Talking therapies for psychosis

Many people were not offered any type of talking therapy or said that talking therapies were too difficult to access.
A few didn’t want counselling as they felt it was a ‘waste of time’, had found talking about their experiences too difficult, or felt that particular types of therapy might not deal with practical obstacles in their lives. Robert thought that talking therapy was ‘not a bad idea’ but that it felt like ‘talking to doctors’, which he didn’t want to do.

However other people spoke about their experiences of talking therapies.

Overview of talking therapies

People had had different types of therapy over their lives, such as psychodynamic therapy, CBT (Cognitive Behavioural Therapy), family therapy, person-centred therapy, and therapies that use a range of approaches. A number of people who had experienced sexual abuse had therapy specially designed for them.
People had different experiences of therapy, both positive and negative. Dolly felt that a six-week period of counselling ‘touched nothing’ and he felt ‘let down’. Arwen tried some ‘basic counselling’ but didn’t want to talk about how she felt.
Some people liked the ‘problem-solving’ types of therapy like CBT, while others liked therapies that allowed them time to explore their feelings and discuss matters in the past, like family issues.

Jenni says that CBT gave her the skills to handle her current situation, including her problems…

Age at interview 30

Gender Female

Age at diagnosis 26

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Like if you are talking about psychoanalysis, you’re talking about your childhood and like problems in the past, but CBT is more like, I’m having a problem with this woman at work. How should I handle it? And they give you skills and tips to handle your current situation, rather than digging up into your past about why it’s happened. Yes. So that’s really good. I think the NHS uses that type of therapy.

And how many sessions did you have of that?

You have, I had a course of ten. And that was really useful, yes.

So what kind of things did you learn from that that you found useful?

It was, again it was about handling people, because the problem with this illness is, it seems that you’re very, susceptible to having problems with relationships, and you’re very sensitive and vulnerable to people, and people being assertive, people not being open. And stuff like that, and, yes, so it just taught me some skills of how to handle nasty people at work. Bitchy people. Pushy people. That kind of thing. Yes.

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People also liked the particular counsellor they went to see, and the different techniques counsellors gave them to cope with their everyday lives. One carer mentioned how useful family therapy was. Some people felt that just talking about their problems and feelings really helped them sort through their issues. People weren’t always sure what type of therapy they had received. Not all therapy was one-one; people also spoke about their experiences of group therapy. Some preferred the idea of individual counselling, and Simon went to group therapy but couldn’t see the benefit of it. However another person fought to get access to group therapy in hospital, and yet another found it very helpful as people helped one another: this last person has continued friendships with group participants outside of hospital.

Types of therapies and experiences

CBT orCognitive Behavioural therapy aims to solve problems or issues by setting goals. It is often a time-limited treatment and usually focuses on the ‘here and now’. CBT helps people identify different thoughts and behaviours which might not be helpful and aims to change them, often through practical exercises. People had mostly had positive experiences of this type of therapy.

Green Lettuce had support workers come to his house; he talked about ‘general stuff and they…

Age at interview 25

Gender Male

Age at diagnosis 20

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But I was soon referred to my, a support worker and he came round every week and talked to me. And she saw how I, she saw how I was getting on. And that helped a lot as well.

I had different people come round to begin with, but I only saw them one time, and they were just talking about general stuff, do with what? Psychosis, and, but I didn’t see them again tillI’m not sure. But the main guy I saw every week or two for about two or three years I think. He visited me at college as well.

And what types of things was he talking to you about?

He was just asking if I was getting better, really most of the time. Then I think I had some cogI can’t remember what it’s called, some therapy.

Cognitive behavioural therapy?

Might have been that. Some woman came round.

CBT?

Yes. I had to write my, get my days back into normal routine and write down when I got up, what I was doing all day. In Ex… on the computer and that helped. It got me back into a normal routine.

And did you like the woman that came round?

Yes.

What did you like about her?

She was just easy to talk to and. would listen to what I had to say.

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Dolly found CBT helpful, practical and good at challenging ways of thinking, but didn’t like…

Age at interview 39

Gender Female

Age at diagnosis 22

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Have you ever had any talking therapy? You said you had this sort of six-week session earlier on.

I’ve had two kind of different talking therapies. I’ve had CBT, which I actually found really useful, actually. Because it was, it kind of mapped out my thinking.

Yes, kind of, just, it mapped up my thinking and it showed me where I, what kind of thinking, helped me go into a psychotic state really. For example when I was paranoid.

For example, you know, just thinking of one of the things we did step by step. Oh yes, I can think of one. You know, say if I was stressed I would act a bit differently. I’d may be, be a bit withdrawn. And because I act, I am different, people will react differently to me, but I’d not seen that react .. their reaction to me. I’m seeing they’re reaction for some, some other reason. And I begin to become paranoid and I, because I think they are up to something I start to get a bit defensive with them, and, and that’ll cause them to say things and in a way which I found as proof of my kind of paranoia that they’re out to get me. And basically, it was just saying, why are you thinking like that? Why do you believe that? Is it possible that it could be for another reason. So that, just that kind of thing has been really helpful.

