Psychotherapy, counselling, and psychological treatment in the NHS

What 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.

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.

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