We explain what talking therapies, also know as psychological therapies, are and the different types of therapies that are a recommended non-treatment for some people living with dementia.
Talking therapies: counselling, psychotherapy, CBT
What are talking therapies?
Talking therapies (or psychological 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 cope with specific difficulties, such as serious illness, bereavement, stress, anxiety or depression, whereas other people may use them for personal growth and development. There are a number of different talking therapies. This section outlines some of these therapies and explains how people with dementia and their carers might find them helpful.
Talking therapies are not the only type of non-drug treatment available for a person with dementia or their carer, however. If a person has depression or anxiety but the symptoms are mild, they may be offered self-help, referred to a support group or encouraged to exercise and engage in social activities.
If the person's symptoms are severe, drug treatment (eg an antidepressant) is usually offered, sometimes before or in combination with a talking therapy. Some people with dementia who have depression or low mood will also benefit from activities such as life story work or reminiscence.
What are the different types of talking therapies?
Talking therapies encourage people to talk about their thoughts and feelings, and how these affect their mood and behaviours. They are delivered by a professional, such as a counsellor, clinical or counselling psychologist, psychotherapist, psychiatrist or nurse. Each will have been trained in the respective approach and have a recognised qualification that is monitored by their professional body or the Health and Care Professions Council.
Talking therapies are all based on a certain understanding of how the mind works. The approach to therapy is tailored to each individual, and is based on the person and the therapist working out what might be causing their particular difficulties.
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 to their problems, rather than being offered answers by someone else.
Counselling is often used to help someone cope with recent events that they have found difficult. For someone with dementia, being diagnosed with such a life-changing and life-limiting condition is clearly a major event.
There are different types of counselling available, including individual, group or self-help group sessions. Family counselling involves focusing on the whole family who have been affected by an issue rather than an individual.
Psychotherapy is a term for another range of talking therapies. There are many different types of psychotherapeutic approach. 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).
- Interpersonal therapy (IPT) - used when difficulties in the person's relationships with others are causing their distress. Interpersonal therapy attempts to improve someone's mood by improving these relationships.
- Family therapy or systemic therapy - involves a family working with one or more therapists to help resolve their problems. Family therapy is particularly focused on the relationships between family members.
- Humanistic therapies - encourage people to think about their feelings and take responsibility for their thoughts and actions by reflecting on their life's meaning and values. The emphasis of humanistic therapies is on personal growth.
A psychotherapist will help a person to understand how their personality, beliefs and life experiences influence their current thoughts, feelings, relationships and behaviour. This may lead to changes in the way people think and behave that will in turn help them to deal with their problems and difficult situations more successfully.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy is a specific form of psychotherapy. It relies on the fact that the way we think about something ('cognition') affects how we feel about and behave towards it. A person having CBT will be supported to explore the links between thoughts, feelings and behaviour. With their therapist, the person will try to develop more positive ways to think, feel and act.
Unlike some of the other talking therapies, CBT focuses mainly 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. This begins with the therapist and client together working out what is triggering the person's distress. Armed with this shared understanding, the client can focus on specific goals by developing more effective ways of thinking, or of coping with difficult problems. An example of a goal for a person with dementia might be 'Feel able to go back to the singing group that I used to enjoy'. CBT may also involve learning relaxation techniques or breathing exercises or trying out different activities.