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Understanding talking treatments
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Why try talking treatments?
What are the different talking treatments?
Who are talking treatments for?
When are talking treatments not suitable?
Do talking treatments work?
How can I get started?
How should this relationship work?
Useful organisations
Further reading
This booklet gives a brief guide to the different talking treatments that are available. It also provides information on who might benefit from them and who you should contact about getting this type of help.
Why try talking treatments?
Talking treatments can help you to overcome emotional difficulties and free yourself from self-destructive ways of feeling, thinking and behaving. They work by providing an opportunity for you to talk in a way that assists you to understand yourself better. Having gained this understanding, you can work out ways of living your life in a more positive and constructive way.
This way of changing your life is very different from using drugs, such as tranquillisers and antidepressants, which doctors often prescribe for people who are emotionally distressed. These drugs change your mood by affecting the balance of chemicals in your body, but do not help you to deal with underlying problems.
People who use mental health services often prefer talking treatments to drugs. Research has proved that talking treatments can be just as helpful as drugs for many mental health problems and suggests they should be offered as well as, or instead of, medication, when possible. The National Institute for Clinical Excellence (NICE) makes recommendations to GPs and hospital doctors about treating mental health problems. They often suggest forms of talking treatment that are brief, cost-effective and supported by clinical evidence. This does not necessarily mean that they are always the best form of talking treatment for you. Many organisations and private therapists offer treatment, although it can be more difficult to find if you can’t afford to pay very much. (See below for more information.)
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What are the different talking treatments?
There is a wide variety of talking treatments. Some last for several years, while others take just a few sessions. You may see someone on your own or be part of a group.
The self-help group
This is usually for people who want to overcome a problem shared by members of the group. It may be alcohol abuse, depression or being scared to go out of the house, to give some examples. Often these groups are led by people who have overcome the difficulties themselves. The people in the group are able to share their experiences, and learn from and encourage each other.
The support group
This is similar, but for people with a common background or interest. For example, it could be a group for mothers of young children, for gay men or for people doing similar, stressful jobs.
Individual counselling
This is an opportunity to talk about whatever is troubling you, and to be heard. It is generally face-to-face, but can also take place over the phone or via email. If you decide to see a counsellor in person, it may be for one session, or you may arrange for regular appointments, perhaps an hour a week for several months. Telephone and internet counselling is also obtainable from a variety of organisations, and is especially valuable in a particular crisis. (See the list of Useful organisations.) Many GP practices now have their own counsellors.
Counselling tends to focus on your current problems, with the counsellor helping you to find the best ways to tackle them. The counsellor's most important skill is the ability to listen. The aim is not to tell you what to do, or to offer a personal opinion, but about helping you to arrive at your own solutions.
Individual psychotherapy
The overall aim of psychotherapy is to help you to understand why you feel the way you do, and what lies behind your responses to other people and to things that happen to you. Talking about your experiences can help you to release painful feelings and find better ways of managing situations you have been finding difficult. This should enable you to reach a greater understanding of events that have shaped your life, and of self-destructive patterns of behaviour. It may, therefore, enable you to overcome specific problems, such as compulsive eating and lack of confidence, or simply allow you to become happier.
Psychotherapists have many different styles of working, and the number of sessions required can vary from one to five times a week. Each session may last for 50 minutes or an hour. You may agree to a fixed term of treatment, or the therapy may be open-ended and could continue for several years.
Some therapists will want you to talk mainly about your early childhood, and others will be more interested in what can be learnt from the relationship you make with them (known as 'the transference'). The psychotherapist may want to know how you feel about yourself, as a woman, a Black person or someone with a physical disability, to give some examples. Others will be more interested in your dreams and fantasies. Some will encourage you to get rid of bad feelings by crying or getting angry, as well as talking.
There is a great deal of overlap between psychotherapy and counselling, and there are many different types of psychotherapy. For more detailed information about the different forms of counselling and psychotherapy, see Making sense of counselling and Making sense of psychotherapy and psychoanalysis. You could also consult the organisations listed under Useful organisations.
Relationship counselling and family therapy
Relationship counselling is for couples who want to sort out problems in their relationship. They attend sessions together and the counsellor helps them to express their difficulties, listen to each other, develop an understanding of each other, and find ways of making their relationship work better. They may decide to end the relationship but, with luck, having gained more understanding of why it was not working and what lessons they can learn for the future. Family therapy works in just the same way, with the entire family attending.
Group therapy
Group therapy enables people to deal with interpersonal problems and develop self-awareness. There are generally 8 to 12 people in the group, who meet together regularly, with a therapist, and talk about their concerns.
