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Electroconvulsive Treatment

Talking treatments

Some of the people we spoke to had had talking treatments such as psychotherapy, counselling and cognitive behavioural therapy (CBT – an approach that challenges unhelpful thought patterns). Talking treatments can be arranged through GP surgeries, charities e.g. Mind or privately by searching online. Talking therapies come in many different forms, but they usually provide a space for someone where they can meet with a trained professional and explore their thoughts, feelings and experiences. Usually a counsellor or therapist doesn’t offer advice on what to do, but instead provides a space for the person to discuss things in more helpful ways, which can aid the person in finding their own way forward. Talking treatments are usually offered by trained health professionals such as counsellors, psychologists, psychotherapists, and psychiatrists.

Most of the people we spoke to had talking therapies as an additional or complementary treatment, rather than as a replacement for medication or ECT. However, at the right time in their recovery, some people felt that talking treatments could ultimately reduce the need for drugs and ECT in the future. More than this, some believed talking therapies were essential to their recovery. Suzanne had accessed counselling through her workplace and she felt that this had helped resolve a bout of depression, such that ECT wasn’t needed again. Jenny felt talking therapies helped address the problems she experienced more than ECT had done. Sue and Ian said there ought to be more psychological treatments available that are “backed up” by the use of medication.

Some felt frustrated that, while drugs were readily available through the NHS, talking treatments were not always offered, or there were long waiting lists. Some people said it was difficult to find out about what talking treatments were actually available.
 
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After Tania had first been seriously unwell at university, having cognitive behavioural therapy helped her recover and stop taking sleeping tablets.

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Age at interview: 41
Sex: Female
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And after that, I mean, it took some time, it took some time to make a full recovery, because, you know, after the experiences of the previous year and I was, I was really in pieces and I, I, you know, took a while, over the course of the next few months I needed to get my sleep sorted out and I just needed to come to terms with the anxiety that whole, the whole episode had produced for me. And I had some cognitive behaviour which really helped me, like, get sort of relaxed and face kind of getting back to life again and just kind of get over what happened. And I also, it helped, I managed to come off the sleeping pills and get back to sleeping again, and you know, that just took a couple of months because I wasn’t, I wouldn’t say I was really ill then, I just, it was more like the after effects of just having the sort of the trauma of the whole year, and then following that I went back to university the next year and I went back and did my final year at university and it was, you know, it was tough going back, a lot of my friends had left by then and I was pretty shaken about what had happened, but my department were lovely and really supportive and I went back to university and I, and it went really well and I ended up, yeah, I ended up getting a First, which is what I’d really hoped for all along and staying in academia.
 

Jane thinks psychotherapy should be readily available on the NHS. She thinks it’s unfair if only those who can afford it get it.Jane thinks psychotherapy should be readily available on the NHS. She thinks it’s unfair if only those who can afford it get it

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Age at interview: 38
Sex: Female
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But I think it was probably, I needed to be on them but it’s been psychotherapy that’s helped me in a sort of more constructive way, and it would be useful if there were ways of being able to access that through the NHS, like through the, the doctors prescriptions for leisure, a model like that, or where you could sort of have a subsidised psychotherapy, because its only available to people that have got enough money or find a psychotherapist on a sliding scale that they can then afford. And, you know, it’s very inequitable really.
Talking treatments and recovery
Those who had had talking treatments often talked about the specific role it had played in their recovery. People credited talking therapies with a range of helpful results like helping them to better manage their feelings of anxiety and stress, coming to terms with difficult childhoods, finding ways to forgive those who had hurt them, and feeling better or “healed”. Tristan’s wife had counselling which helped with her recovery in particular ways. Counselling and learning about ‘mindfulness’ helped her become better equipped to stop her depressive and anxious thinking from reoccurring. She was able to see problems coming and avoid them. She didn’t have a substantial episode of mental illness after the talking therapy. Tristan and his wife are now very positive about the future. Helen had many years of counselling through a charity. She often had trainee councillors and felt able to “let out” the traumatic experiences she had gone through “in the safety of that room”. Her life had been a “living hell” but the counselling helped her to “get rid of all this horrible stuff” and get her sanity back.
 

At first Enid thought that Dialectical Behavioural Therapy (DBT) was “nonsense” but then found it made a lot of sense. She finds she’s able to live in the moment more and enjoy whatever she is doing and not worry.

