What are ‘Talking Therapies’?
Talking therapies include, cognitive behavioural therapy, counselling, psychotherapy, hypnotherapy, self-help groups and group therapy. All the above, except self-help groups and group therapy, take place on a 1:1 basis.
Cognitive Behavioural Therapy
This takes place with a psychologist usually in a clinical setting (e.g. hospital) although it is typically carried on an out-patient basis. CBT involves looking at your problems, examining thought and behaviour patterns, and working out ways of changing negative behaviours/thoughts. Most people seeking this type of therapy will be given a set number of sessions, usually 6-12, each session lasting approx. 50 minutes. Therapists often set clients “homework” to do in between sessions which may include carrying out activities such as monitoring thoughts and feelings throughout the week and entering these into a thought diary.
Those wishing to access CBT can ask their GP to refer them to the local NHS service, or see a therapist privately. If you are a member of Anxiety UK you can access CBT via our in-house therapy service. Click here to become a member.
The Department of Health (D of H) have recently produced a very helpful information booklet entitled: “Cognitive Behavioural Therapy (CBT) for people with depression and anxiety – what skills can service users expect their therapists to have”? Click here to download the booklet.
For information on private therapists consult the British Psychological Society’s (BPS) Directory of Charted Psychologists – copies of which can be found at most major libraries. If your library doesn’t have a copy, visit the BPS website here.
Counselling and Psychotherapy
These two treatments are very similar although psychotherapy tends to examine a client’s past in relation to current problems, whilst counselling tends to focus on the ‘here and now’. Both therapies seek to explore the problem or ‘presenting issue’ from the client’s experience of it. Again, a GP can refer you on for these therapies on the NHS.
Most NHS therapists will offer a set number of sessions, usually 6-12. A session typically lasts 50 minutes and are held on a weekly basis, although some are held fortnightly. Many voluntary sector organisations offer free or discounted counselling or psychotherapy sessions. Private therapists charges vary.
For information on private therapists, contact the British Association for Counselling & Psychotherapy here.
Anxiety UK members can access counselling which is available at a number of locations. Click here to become a member.
Hypnotherapy is the use of hypnosis for the treatment and alleviation of a variety of physical and psychological symptoms. Hypnosis allows the subject to experience often quite deep levels of relaxation and so helps to reduce levels of stress and anxiety. It is often used alongside classical behavioural therapies such as ‘systematic desensitisation’. Two important elements of this therapy are the ability to clearly imagine something that makes you feel anxious and then to attain a deeply relaxed state. Hypnosis helps to achieve both of these more easily and quickly than many other forms of treatment.
If you are a member of Anxiety UK you can access the Clinical Hypnotherapy service. We have therapists across the UK. If you want to find a clinical hypnotherapist privately, we suggest you contact the British Society of Clinical Hypnosis or the General Hypnotherapy Register.
These usually take place in a formal setting (e.g. hospital, day centre), run by professionals (e.g. CPNs, social workers) and are more structured than self-help groups. Some are self-referral, others have a limited number of places and take referrals from GP’s only. Some run for a set period of time, usually 10-16 weeks and operate weekly, fortnightly or monthly for 1-2 hours.
Are talking therapies confidential?
All these therapies operate a confidentiality policy, although if you disclose information which suggest you are likely to harm yourself or others, or are involved in terrorism or some other criminal activity, then the therapists are bound by law to pass such information on to the appropriate agencies.
If you access talking therapies on the NHS, then it will appear on your medical records. Private and voluntary sector therapy will not usually.
How can I ensure I see a reputable therapist?
It is a good idea to check that your therapist is a member of a nationally recognised body such as the BPS, BACP, BABCP or BSCH etc. (this does not apply to self-help groups who do not have a professional association), and has a nationally recognised qualification, diploma or degree in the therapy they practise. If they belong to a professional association, they will have to work to strict guidelines and are accountable to that association.
Check that your therapist has insurance (public liability, professional indemnity). Again, this assures accountability. Your therapist should also have monthly supervision with a more experienced practitioner. You can also ask if they have their criminal record bureau check. This is common practice for therapists.
How can talking therapies help?
A problem shared is indeed a problem halved. A therapist is trained to listen effectively and help you find a way forward through your problems. You may not be aware of patterns or triggers, or links to your past, because you are so integrally involved in your problems. A therapist is outside the situation, and will see the bigger picture. Often, just to talk about your problems can help release the pent-up feelings and reduce your anxiety.
Additional therapy types
(Taken from Department of Health psychological therapies guidelines (2001))
Applied relaxation therapy teaches systematic approaches to relaxation, for example, progressive muscle relaxation, often combined with breathing techniques then asking people to encounter the places or triggers to their anxiety. It is similar to the ‘behavioural’ component in CBT, but will additional relaxation.Autogenic training: is often combined with relaxation methods to create a conditioned relaxation response to an internal stimulus, such as a word of phrase.
Behaviour therapy is a structured therapy originally derived from learning theory, which seeks to solve problems and relieve symptoms by changing behaviour and the environmental factors which control behaviour. Graded exposure to feared situations is one of the commonest behavioural treatment methods and is used in a range of anxiety disorders.
Cognitive analytic therapy (CAT) is a brief (8-25 session) integrative therapy combining elements of cognitive behavioural and psychodynamic therapies in an active, structured and collaborative approach, based on written summaries and diagrams of your problems. It can be useful for looking back over time at how people have coped and examining their patterns.
