Talking Therapies, what are they?

Talking therapies can help you work out how to deal with negative thoughts and feelings and make positive changes. 

They can help people who are feeling distressed by difficult events in their lives as well as people with a mental health problem. 

This information is for anyone who wants to know more about different types of talking therapy or hear the experiences of people who have used them. It advises how to find a therapist who is right for you and suggests where to look for more information. 

The information mainly uses the words 'talking therapy' and 'therapist', although the words that other people use may be different.

 Talking about your thoughts and feelings can help you deal with times when you feel troubled about something. If you turn a worry over and over in your mind, the worry can grow.
But talking about it can help you work out what is really bothering you and explore what you could do about it.
Talking is an important part of our relationships. It can strengthen your ties with other people and help you stay in good mental health. And being listened to helps you feel that other people care about you and what you have to say. 

What are talking therapies?

We often find it helpful to talk problems through with a friend or family member, but sometimes friends and family cannot help us and we need to talk to a professional therapist. 

Talking therapies involve talking to someone who is trained to help you deal with your negative feelings. They can help anyone who is experiencing distress. You do not have to be told by a doctor that you have a mental health problem to be offered or benefit from a talking therapy. 

Talking therapies give people the chance to explore their thoughts and feelings and the effect they have on their behaviour and mood. Describing what’s going on in your head and how that makes you feel can help you notice any patterns which it may be helpful to change. 

It can help you work out where your negative feelings and ideas come from and why they are there.
Understanding all this can help people make positive changes by thinking or acting differently. 

Talking therapies can help people to take greater control of their lives and improve their confidence.
Talking therapies may also be referred to as:

• talking treatments
• counselling
• psychological therapies or treatments
• psychotherapies

The various terms used to describe talking therapies often mean different things to different people.
Some people use them to describe the level of training of the professional delivering the therapy. But sometimes there is no link between a therapist’s training and the name of the therapy they offer.

What kinds of talking therapy are there?

Different talking therapies are called a confusing mix of names and some therapies have several names. Don’t let the jargon put you off! Behind every technical term is a way of working with people that is designed to help. 

Therapies are usually divided into several broad types. But even therapists who offer the same kind of therapy will have a slightly different way of working from each other because all therapists have a personal style as well. 

Some therapists train in more than one kind of therapy. They may decide to combine a few approaches if that will help you best. 

The National Institute for Health and Clinical Excellence (NICE)  recommends certain therapies for certain problems, but other therapies might work for you just as well.

• Cognitive behavioural therapies (CBT)
• Dialectic behaviour therapy (DBT)
• Psychodynamic therapies
• Humanistic therapies
• Other kinds of talking therapy
• Support and information

Cognitive behavioural therapies (CBT)

How do they work?
By looking at how we can react differently to our thoughts and feelings (for example, challenging negative thoughts) and how changing the way we behave can help us feel better (for example trying new activities). 

What are they based on?
They are based on scientific methods. 

What form do they take?
Sessions are clearly structured. The therapist directs the conversation. They are focused on current problems and practical solutions.
 
How long do they take?
Treatment is usually short-term and for a set length of time (between six and 24 one-hour sessions).
 

What are they helpful for?
A range of problems including depression, anxiety, obsessive compulsive disorder, managing long-term illnesses, eating disorders, post-traumatic stress and schizophrenia. NICE recommends CBT for all these.
 
Who will they suit?
People who want a therapy that works towards solutions, with clear goals and using practical techniques.

What are some of the variations?
Cognitive therapy, behaviour therapy, cognitive behavioural therapy, rational emotive behaviour therapy.
"CBT was amazing – it was so simple. My diagnosis is bi-polar disorder and I had very low self-esteem and lack of confidence in my future. I had about 15 sessions over a year. The psychologist showed me how to notice what I was thinking and then how I felt afterwards, and to realise you can choose your own thoughts. I thought they were just random thoughts there to make my life a misery. But I learnt that at any time I could stop and say: 'Why am I thinking that?'"
"I had a CBT therapist but I think she probably used lots of different things - in fact it didn’t feel like she was 'using' anything - it felt like a natural process rather than anything very medical or clinical."