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Age at interview: 74
Sex: Female
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And I started off very anti, thinking “this is a pile of nonsense” and it’s a bit like waving a magic wand and, but over a period of time I realised that there were actually things in there that made a lot of sense, and if you just ignored the Americanisms and I suppose there are different bits that work best for different people, but I have found it helpful in the end, and I did the year’s course and yes, I think it still, it’s still helping and I do, you know, kind of think of various bits of it during the day and it does help.

What are the bits you tend to think of?

Well in the mornings I always think this is a new day it’s open to a lot of opportunities and you don’t have, you know, what’s gone is gone. What, don’t I spend all your time worrying about what’s going to happen tomorrow. Live now. And enjoy, you know, the things that you’re doing now and make the most of what you can do today. And I think for me that’s, that’s probably the best bit of it. Just live in the moment. Live now. This bit’s fantastic. You know, I’ve got a lovely house, I’ve got a lovely husband, I’ve, you know, everything’s absolutely fine. Why worry about all the dreadful things or kind of make things not good. Now is a good time to be, and I think that’s been an enormous help. 
Experience of having talking therapies
The people we spoke to had experienced different types of talking treatments. These included: CBT (cognitive behaviour therapy), DBT (dialectical behaviour therapy), psychotherapy, CAT (cognitive analytic therapy), different types of group therapy, hypnotherapy, mindfulness and counselling (see MIND website for an explanation of the different therapies). People accessed talking treatments through a charity or the NHS or paid for private therapy.

Helen had a lot of talking treatments over the years. Although there was one psychotherapist she didn’t think was very good, her overall experience was positive: “And it does work, yes, it does work. Talking I think is the most important thing”. Sue, Jenny, Yvonne and Helen all emphasised the importance of talking about what had happened to them as children in order to help with their well-being as adults (for more see ‘Childhood’).
 

Tracy had had varied experiences of talking treatments. She found group psychotherapy and CBT very good, but said the counsellors she’d seen weren’t very skilled.

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Age at interview: 49
Sex: Female
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I know that a lot of GP surgeries have tried to get counsellors in and things. I’ve never found counsellors very good, but I have had a psychotherapist and that really made me think and, and cognitive behavioural therapies, I think that’s probably the best thing you could have, that gives you an option, you know, teaches your brain to choose a different pattern. I think something like that would have really helped me. But I just started some treatment like that when I moved up here.

The psychologist wanted me to carry on my treatment up here, it was never pursued either by the medical team or me, because I was better [laughs]. But yes, I do believe that cognitive behaviour therapy would be a really good thing, because it teaches you to think differently and I think people with depression need to think differently. And be taught not to be negative all the time. You know, when you hate yourself you’re not going to like anyone else either. And so life isn’t worth living and if you can be taught to like yourself then you’ll like other people and you’ll get on a bit better I think.

You were saying you’d had a better experience with psychotherapy?

Yes, it was a group psychotherapy meeting and we had lots of arguments because we were all very self-opinionated. But the psychotherapist really made me think about the way I think about things. Like she came in one day and she said, “Just to let you know I won’t be here for much, I won’t be here for much longer.” And we all had to go round the room saying why we thought that. What we thought about that and mine was, “Oh my goodness, are you okay?” I automatically thought she was dying. And in fact she was pregnant. But that didn’t come into my mind. And so she made me think about why I was thinking those things and I suppose that’s what the cognitive behavioural therapy does, it makes you think why you think, why you do the things that you do. 
Some reflected back on the talking therapies they had had when they were children and teenagers, noting mixed experiences. Catherine Y had managed to access different types of both individual and group therapy when she was a teenager. Although she said in hindsight it was very good, as she was a teenager “there [was] an element of…[rebellion]” and she found progress very slow.
 

Yvonne was put into a children’s home when she was thirteen, after she was attacked by her mother. She felt that her psychologist should have “probed a bit deeper” so that her problems could have been dealt with at the time.

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I think when I was 13 I got put into a children’s home, for my own safety, because my Mum had battered me unconscious. And after going from hostel to a children’s home and I was there for about nine months before they returned me back to the family home. But if during that time I’d had some form of, I don’t know, would it have been a talking therapy, or counselling or would it have been… I did see a psychologist who thought that I was an ordinary 13 year old with ordinary 13 year-old worries. And maybe that’s how I did come across but I think if they probed a wee bit deeper, it would have been more apparent what was wrong and I think it would have saved a lot of what happened then to me, you know, in later years, but can I sort of go on what ifs and if what’s? You know, so but I do think, for children’s services, you need to be on the ball and you need to, because if we can stop a lot of, or in my opinion we can stop a lot of illnesses escalating at a later date if a child is treated rather than letting it just build and build. It kind of feels sometimes as if I fell through the cracks a bit, because there was obviously services involved with me as a child and you know when I was in a children’s centre and things, children’s home. But yes, I kind of feel that I kind of got lost a bit.
As the people we spoke to had often experienced severe mental distress over many years, progress in therapy was gradual. Additionally having a good ongoing relationship with the therapist was mentioned as important.
 
