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Cognitive Behaviour Therapy (CBT)
What is CBT?
CBT, or Cognitive Behaviour Therapy, is a talking therapy. It has been proved to help treat a wide range of
emotional and physical health conditions in adults, young people and children. CBT looks at how we think
about a situation and how this affects the way we act. In turn our actions can affect how we think and feel.
The therapist and client work together in changing the client’s behaviours, or their thinking patterns, or both of
these. You will also see CBT referred to just as Cognitive Therapy.
CBT works
There is a great deal of research evidence to show that CBT works. This research has been carefully
reviewed by the National Institute for Health and Clinical Excellence (NICE).
NICE provides independent, evidence-based guidance for the NHS on the most effective ways to treat
disease and ill health.
What can CBT help with?
NICE recommends CBT in the treatment of the following conditions:
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anxiety disorders (including panic attacks and post-traumatic stress disorder)
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depression
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obsessive compulsive disorder
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schizophrenia and psychosis
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bipolar disorder
There is also good evidence that CBT is helpful in treating many other conditions, including:
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chronic fatigue
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behavioural difficulties in children
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anxiety disorders in children
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chronic pain
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physical symptoms without a medical diagnosis
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sleep difficulties
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anger management
CBT can be used if you are on medication which has been prescribed by your GP. You can also use CBT on
its own. This will depend on the difficulty you want help with.
How CBT is delivered
CBT can be offered in individual sessions with a therapist or as part of a group. The number of CBT sessions
you need depends on the difficulty you need help with. Often this will be between five and 20 weekly sessions
lasting between 30 and 60 minutes each. CBT is mainly concerned with how you think and act now, instead of
looking at and getting help with difficulties in your past. However CBT is interested in understanding how
things developed.
You and your therapist will discuss your specific difficulties and set goals for you to achieve. CBT is not a
quick fix. It involves hard work during and between sessions. Your therapist will not tell you what to do.
Instead they will help you decide what difficulties you want to work on in order to help you improve your
situation. Your therapist will be able to advise you on how to continue using CBT techniques in your daily life
after your treatment ends.
CBT is available in a wide range of settings, as well as hospitals or clinics. It is sometimes provided in the
form of written or computer-based packages. This may be combined with flexible telephone or face-to-face
appointments to check progress and help overcome any barriers to putting into practice what you have
learned. This way of delivering CBT has made it more accessible to people with busy lives, and has also
reduced delays in getting help.
Self-help CBT
CBT-based self-help books are available. There are also websites providing information on CBT techniques
which are free to access. Evidence does show that using them works better with support from a therapist,
especially for low mood.
Other therapies that have developed
CBT is constantly developing and being subjected to research. There are several therapies that are based on
CBT which have developed more recently. These include Compassion Focussed Therapy (CFT) and
Acceptance and Commitment Therapy (ACT).
You can find out more by contacting www.babcp.com
Interpersonal Therapy (IPT)
What is IPT?
IPT is a time-limited and structured psychotherapy which was initially developed for moderate to severe
depression. A central idea in IPT is that psychological symptoms, such as depressed mood, can be
understood as a response to current difficulties in our everyday interactions with others. In turn, the depressed
mood can also affect the quality of our relationships. An example may help: If someone is depressed they
may withdraw from those close to them, apparently refusing their help (perhaps because they feel like a
failure and are ashamed of this). Family and friends may feel rejected and hurt, unable to understand why
their offers of help are not taken up, and they may, in turn, pull away. The depressed person may take this as
confirmation of their view of themselves as a failure, and this could make them feel even more depressed and
withdrawn, setting up a vicious circle. The main focus of IPT is on difficulties in relating to others and helping
the person to identify how they are feeling and behaving in their relationships. When a person is able to
interact more effectively, their psychological symptoms often improve.
What is talked about in IPT?
IPT typically focuses on the following relationship areas:
 Conflict with another person: No relationship is perfect, but sometimes a significant relationship at home
or at work can become very stuck in disagreements or arguments, and is a source of tension and
distress.
