Over recent years there has been a proliferation of different psychotherapies based on different theoretical models of the mind.  There are innumerable types of Psychotherapy and Counselling on offer.  Here we outline just some of the approaches that you may come across.

Psychoanalytical and Psychodynamic Therapies

These approaches are all based on psychoanalytic theories of mental functioning that recognise that we all have impulses, perceptions and thoughts of which we are not consciously aware.  Conflict in these hidden aspects of our minds can give rise to disturbance and symptoms.

In Psychoanalysis the analyst listens carefully to what the patient has to say and then offers an understanding for the patient to consider.  Treatment is intensive and long term, usually four or five days a week for several years.

Psychoanalytic Psychotherapy is derived from psychoanalysis and is less intensive. Sessions usually are once to three times a week.  Psychoanalytic therapies can be very helpful to people who want to understand more about themselves as well as dealing with distressing symptoms.  They are particularly applicable to people who feel that their difficulties affect them globally and over a long period, even though there may be some immediate problem that is prompting them to seek help at a particular point in time.  Psychoanalytic therapy is usually one to one, but the same theoretical ideas are often used in Group Therapy which may particularly helpful for people who would benefit from sharing experiences and supporting one another in a group.  People who choose these types of therapy may:-

• Feel anxious and unable to cope with life
• Experience an underlying sense of sadness or dissatisfaction
• Lack confidence or feel they are not adequately fulfilling their potential
• Experience difficulty making or sustaining relationships or are repeatedly drawn into unhappy partnerships
• Find it hard to come to terms with a life change such as bereavement, divorce or job loss
• Express emotional problems through physical symptoms

Psychodynamic Counselling uses the same theoretical ideas but may focus on more immediate external problems and be more practically based and short term than psychoanalytic psychotherapy.

Cognitive /Behavioural Therapies
There are many types of therapy that concentrate on helping people change their behaviour and thinking, that are based on scientific principles and have proved to be very useful in overcoming mental distress and curing troubling symptoms over a wide range of problems.  Although there are many different trainings and techniques employed, therapies that work using these principles are commonly known as Cognitive Behaviour Therapy (CBT).  Clients and therapists work together to identify and understand problems in terms of the relationship between thoughts, feelings and behaviour. 

The approach usually focuses on difficulties in the here and now and relies on the therapist and client developing a shared view of the individual’s problem.  This then leads to the identification of personalised, time-limited therapy goals and strategies which are continually monitored and evaluated and there may be tasks to do between sessions.  Sessions are usually weekly and last an hour.  An average number of sessions is 10-15.  Cognitive and behavioural approaches are often used by Counsellors too.

Cognitive Analytical Therapy
This type of therapy is derived from a synthesis of cognitive and psychoanalytical approaches.  Its aim is to link the problems someone now faces with their earlier life experiences. This is used to help them arrive at a clearer understanding of unmanageable feelings and how these play a role in maintaining present difficulties.

It is a flexible approach with an emphasis on collaborative work between therapist and client.  It is much briefer and more focussed than psychoanalytic psychotherapy (about 16 sessions) and uses active methods such as diary keeping and letter writing.

Humanistic Therapy
These therapies are based less on a theoretical understanding of mental processes and more on the nature of the relationship between the client and the therapist.  By exploring and understanding the client’s experiences in an accepting and non-judgmental atmosphere the therapist can help them to increase their awareness of themselves which can be transferred into everyday life.  This is an optimistic approach based on helping people realise their potential.

Counsellors often use a humanistic approach.
 
Systemic and Family Therapy
This approach can be used with individuals as well as couples and families and other groups.  The focus is on the relational context, and patterns of interaction and meaning.  The aim is to enhance individual well-being and the functioning of the system as a whole.  By definition this type of therapy is particularly useful for couples and families.  It has been shown to be a helpful approach for teenagers with eating disorders and their families.

Hypnotherapy
Hypnosis in itself has no therapeutic value.  It stands in relation to treatment as anaesthesia stands to surgery.  Competent and professionally trained doctors, dentists, psychologists and psychotherapists who may sometimes judge the use of hypnosis a helpful adjunct to therapy may be found by consulting The British Society for Medical and Dental Hypnosis and the British Society for Experimental and Clinical Hypnosis.
 

