The “keep calm and carry on” mantra doesn’t hold as much sway these days. Wherever you turn in the UK, you will find people struggling to cope with mental health challenges.
According to the British Association for Counselling and Psychotherapy (BACP), 20 per cent of the population has considered accessing therapy recently, with half of BACP therapists surveyed saying they had more requests from private clients than they could deal with.
Public perception of therapy has also improved greatly, with 85 per cent of people, across the age groups, concurring that “it is a good idea to seek counselling or psychotherapy for a problem before it gets out of hand.”
Who needs therapy and how can it help?
People enter therapy for any number of reasons. Teenagers, when adolescence sparks anxiety or depression; couples, if their relationships are upended by life’s stresses; midlife women, when faced with the maelstrom of hormonal changes and the twin pressures of elderly parents and challenging nearly grown children; older folk, when they ask themselves, is this it? And this is before you factor in the knocks that life hands out randomly, such as redundancy, divorce, serious illness, accidents and the deaths of our nearest and dearest.
Therapy provides the opportunity to step out of your quotidian life and be listened to, without judgment, for 50 minutes. Regular sessions (usually weekly) build up a trusting relationship with a psychotherapeutically trained individual – not a friend or relative, but someone who is dedicated to supporting you in facing your problems. Many clients report that therapy is a life-changing experience, as it can help overcome social or emotional challenges and improve general mental health.
What types of therapy are there?
CBT
Cognitive behavioural therapy (CBT) is a short-term form of therapy that has surged in popularity in the past 20 years. Nice (National Institute for Health and Care Excellence) recommends it for a broad range of issues, and it is the default therapy style employed by the NHS to promote psychological wellbeing.
CBT therapists focus on identifying troublesome thinking or emotions and then use formalised practices to change thinking and behaviour. This means that clients are often given homework and directed to follow a structured programme, giving them tools and strategies to use in the future.
What is CBT best for?
Anxiety, phobias, OCD, depression, menopause symptoms, insomnia and anger are all commonly treated by CBT therapists. In general, specific issues, rather than general unhappiness, are best treated by CBT, which is well regarded because it has a strong evidence base. The most highly trained CBT therapists are accredited members of BACP.
What is CBT not good for?
CBT therapy does not spend much time talking about the origins of a client’s unhappiness. People who believe their problems started in the family or childhood will not usually find CBT helpful in the long-term. Also, some CBT clients say that, after initial success, its effects wear off.
Psychodynamic psychotherapy
The aim is to understand better how our past experiences, from birth onwards, go on to create our current behaviours and thoughts. Many of us develop coping mechanisms to deal with relationships or trauma in the past, but they no longer benefit us in the present. Unpicking these stories may be difficult and time-consuming as we often build up defences to protect ourselves. The theory is that if we suppress or deny things, they remain in our unconscious, so we won’t actually recognise that they are problems for us.
Shelley Williams, a psychodynamic psychotherapist in London, says “Your therapist will be listening to you on many levels, including your subconscious.” She also points out that even if the issue seems rooted in the present, “the roots and depth of our distress may connect subconsciously to earlier losses, relationships and experiences”.
What is psychodynamic psychotherapy best for?
Long-term depression, trauma, anxiety disorders and relationship issues are often brought to psychodynamic psychotherapists. Clients may complain of repeating old patterns or feel they are stuck. It is also often chosen by people wanting to understand themselves better.
What is psychodynamic psychotherapy not good for?
It is not a quick fix, as most psychotherapists with this training expect to see clients for at least six months.
EMDR
Eye movement desensitisation and reprocessing (EMDR) is a relatively recent treatment for psychological traumas. An EMDR therapist has had specific training, as the process of EMDR is not restricted to talking therapy but involves “bilateral stimulation techniques” such as left-to-right eye movements, sounds or taps on the body to help distressing memories lose their intensity and be accepted and processed as normal memories.
What is EMDR best for?