Dialectic behaviour therapy (DBT)

DBT combines some of the methods of CBT with meditation techniques. It involves individual therapy and group therapy. NICE recommends DBT for persistent binge eating disorder and people with personality disorders who self-harm.

Psychodynamic therapies

How do they work?
By exploring how your personality and early life experiences influence your current thoughts, feelings, relationships and behaviour. Once you have this extra understanding, you can practise more helpful ways of dealing with difficult situations. 

What are they based on?
Originally the ideas of the neurologist and psychotherapist Sigmund Freud, with many changes over the last 100 years.
 
What form do they take?
The therapist works with you to understand your thoughts, feelings, relationships, behaviour, dreams and fantasies.
 
How long do they take?
Usually between several months and several years, although shorter-term versions are available.
 
Where are they practised?
Often privately, and in some charities. They are available on the NHS in some areas.
 
What are they helpful for?
Depression, anxiety, post-traumatic stress, long-term physical health problems, eating disorders and addictions. NICE recommends psychodynamic therapy for people experiencing depression alongside other complex illnesses.
 
Who will they suit?
People interested in self-exploration who are willing to devote lots of time and energy to it.
 
What are some of the variations?
Psychoanalysis, psychoanalytic psychotherapy, psychodynamic psychotherapy, analytical psychology, Jungian or Freudian analysis, focal psychodynamic therapy (NICE recommends this for treating anorexia nervosa). 

"I was quite severely depressed as a teenager. I tried various antidepressants and some CBT-based stuff, but nothing was helping. Finally, my GP suggested that I try psychotherapy at my local mental health unit. 

"At first I was sceptical. I couldn’t see how sitting in a room with a stranger was going to help. I was quite a nightmare, trying to prove to my therapist and myself that the therapy would fail. But with psychodynamic therapy, the therapist is prepared to sit and wait out that part with you. She started helping me link the way I was thinking, feeling and behaving to what might have gone on when I was younger and that really made sense."

Humanistic therapies

How do they work?
By taking a whole-person approach to your problem, using a range of theories and practices to help you develop. 

Where did they come from?
They were developed to offer an alternative to psychodynamic and behavioural therapies, focused on developing your full potential.
 
What form do they take?
These therapies explore your relationship with different parts of yourself (such as your body, mind, emotions, behaviour and spirituality) and other people (for example family, friends, society or culture) and support you to grow and live life to the full.
 
How long do they take?
Therapy can be short or long-term depending on the issues you need to cover, but usually at least several months.
 
Where are they practised?
Therapists working for the NHS or charities and private therapists offer these therapies.
 
What are they helpful for?
Humanistic therapies tend to treat specific problems – such as depression, anxiety or addiction - as chances for you to develop and grow. Therapists work with any issue causing difficulties in your life.
 
Who will they suit?
They will suit people interested in exploring their lives and looking at their problems from a wide range of angles.
 
What are some of the variations?
Person-centred counselling (NICE recommends this for children and young people with mild depression and sometimes for people with schizophrenia), transpersonal psychology, body psychotherapy, gestalt therapy, psychosynthesis, integrative psychotherapy, existential psychotherapy, transactional analysis, psychodrama and personal construct therapy. 

"I was referred to a unit that deals with people who turn to alcohol because of psychological problems. I was in a state of constant panic and had been drinking to keep those feelings at bay. There wasn’t a set formula to the sessions. We’d just go and get a cup of coffee and I’d talk about what was bothering me. With person-centred counselling the therapist steers you through finding out more about yourself and developing confidence."

Other kinds of talking therapy

Group therapies
In groups led by a facilitator (someone who helps to introduce members of the group to each other and who helps the conversation to flow), people find solutions together and learn from each other. NICE recommends group therapy for people with obsessive compulsive disorder and for children and young people with mild depression.

"In group therapy you don’t just talk about yourself, you’re listening to other people - that takes the burden off your problems. You realise you’re not the only one."
 
Couples, relationship or family therapies
Couples or families work with a therapist to sort out difficulties in their relationships. NICE recommends family therapy for anorexia nervosa, depression in children and families of people with schizophrenia. NICE recommends 'couples therapy' if partners have tried individual therapy and this has not helped.
 