 Life changes that affect how you feel about yourself and others: Life changes all the time. As it does it
throws up new challenges, such as when we have a child or lose a job. These changes, whether wished
for or not, can leave us feeling unable to cope with the demands of the new situation and what is
expected of us.
 Grief and loss: It is natural to feel sad following the loss of a significant person in our life. Sometimes,
however, it can be very difficult to adjust to life without that person and we may then put our life on hold,
unable to carry on with our normal activities and with our relationships.
 Difficulty in starting or keeping relationships going: Sometimes relationships are difficult because of what
is missing, for example not having enough people around us or not feeling as close to others as we
would like. Not having someone to turn to for company or support can be very stressful and can leave us
feeling alone and overwhelmed by the demands of life.
What does IPT involve?
Everyone’s therapy will be a bit different, but we have tried to describe some of the important things that a
good IPT therapist will do and what they will help you focus on
Starting off
All therapists should be able to help you feel respected and comfortable. Many people find it difficult to talk
about their problems with someone they do not know, and it is important that your therapist can make you feel
that they are to be trusted, and can help you manage if you talk about things which upset you or about which
you feel embarrassed.
Talking openly about yourself for the first time to a new person can feel difficult and you may be worried about
what your therapist thinks about you. Your therapist will be interested in how you experience them and will
help you to make sense of any worries you may have about starting therapy. They should give you the feeling
that they know that starting therapy can be difficult and that they understand what life is like for you.
The therapist should convey that they are interested in hearing about how you are experiencing the therapy
and your relationship with them at any stage of the therapy. If difficulties do arise the therapist should take
these seriously and work out with you a way of overcoming them.
Getting a picture of what you need (“Assessment”)
Your therapist will need to get as good a picture as they can of what you are finding difficult in your life and
how this is affecting you and people close to you. They will ask some questions, but they should also make it
clear that you only need to give as much information as you feel comfortable with. Many people find that as
therapy gets going they are able to talk more openly, and in the early stages you shouldn’t find yourself under
pressure to say more than you want. In the early sessions of IPT, the therapist will ask you both about your
symptoms and also about current and past relationships in your life. This is because they are interested in
understanding how difficulties in your interactions with others may have contributed to your psychological
symptoms. Your therapist will ask you questions to help you to take stock of the relationships that are
important to you, looking at their strengths and any problems. The idea is to help you to identify those people
that it would be most useful to focus on during the therapy.
At the start of therapy your therapist will also ask you to complete some questionnaires. These will give them
a better idea of the sorts of problems you have (by asking about the sort of difficulties you have), as well as
how badly these affect you (by asking how much each problem affects you). Your therapist will discuss the
results of these questionnaires with you. They will ask you to complete the questionnaires again during
therapy on a weekly basis because this helps you and your therapist see what progress you are making. This
is very useful, because not everyone makes progress at the same rate. If the questionnaires show that you
are not benefiting from therapy it gives you and your therapist a chance to think about why this might be.
Once you and your therapist have gained a clearer picture of the relationships that are connected with your
symptoms, you will agree on the main areas that therapy will focus on. Bearing in mind that the therapy is
time-limited, your therapist will also invite you to think about what you want out of the therapy and help you to
identify goals that are realistic.
Explaining how IPT might work for you
Early on your therapist should explain how IPT works, and help you to think through how the approach makes
sense of what you are finding difficult in your life. In fact the assessment should have given you an idea of
how the therapy works, what is expected of you and what you can expect of the therapist.
The main thing is that your therapist needs to help you see the ways in which ideas from IPT could be
relevant to you and what you want help with. That does not mean you need to be 100% convinced – it’s more
that the idea of IPT and its focus needs to make some sense to you if you are going to get the best out of it.
What can you expect of your therapist?
Your therapist is responsible for ensuring that your meetings take place at a regular time, in a setting where
you can be sure of confidentiality. Wherever possible they should let you know if they expect to be away or
need to change the time of your therapy.