Also I had psychotherapy which was not helpful at all. I didn’t find psychotherapy helpful. I’m not sure quite, because I know it’s been helpful to sort of some friends of mine, but not helpful for me. And that just kind of going over the, the past really. it’s not helpful if you know, you have problems in the present. And, the therapist says it’s because of what happened in the past. I know that. You know, I already know that. I mean how do I deal with it. That’s what I mean. And also they’ll say something like, Well it’s something you have to come to rdquo; I said, Why are you here then? Go away You know [small laugh]. It, I don’t know may be it’s, it’s just, I mean, you can’t one thing to work for everybody, you know, it was probably helpful sort of to somebody, but psychotherapy wasn’t helpful for me at all. I usually came out depressed from it, have a session.

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However other people didn’t find CBT useful for the problems they were experiencing. One man, for example, was said by his carer not to have control over his thoughts so he could not challenge them. Instead he benefitted much more from an approach that allowed him to be mindful of observing himself and his separate psychotic thoughts.

Tom found therapy expensive and unhelpful, and thinks that CBT is mainly used for depression and…

Age at interview 39

Gender Male

Age at diagnosis 21

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I also did try a bit of CBT with the national health. But I think CBT is more geared to depression and there’s very, there’s not much they can do about schizophrenia so I gave it up after a while as just a waste of time. Which is not, you know, [coughs] it’s been proved to be very effective with depression but not that much with schizophrenia.

Yes.

So I it’s not in but I know I also tried a talking cure with a private psychiatrist psychotherapist. That didn’t go, that didn’t, that was also, you know, they were they were loathed to take me on really because they, there’s nothing much they can do about schizophrenia either. So gave that up eventually because it was too expensive. I couldn’t afford it but there was he wasn’t getting anywhere really. I think talking cures are, you know, they’re I think they’re more effective for depression but I have I’ve tried it twice but it hasn’t really worked for me so I I’ve not got on with it.

When you say it hasn’t really worked? What hasn’t worked do you associate?

Well, it’s not made me any better, you know, and so I haven’t I just thought it was a waste of time And I don’t particularly like talking about myself either. I don’t find it particularly helpful sometimes so.

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Other ways of doing ‘therapy’

The benefits of talking were not confined to therapy. People also had a series of helpful ‘chats’ with support workers, doctors, people working for ‘Early Intervention teams’, and other patients, or they went on courses.

Collin had some chats with some guys in the homeless hostel he was in but didnt get anything…

Age at interview 40

Gender Male

Age at diagnosis 19

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I was fairly functional for most of the time in the hostel. It was just, it wasn’t really off, it was more just the general just sort of counselling. It was no really. It was just, I not very sure what it was. But it was that kind of thing where you go into that, if you go into that sort of environment in a hostel, you know, the guys there, a lot of the people are paid to sort of, that’s their job, I mean, to sort of get you through. You do that, and I’ll just go out, or I’ll do that or I’ll do this, and it was like, you know, I don’t know whatif I got anything. But it was a lot of just once a week you know, I would have a word with someone, so I’m not sure, basically it didn’t stop me going you know, full blown. It didn’t really. It never stopped it doing that obviously but As I say we just talked about, you know, a bit like this, you know, briefly going through going your history etc and so on and talking about drink and that. I said we like had adult, an adult conversation about drink, because it was basically aboutI mean they would say why, you know, why do you drink, and I’d say you know, it’s like a sort of, its not Scotland obviously but its may be slightly more, well not really I suppose, but it’s traditional in Scotland [laughs]. I suppose like. it’s just not healthy obviously, but, but yes, to be honest I never really got much benefit, I never got much from that. As I say it was only for a few weeks and it just was what it was.

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Others used techniques that they had read about (e.g. CBT), that they thought were similar to techniques in therapy.

Problems in getting therapy

A few people felt that the therapy they were offered was not long enough, and it was too difficult to get therapy. Arwen and Rachel really wanted specialised counselling for sexual abuse that they had experienced, while one person felt they had to go it alone.

Rachel didnt deal with the powerful feelings about her dads death and her sexual abuse until…

Age at interview 47

Gender Female

Age at diagnosis 27

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Whenever I used to mention Dad, I just burst out crying. I mean I cried for hours. Hours and hours and hours. I think, I mean the main thing I had to come to terms with was a lot of anger. There was a lot of anger anyway about things, such as the sexual abuse issue and it was years before my resolve came. It was about 20, about 25 years, after the event that I actually did something about that. And found it was a group that was specifically for victims of childhood sexual abuse. And I think with my Dad and the overwhelming thing by the end of it was anger. It was anger with everything and everybody. And because, you know, [inhales] I didn’t deal with it at the time. And I think if you’re a thoughtful sensitive person then anger is, is not something that you deal with very well. You know, if you’re not used to these incredibly powerful overwhelming feelings of injustice, and hate [laughs]. I’ll be honest, yes. Yes. they’re very, very hard to deal with, and particularly if you’re quite isolated as well. You know, if you’ve kind of isolated yourself. [sniffs] It is very, very difficult. Yes.

