Talking Treatments

This section gives information about talking therapies. It explains the different kinds of treatment available and how to get them. This section explains how you can get treatment on the NHS and privately.
•Talking therapy involves talking about problems with a trained professional. These problems are usually linked to your mental and emotional health.
•Talking therapies try to figure out what may have caused your problems in the first place and learn ways of managing them.
•There are different types of talking therapy. Finding the right therapy will depend on your problem, what is available in your area and what you want.
•Cognitive behavioural therapy (CBT) is widely available on the NHS. CBT focusses on the “here and now”. CBT looks at how automatic thoughts can affect how you feel and aims to change these.
•Psychotherapy is another type of talking therapy. Psychotherapy focuses on your early relationships and experiences and how they impact on current relationships.
•You will need to go to your GP or key health care professional, such as a social worker or nurse, to get therapy on the NHS.
•You can find a private therapist, prices range from £50-£100 an hour. Some therapists are willing to offer reduced rates if you are on a low income.
•You can get talking therapy from a therapist, social worker, nurse, psychologist, psychiatrist or wellbeing practitioner. You should only get therapy from someone who is properly trained.

This section covers:
•What is talking therapy?
•What can I expect from talking therapy?
•Are there different types of talking therapies?
•Are there other types of therapy?
•How do I get therapy?
•Are there guidelines on talking therapy for different mental illnesses?
•What if I have problems getting therapy on the NHS?
•How do I choose a talking therapy?
•Are therapists regulated and accredited?
•Are there any risks associated with talking therapies?

These pages are created by Rethink Mental Illness’ Advice Service in accordance with the Information Standard. Last reviewed in February 2014. Next review February 2016.

ABOUT

Talking therapy is a general term to describe any psychological therapy that involves talking. This includes:
•counselling
•psychotherapy
•cognitive behaviour therapy
•dialectical behaviour therapy

People find talking therapies useful to treat mental health or behavioural problems. Talking therapy can either be used on its own or with medication.

What can I expect from therapy?

At the start of therapy you will talk to a therapist about what your problems are. The therapist will ask you specific questions to try and figure out what caused the problem and what is blocking your recovery.

These questions help your therapist come up with a treatment plan for your therapy. You and your therapist should agree:
•What you expect from one another;
•Your commitment to the therapy; and
•How to end the therapy if you want to.

You can go to individual one-to-one therapy or group therapy. Some therapies will be a combination of one-to-one and group sessions. The length of therapy will vary from four sessions to 18 months depending on the type of therapy you do.

TYPES OF THERAPY

Are there different kinds of therapy?

There are many different types of talking therapies. Some of the most common types of talking therapy are:
•Counseling
•Cognitive Behavior Therapy
•Computerise Cognitive Behavior Therapy
•Psychotherapy
•Family Intervention Program / Multi systemic Therapy
•Dialectical Behaviour Therapy
•Creative therapies

Counseling

Counseling is a common therapy you can get through your GP. Counseling is for people who are generally well but are going through a difficult time such as bereavement, relationship breakdown, redundancy or life change. Usually you can only get a certain number of counseling sessions (six to 12 sessions). You can expect your counsellor to help you to understand how you are feeling.

Cognitive Behavioural Therapy (CBT)

CBT can help you to change how you think (‘cognitive’) and what you do (‘behaviour’), which are both linked to how you feel. CBT looks at problems and difficulties in the ‘here and now’ more than your past or childhood. CBT will help you look at how you think about yourself, the world and other people and how that affects your reaction to situations.

CBT is often useful for treating a wide range of problems and conditions. CBT can help with:
•poor anger control
•depression
•anxiety
•post traumatic stress disorder
•panic attacks
•psychosis
•phobias

CBT is widely available on the NHS. CBT should only be delivered by someone who is properly trained such as a therapist, nurse or social worker. Sessions are usually weekly and last an hour. An average number of sessions is four to 15 but this depends on what you need. There is more information on how many sessions of CBT are recommended below.

Computerised CBT

You can do CBT on your computer at home, this is called Computerised Cognitive Behavioural Therapy (cCBT). Research has shown some CCBT programs help to treat mild depression and anxiety.

The Department of Health recommends that a psychological wellbeing practitioner guides you through cCBT. The NHS recommends cCBT courses which you can do under the supervision of your GP or a wellbeing practitioner.
•Living Life to the Full Interactive is a CBT-based course for overcoming mild to moderate depression and anxiety. You complete the six-session course under the supervision of your GP or a qualified therapist.
•Overcoming Bulimia is an online CBT-based course to help people with bulimia and other eating disorders. The course includes eight sessions, which you complete at your own pace.
•Overcoming Anorexia is an online course, based on CBT, for carer of people with anorexia nervosa.
•Mood GYM is a free self-help computer program to teach CBT skills to anyone at risk of having depression and anxiety. MoodGym is an independent resource developed and delivered by the Australian National University, and users are able to access the site free of charge. It has five sections and interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment.