Nice recommends EMDR for post-traumatic stress disorder (PTSD) as a result of such events as road accidents or assaults, but therapist Joanna Head explains that EMDR can also be put to use for depression and relationship problems. “It is useful for any trauma. These are not necessarily life-threatening, but could involve any event or series of events that are overwhelming or trigger the fight-or-flight response.”
Jessica Purchall suffered PTSD from birth trauma. “Although this form of therapy felt strange, I left sessions feeling empowered. Painful memories and thoughts began to feel lighter. It was like I began to find peace again. After 12 sessions I was discharged from my therapist. I cried in my last session with her because I just felt so grateful for her help in lifting the huge weight I was carrying off my shoulders.”
If you want to see an EMDR therapist, Google members of EMDR UK and Ireland.
Hypnotherapy
Hypnotherapy combines talking therapy with hypnosis. Hypnosis can be described as a deeply relaxed state with heightened awareness, induced by suggestion. It is not the same as sleep, and you are still aware and in control of your words and actions. A qualified hypnotherapist can help a client with patterns of behaviour, attitudes and emotions. Some hypnotherapists also incorporate regression techniques to help explore childhood experiences.
What is hypnotherapy best for?
Hypnotherapy is often chosen by clients dealing with anxiety, panic attacks and stress. It is also commonly used for treating self-destructive habits and phobias, such as a fear of driving or public speaking. Nice cites hypnotherapy as beneficial for physical issues such as IBS. Look for members of the General Hypnotherapy Register and the National Hypnotherapy Society.
Sex therapy or psychosexual therapy
This is therapy for individuals or couples, men and women of any sexual orientation. It is a talking therapy that does not involve any physical touch. For some difficulties, you may be recommended to try things in your own time that do involve touch. Training is on top of usual therapy or couples training, and psychosexual therapists are usually members of the College of Sexual and Relationship Therapists.
What is psychosexual therapy best for?
There is a wide range of issues that could bring an individual or a couple to see a psychosexual therapist, including differences in desire, issues around sexuality, problems with orgasm, erectile dysfunction, effects of mental health issues such as depression or PTSD, pain with intercourse, infidelity and infertility. These therapists are non-judgmental and open-minded about all sexual issues, including non-monogamy, and consider seriously the impact that our sex lives and relationships have on our overall wellbeing.
How much does therapy cost?
There is a wide range in therapy prices, according to everything from location and time of day to specialist training. Outside London and the South East, a therapist might charge £40 for a 50-minute session; in Central London you would expect to pay at least £70, with evening sessions more expensive. Online sessions will generally be cheaper than face to face. Couples counselling is always charged at a higher rate.
Concessions exist for students, the unemployed and therapy students in training. You can also find low-cost therapy sessions for limited periods through charities such as Mind.
How can I find a good therapist I can trust?
Therapists and counsellors are not covered by government regulation, so any practitioner you are considering should be a member of a major therapy organisation such as the BACP, the UK Council for Psychotherapy or the National Counselling and Psychotherapy Society.
If you use an independent platform such as Welldoing, you might be assured that all members are verified annually for professional membership, and they come from a wide range of therapy styles. Use the filter to make sure any therapist you contact is experienced in the issue you want to address. Many offer a free 15 to 20-minute “chemistry call” before making an appointment. Other such platforms are Counselling Directory and Psychology Today.
What can I get on the NHS?
NHS Talking Therapies are a range of services available for adults and young people with depression, anxiety and other mental health issues. Under-18s are treated via CAMHS (Child and Adolescent Mental Health Services). Referrals for both services can be made through your GP. There are often waiting lists for both services, though this depends on where in the country you are looking.
Treatment follows a “stepped-care” model, so you might first be offered support via a self-help workbook or website with the support of a therapist. Online therapy or group therapy might be offered if the need is clear. All support comes using evidence-based, Nice-recommended psychological therapies (usually CBT) and generally has a limited number of sessions.