Interpersonal therapy
This explores how to link mood with the way you relate to the people close to you. NICE recommends this for people with eating disorders and various forms of depression.

Mindfulness-based therapies
A therapy that combines talking therapies with meditation. It helps people reduce stress, switch off from difficult thoughts and feelings and make changes. NICE recommends this treatment to prevent people who have had depression from experiencing the same problems again. Other versions of this treatment include mindfulness based stress reduction and mindfulness-based cognitive therapy. See our Be Mindful website for more information.
 
Eye movement desensitisation and reprocessing (EMDR)
A way of stimulating the brain through eye movements which seems to make distressing memories feel less intense. It is used for a range of traumas, including past sexual, physical or emotional abuse, accidents and injuries, phobias, addictions and fear of performing in public. NICE recommends for post-traumatic stress disorder.
 
Life coaching This uses empowering, motivational methods to help you reach goals or make changes.
 
Arts therapies
These therapies encourage you to express how you feel through art (painting, drawing, music, theatre or dance). Art can help you work out how to tackle difficulties, release emotions and understand yourself better.
 
Telephone counselling
This offers an easy way of talking to a therapist if you do not want to meet a face-to-face counsellor or if you can’t find one. It is sometimes provided by employers and charities. Online or e-mail counselling is another option.
 
Computerised cognitive behavioural therapy
No talking required! You work through a series of exercises on your computer screen and learn self-help techniques for managing problems in your life. NICE recommends 'Beating the Blues' for mild to moderate depression, and 'FearFighter' for panic and phobia.
 
Bibliotherapy
Health professionals 'prescribe' self-help books which you can borrow from your local library. They will usually offer you these alongside other treatment. NICE recommend these for anxiety and obsessive compulsive disorder, and sometimes for depression.

What is it like to have a talking therapy and when can it be helpful?

The length of a therapy varies depending on what type it is and on your individual needs. Some people have just a few sessions. Other people see a therapist a few times a week for several years.
A course of CBT, for instance, is usually between six and 24 sessions, with each session following a structured agenda. 

In contrast, a client receiving counselling is encouraged to talk freely and the course of therapy may be extended depending on the client's progress.
Talking therapies are not therapies that are 'done' to you by someone else. You play an active part in the therapy. That can be empowering at a time when you may feel you have lost control over part of your life.
If you are determined to get the most from the therapy, it is more likely to work.
Talking therapies require you to be completely honest with yourself and that can be difficult. It may mean facing up to your fears, recalling distressing memories or talking about intimate topics and private thoughts and feelings.
There may be tasks to do between sessions, such as trying out new ways of behaving or keeping a diary. It may be a while until you feel the results, but you get out what you put in.

When can talking therapies be helpful?

Talking therapies can be helpful in many different situations.
They can help people with depression, anxiety, eating disorders or addictions and are often used alongside drugs your doctor prescribes.
They can also help people with problems such as schizophrenia or bi-polar disorder.
Talking therapies can also help people deal with difficult life events such as bereavement, relationship issues, problems at work or physical illness.
They can help people with a long-term physical condition, such as diabetes, who are at high risk of depression. Talking therapies can help them manage their condition more effectively and reduce its burden on them and their family.
A very wide range of people can benefit from talking therapies, but no one type of therapy works for everyone. Different kinds of therapy work well for different people.
  
"What I found really good was being able to talk about what was happening and have someone who was listening - she was really good at giving me space, listening to what had happened and discussing what might have caused it - not in a deep way but trying to help me piece the whole picture together."
 
A good therapist concentrates on you – what you think is important in your life, what you want to achieve, what steps you could take to get there. They shouldn’t tell you what to do. Your therapist may be highly trained and very experienced, but you are the expert on you. 

It's worth taking time to build a trusting relationship with your therapist. Remember therapy is a two-way process. If you have any questions, ask them. If you are worried that you could become dependent on them, say so. A good therapist will help you deal with your worries and work out how you will manage when the therapy comes to an end. 

- by Mental Health Foundation
source: http://www.mentalhealth.org.uk/help-information/mental-health-a-z/T/talking-therapies/