The National Institute for Health and Care Excellence (NICE) gives guidance on treatment for the NHS. It recommends http://www.beatingtheblues.co.uk for depression or http://www.fearfighter.com for anxiety. Your local NHS Trust has to make these available to you unless there is a good clinical reason not to. If you have any problems accessing cCBT contact your local Patient Advice and Liaison Service (PALS). You can also contact the Rethink Mental Illness Advice Service on 0300 5000 927.

Psychotherapy

Psychotherapy looks at how your early or past experiences affect you now. There are different types of psychotherapy. Psychotherapy is not like counseling or CBT. Psychotherapy helps you understand yourself more and is done over a longer time period. Psychotherapy can be useful for people who have a long term or recurring problem.

As you may be expected to talk about possibly difficult or upsetting events you may feel psychotherapy is not suitable for you. If you are considering psychotherapy you should talk to the therapist about what to expect before you start.

Family intervention Program (FIP) / Multi systemic Therapy (MST)

Family intervention programs (FIP) were originally set up to help families deal with a relative who has drug, alcohol or gambling addictions, eating disorders or other harmful behaviour.

The FIP has been adapted to help families caring for someone with schizophrenia. Research shows that family interventions may reduce the risk of relapse and going back into hospital for people with schizophrenia.

Some local authorities or NHS Trusts offer Multi systemic Therapy (MST). MST aims to help families with similar problems as FIP. MST is helpful when there is a young family member who behaves in a difficult or harmful way. FIP and MST are based on an individual or group changing their behaviour by learning from other people in social situations. A therapist comes to your house and works with your whole family to tackle these problems. A therapist may come several times a week for three to six months depending on your needs.

Dialectical Behaviour Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a form of talking therapy for people with borderline personality disorder and significant self harming behavior.

During DBT you learn how to control your behavior and cope with distress. You learn how to reduce harmful behaviours like self harm and also how to deal with relationship problems. You would be expected to go to group sessions, one-to-one sessions, and education groups. You are offered telephone support between sessions during DBT. NICE says DBT can be helpful for people with borderline personality disorder but your local NHS Trust may not offer it. You can contact your local PALS to find out if your local trust offers DBT.

Are there other types of therapy?

Creative therapies

Creative therapies use areas such as art and drama to:

• Make you more in touch with how you feel
• Improve how you communicate with other people
• Make you feel less anxious
• Make you feel better about yourself.

Art Therapy

Art therapy encourages you to express emotion and explore your problems using a wide range of art materials. Art therapy can be helpful to people who may have difficulty expressing themselves in words.

Drama Therapy

Drama therapy uses drama or theatrical techniques (such as role play, mime, story telling) to help you express yourself and understand how you feel.

There is a very wide range of other therapies available and the one that suits you may not be in the list above. You can get a more information about different therapies available by contacting the UK Council For Psychotherapy or British Association of Counseling and psychotherapy. Their details are in further information.

ACCESSING AND TREATMENTS

How do I get therapy?

NHS therapy

The main way to get therapy on the NHS is to talk to your GP or mental health worker. If you are under a community mental health team your care coordinator or psychiatrist will be responsible for organising NHS therapy. If you are not with a community mental health team your GP will be responsible for helping you get therapy. After you talk about what you want they can pass your details to a therapist or local therapy service, this is called a referral.

You should tell whoever is making the referral if you would like a particular type of therapy. You can then talk about what is available in your area and he or she can pass your details to the most appropriate service.

Improving Access to Psychological Therapies (IAPT)

The Government’s ‘Improving Access to Psychological Therapies’ (IAPT) programme has made psychological therapy more available on the NHS. IAPT services mainly offer CBT for anxiety and depression.

The service can be run by the local NHS Trust or a non-NHS agency, like Rethink Mental Illness, who work with the local NHS Trust. IAPT should be available in your area. You can often self refer or ask your GP to refer you. To find out more about who is providing the IAPT service in your area contact your GP, local PALS service or go on the IAPT Website.

Private Therapy

You can choose to pay to see a therapist privately. The benefits of private therapy are:
•Increased choice
•Shorter waiting times
•More flexibility about who you go to

However, the clear drawback is the cost, the average price of a session is £50 upwards. Some therapists have a sliding scale and have reduced fees for people on low incomes. You can find organizations that hold lists of therapists that offer private therapy in further information.

You may be able to see a counselor at a local mental health group, such as MIND or Rethink Mental Illness. You may not need a GP referral but this depends on what services are available in your area. For more information go to http://www.mind.org.uk or http://www.rethink.org.

What if I have problems with accessing therapy on the NHS?

You may come across some problems getting talking therapy on the NHS. Some of these problems can include:
•Long waiting lists
•You did not get enough sessions
•Your GP does not understand mental health conditions or treatment
•Talking therapy is not included in your care plan
•Your care coordinator does not think you need therapy
•The therapy you want is not available in your local area.

There are some things you can do such as:
•Get the support of an advocate
•Ask for a second opinion of your treatment plan
•Ask for a review of your care plan approach
•Make a complaint

You can read the following pages for more information about:
•Advocacy
•The Care Program Approach (CPA)
•Complaining about the NHS or Social Services
•Second opinions

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