Counselling

 

Counselling is the most common type f talking therapy.

It  involves a trained therapist listening to you and helping you find ways to deal with emotional issues.

 

What can counselling help with?

 

Counselling can help you cope with: 

 

• a mental health condition, such as depression, anxiety or an eating disorder

• an upsetting physical health condition, such as infertility

• a difficult life event, such as a bereavement, a relationship breakdown or work-related stress

• difficult emotions – for example, low self-esteem or anger

• other issues, such as sexual identity

 

What to expect from counselling

 

At your appointment, you'll be encouraged to talk about your feelings and emotions with a trained therapist, who'll listen and support you without judging or criticising. 

The therapist can help you gain a better understanding of your feelings and thought processes, and find your own solutions to problems. But they won't usually give advice or tell you what to do.

 

Counselling can take place:

 

• face to face

• in a group 

• over the phone 

• by email 

• online through live chat services 

 

You may be offered a single session of counselling, a short course of sessions over a few weeks or months, or a longer course that lasts for several months or years.

It can take a number of sessions before you start to see progress, but you should gradually start to feel better with the help and support of your therapist.

 

Cognitive Behavioral Therapy

 

 

Cognitive-behavioural therapy (CBT) is one of the most popular types of therapy and is usually what you will receive through the NHS.

 

It is short-term form of psychotherapy directed at present-time issues and based on the idea that the way an individual thinks and feels affects the way he or she behaves. The focus is on problem solving, and the goal is to change clients' thought patterns in order to change their responses to difficult situations. A CBT approach can be applied to a wide range of mental health issues and conditions.

 

When It's Used

 

CBT is appropriate for children, adolescents, and adults and for individuals, families, and couples. It has been found to be highly or moderately effective in the treatment of depression, generalized anxiety disorder, post-traumatic stress disorder, general stress, anger issues, panic disorders, agoraphobia, social phobia, eating disorders, marital difficulties, obsessive-compulsive disorder, and childhood anxiety and depressive disorders. CBT may also be effective as an intervention for chronic pain conditions and associated distress.

 

What to Expect

 

In CBT you will first learn to identify painful and upsetting thoughts you have about current problems and to determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, you will learn skills that help you change your thinking patterns so they are more accurate with respect to a given situation. Once your perspective is more realistic, the therapist can help you determine an appropriate course of action. You will probably get “homework” to do between sessions. That work may include exercises that will help you learn to apply the skills and solutions you come up with in therapy to the way you think and act in your day-to-day life.

 

How It Works

 

CBT integrates behavioural theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances. CBT is rooted in the present, so the therapist will initially ask clients what is going on in their mind at that moment, so as to identify distressing thoughts and feelings. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.

 

Compassion-Focused Therapy

 

Compassion-Focused Therapy (CFT) helps those who struggle with the shame and self-criticism that can result from early experiences of abuse or neglect. CFT teaches clients to cultivate skills in compassion and self-compassion, which can help regulate mood and lead to feelings of safety, self-acceptance, and comfort.

The technique is similar to Mindfulness-Based Cognitive Therapy, which also instructs clients about the science behind the mind-body connection and how to practice mind and body awareness.

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When It's Used

 

CFT has been shown to effectively treat long-term emotional problems including anxiety disorders, mood disorders, personality disorders, eating disorders, hoarding disorder, and psychosis by addressing patterns of shame and self-criticism, which can significantly contribute to mental health issues. 

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Research suggests that humans have at least three different emotion regulation systems: a threat and self-protection system, which generates anger, disgust, or fear to protect us; a drive and excitement system, which motivates us to seek outside resources like mates, food, and status; and a soothing and social safety system, which is activated when we feel peaceful and content enough that we are no longer compelled to seek outside resources. 

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Mental illness can result, in part, from an imbalance between these three systems. People high in shame and self-criticism may not have had enough stimulation of their soothing system early in life, and too much stimulation of their threat system. As a result, they can struggle to be kind to themselves or feel kindness from others. They may be highly sensitive to criticism or rejection, whether real or perceived, and internalize that disapproval. The goal of CFT is to correct this imbalance in the emotion regulation systems.

 

What to Expect

 

CFT treatment can be practiced in individual or group sessions, with the overarching goal of cultivating compassion for the self and others. The therapist will teach the client about the evolution of the brain, the construction of the self, and the systems that regulate emotions.

