Talking therapies (including counselling, psychotherapy and CBT)
Talking therapies give people the chance to speak in confidence to a trained professional about problems or issues that are causing them concern. Some people use talking therapies to help them to cope with specific difficulties, such as serious illness, bereavement, anxiety or depression, whereas other people may use them for personal growth and development. There are a number of different talking therapies. This factsheet outlines some of these therapies and explains how people with dementia and their carers might find them helpful.
Types of talking therapies
Counselling is a general term for a range of talking therapies. A counsellor listens to a person's concerns in a non-judgemental and supportive manner. The aim of counselling is to help the person seeking support (often called the 'client') to be clearer about their problems. In this way people are able to come up with their own answers. It is often used to help someone cope with recent events that they have found difficult. There are different types of counselling available and it may include individual, group or self-help group sessions.
Psychotherapy is a term for another range of talking therapies. They provide a more in-depth form of therapy than counselling and can address a wider range of issues.
There are many different types of psychotherapy approaches. These include:
- Cognitive behavioural therapy (CBT) (see below).
- Psychodynamic therapy - focuses on how a person's current behaviour and relationships are affected by their unconscious thoughts and past experiences (particularly childhood experiences).
- Psychoanalysis - similar to psychodynamic therapy in that it raises awareness of how early experiences and relationships affect current behaviours and motives. Psychoanalysis is more in-depth and sessions are usually more frequent than in psychodynamic therapy.
- Family therapy - involves a family working with one or more therapists to help resolve their problems. Family therapy is particularly interested in the relationships between family members.
- The humanistic therapies - encourage people to think about their feelings and take responsibility for their thoughts and actions in terms of life's meaning and values, and achieving the highest potential. The emphasis of humanistic therapies is on personal growth.
A psychotherapist will help a person increase their understanding of how their personality and life experiences influence their current thoughts, feelings, relationships and behaviour. This may lead to changes in thinking and behaviour that will help people deal with their problems and difficult situations more successfully.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy is a specific form of psychotherapy. It aims to help people to change how they think ('cognitive') and what they do ('behaviour'). These changes can help people to feel better. Unlike some of the other talking therapies, CBT focuses on the 'here and now'. Instead of focusing on the causes of distress in the past, it looks for ways to improve the person's current situation. It is particularly effective as it focuses on specific goals with the therapist and person working closely together, with the aim of teaching the person better ways of coping with difficult problems.
How do talking therapies work?
Talking therapies can involve a number of regular face-to-face sessions that usually last for an hour, but can be shorter. There is an initial assessment where the therapist will obtain an idea of the problem and some background information. The therapist will then discuss a treatment plan with the person. It is also possible to receive certain talking therapies, such as counselling and CBT, over the telephone or online. Cognitive behavioural therapists will also recommend that the person carries out 'homework' between sessions to help reinforce what is learnt in the session and to try out new ideas. This may include keeping a diary or filling out thought records.
There is no standard length of time for therapy. The number of sessions required will depend on the type of problem, the type of therapy, how it is delivered (eg face-to-face or by phone) and who is giving the therapy (eg NHS therapist, private therapist or charity). With counselling and psychotherapy some people get everything they need from one session or from just a few. Others may require counselling or psychotherapy over a much longer period of time, for months or, more rarely, years. CBT usually involves a programme of 5-20 sessions.
Successful therapy depends very much on the development of a trusting relationship between the therapist and the client. It is therefore important that people work with a therapist whose approach and manner they are comfortable with. The relationship between a client and a therapist is confidential. This means that what is discussed during therapy will not be disclosed to anyone else. However, there are some exceptions to this which should be discussed during the first meeting.
How can talking therapies help someone with dementia?
Being diagnosed with, and living with, dementia can raise many difficult feelings and thoughts. People find it understandably hard to make sense of what is happening to them and how their life is changing. Some feel angry, confused, frightened or anxious. Talking therapies may offer someone with dementia the opportunity to speak openly about their feelings and help them to live with their condition more successfully.
