Experimental constructivist
Family, couple, sexual, and systemic therapies
Humanistic and integrative psychotherapies
Hypno-psychotherapy
Psychotherapeutic counselling
In addition to these 7 Sections, UKCP also covers other Organisations, such as The British Psychological Society(BPS) and the Royal College of Psychiatrists who are what is termed ‘Special Members’, and the British Association for Counselling and Psychotherapy (BACP).
Although a wide range of therapies have value, some may be more effective than others in overcoming depression. Given that the scientific literature on some types of therapy as applied to depression is quite limited, we suggest that you start with therapies that are proved to be effective for dealing with depression.
Discovering who’s who in psychological therapy
Until recently, anyone could call themselves a therapist, psychotherapist, psychological therapist, or counsellor and offer their services to the public irrespective of their training or experience without getting into trouble with the authorities, because these titles weren’t regulated. This fact may come as a surprise given the potential for harm to the mental well-being of clients. But the UK Government is now moving to regulate specific professional titles and to specify who has the right to practise psychological therapy.
It’s very important to ask about a practitioner’s specific training in particular types of psychological therapy, because not all professionals have been trained in the types of psychological therapy that have been found effective for depression (outlined in the preceding section).
In the following list, we review the most common professional titles controlled by professional qualification boards. We also describe the usual training needed to obtain each type of professional qualification. Requirements vary across Europe, but recent legislation has changed so psychologists with European qualifications from outside the UK can practise in the UK, without extensive additional training requirements.
Assistant Psychologists (APs): APs provide a ‘helping hand’, working closely with clinical psychologists. They may assess clients for various cognitive and behavioural problems, assist in therapeutic/discussion groups, support carers, family members and clients, and provide relevant information to referrers and other professionals. APs are supervised by a clinical psychologist working in the same department or speciality. They have an honours degree in psychology, plus some previous relevant experience such as NHS voluntary or paid work. APs differ in their amount and relevance of previous experience and likewise their level of responsibility, grade, and the specific tasks they carry out in the department.
Associate Psychologists: The training for this new grade, which is between Assistant and Clinical Psychologist, has recently commenced, with the first courses running in Nothumberland from 2005-7.
Clinical Psychologists: Chartered Clinical Psychologists normally complete a Bachelors (first) degree (B.A. or B.Sc.) in Psychology. Usually they undertake further experience, perhaps as a Psychology Assistant, or Graduate Mental Health Worker, or even do the new training for an Associate Psychologist. They then complete a three-year doctoral training degree in Clinical Psychology, which has both academic and clinical components. In addition, they must complete a yearlong internship followed by one or two years of supervised postdoctoral training. The British Association for Behavioural and Cognitive Psychotherapies (BABCP) or the Health Professions Council (HPC) has taken on the role of assessing and checking the maintenance of ongoing continuous development for therapists from both Clinical Psychology and other professions to become registered as accredited CBT therapists.
Community Psychiatric Nurses (CPNs) and Community Mental Health Nurses: These psychiatric nurses work in the community rather than in hospitals. They may be attached to GPs’ surgeries, Community Mental Health Teams in Mental Health Resource Centres or Psychiatric Units. They may also visit you in your home. Their role includes offering emotional support and helping you explore ways of living with your problems, anxiety management techniques, and administering psychiatric drugs.
Counselling Psychologist: Qualifications in this are by accredited courses, or through an independent route. Training usually lasts three years full-time, or equivalent part-time, at postgraduate level.
Counsellor: At present there are no legal minimum qualifications necessary to practise as a counsellor in the UK. The British Association for Counselling and Psychotherapy (BACP; previously the British Association of Counselling) accredits counselling courses and practitioners. BACP-accredited courses are likely to be one year full time, or two-three years part time. At present, BACP doesn’t accredit shorter counselling skills courses.
Gateway mental health worker: These senior mental health professionals, such as experienced community psychiatric nurses, social workers or psychologists, work with GPs and primary care teams, NHS Direct, and in casualty departments to respond to people who need urgent specialist mental health services. They also help people move smoothly from primary care to specialised services.
Graduate or primary care mental health worker: This new role was introduced in the early 2000s. it encompasses various different levels of training and responsibility. Its exact nature and future is still under discussion, especially in light of other developments and legislation.
