Types of talking therapy

What is talking therapy and what types of therapy are available for depression?

There are many different types of counselling or psychotherapy, some you may be familiar with, CBT for example, but what is it? And how does it differ to other forms of therapy offered in the UK? We answer this nd many more questions in this quick guide.

Counsleling/Psychotherapy: These are known as ‘talking therapies’ as they involve one-to-one meetings with another person during which you can talk about your difficulties with the idea that doing so will help you feel better.

Each meeting, or ‘session’, is generally between 45 minutes and an hour. The sessions are essentially confidential but, depending on the reasons for you seeing a therapist (a generic term used for a counsellor, psychotherapist or psychologist), this level of confidentiality will vary.

Within the NHS, for example, it is likely that your GP will be told something about the difficulties you have discussed and the progress you make. Some therapists will break confidentiality where there are risks of harm to self and others.

What to expect from therapy

At the first session, your therapist would generally discuss your main issues with you and ask you what you want to use any sessions for. You are likely to also discuss how often you will meet and how long for. Some therapies are open-ended and some have a fixed duration. You would have more choice and flexibility if you pay for the therapy privately.

The sessions should be a two way process. You should feel free to ask any questions you wish about the therapy and your therapist. If you are not comfortable with them and do not feel you can work with them then feel free to say so.

Even within the NHS, you should be able to have your choice of therapy and therapist. There are different options for therapy. Broadly, we would talk about counselling and psychotherapy but the terms are effectively interchangeable. In this page, we will use the term psychotherapy to describe both. Psychotherapy is practiced by counsellors, psychotherapists and psychologists but also by a wider range of professionals including Family Therapists, Psychoanalysts and Psychiatrists. We use the generic term therapist here to describe them.

Please see our page on professional services to find out who does what.

What is psychotherapy?

Psychotherapy will provide you with a supportive environment to discuss your issues. Your therapist will help you explore these issues, maybe helping you understand more clearly what is happening in your life and helping you come to decisions about what you might need to do.

Your therapist is impartial and not part of your social network. They have no view one way or another on what you should do. A conversation with a therapist is unlike a conversation with a friend or partner who might have a vested interest in what you do and an emotional reaction towards what you say about them or others. The impartiality of your therapist can help you talk openly about your feelings towards others and about any struggles you might have. Often this process can help validate your feelings, thought and behaviours.

There is no particular time limit for psychotherapy. The number of times you and your therapist meet may depend on a variety of issues such as how many the therapist or their company/institution can offer you, how many you can afford or how many you feel you need to explore/resolve the issues you want to discuss.

The number of times you meet may limit what you talk about and the depth to which you talk about issues. More is not necessarily better however and it may be that you only need or want a few sessions to talk through your problems. Some people see therapy as a means of self-development and would use it much as you might use a coaching session to fine tune areas of your life or to talk over a particular dilemma.

Types of talking therapy used for depression

There are many different types of therapy. For a comprehensive list you should contact the United Kingdom Council for Psychotherapy (UKCP). They have details of various therapies online at http://www.psychotherapy.org.uk/different_types_of_psychotherapy.html

Here, we give two examples of the psychotherapies available that are commonly used to treat/manage depression:

Existential therapy

Existential therapy is a holistic therapy. In the UK, it is generally based on western existential philosophy. It does not necessarily focus on any one aspect of being human but will encourage exploration of what it is like to be you in the world that you live in – e.g. socially, culturally and spiritually. Existential therapy would consider emotional distress, such as “depression”, as arising out of how you make sense of yourself and the world around you.

Existential therapists would generally believe that people have the freedom to make choices in their life. These choices indicate how we see ourselves and the world around us. We have the freedom to choose any number of possible options so how come we choose the ones that we do? Are these the choices we want to make? Do we feel forced to make them for some reason? How do we limit ourselves (and others) through the choices we make? What obstacles do we put in our way? What possibilities are we not seeing or not taking? What impact does this have on us?What would it be like to do things differently?

This philosophical approach believes there is not necessarily aright or wrong way to do things. Each of us has ways of doing things that suits us best. There are both consequences and benefits of the choices we make. Sometimes we act however in ways that work against us rather than for us. This can happen for many reasons. For example, we might be trying too hard to please someone else or we might not feel able to express ourselves in the way we want to.

This therapy can open our awareness to what we do and why we might do it. It can free us up from misconceptions we might have held and give us more of a sense of responsibility for ourselves, the way we feel, the way we conduct ourselves and the way we shape our lives.

For further information on existential therapy and to find an existential psychotherapist, contact the Society for Existential Analysis (SEA). Their website is: http://www.existentialanalysis.co.uk/

Cognitive Behaviour Therapy (CBT)

CBTis a therapy that looks at the relationship between ourselves and our environment (situations, other people). It also asks us to consider the interactions between our thoughts (cognitions), feelings (or emotions), behaviours and physical sensations (e.g. headaches, butterflies in the stomach).

It may also address our beliefs and assumptions about the world and consider how they might influence what how we see things and what we do. CBT is generally focused on providing a solution to a problem. You would be asked to do homework such as rate your mood against an activity to determine what lifts your mood and what lowers it. You might be asked to test out your assumptions about yourself and other people and challenge them.

CBT works on the premise that the way you currently do or think about things has contributed towards your depression. Therefore by doing and thinking about things differently, perhaps in a more helpful way, you can change the way that you feel, lift your depression and make it less likely that it comes back. CBT is practiced by a variety of ‘mental health’ practitioners including CBT therapists, psychologists, community mental health nurses, social workers and, increasingly, counsellors.

Different therapies, like different medications, will be more or less useful to individuals. CBT is the therapy of choice for depression for NICE and the NHS because it meets criteria set out by them (defined by a medical model). It is not necessarily the best choice for you. The fit between your way of thinking and the model of therapy is a very important factor as is the relationship between you and your therapist.

The most important determinant of success of any therapy, however, is your willingness to engage in the therapy. This is not just about going to the sessions and talking but more about how and what you talk about in the sessions and, most importantly, how you use the time between the sessions to consider what was discussed and make changes as a result of these discussions.

Therapy therefore is not a passive act; it is about engaging in a process of reflection and change. It can be unsettling and disturbing at times but, ultimately, it can be rewarding.