They’ll also help the client develop skills such as compassion, self-compassion, and mindfulness. Clients typically receive homework to practice these skills on days without sessions.

 

How It Works

 

Psychologist Paul Gilbert developed Compassion-Focused Therapy in the 2000s to specifically address shame and self-criticism, drawing on evolutionary, social, developmental, and Buddhist psychology and neuroscience. 

Shame and self-criticism often arise from abuse, neglect, and bullying. People who experience early trauma can come to feel that their internal and external worlds are almost always on the brink of hostility. Internal self-berating and fear of outside rejection can become so chronic that it can “literally harass” people into depression and anxiety, according to Gilbert.

 

CFT overlaps with therapies developed to treat trauma, which address early memories, recognize negative thoughts, and correct misperceptions. But for some clients who struggle with shame and self-criticism, being able to counter unreasonable thoughts isn’t enough; without self-compassion, the logic does not translate into feeling better.

CFT replaces feelings of hostility and insecurity toward oneself with compassion and understanding, so that clients can begin to soothe themselves, accept soothing from others, and generate feelings of contentment and safety.

 

Hypnotherapy

 

Hypnotherapy is guided hypnosis, or a trance-like state of focus and concentration achieved with the help of a clinical hypnotherapist. This trance-like state is similar to being completely absorbed in a book, movie, music, or even one's own thoughts or meditations. In this state, clients can turn their attention completely inward to find and utilize the natural resources deep within themselves that can help them make changes or regain control in certain areas of their life.

 

When It's Used

 

Since hypnotherapy is an adjunct form of therapy, used along with other forms of psychological or medical treatment, there are many applications. Hypnotherapy can be used to treat anxiety, phobias, substance abuse including tobacco, sexual dysfunction, undesirable spontaneous behaviors, and bad habits. It can be used to help improve sleep, learning disorders, communication, and relationship issues. Hypnotherapy can aid in pain management and help resolve medical conditions such as digestive disorders, skin issues, and gastrointestinal side effects of pregnancy and chemotherapy. It can also be used by dentists to help patients control their fears or to treat teeth grinding and other oral conditions.

 

What to Expect

 

Although there are different techniques, clinical hypnotherapy is generally performed in a calm, therapeutic environment. The therapist will guide you into a relaxed, focused state and ask you to think about experiences and situations in positive ways that can help you change the way you think and behave. Unlike some dramatic portrayals of hypnosis in movies, books, or on stage, you will not be unconscious, asleep, or in any way out of control of yourself. You will hear the therapist’s suggestions, but it is up to you to decide whether or not to act on them.

 

How It Works

 

Hypnosis is not a psychotherapeutic treatment or a form of psychotherapy, but rather a tool or procedure that helps facilitate various types of therapies and medical or psychological treatments. Only trained health care providers certified in clinical hypnosis can decide, with their patient, if hypnosis should be used along with other treatments. As with psychotherapy, the length of hypnosis treatment varies, depending on the complexity of the problem.

 

 

Psychodynamic Therapy

 

Psychodynamic therapy is similar to psychoanalytic therapy in that it is an in-depth form of talk therapy based on the theories and principles of psychoanalysis. But psychodynamic therapy is less focused on the patient-therapist relationship because it is equally focused on the patient’s relationship with his or her external world. Often, psychodynamic therapy is shorter than psychoanalytic therapy with respect to the frequency and number of sessions, but this is not always the case.

 

When It's Used

 

Psychodynamic therapy is primarily used to treat depression and other serious psychological disorders, especially in those who have lost meaning in their lives and have difficulty forming or maintaining personal relationships. Studies have found that other effective applications of psychodynamic therapy include addiction, social anxiety disorder, and eating disorders.

 

What to Expect

 

With help from the therapist, the patient is encouraged to speak freely about anything that comes to mind, including current issues, fears, desires, dreams and fantasies. The goal is to experience a remission of symptoms but also derive such benefits as increased self-esteem, better use of their own talents and abilities, and an improved capacity for developing and maintaining more satisfying relationships. The patient may experience ongoing improvements after therapy has ended. Although short-term therapy of one year or less may be sufficient for some patients, long-term therapy may be necessary for others to gain lasting benefits.