Occupational Therapists (OTs): OTs work for the NHS or social services, and they assess and treat physical and psychiatric conditions. They have a degree in Occupational Therapy, which usually takes three years, and they may also do additional training in psychological therapy, for example, in CBT.
Psychiatrist: Psychiatrists first qualify as medical doctors. They then undertake specialist training in Psychiatry, covering the treatment and diagnosis of a range of emotional and psychiatric disorders, including depression. Their training emphasises biological treatments, and allows them to specialise in prescribing medication as well as biological therapies such as electroconvulsive therapy (see Chapters 15 and 16). Psychiatrists also train in psychological therapies including CBT and another form of psychological therapy, psychodynamic psychotherapy, often known as ‘psychotherapy’.
Registered Mental Nurses (RMNs): RMNs are qualified Nurses who have specialist training in mental health and who have taken a three-year course, usually at a university with some general nursing included. An RMN qualification doesn’t make someone a psychotherapist or counsellor, but is a good basis from which to take further training, which is what many nurses now do.
Social Worker: Social workers register with the General Social Care Council. They are professionally qualified staff assessing the needs of service users and plan the individual packages of care and support that best help their clients. A Social Worker usually has a first degree in Social Work, but sometimes considerable experience overrides the requirement of a degree.
Finding the right therapist for you
Some people take less time choosing a therapist than they do selecting the best fruit at the supermarket. That’s a real shame, because the right therapist can make an enormous difference to both your speed and level of recovery, even allowing you to feel still better than how you were before suffering depression. And in the worst case, the wrong therapist can cost both time, money, and may even actually cause increased emotional distress.
Important issues to consider when you look for a therapist include:
NHS or private: Many NHS Clinical Psychology Services have long waiting lists, but there are developments to provide a range of mental health professionals to work directly with GP surgeries and ease the problem of the waiting list. Increasingly the Community Mental Health Teams (CMHTs) don’t offer help for the milder forms of depression. GP surgeries can sometimes provide a fixed number of sessions from the practice’s counsellor fairly promptly. However, depression that’s more severe, while still not qualifying for CMHT criteria, can require longer that the fixed number of sessions available through the GP surgery.
/> Some people choose to go private, to speed up getting help, or perhaps because they want to see a particular professional or have special concerns about privacy. Private therapy means paying for this yourself, or through private health insurance. If the latter, do ensure your policy covers that particular form of therapy, and therapist for that particular problem. Some insurance companies have lists of preferred provider therapists that they cover, while others allow you to see almost any qualified therapist. Certain ones restrict access to a very narrow choice. A few companies only cover psychological therapies known to be effective, such as the ones in this book.
Reputation and recommendations: Therapists can’t provide you with the names of satisfied customers, because they’re required to respect confidentiality. However, you can find out more about therapists’ reputations from other sources. Ask around. Talk to your friends and/or your GP.
Be cautious about advertisements on TV, the Internet, in newspapers magazines and the phone book: they aren’t especially reliable sources of information about therapists’ reputations. Consider checking that the person really is registered with their professional organisation. You can do this by contacting the organisation over the Internet or by phone.
Availability of appointments: Therapists vary. Some offer early morning, or evenings, or even weekends, to fit in with your own work commitments, while NHS times are usually but not always 9am to 5pm.
Training and professional registration: We discuss the general training requirements for various qualified mental health professionals in the previous section. Remember to ask about training and experience in the therapies that have been shown to work best for depression, such as CBT and IPT (see the earlier section ‘Uncovering what works: The effective physiological therapies’.)
Putting time, effort and even money in therapy ultimately pays off in many, sometimes unexpected, ways. For example, studies show that psychological therapy actually cuts visits to the GP, and it also appears to improve both physical and mental health.
Having rapport with your therapist
Most people relate well to their therapist, and make improvements with their depression. They develop what has been called a good ‘therapeutic alliance’, both working hard and making progress towards a common shared goal. Therapists are generally bright, kind, and skilful. However, therapists and clients sometimes just don’t gel.
You may find that you and your therapist just don’t have rapport, and feel that your therapist doesn’t understand you. Perhaps the therapist closely resembles your ex and every therapy session triggers a flood of painful memories. Or maybe you just don’t feel there’s a connection between you and your therapist, for no apparent reason.
The quality of the therapeutic relationship (how well you and your therapist relate to each other) has been found to consistently predict therapy outcomes, so it’s essential that you feel comfortable. A good relationship is linked to successful therapeutic change.
