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I will try to create more happiness and less unhappiness in the world around me

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Action 9

Get help if you're struggling

There is a lot we can do to increase our own happiness but sometimes it can feel like we are stuck with negative emotions, unhelpful patterns of thought or locked on a particular issue that feels irresolvable. This "stuckness" can sometimes become overwhelming and can start to significantly affect the quality of our lives and our relationships. So if our stuckness persists it may be helpful to seek professional support.

Why do it?

If we browse through the wide range of tools, techniques and strategies to help ourselves and those around us live happier lives, we can see how much we are capable of doing on our own and with the help of our loved ones. But we can all go through particularly difficult times when our own internal and external resources are stretched and we might need to find professional support.

Therapy or counselling can provide regular time, a safe space and professional guidance for us to explore difficult issues and emotions; cope with crises or losses; improve relationships; or develop new ways of thinking and living.

There are many different types of therapy available and it's important to find one that is appropriate for you and your needs. What works well for one person might not work as well for the next. This guide and the resources section will help you to get a feel for what is available and what to look for in a therapist or counsellor.

Cognitive Behavioural Therapy (CBT) has the largest body of evidence of any psychological therapy for the treatment of depression and anxiety disorders.[1] It is associated with longer-term improvements than medication alone.[2]

This is not to say that other types of counselling or psychotherapy will not work for you. There have not been anything like as many clinical trials for non-CBT approaches, which makes comparisons between the different therapies difficult. However, research has already established that several non-CBT treatments are also effective in depression. The National Institute of Clinical Excellent (NICE: www.nice.org.uk) publishes clinical guidelines for the treatment of many emotional difficulties that can be consulted to see which therapies have strong research support at the moment. The increasing awareness of the importance of mental health and wellbeing and the efficacy of talking therapies and other practices such as mindfulness means that it is likely the coming decades will bring a growing evidence base for a wider range of options.

Where to start

1 What types of therapy are there?

It can be useful to gain an understanding of the different types of therapy on offer today. Some may be more effective for certain issues or conditions than others and our personality may suit some approaches more than others. So it is important to do some research to find what is right for you.

If the issue is urgent and you are not in a position to research - please see your GP.

There are different therapies available which can make it difficult to navigate. But the good news is that this makes it increasingly likely that there is something out there that will be a help to you.

Here is a list of some of the main types of therapy available. For more detailed information on the different types of therapy and counseling, MINDand the British Association for Counselling and Therapistscan provide more details. Your GP will also be a good source of advice (see step 2 below).

Cognitive Behavioural Therapy: CBT mainly focuses on the present but in some cases it can also look at past events. It is based on the idea that the way in which we think about and respond to life events has a profound impact on how we behave and how we feel emotionally. The aim is to learn how to identify and deal with irrational and unhelpful thoughts, and to understand the connection betweenthoughts and feelings. Therapy sessions can involve practical exercises as well as talking and the therapist will usually set 'homework' between sessions.

There are also some online CBT courses available (see Resources below) which can be effective for certain issues of moderate severity.

Counselling: Counseling provides a safe space for you to talk about the issues and emotions that are troubling you. Despite what the names suggests, counsellors are not there to give you advice on what to do; they are trained to listen 'actively' to what you say, to comment from a professional prospective, and to help you gain insight into what is going on.

Family therapy: This type of therapy helps family members find constructive ways to help each other. Family therapists not only support change with individuals but also in their relationships in their family and beyond, so children, young people, adults and/or those important to them are supported in continued recovery. As a form of systemic therapy it requires specifically trained counsellors.

Gestalt therapy:In this type of therapy the focus is on helping the client to gain self-awareness by analysing behaviour and body language and talking about their feelings. This approach often includes acting out scenarios and dream recall.

Group therapy:In this type of therapy there are generally 8 to 12 people in a group, who meet together regularly, with a therapist, to talk and work on their issues. It is especially helpful for people with problems around relating and communicating with other people, and to develop self-awareness. As there are several people in the group it may cost less than one-to-one therapies.

Psychoanalysis and psychodynamic therapy: This type of psychotherapy is based on the idea that our past experiences, relationships and thoughts have an impact on our experience of the present. It is traditionally based on the work of Sigmund Freud, who believed that our experiences from early childhood are often repressed in the unconscious mind. The therapist seeks to bring these to the forefront of the client's mind in order to explore and work through them with the client.

Solution-Focused Brief Therapy:This type of therapy aims to promote positive change and to move the client on from dwelling on past problems. Clients are encouraged to focus positively on what they do well, to set goals and work out how to achieve them. As little as three or four sessions may be beneficial.

2 Finding a therapist

The main ways to find a therapist are through the NHS, privately or through a voluntary organisation. It is critical is that you check that they are appropriately qualified to work with the issue you want to work on and that you feel comfortable with them. Guidance on what to look for is given in the sectionsbelow.

Finding a therapist through the NHS -If you think that you could benefit from counselling of some kind, the best thing to do is to have a chat with your GP first. It is useful for them to gain an understanding of the issues you are facing so that they can refer you on to an appropriate kind of therapy.