 

How It Works

 

The theories and techniques that distinguish psychodynamic therapy from other types of therapy include a focus on recognizing, acknowledging, understanding, expressing, and overcoming negative and contradictory feelings and repressed emotions in order to improve the patient’s interpersonal experiences and relationships. This includes helping the patient understand how repressed earlier emotions affect current decision-making, behaviour, and relationships. Psychodynamic therapy also aims to help those who are aware of and understand the origins of their social difficulties but are not able to overcome their problems on their own. Patients learn to analyze and resolve their current issues and change their behaviour in current relationships through this deep exploration and analysis of earlier experiences and emotions.

 

 

Dialectical Behavior Therapy

 

Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

 

When It's Used

 

DBT was originally developed to treat borderline personality disorder. However, research shows that DBT has also been used successfully to treat people experiencing depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse. DBT skills are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment and communicate and interact effectively with others.

 

What to Expect

 

DBT treatment typically consists of individual therapy sessions and DBT skills groups. Individual therapy sessions consist of one-on-one contact with a trained therapist, ensuring that all therapeutic needs are being addressed. The individual therapist will help the patient stay motivated, apply the DBT skills within daily life, and address obstacles that might arise over the course of treatment.

 

DBT skills group participants learn and practice skills alongside others. Members of the group are encouraged to share their experiences and provide mutual support. Groups are led by one trained therapist teaching skills and leading exercises. The group members are then assigned homework, such as practising mindfulness exercises. Each group session lasts approximately two hours, and groups typically meet weekly for six months. Groups can be shorter or longer, depending on the needs of the group members. DBT can be delivered by therapists in many ways. For instance, some people complete the one-on-one therapy sessions without attending the weekly skills group. Others might choose the group without regular one-on-one sessions.

 

 

How It Works

 

DBT is a cognitive-behavioural treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships.

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As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.

 

 

Eye Movement Desensitization and Reprocessing Therapy

 

EMDR is a unique, nontraditional form of psychotherapy designed to diminish negative feelings associated with memories of traumatic events. Unlike most forms of talk therapy, EMDR focuses less on the traumatic event itself and more on the disturbing emotions and symptoms that result from the event. Treatment includes a hand motion technique used by the therapist to guide the client’s eye movements from side to side, similar to watching a pendulum swing. EMDR is a controversial intervention, because it is unclear exactly how it works, with some psychologists claiming it does not work. Some studies have shown, however, that EMDR is effective for treating certain mental-health conditions.

 

When It's Used

 

EMDR was originally developed to treat the symptoms of post-traumatic stress disorder, anxiety, and phobias. Some therapists also use EMDR to treat depression, eating disorders, schizophrenia, sexual dysfunction, and stress caused by chronic disease.

 

What to Expect

 

In the early stages of therapy, you will discuss your problems and symptoms with your therapist, but you won’t necessarily have to reveal all the details of your traumatic experience(s). Instead, your therapist will help you focus on related negative thoughts and feelings that you are still experiencing, and decide which of these beliefs are still relevant and which ones you would like to replace with positive thoughts and beliefs. You will learn techniques to help you deal with disturbing feelings. Your therapist will then guide you through a process known as desensitization. While keeping the memory of a painful or traumatic event in mind, you will follow the therapist’s back-and-forth finger movements with your eyes. The purpose of this technique is to help you fully process your negative feelings and begin to recognize that you no longer need to hold on to some of them. Future sessions are devoted to reinforcing and strengthening positive feelings and beliefs until you get to a point where you can bring up memories of the traumatic event without experiencing the negativity that brought you to therapy in the first place.

 

How It Works

 

The goal of EMDR is to fully process past experiences and sort out the emotions attached to those experiences. Negative thoughts and feelings that are no longer useful are replaced with positive thoughts and feelings that will encourage healthier behavior and social interactions. Ultimately, clients learn to handle stressful situations themselves. EMDR therapy occurs in eight phases:

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1.  History and treatment planning

2. Preparation, to establish trust and explain the treatment in-depth

3. Assessment, to establish negative feelings and identify positive replacements

4. Desensitization, which includes the eye movement technique

5. Installation, to strengthen positive replacements

6. Body scan, to see if the client is now able to bring up memories of trauma without experiencing negative feelings that are no longer relevant, or if reprocessing is necessary

7. Closure, which occurs at the end of every session

8. Re-evaluation, which occurs at the beginning of every session

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