The idea of group therapy can be intimidating, but most people find it reassuring that others may be in a similar position to themselves. In a group environment, opportunities may arise to behave differently, to be more assertive or more vulnerable. It is also helpful for people to hear other points of view about their concerns, the way they appear, how their behaviour comes across and in what way it affects other people.
Cognitive behaviour therapy (CBT)
Behaviour therapy, also known as exposure therapy or desensitisation, is often practised by psychologists. It is used to help people overcome fears or phobias, such as feeling too scared to go into a shop, or obsessive behaviour, such as washing many times a day. An opportunity is usually given to discuss the problem, and then to face your fear, gradually, so that you learn to cope. Cognitive therapy helps to identify connections between your thoughts, feelings and behaviour. It is a practical treatment that focuses on specific problem-solving techniques, and enables you to develop new coping mechanisms.
Behaviour and cognitive therapies are often combined, and practitioners of either may refer to their approach as cognitive behaviour therapy. (See Mind’s booklet, Making sense of cognitive behaviour therapy). New forms of CBT have been developed and NICE has recommended particular types for particular problems, such as depression, anxiety, eating disorders, schizophrenia and personality disorders. They include Mindfulness, interpersonal therapy and dialectical behaviour therapy.
CBT may be offered by clinical psychologists, mental health nurse specialists or psychiatrists, but to begin with, your GP may recommend a self-help book or computer programme for you to try, under guidance.
The therapeutic community
This is a place where you can either live full time or attend regularly during the day. Usually, there is a mixture of individual and group therapy, and informal support from other members of the community.
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Who are talking treatments for?
Prejudice about emotional distress sometimes stops people from using talking treatments they could benefit from. They may feel that it is a sign of weakness or inadequacy to seek assistance in this way. The truth is very different; it is not your fault if you experience emotional difficulties, and it takes courage to face up to them and find better ways of coping. Most people can benefit from talking treatments. They can do for the mind what exercise does for the body. They liven you up, help you to think more flexibly, make you stronger, emotionally, and help to stop more serious problems from occurring. Just like taking exercise, it is important to find what suits you best.
Unfortunately, it is also true that doctors are more likely to suggest talking treatments if you are white and middle class. Talking treatments work just as well for working class people, Black people and people from minority ethnic communities.
The only difficulty is that most counsellors and psychotherapists are white and middle class, and they may not have a good understanding of what it is like to be you. It can help if they have made the effort to learn about cultures that are different from their own. People with learning disabilities, lesbians and gay men, older people and people with chronic illness are also under-represented when it comes to receiving talking treatments.
Good psychotherapists and counsellors listen and learn from their clients, and don’t try and impose their values on them. There are some organisations that offer talking treatments to specific sections of the community. There is now much more awareness of this issue, and more effort has been focused on tackling it.
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When are talking treatments not suitable?
There are some good reasons (as well as bad ones) for not offering talking treatments. In groups, for instance, it is important that people should be prepared to listen to, and support each other, as well as to talk about themselves. If you aren’t able to do this, or are abusive towards others, you may be asked to leave.
Psychotherapists and counsellors may decide they can’t help you. If you are abusing alcohol or other drugs, they may say you first need specialised care to help you stop. If your doctor has prescribed you psychotropic (mood-altering) drugs, such as tranquillisers, some psychotherapists and counsellors will not mind, but others will say that you need to come off them for the treatment to work. They may be able to help you do this as part of the treatment.
There is no general agreement among psychotherapists and counsellors about whether they can assist people who are diagnosed as having serious mental illnesses, such as schizophrenia or manic depression (bipolar disorder). Some will say, 'Yes, but only if you stop taking the drugs'. Most will say that whether they can help depends on the person, not on the diagnosis.
Generally, successful treatment depends on the person being prepared to try and make their life better, using the support that is offered. If you blame all your difficulties on other people, or expect the counsellor, psychotherapist or fellow group members to 'make you better' without putting in any effort yourself, then you will not be able to benefit.
Talking treatments can assist people to overcome many different sorts of problems, but some difficulties are better helped by other treatments as well, or instead. For example, if you find it hard to sleep, learning relaxation techniques would probably be your first priority.
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Do talking treatments work?
Talking treatments certainly do work, but not always. There are many people whose lives have improved beyond recognition as a result of attending a group, or seeing a counsellor or psychotherapist. It may have been a struggle and taken a long time, but it has been worth it. Profound changes have taken place and they know, whatever happens, they will not experience their old problems again.
Others know that they have, at least, experienced some benefit. They may understand themselves better and have some clues about how they can lead more positive lives. The good periods may last longer and the bad times may be more manageable.
