be weekly or more often if
needed. If you have a more straightforward problem, you may only
need a few weeks or months of therapy. If your problems are more
complicated – or long-standing – you may have to carry on for
several months or longer.
Cognitive Behavioural Therapy (CBT)
Behavioural psychotherapy helps you overcome
problems by changing how you behave. For example, you may need to
overcome a fear, or phobia. The therapist will help you, very
gradually, to spend more and more time in the situation you fear –
and will help you to feel comfortable and relaxed in that
situation.
Cognitive therapy focuses more on the way that
what you believe and think can keep problems going. It helps you to
test any unhelpful beliefs by talking about them, and then
developing ideas that are more helpful for you. You then try these
out in between sessions and so develop more helpful ways of
thinking and acting. It can take account of what has happened in
the past, but mainly looks at the present and future.
Cognitive behavioural therapy (CBT) combines these two
techniques. It is structured, usually aimed at a particular problem
and is fairly brief (6-20 sessions). It's a bit like being coached
– you have a number of exercises to do between sessions. In a way,
you learn to become your own therapist. The National Institute for
Health and Clinical Excellence (NICE) recommends CBT as a treatment
for a wide range of problems. For further information, see our
factsheet on Cognitive Behavioural
Therapy.
Family and Marital Therapy
Your problems may not just be yours – there
may be problems in your marriage, relationship or family. So,
family and marital therapies:
- involve everybody concerned
- look at the relationships involved
- look at how everybody involved thinks about
how they get on.
In marital therapy, a therapist or pair of
therapists meet with a married or committed couple, so that they
can work on their problems together.
In family therapy, the family are asked to
come to sessions that are led by one or two therapists. These
sessions are often observed by other therapists or recorded. This
can help the therapists and family members to reflect on what has
happened during the discussion. Systemic psychotherapy works
with a family's strengths to help family members think about (and
try) different ways of behaving with each other.
Cognitive Analytical Therapy (CAT)
Like CBT, this is usually quite short, often
about 16 sessions. The therapist helps you to:
- Describe how your problems have developed
from the events of your life and your
personal experiences.
- Look at the ways of coping you have developed
to deal with these problems.
- Think of ways of changing your ways of coping
so that you feel better and can cope more easily.
The therapist puts this all into writing after your first few
sessions. At the end of treatment, the therapist gives you a final
letter which summarizes your difficulties and the ways you have
worked out how to cope better.
Interpersonal Therapy (IPT)
This is a treatment for depression, but it has
also been used with other problems. It aims to help you to
understand how your problems may be connected to the way your
relationships work. It then helps you to find out how to strengthen
your relationships and find better ways of coping.
Counselling
This is often provided in primary care, at
your GP's surgery. It is usually fairly short, and aims to help you
to be clearer about your problems – and by being clearer, to come
up with your own answers. It is often used to help someone cope
with recent events they have found difficult. It does not aim to
help you change as a person, as most of the other therapies
described here do.
Can these different approaches work
together?
These approaches may be different but they all
help you to understand better how you work - which can help
you to make changes in your life. Psychotherapists may use a
combination of techniques to suit you. For example, you may start
with individual therapy and then move to group therapy, or from
marital work to individual treatment.
What actually happens?
Psychotherapy usually involves regular
meetings at the same time and same place every week or two weeks.
In most cases you will agree the length of the treatment with your
psychotherapist within a month or so of starting. What happens
during a session is usually considered confidential and will only
be discussed with the psychotherapist's supervisor.
Individual psychotherapy
You meet a therapist on your own to talk
together in a quiet room, usually for 50 minutes or so.
Group therapy
You meet regularly with a group of people who
have similar problems and a psychotherapist. The sessions are
usually longer than in individual psychotherapy, often around 90
minutes. It is not provided because it is cheaper but because it is
the best treatment for some people. It is particularly
helpful if you have problems in relationships that happen again and
again. It is actually powerful and encouraging to find that
you aren't alone with your problem – and that you may even be able
to help other people in the group.
Can I get psychotherapy on the NHS? (UK
only)
Through your GP
Your GP has always been able to refer you to
local psychotherapy services, but there have often been long
waiting lists – and, in some areas, very little psychotherapy
available. However, in November 2007, the government put £173
million into the Improving Access to Psychological Therapies
programme (IAPT). This should mean that psychotherapy services for
depression and anxiety in England will become more available.
Even without this recent development, many GPs
already have mental health workers and psychotherapists working in
their surgeries. These include primary care gateway workers,
counsellors, counselling psychologists and clinical psychologists.
For less serious problems you may be able to use psychotherapy
self-help material (particularly CBT) with the help of books or
computer programmes. These can be combined with some contact with a
psychotherapist to guide and support you while you work through
them.
Your GP may refer you to a:
- Community
Mental Health Team (CMHT): if you are referred to a
CMHT they will find out what you need and refer you, either to
someone in the team, or to a local specialist psychotherapy
service.
- Specialist Psychotherapy Service: these
departments have a team of different professionals specialising in
different kinds of psychotherapy, including a consultant
psychiatrist in psychotherapy. They can do a thorough assessment of
what you need and match you with the person on the team who can
best meet your needs.