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Kathleen described feeling anxious at first about speaking to her psychiatrist about things she’d never spoken to anyone about. She says they have since developed “a good therapeutic relationship”.

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Age at interview: 51
Sex: Female
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Because I just recently started this psychology treatment and after my first appointment with the psychologist and she’s a lovely lady, but I still worry about it afterwards and I did tell her. I did tell her, I said, “I did worry about it.” But like she said, you know, she has nothing to work on if, if I don’t talk or say anything and I’ve not had the kind of reaction that I’ve perhaps assumed, you know, I’ve had a, I’ve been talking to someone about it, it’s been different from my. Their reaction has been different from what I’ve assumed it would be, because I’m thinking one way so I just assume everyone else is thinking in that warped way.

So you mean in a negative sort of?

Yes.

And obviously I mean coming from you know, almost forced to talk to your GP initially to having relationships with several psychiatrists and so on…

Yes, I’ve come a long way.

Yes.

It doesn’t bother me now.

But how have they been for you. You’ve tended to talk about them in quite positive terms.

Yes. Yes. I miss my psychiatrist I’ve been seeing the longest, the one in [name of country], I probably been seeing him since 2007, almost every week. I had a regular appointment with him for an hour every week. We had a good relationship but even the first time I went to meet him, when I got home, I thought ‘oh no, he got me to tell him things which I’d never told anybody before. Oh why did I tell him about that?’ Things that I’d done to myself when I was young. Self-harm etc. I just felt, oh I can’t go and see him again, I can’t go and see him again after that, and I was just cross with myself for having told him these things. I very nearly didn’t go back to see him again, but I did, and I’m glad I did, because as I say, we did develop a good therapeutic relationship and over the years and he’s been a very positive influence and very helpful particularly in problem solving and sort of psycho therapeutic approach, and really not just medication.
 

Sue has had long-term therapy for the trauma she went through as a child, and in her adult life. She felt her psychotherapist was the only person who understood why her past was causing her problems.

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I’ve had an awful lot of psychotherapy. I’ve actually talked about it with the psychotherapist. And I think he was the only one that really understood where the past was coming into the future, sort of like causing problems, and whilst people say, “Oh you got over it, it didn’t work, move on.” It’s the psychological impact I’ve had through having ECT and thinking this is the ultimate treatment you could have.

And I also lost heart. If this is the ultimate treatment and I haven’t responded [claps hands] what is there? And I became more suicidal, which was initially why I was in hospital. And I also, that has a knock on effect, because each time I’m sectioned, it’s usually because I’m highly suicidal and I reach the stage, well nothing’s worked and I’m still in this same place, and with people saying to me, oh, you know, like it might never happen again. How many times have I heard that? And I just sort of brush it off, thinking you don’t really know me. Especially new people who work with me, who don’t really know me. Its sort like seems like a throwaway comment and I think there’s very few people that have been with me all those seventeen, eighteen years, I’ve been within the mental health system here, who can actually follow the whole thing.
Shorter interventions, such as a block of six weekly sessions sometimes offered by GPs, while frequently helpful, might not be enough for those who have suffered all their lives. Similarly, longer-term talking therapy could be too deep for others. Sue’s psychotherapist felt she needed 5 or 6 years of therapy. When he discharged her, he said it was difficult for her to overcome the trauma she had been through both as a child and as an adult going through mental health treatments.
 

Mandie described different approaches taken by counsellors and psychotherapists. Psychotherapy on the NHS came too late for her and “[ripped her] open”, whereas counselling was “looking for solutions”.

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Age at interview: 39
Sex: Female
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But, you also said, that you’d been waiting for psychological therapy and, but you didn’t actually have that?

