Tuesday 4 August 2015

Talking... Therapy.

Here is a primer on different therapies you may be recommended or offered, for perinatal mental illness.  This is not an exhaustive list.  Much more information can be found on the British Association for Counselling and Psychotherapy website at www.bacp.co.uk.  

Before we begin, it is worth mentioning a few things that (in my opinion) therapy is not:
- a path to happiness (it can only teach you how to respond more positively to life's vagaries.  It cannot make life better for you!)
- a one-off treatment (you need to commit to what therapy has taught you, often for the rest of your life)
- something that is "given" to you (the patient is the most important participant in the therapeutic relationship - it is not passive, like most other medical treatments)
- a miracle cure for mental illness (it is entirely possible you might still need that medication... )

Cognitive Behavioural Therapy (CBT)
CBT is commonly prescribed for depression, as well as many other mental illnesses.  It is the therapy associated with the NHS "Improving Access to Psychological Therapies" programme (and is therefore the easiest to access, albeit with the usual waiting list hurdle).  I have been offered CBT in a number of different formats, with various degrees of adherance and success: book-based CBT, online and face-to-face.  I understand it as a way of encouraging the patient to put their Actions ahead of their Thoughts/Feelings.  That is, instead of "I feel sad therefore I cannot possibly get out of bed and get dressed" the person is encouraged to challenge that negative thought process and instead get out of bed regardless of how they feel, in the likelihood that getting dressed will make them feel better.  Don't think, Do.  CBT doesn't require any raking-over of the past, or analysing feelings.  It is a forward-focused process which emphasises coping skills and strategies.

Acceptance and Commitment Therapy (ACT)
This is a process of better understanding our negative feelings and emotions, but learning not to act on them.  It is a process of behaviour change, the goal of which is not necessarily "happiness" but a more positive cycle of feelings--behaviours.

Dialectical Behavioural Therapy (DBT)
DBT grew out of CBT and is designed to encourage even those who are reluctant to change their negative behavious.  The client is helped to "accept" their unhelpful behaviour, as a way of coping with life events and emotions in the short term.

Psychodynamic psychotherapy
Unlike CBT, this method stresses the importance of past events and the unconscious mind in shaping current behaviour.

Family therapy 
As the name suggests, this form of therapy involves the whole family unit.  It focuses on the "transactional" dynamics within the family.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a very specific therapy to resolve symptoms from very traumatic past events.  It works with the memory function of the brain to reprocess damaging associations.

Mindfulness-based Therapy
Mindfulness is a hugely popular therapy (and activity in general) which guides the person through various exercises in "intentionally paying attention".  It is a way of catching negative thoughts (which are not the object or sensation in which one is supposed to be focused) before they become a vicious cycle.

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