Depression and low mood

Talking treatments

Talking treatments are a common psychological method of processing distress, overcoming emotional difficulties and changing negative or destructive patterns of thinking and behaving. It can help someone gain understanding over their behaviour and aid positive and proactive change. Talking treatments cover a broad range of approaches from generic counselling to specific forms of therapy (such as psychotherapy and cognitive behavioural therapy).

Most of the young people we spoke with had received help from talking treatments for depression and low mood. For some, this had been a few sessions over a couple of weeks or months, others had received therapy for over a year or two. Most young people who received therapy had CBT (Cognitive Behavioural Therapy), while a few received behavioural therapy or psychodynamic therapy. Some had received generic counselling. As many people didn’t know, or talk about which kind of therapy they’d had, our focus here is on their experiences of talking treatments generally, rather than disseminating the pros and cons of the different approaches.

Many young people had initially seen their school counsellor, who had either seen them for a few sessions or referred them on for talking treatment elsewhere. Many felt that counselling provided through school wasn’t enough to deal with some of the problems they had and was more focused on exam stress, for example. Some said they felt the appointed school contact wasn’t experienced or skilled enough to counsel as they were for example a teacher or a tutor, not a trained counsellor. A few people’s first contact with counselling was through their college or university counselling services which many had found very professional and helpful.

Most people also had talking treatments through the NHS or community projects. A few people had therapy as a part of their inpatient care at a psychiatric hospital. One man said of the talking treatments provided by the NHS:

“A lot of people say the NHS is dead and everything like that. I just think, maybe you’re just complaining a bit too much. It’s free, you know.”

Several people felt that that the waiting lists for the NHS talking treatments were far too long and the number of sessions they could have too limited. A couple of people had had to go privately, to be able to get the kind of help they felt they needed, when they needed it. A couple of people really keen to have talking treatments were still on a waiting list which was hard and frustrating.

Most young people had been to individual (one-to-one) therapy and a few had been to group therapy. Among the benefits of attending groups were feeling under less pressure to take part and be active, regarding groups as “easier” than individual work and most importantly, meeting other people in a similar situation and learning from each other. The main disadvantage some people experienced was feeling uncomfortable in such a social situation. One man said it wasn’t “his thing” because; “we just sat there kind of with candles and spoke about our problems”.

People also talked about the process of therapy and what happened in their sessions. For most, the sessions were mainly focused on talking, the topics initiated by both themselves and the therapist. They described the process as a way of analysing and looking at their behaviour and thoughts from a different angle, to try to rationalise why they behaved in a certain way and to find alternatives.

For some, therapy was more focused on learning particular skills or techniques, for example managing stress or anger or learning relaxation techniques. Particularly for those who’d had CBT, sessions focused on developing particular strategies to alter their usual thought patterns and trying to find ways to break cycles of negative thinking. A couple of people had also learnt such strategies through CBT online resources.

Benefits of talking treatments
The majority of people found talking treatments a positive experience and something which helped them. The benefits were wide-ranging. For many, it was an opportunity to be listened to; a regular slot just for them to air their feelings. Young people described therapy as an “outlet”, an opportunity to “let go”, to “vent anger”, “get weight off” their shoulders and “a release”. One man said it was “fantastic to finally let go”, another woman said “counselling makes you feel lighter”. Talking treatment functioned as a way for people to let out feelings which they might otherwise have bottled up and helped them cope better. For many, talking was helpful in itself. One woman described how free she felt to express herself in counselling:
 
“You don’t have to justify anything that you’re saying or feeling because anything and everything’s normal with depression. Anything that you are feeling is normal.”

This is how one woman described why CBT worked for her:

“This positive thinking really helps you to uplift your mood, which helps you then fight the depressions, whereas like the sort of the tablets that were given to me would uplift my mood, but not tackle the thoughts. So although my mood was uplifted I didn’t have the application to tackle the thoughts which were the things that kept on eating away at me. I think like the best thing for me was… to tackle my thoughts and it uplifted my mood.”
 
Another important benefit of talking treatment was getting non-judgemental and impartial support, advice and help. Many compared speaking to a counsellor or therapist to sharing their thoughts and feelings with friends or family and said it was often emotionally harder to share negative feelings with close people. Some also worried about burdening their friends too much, or that friends might not be balanced or rational in their response. One woman described how a therapist provided an “outsider’s perspective” that she could trust not to be biased or judgemental. Some felt that therapists were there to give advice, if they wanted it, but didn’t “force their opinions” so young people had the control over decisions they made.
Many people felt talking treatments had boosted their confidence and feeling of self-worth, which many had struggled with. Similarly, it provided them with hope and helped them to gain a more positive attitude to their lives and recovery from depression.

