Follow-on treatment options
Follow-on treatment options are recommended if a more specific one-to-one therapy is needed to address particular types of symptoms or when more individual support is needed.
If a follow-on therapy is advised, your therapist will explain the different options so you can discuss together which is likely to be the best fit.
What is it?
It is a form of therapy which focuses on developing strategies for tackling the thoughts and behaviours which can affect how we feel.
Who is it for?
CBT is a NICE-recommended therapy for depression and anxiety disorders.
What does it involve?
CBT (sometimes referred to as ‘High Intensity CBT’) usually involves around 12 weekly sessions lasting between 50-90 minutes, although depending on the nature of the problems you’re seeking help for, more sessions are sometimes needed. You and your therapist will work collaboratively together and agree from the outset on the goals for therapy. Sessions are fairly structured, with an agenda being set at the start of the session, outlining what you and your therapist think should be covered. In the early sessions the client and therapist work together to develop an understanding of the client’s difficulties and what is driving them or maintaining them.
For example, looking at what thoughts are occurring that increase feelings of anxiety. Your therapist will also help you to work actively to address the thoughts and behaviours; for example, challenging negative thoughts about yourself, experimenting with different ways of responding to anxiety. There is also regular ‘homework’ between the sessions, such as monitoring thoughts, reading, trying out new techniques and experimenting with new behaviours.
During therapy the therapist will ask for and give feedback; this often occurs at the end of sessions and in a review session in the middle of therapy. Towards the end of therapy there is often some work on preventing problems recurring and planning how you can make further progress after the sessions end. After the final session there is usually one follow up session 2-3 months later, to review progress. After discharge from the service some people subsequently opt to return for 1-2 ‘booster’ sessions later where they can be reminded of the work they did in CBT and get back on track with making further progress.
See www.babcp.com for further information about CBT.
Who is it for?
EMDR is a NICE-recommended therapy for post-traumatic stress disorder (PTSD).
EMDR is an effective and well researched therapy for people suffering from PTSD. When people become the victim of a traumatic event they sometimes experience such strong emotions that the brain is overwhelmed and unable to process information. Distressing experiences become ‘frozen in time’, stored in the original ‘raw’ form and can recur as ‘action replays’ or intrusive memories, where the person feels as if they are repeatedly reliving the original event. Distressing nightmares are common, as is generally feeling on edge all the time and avoidance of certain activities. Often, over time these symptoms reduce naturally as the brain tries to make sense of the traumatic events on its own accord. Sometimes however, we may need help from a therapy such as EMDR to be able to move on.
EMDR works by facilitating the brain to process traumatic memories and file them away into the past. It uses bi-lateral stimulation (typically eye-movements) to help the brain to do this. It appears to mimic what the brain does naturally during dreaming or REM (Rapid Eye Movement) sleep in order to integrate incoming information. It is also client-centered, helping the individual to resolve the trauma in the way they need to. In EMDR the client does not have to go into detail about what happened. Nevertheless, it can be an intense and emotional process and you need to be in a reasonably stable situation (both internally and externally) to be able to tolerate some distress.
Counselling is a broad term that can cover a number of slightly different approaches.
However, the main form of counselling offered in IAPT services is Counselling for Depression.
Counselling for Depression
This is a one-to-one therapy which:
- was developed from the work of Carl Rogers
- is often known as person-centred therapy because it centres on the client perspective
- is also called an experiential therapy because it focuses on our experience, particularly feelings
- has been shown to be effective in the treatment of depression
Your counsellor will aim to
- work with you to explore how you feel and whatever might be keeping you stuck in depression
- support you to reach your own understanding of your experiences, without any judgement, and without telling you what to do
- support you to come to terms with difficult things that may have happened in your life so that you can move on
In the first session or two
- your counsellor will answer any questions you may have about this approach
- agree an initial number of sessions (usually 6-8)
- together you will identify some particular aspects of your experience that you
- want to explore over the coming block of sessions
- this is make sure that time is spent on what is most important and also
- realistic within the time frame
After about 5-6 sessions
- you and your counsellor will review progress and decide whether or not to continue with a further block of sessions beyond the 6-8 so you can work towards an ending or continue exploring some issues in more depth
Interpersonal Psychotherapy (IPT) understands symptoms of depression as a response to significant life changes and / or current difficulties in relationships. In turn, the psychological symptoms can also affect the quality of our interactions or relationships with others.
IPT typically focuses on the following relationship difficulties:
- Conflict with another person – difficulties encountered in significant relationship can often be a source of tension and distress.
- Life changes – Life changes throw up new challenges, such as when we have a child or lose a job. These changes can leave us feeling unable to cope with the demands of the new situation and what is expected of us.