Cognitive behaviour therapy (CBT) looks at the impact of your thoughts and behaviours on how you feel. It then helps you to identify strategies for changing your thinking patterns and behaviours.
Cognitive therapy is a structured treatment approach derived from cognitive theories. Cognitive techniques (such as challenging negative automatic thoughts) and behavioural techniques (such as activity scheduling and behavioural experiments) are used with the main aim of relieving symptoms by changing maladaptive thoughts and beliefs.
Dialectical behaviour therapy (DBT) is a longer term cognitive behavioural treatment devised for borderline personality disorder which teaches patients skills for regulating and accepting emotions and increasing interpersonal effectiveness.
Eclectic therapies: Many NHS therapists formulate the patient’s difficulties using more than one theoretical framework and choose a mix of techniques from more than one therapy approach. The resulting therapy is pragmatic, tailored to the individual. These generic therapies often emphasise important non-specific factors (such as building the therapeutic alliance and engendering hope). By their nature, they are more idiosyncratic and difficult to standardise for the purposed of randomised controlled trials research.
Eye movement desensitisation and reprocessing (EMDR) is a form of imaginal exposure treatment for post-traumatic conditions where the traumatic event is recalled whilst the client makes specific voluntary eye movements.
Focal psychodynamic therapy identifies a central conflict arising from early experience that is being re-enacted in adult life producing mental health problems. It aims to resolve this through the vehicle of the relationship with the therapist, giving new opportunities for emotional assimilation and insight. This form of therapy may be offered in a time-limited format, with anxiety aroused by the ending of therapy being used to illustrate how re-awakened feelings about earlier losses, separations and disappointments may be experienced differently.
Hypnotherapy refers to any therapeutic approach using hypnosis as a main technique, for example, to promote imaginal re-exposure or relaxation.
Integrative therapy refers to a formal theoretical and methodological integration of, for example, behavioural, cognitive, humanistic or psychodynamic approaches.
Interpersonal therapy (IPT) A structured, supportive therapy linking recent interpersonal events to mood or to other problems, paying systematic attention to current personal relationships, life transitions, role conflicts and losses.
Problem-solving therapy systematically teaches generic skills in active problem-solving, helping individuals to clarify and formulate their life difficulties and apply principles of problem solving to reduce stress and enhance self-efficacy.
Psychoanalytic psychotherapy is a longer-term process (usually a year or more) of allowing conscious conflicts opportunity to be re-enacted in the relationship with the therapist and, through interpretation, worked through in a developmental process.
Psychoanalytically informed day hospital treatment is designed to help patients understand their unconscious conflicts as they are enacted in their relationships with other patients and staff in the groups and activities of the day hospital programme.
Psychodynamic-interpersonal therapy (formerly known as the Conversational Model of Therapy) assumes that symptoms and problem arise from, or are exacerbated by, disturbances of significant personal relationships. It explores feelings using cue-based responses and metaphor; links distress to specific interpersonal problems and uses the therapeutic relationship to test out solutions in the ‘here and now’.
Rational emotive therapy is a form of cognitive therapy that identifies underlying assumptions and patters of thinking linked to negative unwanted emotions and challenges these.
Schema-focused cognitive therapy is an integrative, long-term form of cognitive therapy, which addresses the deeply held, enduring beliefs (schemas) found in personality disorders.
Social skills training is a form of behaviour therapy in which patients are taught skills in social and interpersonal relationships.
Stress inoculation therapy is a type of behaviour therapy that involves exposure to increasing levels of stress to enhance ability to cope with stress.
Supportive psychotherapy refers to any psychotherapeutic approach that supports existing ways of coping with problems rather than challenges and attempts to change ways of thinking and responding.
Systemic therapy (whether treating individuals, couples or families) focuses on the relational context, addresses patterns of interaction and meaning, and aims to facilitate personal and interpersonal resources within a system as a whole. Therapeutic work may include consultations to wider networks such as other professionals working with the individual or the family. Therapy aims to identify and explore patterns of belief and behaviour in roles and relationships. Therapists actively intervene to enable people to decide whether change would be desirable and to facilitate the process of establishing new, more fulfilling and useful patterns.
Therapeutic community refers to a residential treatment in which patients learn to understand their problems and to change through their interactions with other patients and staff throughout the 24 hours of community life.
Counselling is a systematic process which gives individuals an opportunity to explore, discover and clarify ways of living more resourcefully, with a greater sense of well being. Counselling may be concerned with addressing and resolving specific problems, making decisions, coping with crises, working through conflict, or improving relationships with others. Counsellors therefore focus on client choices in their life circumstances, as a basis for their work. Counsellors may practice within any of the therapeutic approaches listed here, using psychodynamic counselling, cognitive behavioural counselling, and systemic counselling and so on. However, most are influenced by humanistic, process-experiential and psychodynamic principles.
Other psychotherapies: The above list is by no mean comprehensive. Other types of therapy practised in the NHS include bibliotherapy, existential therapy, functional analytic therapy, humanistic therapy, process-experiential (client-centred) therapy, feminist therapy, personal construct therapy, art therapy, drama therapy, neuro-linguistic programming, solution-focused therapy, transactional analysis and group analysis. Further information about psychotherapy types can be obtained from the UK Council for Psychotherapy.