Depression

Talking therapies - considering talking therapies

A range of different professionals provide various kinds of counselling, therapy and psychotherapy in the UK. When we talk about counselling and psychotherapy here, we usually group the different approaches together for the sake of simplicity and call them 'talking therapies,' or just 'therapies'. Therapies aim to reduce symptoms, increase wellbeing and help people to function better.

Talking therapies generally involve one-to-one interaction over quite long periods of time. For this reason, they are expensive to provide and their availability through the NHS remains patchy. Current government policy aims to make talking therapies more easily available on the NHS. Guidelines for the treatment of depression advise doctors to refer patients with a new diagnosis of mild to moderate depressive symptoms for talking therapies before prescribing antidepressants. Many GP surgeries were encouraged to take on counsellors as part of their practice teams in the 1990s, and more recently there has been an emphasis on cognitive therapy (or cognitive behavioural therapy, CBT). Some counsellors use CBT as part of a range of treatments, but others do not, and there is a wide range of access and funding arrangements which vary from one area to another (the so-called "postcode lottery"). Whereas traditional modes of psychotherapy and counselling involve long sessions to explore deep underlying issues, others such as computer-led CBT or brief cognitive therapy seek mainly to teach practical ways of overcoming negative thoughts and behaviours. The cost of computer-led CBT such as ‘Beating the Blues’, developed by the Institute of Psychiatry is lower than traditional modes of counselling and is approved by the National Institute for Clinical Excellence (NICE) as a cost effective treatment for depression. In some areas this type of treatment is more readily available and paid for by the NHS.

You need to think about several things before deciding on therapy. For instance, therapy usually costs money, takes time and can be challenging. You can also discover difficult things about yourself, e.g. your rage at your therapist. Some people need to be in a safe space to 'unravel' as they get in touch with their feelings and gain insight' that is, people can get worse before they get better in therapy. For this reason, people need to decide if they are ready to undergo therapy. One woman we interviewed was surprised when a psychotherapist told her she was not ready for therapy. The therapist explained that she needed to be more stable on her medication and gather more social support around her. A community psychiatric nurse was assigned to help her prepare for therapy. One young man found he had unresolved issues after therapy because he was not ready to deal with some problems at the time.

While some people take to therapy easily, others had to overcome a fair amount of prejudice and fear to benefit from talking therapies. One Brazilian man felt that while therapy was an ordinary thing for the middle classes in his country of birth, it was more stigmatised in the UK because the benefit of talking about feelings was not so readily understood. One woman described herself as initially 'petrified' of counselling, fearing she would be forced to talk about painful issues and forgive her parents against her will.

Men, in particular, can be very resistant to therapy, at least until they have had therapy! One man initially thought that therapy was for 'anorexic' upper-class women to talk about their feelings. Instead, he found that he liked his therapist, enjoyed the problem-solving aspects of cognitive therapy, and was able to talk about his emotional vulnerability in a safe environment. People were sometimes unsure what 'format' talking therapies took, and this made them more anxious about therapy. One suicidal man wanted to phone the Samaritans (see 'Resources' section) but worried that he did not even know what to say. Unfortunately, some people who have a counsellor/therapist resist seeing them when they are depressed (and most need to talk) because they do not want their therapist to think poorly of them. However, skilled therapists always have a warm and positive approach to their clients, depressed or not.

Most (but not all) therapy on the NHS was short-term (e.g. 6 or 12 sessions). Given the scarcity of long-term therapy available on the NHS, some people strung together various short courses of therapy to get the help they needed. Also, a few lucky people were able to benefit from long-term therapy on the NHS. These people found that their issues were complex and painful, and could be addressed only through therapy over the course of years. One woman who started a local support group in her area 20 years ago reflected sadly on her observation over the decades that there was much need for short-term and long-term therapy for depressed people, and yet so little was available in the NHS. Another woman made an emotional plea for more help from the NHS with talking therapies.

For more information on talking therapies see 'Experiences of antidepressants- Talking therapies and antidepressants'.

Last reviewed April 2015.

Last updated April 2015.

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