A therapy that combines talking therapies with meditation. It helps people reduce stress, switch off from difficult thoughts and feelings and make changes. NICE recommends this treatment to prevent people who have had depression from experiencing the same problems again. Other versions of this treatment include mindfulness based stress reduction and mindfulness-based cognitive therapy.
Dialectic behaviour therapy (DBT)
DBT combines some of the methods of CBT with meditation techniques. It involves individual therapy and group therapy. NICE recommends DBT for persistent binge eating disorder and people with personality disorders who self-harm.
Psychodynamic therapies
How do they work?
By exploring how your personality and early life experiences influence your current thoughts, feelings, relationships and behaviour. Once you have this extra understanding, you can practise more helpful ways of dealing with difficult situations.
What are they based on?
Originally the ideas of the neurologist and psychotherapist Sigmund Freud, with many changes over the last 100 years.
What form do they take?
The therapist works with you to understand your thoughts, feelings, relationships, behaviour, dreams and fantasies.
How long do they take?
Usually between several months and several years, although shorter-term versions are available.
Where are they practised?
Often privately, and in some charities. They are available on the NHS in some areas.
What are they helpful for?
Depression, anxiety, post-traumatic stress, long-term physical health problems, eating disorders and addictions. NICE recommends psychodynamic therapy for people experiencing depression alongside other complex illnesses.
Who will they suit?
People interested in self-exploration who are willing to devote lots of time and energy to it.
What are some of the variations?
Psychoanalysis, psychoanalytic psychotherapy, psychodynamic psychotherapy, analytical psychology, Jungian or Freudian analysis, focal psychodynamic therapy (NICE recommends this for treating anorexia nervosa).
"I was quite severely depressed as a teenager. I tried various antidepressants and some CBT-based stuff, but nothing was helping. Finally, my GP suggested that I try psychotherapy at my local mental health unit.
"At first I was sceptical. I couldn’t see how sitting in a room with a stranger was going to help. I was quite a nightmare, trying to prove to my therapist and myself that the therapy would fail. But with psychodynamic therapy, the therapist is prepared to sit and wait out that part with you. She started helping me link the way I was thinking, feeling and behaving to what might have gone on when I was younger and that really made sense."
Humanistic therapies
How do they work?
By taking a whole-person approach to your problem, using a range of theories and practices to help you develop.
Where did they come from?
They were developed to offer an alternative to psychodynamic and behavioural therapies, focused on developing your full potential.
What form do they take?
These therapies explore your relationship with different parts of yourself (such as your body, mind, emotions, behaviour and spirituality) and other people (for example family, friends, society or culture) and support you to grow and live life to the full.
How long do they take?
Therapy can be short or long-term depending on the issues you need to cover, but usually at least several months.
Where are they practised?
Therapists working for the NHS or charities and private therapists offer these therapies.
What are they helpful for?
Humanistic therapies tend to treat specific problems – such as depression, anxiety or addiction - as chances for you to develop and grow. Therapists work with any issue causing difficulties in your life.
Who will they suit?
They will suit people interested in exploring their lives and looking at their problems from a wide range of angles.
What are some of the variations?
Person-centred counselling (NICE recommends this for children and young people with mild depression and sometimes for people with schizophrenia), transpersonal psychology, body psychotherapy, gestalt therapy, psychosynthesis, integrative psychotherapy, existential psychotherapy, transactional analysis, psychodrama and personal construct therapy.
"I was referred to a unit that deals with people who turn to alcohol because of psychological problems. I was in a state of constant panic and had been drinking to keep those feelings at bay. There wasn’t a set formula to the sessions. We’d just go and get a cup of coffee and I’d talk about what was bothering me. With person-centred counselling the therapist steers you through finding out more about yourself and developing confidence."
Other kinds of talking therapy
Group therapies
In groups led by a facilitator (someone who helps to introduce members of the group to each other and who helps the conversation to flow), people find solutions together and learn from each other. NICE recommends group therapy for people with obsessive compulsive disorder and for children and young people with mild depression.
"In group therapy you don’t just talk about yourself, you’re listening to other people - that takes the burden off your problems. You realise you’re not the only one."
Couples, relationship or family therapies
Couples or families work with a therapist to sort out difficulties in their relationships. NICE recommends family therapy for anorexia nervosa, depression in children and families of people with schizophrenia. NICE recommends 'couples therapy' if partners have tried individual therapy and this has not helped.