- Grief and loss – It can be very difficult to adjust to life following the loss of a significant person.
- Starting or keeping relationships – sometimes relationships are difficult because of what is missing, for example not having enough people around us or not feeling as close to others as we would like.
The main focus of IPT is on relationship problems and on helping the person to identify how they are feeling and behaving in their relationships. When a person is able to deal with a relationship problem more effectively, their psychological symptoms often improve.
What is DIT?
DIT stands for Dynamic Interpersonal Therapy. It is a time limited and structured psychotherapy, typically delivered over 16 weekly sessions. It aims to help you understand the connection between presenting symptoms and what is happening in your relationships through identifying a core repetitive pattern of relating that can be traced back to childhood. Once this pattern is identified, it will be used to make sense of difficulties in relationships in the here-and-now that contribute to psychological stress.
Therapy comes in many forms, each having a particular focus and emphasis. DIT focuses mostly on relationship problems and aims to help people recognise specific relationship patterns and to make changes in their relationships. There is a growing body of scientific evidence demonstrating the benefit of this approach.
What can I expect to happen over the course of treatment?
In the first few sessions of DIT, you and your therapist will spend time talking about the important relationships in your life and their connection to your depression. Your therapist will work with you to identify a key repeated pattern in how you see yourself in relation to others and a questionnaire will be used to help with this process. At the end of the initial sessions, your therapist will share with you this specific and personally tailored understanding and you will agree on the areas you wish to focus on during therapy.
Your therapist will encourage you to reflect on what you think and feel, thereby enhancing your ability to manage current interpersonal difficulties. It aims at relieving your symptoms of distress, enhancing your interpersonal functioning and your capacity for understanding yourself and others. During this therapy, your therapist will help you find more appropriate ways of being and coping with difficult relationships in your life.
At each session, you will be asked to complete outcome measures so that you and your therapist can track your weekly progress during treatment. Sessions will involve discussing your agreed main area of interpersonal difficulties and working on making positive changes. Therapy does not include any written exercises or homework, however, you need to be willing to be actively looking for ways to make constructive changes.
When concluding therapy, you and your therapist will discuss feelings about therapy ending and the progress you have made during the treatment. Given that this is a focused and time limited treatment, it is unlikely that you will have addressed all your difficulties during the sixteen sessions and you should also spend some time thinking about how the understandings you have gained will help you continue with the gains you have made.
Behavioural Couple Therapy (BCT) for depression is a brief (typically about 12 sessions) treatment for people in committed relationships where there is both relationship distress, and depression in one or both partners. BCT is recommended by NICE as one of the evidence-based treatments for depression. There is also some evidence that this form of therapy can be helpful where either or both partners are experiencing anxiety.
BCT for depression focuses on the aspects of depression that concern others around you and on factors that reduce stress and increase support within the couple.BCT usually works best when both partners are interested and willing to work on improving their relationship and supporting one another.
This could include goals such as improving communication, managing feelings, changing behaviour, enhancing problem-solving skills and promoting acceptance within the couple. It is quite an ‘active’ form of therapy and couples are often asked to do ‘homework’ between sessions.
Couple therapy can be helpful for all kinds of committed relationships, including same-sex relationships. We would like to encourage referrals for couple therapy from the local LGBTQ+ community.
In addition to intensive regular couple therapy sessions, we also offer a weekend workshop for couples which focuses on teaching skills such as how to share thoughts and feelings helpfully and how to tackle problems together as a team. We usually recommend that couples attend this workshop prior to the intensive couple therapy sessions as it can provide a good introduction to the techniques and strategies that will be taught in therapy sessions.
Suggested reading for couples:
- Overcoming Relationship Problems: A Self-Help Guide Using Cognitive Behavioural Techniques by Michael Crowe
- Couples and depression: Improving the relationship and improving depression. A chapter by Donald Baucom, Tamara Sher, Sara Boeding, and Christine Paprocki in “The Complete CBT Guide for Depression and Low Mood” by Lee Brosan and David Westbrook.
- Reconcilable Differences by Andrew Christensen and Neil Jacobsen
- After the Affair by Janis Spring
- Overcoming Sexual Problems by Vicki Ford
- The Relate Guide to Sex in Loving Relationships by Sarah Litvinoff
- Stop Arguing, Start Talking: The 10 Point Plan for Couples in Conflict by Susan Quilliam
- Getting Past the Affair: A Program to Help You Cope, Heal, and Move On – Together or Apart by Douglas Snyder, Donald Baucom and Kristina Coop Gordon
- Happy together: Thriving as a same-sex couple in your family, workplace, and community by S Rostosky and E Riggle