Your GP can refer you to a counsellor or for CBT that is free on the NHS if he or she thinks that this will benefit you.

Recently the Government has substantially increased the availability of psychologicial therapies for depression and anxiety disorders through the Improving Access to Psychological Therapies (IAPT) initiative. Many areas now have an IAPT service and they should be available throughout the country within two years. These are highly professional services with good success rates. You are entitled to refer yourself direct if you wish, rather than through your GP.

Finding a private therapist -Private therapy usually costs between £40 and £100 per hour. If you would prefer to go privately, it is also a good idea to ask your GP in the first instance about what type of therapy they think will be most helpful to you and if they can recommend someone in the local area.

The following professional bodies also list approved therapists:

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

  • cognitive behavioural therapists

Association for Family Therapy (AFT)

  • family therapists

British Association for Counselling and Psychotherapy (BACP)

  • counsellors and therapists

British Psychoanalytic Council (BPC):

  • psychoanalytic psychotherapists

UK Council for Psychotherapy (UKCP):

  • psychotherapists

British Association for Sexual and Relationship Therapy (BASRT)

  • couples counselling and sex therapists

Word of mouth recommendations can be helpful, so if you know of a friend that has found therapy helpful they may be willing to recommend the person they used (but your needs and who you feel comfortable with may be different). Therapists will also advertise on the internet, the Yellow Pages and through voluntary organisations (see below).

Most therapists will list their credentials. It is perfectly fine to verify these with the professional body they belong to.

Therapists through a voluntary organization -Some voluntary organisations that are either focused on mental health issues or particular issues such as domestic violence may offer an affordable low-cost, or occasionally free, counselling service. Often therapists and counsellors there are in training. Although not fully accredited the trainees usually have intensive supervision. Some organisations such asMINDwill be able to point you in the direction of a suitable organization in your local area.

3 How do therapy sessions work?

Therapy sessions are typically 50 minutes long. The frequency of sessions varies depending on the client's needs and the type of therapy, but once a week is common. The therapist you are considering will suggest what is appropriate for you and taking into account your time and budget. The number of sessions required will again vary and may be difficult to estimate at the start. Some forms of therapy such as CBT, typically require fewer sessions than psychoanalysis and psychodynamic therapy.

4 What do I look for in a therapist?

It is difficult to be 100% sure before you try working with a therapist, but here are some tips on what to look for.

Before you start -It is important to ensure that you are seeing a qualified therapist who is registered with a professional body (see Step 2 above) and that you have chosen an appropriate type of therapy (to your knowledge). This is why it is a good idea to go through your doctor and to do some research beforehand.

Telephone first - A good first step once you have identified a qualified person in your area, especially if you are finding a therapist yourself, is to arrange a telephone call. This will enable you to briefly explain why you are seeking therapy and for them to explain how they usually work and their experience in the area you are seeking help with. It is also perfectly fine to ask them about their credentials and the professional body they belong to.

There are also some practical considerations to explore:

  • Do they have space to take on new clients?
  • The location they work from - how easy is it for you to get to?
  • When they work - do they offer sessions at times you can commit to on a regular basis?
  • If applicable, cost - how much do they charge and is this affordable for you?
  • What you might expect in the first session?

A call will start to give you a sense of whether you feel comfortable with them and if their working arrangements are practical for you. You may wish to speak with several therapists in your area to find the one you feel most comfortable working with.

The first session- This is typically what is called an assessment and so may be structured differently from ongoing sessions. The therapist will want to understand why you are looking for therapy, what you want to get out of the sessions, the background to the issue and, in some cases, and what your goals are. It may also (especially for CBT) include the completion of some questionnaires.

It is a chance for both you and the therapist to work out if it is the right fit and the right kind of therapy for your needs. You will get a sense of how it feels to work with them and how supportive they are of your issue and committed to helping you resolve it.

Questions you may want to explore are:

  • How the sessions are likely to work?
  • How many sessions might be needed (this is sometimes difficult for them to estimate initially)?

It is worth bearing in mind that it may feel uncomfortable at first. It is difficult to speak about painful issues and emotions, particularly if you are not used to talking about them. Therapy is not like a cup of tea with a friend. Therapists are trained professionals and they might ask you difficult questions from time to time in order to help you work things through. This might feel uncomfortable at times too and emotionally tiring.

But with that in mind, it should feel like a safe space for you. You should always feel completely at ease with your therapist and able to speak honestly about whatever is on your mind. This includes being able to raise any concerns you might have about how the two of you are working together, anything the therapist says that isn't clear or that you have found upsetting in any way.

For more information on what to look for, how to get the best our of your therapistand what to do if you are unhappy, please visit:http://www.itsgoodtotalk.org.uk/

References

Resources

POSTER #7: RESILIENCE

Find ways to bounce back

Resilience 200

POSTER #9: ACCEPTANCE

Be comfortable with who you are

Acceptance 200

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Our happiness is not set in stone

Although our genes influence about 50% of the variation in our personal happiness, our circumstances (like income and environment) affect only about 10%.

As much as 40% is accounted for by our daily activities and the conscious choices we make. So the good news is that our actions really can make a difference.