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Margaret was offered CBT, but it never materialised so she developed her own coping strategies to…

Age at interview 41

Gender Female

Age at diagnosis 27

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They said we’ll once, years later, they said, we’ll do a CBT or talking therapy but then that never happened. So all my CBT has been DIY [laughs] you know, I’ve to do it myself because I had no help at all from professionals, so, yes. I think that’s a shame really, because .. But anyway I can, I can tell you about some of my DIY CBT.

Okay so, dealing with, dealing with… voices, I think… now it’s having, I’ve always had insight generally. I’ve, I’ve never lost the plot completely, even though I’ve had my fair share of the delusions at the beginning of my illness. I, you know, I’ve never like totally, apart from after I’d had the general anaesthetic may be,
it’s very difficult.

Before coming to [place] and yes. Then I did lose touch with reality a bit. But yes, and that’s after I’d yeah. So I think now I tend to look at it as a challenge, and a great challenge, so I f I’m hearing people saying things about me, or I tend to think well that does I have to take a double take and think what I have just heard and then think, well that can’t be right, people don’t say that. People don’t say that sort of thing, and if they do, then I think they’re the one with the problem, not me. So that’s that. So I have to rationalise and take a double take and, and do re-enforcement when I hear things. And that still goes on. And then I think laughter is quite a good one, because I, I actually, I actually now find it amusing when I hear things, even they’re quite horrible insults. By laughing at it that is a coping strategy. it’s took me a long time to get to that.

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Outcomes of doing therapy and recovery

David used CBT and other therapy to challenge black and white thinking.

Age at interview 31

Gender Male

Age at diagnosis 17

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But the fact is a lot of it’s, it changed, a lot of that changed after I actually did the Cognitive Behaviour Therapy. I actually walked out and went hang on a minute, I’m not sure, I’m not sure who I am again because I started looking back at all my past experiences and started thinking right this is how I remember that experience, but was I thinking along these lines of black and white thinking or everything was my fault or everything was someone else’s fault or t made me have to really rethink where I’d been, what I’d done. And some of my experiences my actual life experiences. I had to re-evaluate every little bit and think hang on a minute I can’t really sit in and do, I know this from this experience of my life. That sort of in a way dismiss a lot of it, crushing it. Which isn’t a bad thing. But it’s like getting into that feeling of lost again. So you feel like you’ve lost your personal identity and your self-identity.

So you said you rebuilt a lot of that?

I’d say a lot of times I think. It keeps happening and then it gets to a point everything just goes out the window and then it’s a case of like rebuild. But I think over years I’ve managed to build together quite a solid foundation. So when I’ve fallen out, I can only fall so far and I’ve got all the steps there to build myself back up quickly without going too far. So as I said I’ve built up relationships with my family and that now and
What was it like doing that?

It was hard work, because I think going back to how I used to be when I was younger some of my behaviours and where I was in my own head, it’s very destructive, and then I couldn’t really comprehend where I was, so god forbid how anyone could actually, how anyone else could comprehend where I was or what I was doing, or why I was doing it. But yes, it’s taken time and effort.

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Rachel had different types of therapy, and found it good to get things out of her system and…

Age at interview 41

Gender Female

Age at diagnosis 19

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I find talking is a real therapy for me and gets it out of my system and I feel a lot better once I’ve said it, and it kind of, it works for me to, you know, to be able to do that. And I’m sure that for other people that same system of discussing things, you know, is all important and if they’ve got access to it, instead of just being given medication they would find that they, they got better in a different way or quicker or things like that. So, you know, I wish well I hope more people get access to talking therapies and I think that’s a thing there’ll be doing more in the future as well. You know, it will be less medication orientated in the future and more in support. So I’ve been very lucky with that really.

The Psychodynamic therapy I just had for a year. And I didn’t take to her as much and she was the second one I saw. And that just flew by a year and yes I didn’t find it very proactive. I didn’t really enjoy that as much. The psychologist I saw, who did a bit of CBT was very good. And in fact, he made me fill a questionnaire out when I started and a questionnaire when I was leaving about how I felt, and it was quite interesting at the end to realise what I’d written at the beginning and how much better I’d got which showed, and I was with him only for nine months, but it was very effective. So that was really good. So that really worked yes.

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Some people felt that therapy did not help them. However, other people who had done some or a lot of therapy found that their attempts to understand their feelings and behaviour in therapy helped them with their recovery. Whilst some people felt it was good to talk about problems, others talked about dealing with the guilt of abuse or conflict. People didn’t often see talking therapies as a substitute for medication, but felt that they ought to receive more talking therapies in addition to medication.