You can expect your therapist to be active: they will ask you questions, especially about your symptoms, what
is happening in your personal interactions week-by-week, and how you feel. Because this is a time-limited
therapy, your therapist will help you to keep focused on the area that you agreed to work on. This will include
helping you to monitor how your symptoms are affected by what is happening in your relationships with others
and how your symptoms affect these. The therapist will also help you to think about the people in your life
who may be able to provide support to help you overcome your current difficulties. Where appropriate they will
help you to develop new relationships that can provide the support you need.
The therapist will also support you in making positive changes in your life. For example, they might encourage
someone who fears that they will be rejected if they speak their mind to take the risk of trying out different
ways of communicating more directly. This may feel difficult at first, but your therapist will be interested in
thinking with you about any anxieties you have about putting into action what you discuss in the therapy.
Ending the therapy
Many clients find that ending the therapy is difficult. This is because the relationship that develops between
you and your therapist can become quite important. Ending therapy can feel like a big loss and you are likely
to experience a range of feelings about it. Your therapist will know and understand this and you should expect
them to help you to explore your feelings. They should help you to anticipate problems that may arise in the
future and think with you about how you would manage if things became difficult again. However, they will
also remind you of what you have learnt and achieved over the course of the therapy.
Length and frequency of treatment
Your therapist will talk with you about the number of sessions you can expect to have; this will depend on the
problems you have and the setting you are being seen in. IPT is often offered over 16 sessions, but
sometimes it is offered over fewer sessions. 6 months after your therapy has finished, your therapist may
contact you just to see how you are getting on.
Medication and IPT
It is quite common to use IPT alongside medications such as anti-depressants, and for some people this may
be more helpful than receiving either treatment alone. Your therapist will discuss this with you where
appropriate.
Finding out more about IPT
You can find more information about IPT on the internet from the IPT-UK network site:
www.interpersonalpsychotherapy.org.uk
Cognitive Analytic Therapy (CAT)
What is CAT?
CAT stands for Cognitive Analytic Therapy. As its name suggests, it brings together
understandings from cognitive psychotherapies (such as Cognitive Behavioural Therapy) and
from psychoanalytic approaches into one integrated, user-friendly and effective therapy. It is a
collaborative programme of looking at the way you think, feel and act; a programme which is
tailored to your individual needs and to your own manageable
goals for change.
In order to bring about change, CAT offers a way of:
 thinking about yourself differently.
 finding out exactly what your problems and difficulties are; how they started; how they
affect your everyday life – your relationships, your working life and your choices of how
to get the best out of your life.
 getting under the limitations of a diagnosis or ‘symptom hook’ (that is, understanding the
reasons that underlie a symptom such as bulimia), by naming what previously learned
patterns of thinking or behaving contribute to difficulties and finding new ways of
addressing them within yourself.
 thinking about the importance of relationships in your psychological life. This includes
the relationship you have with yourself, and the relationship you have with the therapist.
How long does therapy last?
A CAT therapy is a time-limited course, usually between 16-24 sessions – this is discussed and
agreed with the therapist at the start of therapy. Each weekly session is for 50-60 minutes.
Between one and five follow-up sessions are offered after the end of regular therapy. Again this is
discussed and agreed with the therapist.
What sort of problems can CAT help with?
You might have problems that have been given a name by a professional such as depression;
anxiety; phobia; obsessive compulsive disorder; or borderline personality disorder. You might
recognise that you are suffering from unmanageable stress or that you self-harm, have problems
with substance misuse or suffer with an eating disorder. You may have a pattern of difficulty in
looking after yourself properly or unsuccessful or broken relationships. You might have long-term
physical symptoms that have not responded to medical intervention.
What CAT is not:
CAT is not prescriptive or pre-designed, and it’s not like ‘painting by numbers’. The work is shared
collaboratively and right from the beginning you will be involved in your own self monitoring, diary
keeping and, alongside the therapist who starts the ball rolling, writing something of your own life
story and mapping goals for change.
Is it Confidential?
What you talk about in the therapy will not be shared with anyone else unless you agree to it. In a
few cases, the therapist will have to share things, for example, if there is a high risk of you doing
serious damage to yourself or others. Even in these extreme situations, the therapist will try and
work out with you the best way to share this information.