Ironically, I finally accessed the NHS’s psychological therapy, I was offered a ten-week course, just as I knew I was getting better. And I remember phoning them up and saying, “Look, I’m not being funny, I’ve waited like fourteen months for this. This would have been good, a long time ago.” And they said, “Well, if you turn this down, and if you ever got ill again, you wouldn’t get any help.” And so I then, went through their therapy as well, at the same time, which was really difficult, really, because they had a very different, their approach was looking back, and, “Where in your past has this been caused by?” Whereas the counselling with the CBT, and CAT, was very much about looking for the solutions, to help me adjust my thinking, so I could live in a better place. I mean I think the first thing the charity did, was they helped me understand that this is an illness, this isn’t me being lazy, or selfish, or can’t be bothered to clean up the house, or something, this is me. They used the analogy all the time, “This is like a broken leg. You wouldn’t try and drive a car with a broken leg. Stop trying to do it now.” And the NHS’s therapy, I remember saying to her one day, I said to her, “I’m sorry, but I’m finding this harrowing.” And she went, “Harrowing? That’s interesting. Do you know what the word harrowing means? Do you know what harrow means?” I said, “Well, it means to dig deep and break things up.” And she said, “Well, harrow does.” She said, “It means to turn the soil completely over.” I said, “Yes, you’re ripping me open, and opening me up.” And what was interesting, was at the end of the ten weeks, they kind of went, “Right, we’ve gone really deep.” And I went, “Yes, but you’ve broken me open. You’ve not fixed me.” “Well, you’ve had your ten sessions.” “Right, okay, well, I must be fixed then.” Whereas with the charity it was never, there wasn’t, I wasn’t on their agenda, they were on my agenda.
Sheila’s husband had two lots of talking therapy on an inpatient ward. The psychologist involved Sheila (asking her about her husband’s past and explaining how she was working with him). She also helped refer her husband to a therapist specialising in Obsessive Compulsive Disorder (OCD) and helped her to understand more about her husband’s diagnosis of OCD.

Timing of talking treatments
The timing of, and access to, talking treatments was seen as very important for some people we spoke to. Mandie turned down ECT because she felt talking treatments were what she needed. She waited fourteen months to have psychotherapy through her GP, which she said was too long to wait when so ill, although she managed to access counselling through a charity in the meantime. She felt that if she had had these therapies sooner, her illness would not have developed.
 

Yvonne went to counselling sometime after she had had ECT. She felt able to participate in counselling sessions at that time and felt that when she was first admitted she wouldn’t have been able to.

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I did go through a lot of counselling a couple of years after ECT treatment. And that really helped, but I think it was because the depression had become better, so I was able to speak more openly and I was able to grasp what people were saying to me in the counselling sessions. You know, where with my first admission here would have been no point in trying to put me through counselling. Seeing as I didn’t know what time it was, let alone trying to take in what people were saying. I did na have the concentration. But ECT was definitely the first step to me being able to recover.
 

It was only after her mum died that Helen could acknowledge what had happened and begin to forgive her mum. Psychotherapy helped her to do this.

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Age at interview: 60
Sex: Female
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It’s so good talking to you because it’s gone now. I’ve been, I’ve talked to you. Six months ago I’d have still been, a year or so. And it’s all gone, it’s all gone. Yes, I’ve been healed really. It, it is all gone. Yes, that was, that was the biggest problem in lots of ways. Even I was made to feel that my dad’s suicide was my fault, my brother’s brain tumour was my fault, that me having an illegitimate child was my fault. And it’s only been through counselling and working through these things in my head, I thought, “None of it was. I was a kid, you know” [laugh]. And I’ve let go of it all now, I’ve apportioned it all. And, no, I wasn’t responsible for any of it really. But that was the only way my mother could survive was by putting that horrible stuff on me, you know. If someone gets left, their husband committed suicide, it was all going to be on her. And she was obviously a damaged person and there was no help in those days, no help at all. And her way of surviving psychologically was to put it all on to me and on to my sister. And the healing has been that she’s been dead for two years really. Once she’s died, once she’s died, you, at first I was making excuses still and being sugary and sentimental about the good points and hanging on to that. And I had made my point, peace with her, and that was good. But as I’ve worked through that with a counsellor, yes, I’ve come out with the fact, I realised she was just really evil, really wicked and really terrible. But also it’s all gone. You know, forgive her because like myself she was just human. But you’ve got to, you can’t forgive people and you can’t deal with them till you acknowledge what’s happened. That’s the problem a lot of the time. You have to acknowledge this happened, this was done to me, and that’s real and that’s wrong, and then you can forgive it. But you can’t forgive I... a lot of that, with all the Christian stuff we, and you can’t, not until you’ve actually acknowledged something and felt it and got it out. 
Last reviewed January 2018.
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