About psychotherapy
Psychotherapy is a collaborative treatment that helps people address psychological conditions and mental distress by talking with a trained professional and using various techniques to change behaviours, thoughts, and emotions.
Many people feel a great deal of benefit from therapy, even after comparatively few meetings. When one comes to a turning point in life, help from someone who has experience of such difficulties, and an understanding of the processes you need to go through, can be invaluable.
Much research has been carried out on the effectiveness of psychotherapy. Significant improvements have been demonstrated in a number of areas, including symptoms, social and occupational functioning, family and other relationship patterns, personality change and reduction in the relapse rate of severe mental illness.
Other studies have shown that with particular medical conditions there have been clear improvements, such as with irritable bowel syndrome and in the control of blood sugar in brittle diabetes. Like any other treatment or life experience, psychotherapy may not be suitable for everyone. Each individual has to make up their own mind about whether therapy is helpful for them. The initial consultations aim to help people think about this, in collaboration with a therapist.
People suffering from a wide range of psychological and emotional problems can be helped.
People with quite clear-cut symptoms such as phobias, obsessions, compulsions or panic attacks often find much relief in behavioural approaches that target the specific symptom.
Cognitive therapies extend these approaches, and pay particular attention to recurring, self-defeating patterns of thought, in conditions such as depression and anxiety.
Family therapy may be sought by a family where they have relationship difficulties. It may be suggested to a family where, for example, children have behavioural disturbances, or when one or more family members develop symptoms. It may also help with difficulties at a time of change in the family, such as a bereavement, a birth, or when children are about to leave home).
The psychodynamic therapies are used mostly with difficulties arising from problems of living with oneself, or in relation to others. People vary in their susceptibility to emotional distress, often through a combination of temperament, family relationships in childhood, and possibly experiences of trauma, loss, neglect, and abuse. Circumstances may then trigger psychiatric symptoms, or disturbed behaviour, including self-harm.
The focus is on helping people become more aware of hidden patterns in their thoughts and feelings. Understanding, and becoming more tolerant of themselves, they can be free to live more fully. The demands and challenges of the present can then be tackled anew, with the opportunity to make changes and find new solutions.
Where the source of the problem concerns a particular event such as a bereavement or unexpected trauma in a person with an otherwise healthy personality, the therapy may only need to be brief. Where such events touch on deeper problems, the issues are more complex, and the person may need a longer term therapy. Sometimes there is a need to combine medication and psychotherapy over a longer period of time. The choice of therapy is decided upon individual need.
Psychotherapists in the NHS are mental health professionals with a range of core professional backgrounds which may be either medical (psychiatry) or non-medical (generally psychology, nursing, occupational therapy and social work). Normally the psychotherapist will be working as part of a specialist psychotherapy department or service.
Independent psychotherapists (who usually work in private practice) will have completed a specialist training registered by the United Kingdom Council for psychotherapy. Some psychotherapists with specialised psychoanalytic training are registered with the British Psychoanalytic Council.
Counsellors are from a variety of backgrounds. The British Association for Counselling and Psychotherapy governs standards of training in counselling courses and administers accreditation.
All psychiatrists working in the NHS have some basic training in the different forms of psychotherapy, but only a minority have extensive training in the field - these are the specialist Consultant Psychotherapists.
Clinical psychologists are licensed to carry out psychologically based treatments and most of the cognitive behavioural therapy in the NHS is provided by them.
Nurses, occupational therapists and others use a wide variety of psychological approaches in their work, but are not psychotherapists unless they have a specialist training.
All effective treatments carry some risk. During psychotherapy there may be spells of being in touch with painful emotions, sometimes for the first time, which may temporarily lead to feeling worse. This is part of the process of facing, and learning to live with, one’s feelings.
The process of psychotherapy can make people question the way they live their lives and make relationships. It is important that people try not to make major life decisions whilst they are in such upheaval, because the decisions may be impulsive, before the underlying issues have been understood. Sometimes, however, important decisions have to be made, and therapy should then provide a place for reflection and considering the options.
On occasions, a person drops out of therapy, feeling disappointed or angry with their therapist. As with any relationship, the reasons for this may be simple or complex - and there may be great benefit, even if the relationship ends, from understanding what went wrong, and why. Ideally this understanding can be worked out in collaboration with the therapist.
If a therapy does break down, sometimes the person will later come back to treatment with someone else, to tackle problems that were not able to be dealt with the first time round.
Risks are minimised by skilful assessment of suitability for psychotherapy and by the availability of experienced and properly qualified psychotherapists.
Psychotherapy in the NHS is part of the mental health services. It is a specialist resource alongside the general psychiatric services for the treatment of those patients who will be able to benefit from it. The Royal College of Psychiatrists has recommended that psychotherapy as a service is expanded nationally so that it is available all areas.
While all psychiatrists will have received a basic training in psychotherapy, a smaller number of psychiatrists will have completed a higher specialist training in psychotherapy and are then designated 'consultant psychiatrists in psychotherapy'. Together with clinical psychologists, they are normally responsible for the psychological treatment services in NHS trusts.
There are two national registers of psychotherapists, and one for counsellors. These are maintained by the UK Council for Psychotherapy (UKCP), the British Psychoanalytic Council (BPC) and the British Association for Counselling & Psychotherapy (BACP).
These organisations will be able to send general information and let you know the names and addresses of any of their therapists or counsellors working in the area.
Therapists on the BPC list are exclusively psychoanalytic practitioners. With the UKCP you will have to specify the type of therapy you are looking for, since they have a number of different sub-groups.
The BACP maintains a list of counsellors accredited by the organisation. None of these bodies are part of the NHS, but are responsible for setting standards and trainings for all professionals working in these fields, within the NHS or outside it.
Various reports on psychological treatments and the arrangements needed to provide them have been issued in recent years by the Royal College of Psychiatrists. Local NHS services will be able to give information about what is provided in their area.
Psychotherapy, counselling, and psychological treatment in the NHS
All psychotherapeutic treatments are 'talking therapies' – they involve listening and talking. The relationship between the people involved is important andi n some therapies understanding this relationship is a crucial part of the work.
There are four broad categories of therapy practised in the NHS:
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 earlier life.
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 always available.
- 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 old age.
- 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 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 encouraged instead.
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.