Are there any side effects?
Any therapy can stir up painful memories and feelings; hopefully the work will help you come to
terms with these and let go of some of the pain, but sometimes you may need to wait until your
life is more stable before you have therapy. If you manage to make changes in therapy, other
people may have to change the way they react to you and this can be difficult for some people
and put a strain on relationships.
You can find more information about CAT by contacting www.acat.me.uk
Systemic Family Therapy
What is Systemic Family Therapy?
Family therapy and systemic practice supports the notion that family relationships form a key part of the emotional
health of each member within that family. This type of therapy can help people who care for each other find ways to
cope collaboratively with any distress, misunderstanding and pain that is affecting their relationships and putting a
strain on the family unit.
Sometimes it doesn’t take much to help a family free up their strengths. Sometimes difficulties are more complex and
families may need longer to find solutions that work for them.
What can Systemic Family Therapy help with?
Research shows Family Therapy is useful for children, young people and adults experiencing a wide range of
difficulties and circumstances, as well as relationship problems. These include:
 Family communication problems
 Child and adolescent difficulties with behaviour
 Couple relationship difficulties
 Illness and disability within the family
 Eating disorders
 The needs of ‘looked after’ children
 Self-harm
 Drug and alcohol misuse
 The effects of trauma
 Difficulties related to ageing
What happens in family therapy?
Essentially, by evaluating these issues and providing support, family therapy can help families and individuals to:
 better understand how their family functions
 identify strengths and weaknesses within the family system
 set goals and devise strategies to resolve problems
 develop their communication skills
 make the entire family unit stronger.
Family therapy will typically take place in the form of sessions in which individuals and people important to them will
be brought together with a family therapist to discuss the issues that are affecting their relationships. These sessions
- and the family therapy techniques used - will be adapted according to the therapy goals and the ages, needs,
resources and preferences of the individuals involved. Sessions involving children for example may include drawing
and play.
Generally family therapists will aim to adopt an approach that does not take sides or blame individuals, but instead
engages families in sharing understanding and views with each other - getting them to discuss the problems that are
putting a strain on their relationships. By supporting this system of interaction, and giving everyone an opportunity to
contribute to discussion, family therapy enables family members to explore ways forward that will work for them as a
unit.
The number of family members who attend each session can vary, depending on therapy goals. Sometimes a family
therapist will offer individual sessions to supplement the family meetings. These can be particularly beneficial for
those who want to meet with the therapist before a family session to decide on the best ways to express their
thoughts and feelings with others. In family therapy involving parents and children, therapists may wish to chat with
parents separately following family sessions.
Whilst some family therapists work individually, others will collaborate with a co-therapist or team. In some cases,
these colleagues will observe sessions to monitor how the family therapist and clients interact. They will then be in a
position to share reflections and explore possibilities to help resolve issues. Many families find this approach to
complex issues very helpful.
How many sessions will be needed?Family therapy tends to be a solution-focused and short-term approach, and
generally around six to 20 sessions are needed for families to realise their strengths and find ways forward. For
families and loved ones who are experiencing more complex difficulties however, further sessions may be needed.
Sessions can last from between 50 and 90 minutes, and intervals between each one could be several weeks at a
time depending on various factors, such as the problems being addressed, the stage of treatment and the needs of
family members. Ultimately all elements of family therapy, including the setting, family therapy techniques and length
of sessions will result from a collaboration and mutual agreement between the therapist and family.
You can find out more information by contacting the Association for Family Therapy and Systemic Practice on
www.aft.org.uk
Psychodynamic Therapy
What is Psychodynamic (psychoanalytic) psychotherapy?
Psychodynamic, or psychoanalytic, psychotherapy improves wellbeing by increasing awareness of thoughts
and feelings and of how we relate to others, especially those close to us.