Learning skills and techniques for relaxation or managing anger was also something useful people could take away from talking treatments, and as one woman said, “apply it to all of my life”. A couple of people said they only had a couple of sessions but felt reassured by just knowing how to get help if they decided to go back. In this way, therapy or counselling enabled young people to cope better on their own and equipped them with skills to get by.
A couple of people pointed out how good just the act of going to counselling or therapy made them feel. One woman said she felt great because she knew she’d taken a positive step to help herself and make a difference to her life. Another said how going to counselling, and being taken seriously, made her feelings and experience of depression “validated”; to know things weren’t OK and she was “worthy” of support. One man said:
 
“It [benefit of counselling] was partly having someone to listen, but also partly just making the positive step, making that decision to do something about it made me feel a lot better.”
The counselling or therapy process wasn’t always easy and a few people emphasised that they had to be “willing” to get help and work through the issues themselves. One person described counselling as “a very active process” and another as “hard work”. One man said it was hard for him to accept he couldn’t deal with things on his own but once he got over that thought, he really benefitted from the sessions.
 
It is important to remember though that to find these types of therapy beneficial it can involve a lot of hard work and can take up a lot of time.
 
Finding the right therapy and the right therapist
Finding the right counsellor or therapist who “you click with” was really important. Among the qualities young people wanted from their counsellors were; being “down to earth”, “open”, “relaxed” and “inclusive” and “not being patronising”. A few people’s therapists had personal experience of mental health problems, something they found beneficial. It was essential that people felt able to trust their therapists and that they were impartial.
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Some of the people felt that the type of counselling or therapy they had been to had been unhelpful and not suitable for their needs. Some found their therapist’s approach or attitude unsupportive or too focused on underlying causes rather than exploring methods of moving on. By contrast, others felt that counselling they had focused solely on getting them back to school, for example, without addressing the underlying causes of the problems. Finding the right type of talking treatment, suitable for the young person’s individual life situation was essential. Some found it helpful to change the therapist or counsellor when it hadn’t worked out in the first place.

A few people felt talking treatment wasn’t flexible enough. A couple commented that sessions at pre-arranged times didn’t work because of their fluctuating moods. They would have preferred having the help there at the time when they needed it the most, or felt able to talk. One woman said she just “ran out of things to say” and didn’t feel her problems were helped by talking about them.

Some didn’t see the point in what they saw as the principles behind talking treatment. One woman described counselling as too “scripted” and “rehearsed” and not based on genuine rapport. Another person said that for her the idea behind talking treatment was “to think happy thoughts” and that recovery “didn’t work like that”.
For some people, the particular type of talking treatment had been unsuitable, for example too childish or “boring”. A few of them had found therapy with CAMHS more suited to younger children and felt the focus wasn’t enough on “talking” which is what they had wanted.

A couple also had problems with their parents intervening too much or “controlling” the therapy process. They felt they couldn’t say what they wanted to say in sessions in case their parents found out. Confidentiality and trust were essential to establish for talking treatment to work.

Other types of therapy

Interpersonal Psychotherapy
(IPT) is based on the belief that for some people relationship problems play a big role in their depression. It is different from other forms of therapy in its emphasis on relationships and building interpersonal skills rather than focusing on the specific mental health problems of the individual.

Since these interviews were recorded, new techniques such as ‘Mindfulness’ are increasing being used to help.

Mindfulness Based Stress Reduction (MBSR)
Combines various meditation practices with modified yoga exercises and mind-body education. The idea behind mindfulness is that by being more aware of the present moment, including feelings and thoughts, your body and the world around you it can positively change the way people feel about life and how they approach challenges (see NHS Choices, Breathworks or Mind websites for more details on mindfulness).

Acceptance and Commitment Therapy (ACT)
Encourages people to re-evaluate their relationship with their experiences, including learning to develop a greater division between themselves and their thoughts. These changes are used to help people become more psychologically flexible changing the agenda away from controlling negative experiences and instead helps to focus on setting value-based goals.

We have not been able to interview anyone who has had these therapies. If you have experience of these treatments and you would like us to include your story on this website, please email us.

Last reviewed June 2017.

Last updated June 2017.

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