IT’S GOOD TO TALK

The WH guide to therapy

Talking treatments can help with a range of mental health issues. Here’s how to get the conversation started

You could talk about it with friends or family. But maybe the problem that’s taken hold in your head feels too big or messy. Maybe it can’t be parcelled into neat sentences that slide off the tongue over a brew. Maybe it’s time to talk to someone else. We use therapy as shorthand for seeing a professional mental health expert. But what kinds are there? And what will you feel serving up the spaghetti contents of your brain to a stranger?

We have your need-to-know covered.

DO YOU ACTUALLY NEED THERAPY?

Necessity isn’t everything.

‘Some people find therapy helpful for positive development, almost like coaching,’ notes Dr Carina Eriksen, a registered and chartered consultant counselling psychologist. When it comes to mental health, you don’t have a cookie-cutter mind, but if you’ve been feeling any of the following, Dr Eriksen suggests you might benefit from talking to a pro…

‘I CAN’T COPE WITH EVERYDAY LIFE’

‘Reduced functioning can hint at various psychological difficulties,’ says Dr Eriksen. ‘You might be depressed and lacking motivation or you may just be anxious and routine tasks seem to overwhelm you. In addition, drinking in excess or taking drugs could be a sign that you’re trying to self-medicate or shut off from a difficult situation.’

✔‘MY FOCUS IS SHOT’ Impaired concentration is a common symptom of depression. ‘Other problems can cause this too,’ says Dr Eriksen, ‘such as anxiety, or intrusive or obsessive thoughts.’

‘I DON’T ENJOY… WELL… ANYTHING’ It can be a warning sign of depression or anxiety if you lose interest in previously rewarding activities and stop feeling joy across the board.

✔‘I’M ALWAYS FLYING OFF THE HANDLE’ Stress, anxiety or depression could be at the root.

✔‘I’M STRUGGLING WITH CHANGE’ ‘If you’ve tried to make positive changes in your life – from taking up exercise to ridding yourself of a toxic relationship – but can’t stick to them, you may find it beneficial to work through the stumbling blocks with a professional,’ says Dr Eriksen.

FIND YOUR FIT

Your GP is a good first port of call if you’re struggling with a mental health problem. (Visit mind.org.uk for its Find the Words guide on how to prepare for your first appointment.) If they refer you for NHS talking treatment, the obvious perk is it’s free. Waiting lists can be long but, once you get started, you’ll usually meet your therapist regularly for around 50 minutes.

If you’re going private, cast a critical eye over a therapist’s credentials. A whole range of specialists can offer therapy and, as such, qualifications vary dramatically. Look for someone who’s a member of or accredited by a relevant professional body, such as the British Association for Counselling & Psychotherapy (BACP) or the British Psychological Society (BPS).

Therapists’ qualifications and experience will, not surprisingly, have a knock-on effect on the cost. ‘As a rough guide, you could expect to pay around £70 or more per session for a registered psychologist (who will usually have had to train for a minimum of six years), whereas an accredited counsellor might cost £35 or more per session,’ says registered counselling psychologist Dr Victoria Galbraith (drvictoriagalbraith.co.uk). ‘Many therapists will offer a sliding scale for those who are struggling financially.’

Undeniably, chemistry matters too. ‘[My feeling is that] having the right person to speak with is one of the most fundamental parts of therapy,’ says Dr Galbraith. ‘After a first meeting, reflect on whether you feel you could eventually tell that person significant things about your life.

Trust your instincts.’

Remember that therapists don’t have, as Dr Galbraith puts it, ‘a magic wand’. It’s important to approach therapy with a willingness to work. ‘A misconception is you’re going to get advice about life choices. That’s not what we do,’ notes Dr Galbraith. ‘The client is the expert on their own life. It’s our job to help them find their own solutions. Timing is really important. I always ask a new client, “Why now?” It’s important to be in the right place in your life for therapy, and not just be coming because someone else has told you that you should.’

So what does therapy involve? Your first session should cover practical stuff – how the therapy will be structured, its cost, the therapist/client relationship, confidentiality etc. Beyond that, approaches vary as dramatically as Victoria Beckham’s career. Here’s a taster of five types and the issues they can address…

‘HAVING A RIGHT PERSON TO SPEAK WITH IS CRUCIAL’

IF IT’S CLEAR WHAT THE PROBLEM IS…

CONSIDER HAVING COGNITIVE BEHAVIOURAL THERAPY (CBT).

‘In CBT, we look at how the way someone thinks and behaves may be causing or exacerbating a particular difficulty and how to change these patterns,’ explains Dr Galbraith. CBT is ‘hands on’; you’ll tend to set goals together around specific issues you want to tackle and work through them, often with ‘homework’.

It’s particularly recommended for depression and anxiety, but can help with many problems, including panic attacks, eating problems and phobias. ‘Because CBT is directive and structured, a course of it can be completed in a relatively short period of time, so it may be a more

suitable approach than an open-ended therapy if you’re self-funding and can only afford limited sessions,’ notes Dr Galbraith. ‘Although, of course, you should always discuss if it’s an appropriate path for you with your therapist,’ she adds.

IF YOU WANT TO DIG DEEPER…

CONSIDER PSYCHODYNAMIC (OR PSYCHOANALYTIC) THERAPY.

Not only used to treat anxiety and depression, this method can also be helpful for those experiencing a loss of meaning in their lives, or suffering from obsessional behaviours. With its roots in Freudian psychoanalysis, psychodynamic therapy involves working collaboratively with your therapist to look at the bigger picture of why you are how you are – in particular, the impact of past experiences. ‘It also explores your relationships with others to help you understand how you relate to the world,’ says Dr Eriksen. ‘Because it explores issues more deeply, it can be helpful for more complex difficulties or if you have multiple, intertwined issues,’ says Dr Galbraith.

‘GROUP THERAPY CAN HELP TO DEAL WITH ADDICTIONS’

IF YOU’VE HAD REPEATED BOUTS OF DEPRESSION…

CONSIDER MINDFULNESS BASED COGNITIVE THERAPY (MBCT).

Mindfulness is the practice of bringing awareness to the present. ‘It’s about not allowing your roller-coaster thoughts to take control but rather observing them go by,’ says Dr Galbraith. ‘It’s really a strategy for living well.’

MBCT takes things an extra step further, combining mindfulness with cognitive therapy in a structured programme, and is particularly recommended for people who experience recurring depressions. Research found that in people who’d had three or more episodes of major depression (at least two of which occurred in the previous five years, and one of which occurred in the previous two years), MBCT (delivered when they were in remission/recovery after taking anti-depressants) almost halved the recurrence rate over 12 months compared with usual care.

IF YOU’RE FACING A DIFFICULT LIFE EVENT…

CONSIDER COUNSELLING.

Not to be dismissed as a wishy-washy chat over a cuppa, counselling is one of the more common therapies offered at GP surgeries for treating mild anxiety and depression.

‘Counselling can be well-suited to difficult life situations, such as divorce,’ says Mind’s Stephen Buckley. ‘The benefit is having someone listening to you, no judgement.’ Some charities may offer free/low-cost counselling.

IF THE THERAPIST/ CLIENT RELATIONSHIP SOUNDS A BIT INTENSE…

CONSIDER GROUP THERAPY.

Yup, this involves working with a therapist in a group. For some, this might dilute the awks factor of one-on-one sessions.

‘As well as anxiety and depression, this can be especially good for people with quite specific problems, such as addiction. They might feel because other people in the group have similar experiences they can understand them, so they’re more comfortable sharing,’ says Buckley. It may also be cheaper than individual private sessions.