The central concept of psychodynamic thinking is the presence of an unconscious part of the mind that is
timeless. The unconscious contains unwanted feelings and thoughts and also memories of early life
relationships both of which constantly influence, in the present, our behaviour, feelings and relationships with
others, sometimes unfavourably. The less aware we are of these unconscious factors, the more they control
us and the more we stay stuck in unproductive patterns of thinking, feeling, and behaving that disable and
limit us.
A Psychodynamic psychotherapist assumes that these unconscious feelings and childhood events play a key
role in mental distress and aims to help the person become more aware of how past experiences might be
influencing the present. The person then has the choice to become free from some of their internal conflicts,
and emotional development can occur with increase in wellbeing and reduction of symptoms.
History
Psychodynamic psychotherapy draws on theories and practices of analytical psychology and psychoanalysis
developed most famously by Freud. During the late 1800s Freud began studying with Charcot in Paris who
used hypnosis to treat women suffering from what at the time was called hysteria. Charcot found that by
talking to his patients about past traumatic experiences, symptoms lessened. Freud went on to develop his
own method of ‘the talking cure’ and established therapeutic techniques such as free association, dream
analysis and use of transference, many of which remain central to psychoanalysis today. This work was
further developed by people like Jung, Klein, Bion, Winnicott and many others.
What happens in therapy?
Sessions usually last 50 minutes and occur weekly at the same time. The relationship with the therapist is a
crucial element in the therapy and the patient is encouraged to say whatever is on their mind in a safe, nonjudgmental environment. The therapist will be particularly interested in exploring how early life experiences
might have influenced the individual’s life and personality, and whether these experiences are contributing to
any current difficulties or illness.
The therapist might use specific techniques to help identify potential causes of distress such as free
association (talking about whatever comes into the mind without censoring or editing the flow of
memories/ideas); interpretation ('reading between the lines' to help illuminate psychological blind spots);
and dream work (dreams are important sources of unconscious material). The therapist will also watch for
hidden patterns and meanings in what is being said, and for the development of ‘transference’ in which
thoughts, feelings and ways of relating to influential figures in the patient’s life (for example parents) are
‘transferred’ onto the therapist.
The process of therapy helps patients gradually to become aware of hitherto unconscious thoughts and ways
of relating. Once conscious of them, the patient can develop the capacity to understand and change them.
This form of therapy is considered a longer term choice (about one year) and can vary between so called brief
psychodynamic psychotherapy in which there is an agreed focus of the work; to more formal psychoanalysis
that requires four or five sessions per week over several years.
Who is it for?
Psychodynamic therapy can be used by those with a specific emotional concern as well as those who simply
want to explore themselves. Understanding why we are the way we are often brings with it a sense of wellbeing and a stronger sense of self. Many people who experience a loss of meaning in their lives or who are
seeking a greater sense of fulfilment may be helped by psychodynamic therapy.
People who tend to benefit most are generally those who are curious about themselves and seek selfknowledge in addition to symptom relief. Some of the personal qualities that can facilitate this type of therapy
include:
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the capacity for self-reflection
a curiosity about them self and their internal life
a willingness to tolerate vulnerable and painful feelings
a recognition that the solution to difficulties is to be found within them self, not externally
It is perhaps less useful for those seeking quick, solution-focused therapies. It can be used across the age
range and there are specifically trained psychoanalytic therapists for children.
What types of problems respond to psychodynamic psychotherapy?
This type of therapy can be used for a wide variety of problems and symptoms but is probably best used for
those with problems associated with relating to others; with personality issues such as low self-esteem; and
other problems that have also an unconscious element such as psychosomatic disorders.
Some examples of problems for which it is helpful include:
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repeated disappointments in relationships
depression, anxiety
low self-esteem, feelings of emptiness, lack of goals or motivation
fear of emotional intimacy, closeness, and trusting others
inability to sustain feelings of pleasure or happiness
self-destructive behaviour patterns
physical problems that have a psychological origin
Research evidence
Randomised controlled trials have shown efficacy of psychodynamic therapy in a wide range of common
mental disorders, including depressive disorders, anxiety disorders, somatoform disorders, personality
disorders, eating disorders and substance related disorders.