For example, counselling has been shown to be a way for people to gain support and make sense of living with dementia. Research suggests that counselling can play a particularly important role in helping people with an early diagnosis of dementia. Telephone counselling has also shown to be extremely useful in helping people identify support and come to terms with a diagnosis.
There is also evidence to suggest that psychotherapy can help people with dementia. Psychotherapy, including CBT, has been shown to help treat depression, anxiety and problem behaviours in people with dementia.
In the past it was not thought that people with dementia would benefit from counselling or psychotherapy, but increasing evidence suggests that these talking therapies can help maintain mental well-being. Stress, anxiety and depression can all affect memory and thinking, and so maintaining mental well-being can ensure these abilities are not compromised further in people with dementia.
How can talking therapies help carers?
Being close to someone with dementia can feel overwhelming and lonely. Many carers experience feelings of sadness, grief, guilt or anger, as well as high levels of anxiety and depression. Talking therapies may help people to explore these feelings in confidence, as well as providing extra support outside their network of friends and family. This can be especially important at times when decisions are being made about how to look after a person with dementia.
A former carer or care worker may feel lost or sad when the person they have cared for moves away or dies. After the caring relationship ends, it may be difficult to move on, to recover from the loss and to accept a new and different role. This is a common reaction. Talking therapies may help a former carer to accept the past and look ahead to the future. Some talking therapies, such as bereavement counselling or bereavement CBT, are specifically aimed at helping people to cope with the loss of someone close to them.
What should I look for in a therapist?
It is important that you feel comfortable with your therapist. This will depend on your own personality and that of the therapist. You might want to use a therapist who has experience or an understanding of the effects of dementia. You may need to speak to several different therapists before you find the right person. It is also important to check that the therapist:
- is accredited by the relevant professional body
- abides by a professional code of ethics
- has regular ongoing professional supervision to ensure safe and ethical practice
- discusses their approach, confidentiality, fees (if applicable), length of sessions and responsibilities (yours and theirs) with you before committing to sessions.
What is the best way to find a therapist?
Talking therapies accessed through the NHS are usually free of charge and are becoming increasingly available. GPs can often provide details of local therapists and some GP surgeries even run talking therapy services. Your GP or local social services department may also have information about local charities offering services − the number of your local social services department will be in the phone book.
Another option is to find a private therapist. There are many ways to find a private therapist but a recommendation from someone else or your GP can be very helpful. Most private services operate a sliding scale for fees. The British Association for Counselling and Psychotherapy (BACP) can provide more information about local counselling and psychotherapy services. For an accredited CBT therapist contact the British Association for Behavioural and Cognitive Psychotherapies (BABCP). For a clinical psychologist or counselling psychologist contact the British Psychological Society (BPS). See 'Useful organisations', below.
British Association for Counselling and Psychotherapy (BACP)
National body representing counsellors and psychotherapists. Can provide a list of counsellors and psychotherapists in your area.
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
Can provide a list of CBT therapists in your area.
British Psychological Society (BPS)
Provides access to a list of clinical and counselling psychologists that offer private therapy services.
Cruse Bereavement Care
Provides help to enable anyone bereaved by death to understand their grief and cope with their loss. The organisation provides counselling and support and offers information, advice, education and training services.
Provides information and support services to people affected by depression.
Mental health charity which publishes information on all aspects of mental health and provides a range of support through 200 local associations.
Offers relationship counselling for individuals, couples and families in England and Wales. Provides advice and support face-to-face, by phone and through its website.
Provides confidential relationship counselling and support to individuals, couples, young people and families in Northern Ireland.
Samaritans provide confidential non-judgemental emotional support, 24 hours a day, for people who are experiencing feelings of distress or despair, including those which could lead to suicide. To find your nearest branch look in the phone book or on the Samaritans website (above).
Last reviewed: January 2012
Next review due: January 2014
Reviewed by: Dr Catherine Mummery, Consultant Neurologist and Honorary Senior Lecturer, Institute of Neurology, London and Dr Yvonne McCulloch, Clinical Psychologist, Charing Cross Hospital, London
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