Some people are disappointed. They may have found their counsellor or psychotherapist never really understood them, or felt that they did not fit into their group. A bad experience of talking treatments may have left them feeling more hopeless than before. Talking treatments vary in their quality. Some professionals are simply better at their jobs than others. They all have strengths and weaknesses. Some may be better at helping women than men. Others may have a great deal of understanding of depression but not of addiction.
Therapists use different methods, and some may be more effective than others. Or one may particularly suit you when another one does not. Your own attitude will also make a difference. Some people find that just knowing that their therapist is there and focusing on their concerns makes them feel valued.
If you go along determined to make the most of every session and to be completely honest about yourself, it is more likely to work. If, as a result of what you learn about yourself, you are prepared to face your fears and risk making changes in your life, you are much more likely to achieve good results.
It is useful if you can be clear about how you hope to benefit from the talking treatments. It will help you to make the best use of your sessions and, also, to decide if it is proving to be useful for you.
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How can I get started?
Talking treatments may be available free through the NHS, through social services or from independent organisations, such as local Mind groups. What is available varies a great deal from place to place. Unfortunately, there is not always something suitable on offer. What services do exist are often not well publicised, and it is worth asking about them in as many places as possible. Try your local Mind group, your GP, local social services or Citizens Advice (CAB), or the other organisations listed below.
Sometimes, counselling organisations ask for a donation, based on what you can afford. If you are a student, you may find you can see a counsellor at your college. Large companies sometimes employ counsellors for their staff. Some therapeutic communities are free.
The cost of private counselling or psychotherapy can vary a great deal. A fee of £20 to £50 per session is quite common. Groups may be cheaper. Sometimes you can pay less if you are on a low income, or if you are prepared to see a student (who should be supervised by an experienced therapist).
At the moment, there is no government-regulated body for either counselling or psychotherapy, but this is coming closer. The United Kingdom Council for Psychotherapy (UKCP) has been set up by the psychotherapy profession to regulate standards of training and practice. The British Confederation of Psychotherapists (BCP) has a similar function.
The counselling profession has set up the United Kingdom Register of Counselling (UKRG) via the British Association of Counselling and Psychotherapy (BACP).
There are currently no nationally recognised qualifications. Instead, there are many diplomas and certificates, each requiring different amounts of study and experience. (For information about the organisations mentioned see Useful organisations.) Check whether your counsellor or therapist is a member of a professional body with insurance and a complaints procedure. He or she should be working to a code of practice and should be able to give you a copy of it.
Word-of-mouth is one of the best ways of identifying good practitioners. If you know people who have seen counsellors and psychotherapists, it’s worth asking them if they can recommend someone.
It’s usual to have an initial assessment or interview so that the group leader, psychotherapist or counsellor can decide if they can help you, and you can decide if you want to see them. Don’t be afraid to ask questions about their training, experience and anything else you want to know, and whether or not they are receiving supervision from someone more experienced. If you are religious, you may want to ask how the person feels about your beliefs.
If you have the choice, it may be worth seeing several people before you make up your mind. The most important question to ask yourself is, 'Can I make a good relationship with this person?' Research suggests this is one of the most important ingredients in successful treatments.
If you can’t find the talking treatment you want, there may be a befriending scheme, in your area. This is not as formal as the talking treatments described here. You will be introduced to someone who will listen to you sympathetically and help you in whatever ways they can.
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How should this relationship work?
The relationship with a psychotherapist (or indeed with counsellors, psychologists and group leaders) is very different from the one you make with a friend. You will find out very little about their personal life and their own difficulties and struggles. But you will reveal a lot about yourself.
The psychotherapist will be an important figure in your life. You are likely to develop strong feelings about him or her, which could be positive or negative. Either way, it is easy to feel that the psychotherapist is stronger and more powerful than you. This need not cause any difficulties, but it can leave you vulnerable to exploitation. A psychotherapist may persuade you to carry on seeing them (and paying for your sessions) even though your best judgement is that the sessions are not working. Psychotherapists have also been guilty of sexual harassment. Remember that you are the customer, as well as a client or patient.
You may need to discuss practical arrangements, review how your sessions are going, or air a grievance. You have every right to do this, as one responsible adult to another. If a psychotherapist can only relate to you as a neurotic patient, treat them with suspicion. Remember you can always leave.
It’s worth remembering that your psychotherapist or counsellor is a real person, doing a challenging job. They have good days and bad days, like the rest of us. You can help them to do their job to the best of their ability by treating them respectfully – by being on time for your session and paying your bills. If you appreciate their efforts, tell them so, and give them feedback, so they know when you can see their work is producing results.
