Psychotherapy, counselling, and
psychological treatment in the NHS
are the talking therapies?
All psychological treatments involve listening and talking. The
relationship between the people involved is important. In some
therapies understanding this relationship is a crucial part of the
work. There are three broad categories of therapy practised in the
NHS. These are:
Psychodynamic therapy is based on
psychoanalytic ways of understanding personal and emotional
development. The way we see and relate to the world develops
through relationships made in infancy, childhood, and later life.
Disturbances in these relationships can produce continuing
vulnerabilities, and symptoms and relationship problems in later
life. Symptoms have a meaning in the context of our lives, and
difficulties in relationships often follow patterns laid down in
The therapist offers a reliable and professional relationship,
where old patterns may be repeated, but can be thought about and
understood in a way that frees people to change.
- Individual psychodynamic therapy in the NHS is usually offered
weekly. The duration can range from a few months to considerably
longer, although NHS resources for long-term treatments are not
- Couple therapy may be suggested where problems seem to centre
in the relationship between partners.
- In group therapy a small group of people meets weekly, with a
therapist, over a substantial period of time. The group becomes a
reliable setting within which members can come to a new
understanding of themselves and others, in a way that allows change
to take place. Most groups involve men and women with a variety of
problems and backgrounds. Some groups consist of people with
similar experiences coming together to share these. This can
relieve feelings of isolation - such as in groups for those
recovering from child sexual abuse, young people, or those facing
- For more intensive group therapy, the therapeutic community
approach can be used, where people meet together for a therapeutic
programme lasting several hours a day. This treatment is sometimes
offered on a residential basis.
Cognitive behavioural therapy
Cognitive behavioural therapy
has been developed from learning theory and is less concerned with
development of personality, or with the nature of the relationship
with the therapist. A less intense, but supportive relationship is
The focus is often on the practical effects of a problem, rather
than its meaning and the reasons behind it.
The aim is to treat difficulties by problem solving, finding
better strategies for coping, and overcoming irrational fears.
Treatment is usually on a weekly one-to-one basis, lasting for up
to a few months.
Cognitive analytic therapy, or CAT, is a therapy that
incorporates both cognitive and psychodynamic insights. It has a
relatively brief, but intense, format.
Systemic therapy sees a symptom or problem in
one individual as arising from unhealthy interactions within a
network of people. In NHS practice, this usually means the person’s
family, but the understanding can be applied to other groups, such
as a work setting. The approach does not label one single person as
"ill", or as "the patient".
Treatment consists of meeting with the whole family, and
exploring the network of views and relationships, to throw new
light on the problems the family is having. This can help family
members discover new and more helpful ways of communicating with
each other. Appointments are usually several weeks apart, with
meetings spaced over a period of months.
Counselling is a general term for exploring
emotional problems by talking them through with a trained
counsellor or therapist. The term covers a considerable range of
approaches. In its simplest form, this can be supportive and
sympathetic listening in the form of weekly sessions over a small
number of weeks. This sort of counselling is suited to people with
fundamentally healthy personalities who need help in addressing a
current crisis in their life or relationships.
Some more experienced counsellors, who have had further training
in any of a large range of theoretical approaches, work in a deeper
way, and are able to help people with more complex problems.
Counsellors are sometimes attached to Health Centres and able to
see patients directly at the request of the GP.
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