Counselling or Psychotherapy?
There is a large area of overlap between those using the title of Psychotherapist and those called Counsellors. On the whole Psychotherapists have undergone a longer training than Counsellors and their work is more appropriate for those with long standing and/or more global problems.

Counsellors use many of the same approaches in their work as Psychotherapists but they may focus more on helping their clients to cope with problems of relatively recent occurrence and/or external rather than internal difficulties.
 

Risks of talking therapies
There are risks: focusing on your problems can make you feel worse, and therapy can sometimes affect your relationships with your friends and family in a negative as well as a positive way. Strong feelings may come up in therapy and you may feel vulnerable or angry.

You may become dependent on your therapist and have strong feelings of attachment to him or her.  It is the therapist’s job to understand these feelings, to help you to deal with them as they arise, and not to take advantage of your vulnerability or neediness.  It is not unusual to feel worse before you feel better. But you should not consistently feel unheard, humiliated or used.

Remember that therapy is supposed to be for your benefit.  You can stop it if it is not helping you or if the approach is not right for you. A good therapist will regularly check that you are getting something out of it and will suggest ending therapy if you are not. Trust your instincts and feelings, and consider ending therapy if you continue to feel worse. Keeping a diary of your thoughts and feelings during therapy can help you to judge your own progress.

Evidence Based Treatment
Since the late 1950s efforts have been made to research and develop the talking therapies as well as examining the evidence for them. Some of the therapies have been subject to intensive research and development, others have had little attention.  The costs of research and development in this very complex field are huge and perhaps unsurprisingly the current evidence is therefore patchy at best.  One might bear in mind the absence of evidence is no more than that, it does not necessarily mean some established methodology does not in fact actually work.

In considering whether or not to engage in counselling or therapy, and if so, then what type of counselling or therapy, one might bear in mind that after qualifications, the most important issue is whether you get along well with the counsellor or therapist.  An initial visit to such a professional to check this out is helpful.

We draw your attention to “Choosing Talking Therapies” (2001) published by the Department of Health and also to “Treatment Choice in Psychological Therapies and Counselling” – evidence based clinical practice guidelines also published by the Department of Health both available in the publications section of the Department of Health website.

You might also like to consult: Roth A and Fonagy P What works for whom?  Hamilton Press 1996 and the “clinical and scientific section” of the International Psychoanalytical Association.

Free treatment
Free treatment for mental health problems is available through the NHS.  You cannot refer yourself directly to the appropriate specialist department (Clinical Psychology, Psychotherapy or Psychiatry) but must first consult your GP.  In fact a discussion with your GP is often the best starting point.  Some mental health disorders are best treated by medication and others by a combination of medication and psychotherapy or counselling.  Your GP will not only have access to other NHS services but also may have their own Counselling Service and also may be aware of reputable and appropriately qualified private practitioners in the area.  There is often a long wait of several months for an assessment and then a further long wait for psychotherapy treatment in the NHS.

Privately funded treatment
Some people choose to pay for private treatment rather than use the free facilities.  This often means that they can be seen much more quickly than in the NHS and a wider range of therapies is available.  However, at present anyone is entitled to call themselves a Counsellor, Psychotherapist or Psychologist (but not Chartered Psychologist which is a legally restricted term) and even if they are qualified, qualifications vary enormously and may represent anything from a brief correspondence course to years of rigorous training.  Therefore we do not recommend that you choose someone from Yellow Pages or newspaper adverts.  It is important to find someone reputable, who is properly qualified to provide the treatment which you need.  You will need to find a practitioner who has a vacancy to see you, at a price that you can afford on an ongoing basis, and at a time and a place which is practical for you.

Neither the Hospice Bereavement Service nor individual members of staff can formally recommend outside practitioners as this opens the possibility of legal liability should a complaint arise.  However, staff can often give informal information about a practitioner whom they know.

Together with guidance from a professional we suggest that you use the Professional Registers listed at the end of this leaflet. 

Procedures vary, but usually when you contact a private practitioner, if they have a suitable vacancy (not always the case as these services are in heavy demand) they will invite you to an assessment interview.  This is the opportunity for you and the Counsellor/Therapist to decide if you wish to work together. (Being well qualified does not mean that you will get on with someone).  Usually you will have to pay for the assessment whether you decide to continue or not.  Fees vary tremendously so it is always worth asking what they are before going for an assessment.