Interpersonal therapy
This explores how to link mood with the way you relate to the people close to you. NICE recommends this for people with eating disorders and various forms of depression.
Bibliotherapy
Health professionals 'prescribe' self-help books which you can borrow from your local library. They will usually offer you these alongside other treatment. NICE recommend these for anxiety and obsessive compulsive disorder, and sometimes for depression.
What is it like to have a talking therapy and when can it be helpful?
The length of a therapy varies depending on what type it is and on your individual needs. Some people have just a few sessions. Other people see a therapist a few times a week for several years.
A course of CBT, for instance, is usually between six and 24 sessions, with each session following a structured agenda.
In contrast, a client receiving counselling is encouraged to talk freely and the course of therapy may be extended depending on the client's progress.
A session of one-to-one therapy usually lasts 50 minutes to an hour.
Talking therapies are not therapies that are 'done' to you by someone else. You play an active part in the therapy. That can be empowering at a time when you may feel you have lost control over part of your life.
If you are determined to get the most from the therapy, it is more likely to work.
Talking therapies require you to be completely honest with yourself and that can be difficult. It may mean facing up to your fears, recalling distressing memories or talking about intimate topics and private thoughts and feelings.
There may be tasks to do between sessions, such as trying out new ways of behaving or keeping a diary. It may be a while until you feel the results, but you get out what you put in.
When can talking therapies be helpful?
Talking therapies can be helpful in many different situations.
They can help people with all types of mood or emotional problems such as depression, anxiety, eating disorders, stress, anger, OCD, PTSD, addictions and are often used alongside medicine your doctor prescribes.
They can also help people with problems such as schizophrenia or bi-polar disorder.
Talking therapies can also help people deal with difficult life events such as bereavement, relationship issues, problems at work or physical illness.
They can help people with a long-term physical condition, such as diabetes, who are at high risk of depression. Talking therapies can help them manage their condition more effectively and reduce its burden on them and their family.
A very wide range of people can benefit from talking therapies, but no one type of therapy works for everyone. Different kinds of therapy work well for different people.
What kind of therapy would suit me?
What are the different kinds of therapy available?
What kind of therapist could I work well with? (You may prefer a man or a woman, someone with the same background as you or someone your own age or older).
How much time or money am I willing to spend?
How far am I willing to travel?
Do I mind where I see the therapist? (Options include at a GP practice, clinic, hospital, community centre or in the therapist’s own home)
Who may be able to recommend a therapist to me? (Friends or your GP may be able to put you in touch with a therapist they respect).
Questions to ask a therapist
About the therapist
What are your qualifications?
What other training have you done?
How long have you been working as a therapist?
Do you belong to a professional organisation?
Can I see your professional organisation’s code of practice or code of ethics?
Can I opt out any time?
About the therapy
What kind of therapy do you offer?
Do you specialise in helping people with certain types of problem?
What happens at a typical session?
How long is a session?
How often do you see people?
How many sessions would I have?
About the cost
What is the cost for each session?
Are there any reductions for older people, students or people on benefits?
When you meet a therapist for the first time (sometimes called an assessment), they will be working out if they can help you. That’s your chance to find out about the therapist too. Ask yourself:
Do you feel comfortable talking to them?
Would you be able to trust and work with them?
What’s your 'gut feeling' about them?
What makes a good therapist?
Your relationship with your therapist is really important.
A good therapist:
listens to you
values what you say
has your best interests at heart
helps you learn how to change
challenges negative thoughts
reinforces positive thoughts
checks you are getting what you want from therapy
knows their own limits and when to refer you to someone else.
A good therapist concentrates on you – what you think is important in your life, what you want to achieve, what steps you could take to get there. They shouldn’t tell you what to do. Your therapist may be highly trained and very experienced, but you are the expert on you.
It's worth taking time to build a trusting relationship with your therapist. Remember therapy is a two-way process. If you have any questions, ask them. If you are worried that you could become dependent on them, say so. A good therapist will help you deal with your worries and work out how you will manage when the therapy comes to an end.
Counselling and psychotherapy are umbrella terms that cover a range of talking therapies. They are delivered by trained practitioners who work with people over a short or long term to help them bring about effective change or enhance their wellbeing.