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Useful organisations
Alcoholics Anonymous
PO Box 1, Stonebow House, Stonebow, York YO1 7NJ
tel. 01904 644 026
web: www.alcoholics-anonymous.org.uk
For anyone with an alcohol problem
Association of Therapeutic Communities
Barns Centre, Church Lane, Toddington GL54 5DQ
tel. 01242 620 077
web: www.therapeuticcommunities.org
Directory of therapeutic communities available on the website
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel. 0161 797 4484
web: www.babcp.com
Full directory of psychotherapists available on the website
British Association for Counselling and Psychotherapy (BACP)
BACP House, 35–37 Albert Street, Rugby CV21 2SG
tel. 0870 443 5252
web: www.bacp.co.uk
See website or send A5 SAE for details of local practitioners
British Confederation of Psychotherapists (BCP)
West Hill House, 6 Swains Lane, London N6 6QS
tel. 020 7267 3626
web: www.bcp.org.uk
Professional body of psychoanalysts, analytical psychologists, and psychoanalytic psychotherapists
Institute of Group Analysis
1 Daleham Gardens, London NW3 5BY
tel. 020 7431 2693
web: www.igalondon.org.uk
A membership body of group psychotherapists
Association for Family Therapy and Systemic Practice (AFT)
7 Executive Suite, St James Court, Wilderspool Causeway, Warrington WA4 6PS
tel. 01925 444 414
web: www.aft.org.uk
Professional association of family and systems therapists
Nafsiyat
262 Holloway Road, London N7 6NE
tel. 020 7686 8666
email: admin@nafsiyat.org.uk
An inter-cultural therapy centre
PACE (Project for Advocacy, Counselling and Education Ltd)
34 Hartham Road, London N7 9JL
tel. 020 7700 1323
web: www.pacehealth.org.uk
For lesbians and gay men
Relate
Herbert Gray College, Little Church Street, Rugby CV21 3AP
tel. 01788 573 241
web: www.relate.org.uk
Offers counselling for adults with relationship difficulties
Samaritans
By post: Chris, PO Box 9090, Stirling, FK8 2SA
Helpline: 08457 90 90 90
Minicom: 08457 90 91 92
web: www.samaritans.org.uk
email: jo@samaritans.org
24-hour telephone helpline
United Kingdom Council for Psychotherapy (UKCP)
167–169 Great Portland Street, London W1W 5PF
tel. 020 7436 3002
web: www.psychotherapy.org.uk
Professional body with a voluntary register of psychotherapists
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Further reading
Beyond Prozac: healing mental distress without drugs Dr T. Lynch (PCCS Books 2004)
Conquering fear D. Rowe (Mind 2003)
Conquering a sense of inferiority D. Rowe (Mind 2004)
Going mad? Understanding mental illness M. Corry, A. Turbridy (Newleaf 2001)
How to cope as a carer (Mind 2003)
How to cope with hospital admission (Mind 2004)
How to improve your mental wellbeing (Mind 2004)
How to rebuild your life after breakdown (Mind 2004)
How to recognise the early signs of mental distress (Mind 2004)
How to stop worrying (Mind 2004)
Making sense of antidepressants (Mind 2004)
Making sense of antipsychotics (major tranquillisers) (Mind 2004)
Making sense of cognitive behaviour therapy (Mind 2004)
Making sense of counselling (Mind 2004)
Making sense of minor tranquillisers (Mind 2003)
Making sense of psychotherapy and psychoanalysis (Mind 2004)
Manage your mind: the mental health fitness guide G. Butler, T. Hope (Oxford University Press 1995)
The Mind guide to managing stress (Mind 2005)
The Mind guide to physical activity (Mind 2004)
The Mind guide to relaxation (Mind 2004)
The Mind guide to yoga (Mind 2004)
Understanding anxiety (Mind 2005)
Understanding depression (Mind 2005)
Understanding eating distress (Mind 2004)
Understanding manic depression (bipolar disorder) (Mind 2003)
Understanding mental illness (Mind 2004)
Understanding obsessive-compulsive disorder (Mind 2004)
Understanding phobias (Mind 2004)
Understanding postnatal depression (Mind 2003)
Understanding schizophrenia (Mind 2003)
For a catalogue of publications from Mind, send an A4 SAE to:
Mind Publications
15–19 Broadway
London E15 4BQ
tel. 0844 448 4448
fax: 020 8534 6399
email: publications@mind.org.uk
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This booklet was written by Jim Read
First published by Mind 1989. Revised edition © Mind 2005
ISBN 1-874690-97-9
No reproduction without permission
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