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 or 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 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 BCP 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.