Under Review April 2018
This leaflet is for anyone:
- who may have been offered psychotherapy
- who thinks that they might need
- who wants to know more about
- 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:
- 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 using the internet.
What types of psychotherapy are there?
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
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 Care Excellence (NICE) recommends CBT as a treatment for
a wide range of problems. For further information, see our
factsheet on Cognitive Behavioural
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. The
therapy might deal with problems between the partners or stresses
that both partners are facing (i.e. loss of a child).
Family therapy sessions
are sometimes 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
- 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.
Mentalization-based therapy and Dialectic behaviour
These therapies are mostly aimed at helping people with
borderline personality disorder. Both treatments involve regular
sessions over a period of 12 to 18 months. The treatment may
include a mix of individual and group session.
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
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.
You meet a therapist on your own to talk
together in a quiet room, usually for 50 minutes or so.
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
Your GP has always been able to refer you for
psychotherapy, but there have often been long waiting lists – and,
in some areas, very little psychotherapy available. However, the
Improving Access to
Psychological Therapies programme (IAPT) means
that psychotherapy services for depression and anxiety in
England are more readily available.
Many GPs also have mental health workers
and counsellors working in their surgeries. For less serious
problems you may be able to use self-help material from books or
online. These can be combined with some contact with a therapist to
guide and support you while you work through them.
Your GP may refer you to a:
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
- Specialist Psychotherapy Service: these
departments have a team of 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
- 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
- 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
- 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 may 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
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
There are currently two software programmes
recommended by the Department of Health:
These can both be used via an internet
…. But does psychotherapy work?
The National Institute for Health and
Care 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
How private are my psychotherapy
Your sessions are confidential. However:
- 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
- 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
Highly accessible and amusing
Skinner R and Cleese J: Families and How to Survive
Psychoanalytic Council (BPC)
A professional association and voluntary regulator of the
psychoanalytic psychotherapy profession, publishing a Register of
practitioners who are required to follow their ethical code
and meet their fitness to practise standards. Telephone 020 7561
9240; Email: firstname.lastname@example.org
Association for Behavioural and Cognitive
A multi-disciplinary interest group for people
involved in the practice and theory of behavioural and cognitive
psychotherapy and provides further information on CBT and a list of
trained psychotherapists.Tel: 0161 705 4304; General Enquiries:
for Psychotherapy (UKCP)
Professional body for the education, training
and accreditation of psychotherapists and psychotherapeutic
counsellors. Our membership includes over 7,800 individual
therapists and more than 70 training and accrediting organisations.
Tel: 0207 014 9955; Email: email@example.com
The British Psychological
The BPS provides a Directory of Chartered
Psychologists, information to the
public and ensures high standards of education, training
- 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.
- 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
Expert review: Dr Sarah Robertson, the Royal College of
Psychiatrists' Medical Psychotherapy Faculty; Dr Martin
Briscoe and Dr Melvyn Zhang.
Under Review April 2018 Royal College of
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