- Consultant psychiatrist in
psychotherapy: a consultant psychiatrist in
psychotherapy is trained as a medical doctor, psychiatrist and
specialist in psychotherapy. Because their training and experience
is particularly wide, they can often help out with complicated
problems or help to work out what sort of treatment is most likely
to help.
- Through your psychiatrist or community mental health
team: if you are already seeing a psychiatrist, you can
ask him or her how you could receive psychological therapy as part
of your care.
- Referring yourself: you may be able to refer
yourself to some psychotherapy services – they are usually a part
of your local mental health services and provided by a local NHS
Trust. Check out the Trust website to find out what they
offer.
- Private psychotherapy: you may want to think
about private treatment because it's more convenient or you want to
have more choice. It is important that any psychotherapist
you see is properly qualified. There are plans for all
psychotherapists to be registered – this will be a way of checking
that a therapist is properly trained. For the time being, your GP
should be able to recommend a qualified psychotherapist for an
assessment. Personal factors are very important - don't be
afraid to 'shop around' for someone who suits your needs and whom
you feel happy to go on seeing. A list of organisations is
available at the end of this leaflet for further
information.
Self-help
You may find that a self-help book is useful
to you - there are a number of books now on the market, mostly
based on CBT principles. These will not usually be a substitute for
psychotherapy, but may be enough with mild anxiety or
depression.
Computer-aided CBT
There are currently two software programmes
recommended by the Department of Health:
These can both be used via an internet
connection.
…. But does psychotherapy work?
The National Institute for Health and
Clinical Excellence (NICE) produces regular guidelines and
updates on therapies that research has shown to work. There is now
good evidence that the psychotherapies can help anxiety,
depression, the effects of trauma and psychotic symptoms.
Which therapy will be best for me?
This will depend on what sort of problem you
need help with, how bad it is and how long it has been going on
for. Long-term psychodynamic psychotherapy seems to work better
than short-term therapies if you have complicated or long-standing
problems.
Who provides psychotherapy in the NHS?
- Clinical psychologists
- Counselling psychologists
- Adult psychotherapists
- Child psychotherapists
- Doctors, nurses and social workers who have
had further training in psychotherapy
·
Specialist psychotherapists will have had a
long period of training and will have a recognised qualification
with a professional organisation. Ask about their qualifications if
you are in any doubt. Many NHS psychotherapy departments also have
trainees who provide therapy. Their work will be supervised by an
experienced therapist.
They may work in a special team – it may be
called the psychotherapy service, the department of psychology or
psychological therapies. You should be able to find out about this
from your GP surgery or the website of your local mental health NHS
Trust.
Are there long waits for psychotherapy on the
NHS?
A lot of people want talking therapies - and
they take time to work properly. So there are still long
waiting lists in many areas. The IAPT programme (see above) should
improve the situation over the next few years.
How private are my psychotherapy
sessions?
Your sessions are confidential and your
therapist will only discuss them if it is in your interests.
This means that:
- Your therapist will usually send a letter to
the person who has referred you to explain why psychotherapy may
help – and another letter to let them know when the therapy is
expected to start and finish.
- They may discuss your sessions with their
psychotherapy supervisor.
- If the therapist feels that you have become a
danger to yourself or (rarely) other people, your therapist has to
tell others – although they would usually discuss this with you
first.
Further information
Recommended reading
Highly accessible and amusing
Skinner R and Cleese J: Families and How to Survive
Them
If you require a fully-registered
psychotherapist, you can contact the following organisations
British Psychoanalytic
Council (BPC), West Hill House, 6 Swains Lane, London
N6 6QS.
British Association for Behavioural and
Cognitive Psychotherapies, BACP House, 35-37
Albert Street, Rugby, Warwickshire CV21 2SG.
For information on CBT and a list of trained
psychotherapists.
UK Council for Psychotherapy
(UKCP)167-169 Great Portland Street, London, W1W
5PF.
The British Psychological
Society
Have a list of psychotherapists specialising
in psychotherapy.
References
Cuijpers, P, van Straten, A, Andersson, G, van
Oppen, P (2008) Psychotherapy for depression in adults: A
meta-analysis of comparative outcome studies. Journal of
Consulting and Clinical Psychology. 76; 6; 909-922.
Fonagy, P (1999). An open door review of
outcome studies in psychoanalysis. London: International.
Psychoanalytical Association.
Knekt, P, Lindfors, O, Harkanaen, T, et al
(2008) Randomized trial on the effectiveness of long-and short-term
psychodynamic psychotherapy and solution-focused therapy on
psychiatric symptoms during a 3-year follow-up. Psychological
Medicine, 38, 689–703.
Leichsenring, F, Rabung, S Effectiveness
of long-term psychodynamic psychotherapy: a meta-analysis. JAMA;
300(13): 1551-1565.
This factsheet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
Series Editor: Dr Philip Timms.
© September 2009. Royal College of Psychiatrists. This
factsheet may be downloaded, printed out, photocopied and
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