Here are some questions you may want to ask yourself after you’ve had a few sessions with your therapist, to help decide the quality of the relationship:
Do I feel like I can tell my therapist just about anything?
Does it seem like my therapist cares about me?
Does my therapist understand me?
Does my therapist seem interested in my problems?
Does my therapist hear what I’m trying to say?
Do I trust my therapist?
Is my therapist non-judgemental and non-critical with me?
Do I feel safe discussing my problems with my therapist?
If you answer any of these questions with a firm ‘no’, or you answer several of them without a definitive ‘yes’, discuss your concerns with your therapist. If you feel that you can’t discuss these issues with your therapist, ask yourself the reasons for this.
If you find you have good reasons for feeling so unsafe that you can’t imagine being open and honest, you probably need to look for another therapist. However, if you have a problem in speaking frankly to your therapist because of shyness or embarrassment, remind yourself that the therapist has been trained to hear your concerns, and that it is both right and necessary that you express them.
How your therapist reacts to your concerns about the quality of your relationship with each other shows whether the relationship can be repaired. Here’s how a therapist with good rapport may respond to a client’s concerns:
Client: I need to talk to you about something.
Therapist: Sure, what is it?
Client: I’ve been feeling that I can’t be honest with you because I’m afraid you’ll be critical.
Therapist: It’s very helpful that you’re telling me this. Can you help me understand anything about the times when it’s felt like I’ve been critical of you?
Client: Well, last week I told you about my plans to look for another job and you said I shouldn’t do it.
Therapist: I guess that sounded to you like criticism, and as if I wasn’t supporting you?
Client: Yes, it really did. It felt as if you thought I was stupid.
Therapist: That must have been pretty awful, and I’m sorry you felt like that. But looking at things another way, can you come up with any other reason as to why I might have suggested that PERHAPS (which is what I recall I actually said) it wasn’t a good idea to give up your job and try to find something else at this particular time?
Client: No. Are you saying there really was another one?
Therapist: Well, yes. I’ve found that many times, when someone makes major life decisions while they’re caught up in a major depression like you are, they often regret it later. I’ve seen it’s just so hard to look at things objectively at times like this. On the other hand, I certainly think we need to explore your unhappiness with your job. And coming to think of it, I probably didn’t ask you enough about that. Would you like to tell me more about that now?
That exchange seems to work out pretty well, doesn’t it? The therapist listens carefully to the client’s concerns, acknowledges having failed to adequately explore the particular issue, and demonstrates an interest in doing so. If your therapist responds to you in this manner, it’s likely to be helpful if you stick with the therapy, and the therapist, for a little longer, to see whether the relationship can become more productive.
Sometimes therapists can have their own problems, and they don’t respond very well to clients’ concerns. Here’s an example:
Client: I need to talk to you about something.
Therapist: Sure, what is it?
Client: I’ve been feeling like I can’t be honest with you because I’m afraid you’ll be critical.
Therapist: Well, I certainly don’t think I’ve ever criticised you. What on earth’s given you that idea?
Client: Well, last week I told you about my plans to look for another job, and you said I shouldn’t do it.
Therapist: That’s exactly what I said! But it’s because you’re really in no condition to be looking around for anything else. You’re far too depressed to do something like that. And you really thought I was criticising you?
Client: Yes, I did. It felt like you thought I was stupid.
Therapist: But that’s ridiculous! You’re obviously feeling completely defensive. We need to work on that.
Client: To be honest, I’m just not feeling heard by you.
Therapist: Well, you’re wrong. It’s absolutely obvious that I’m clearly listening to you.
In this case, the conversation does less than nothing to repair the strained relationship. The therapist reacts defensively and shows no support, empathy, or connection with the client. If your discussions with your therapist often sound like this one, consider going to another professional.
Consulting a Professional about Antidepressants
The decision about whether to take medication to help overcome your depression is a complex one. In Chapter 15, we review in detail the pros and cons of treating your depression with med
ication. If you do think you may benefit from antidepressants, or are unsure about this, you need to know who to go and see.
Prescribing professionals
Medically qualified doctors prescribe antidepressant medications. GPs and Psychiatrists prescribe these more frequently than other specialist doctors.
Overcoming Depression For Dummies Page 12
