Treatments

It is important to consider the following in order to decide whether treatment is right for you at this time:

• Can you commit to treatment sessions and complete between-session tasks outside of appointments?
• Do you use alcohol and/or other drugs to manage your emotions? If so, depending on the amounts being used it may be necessary to safely reduce before starting treatment. This is because alcohol and other drug use can hinder the effectiveness of treatment
• With support, are you able to commit to focussing on addressing your problem(s) at this point in time?

If you are going to start a course of treatment, it would be useful if you could consider the following before your first appointment:

• What you would like to have gained by the end of your treatment and therefore what would be most useful to focus on?
• If you have had treatment before what was helpful about it and / or was there anything you wanted or needed to be different?
• For your current course of treatment what would help you to make the most of it?

A telephone assessment will be completed by one of our trained health professionals. The call is to gather information to help you and the health professional decide if brief therapy is right for you. What you say in the call will be kept confidential. This will only be shared with your GP or other services if there are any risks to yourself or others.

It is essential that you are able to take the call in a private place and one that is free from distraction. We are unable to have the call if you are driving (even if using hands-free technology). You will be asked questions that may require talking about sensitive information. This is to help us make sure we are the right service for you and to reduce the risk of harm.

We do not have your medical or GP records so we may ask you to tell us things you have already told other health professionals. The kind of things we will ask you include:

• Whether there are risks to yourself or others (we may ask sensitive questions about whether you have ever deliberately hurt yourself or other people, or whether you have thoughts like this at the moment);
• Whether you have ever experienced domestic violence or abuse (previously or presently).
• Details of any other caring responsibilities you may have. If you have children, we will ask if you are happy to share their names and dates of birth. Sharing this information is voluntary, but we do ask it to make sure that we are considering everyone’s needs in the assessment;
• Whether you use drugs or alcohol, and if so, the impact of this.

We appreciate that for some people, these can be difficult and upsetting questions to have to think about. The purpose of these is to make sure we are able to identify the best and most appropriate care for you. Our therapy works when you and the therapist are working towards a common goal, so it will be helpful if you can identify any goals you wish to focus on prior to the call.

Brief therapy is not always the most suitable treatment option. If this is the case, we will advise and direct you to other local services that may better suit your needs.

If you are unable to make this appointment, you must contact our office (number on the letter) if you want to rearrange.

What is a psychological wellbeing practitioner?

• A psychological wellbeing practitioner (PWP) will offer guided self-help and work with you to gain a better understanding of your difficulties.
• Support you to identify unhelpful thoughts, habits and behaviours which may be contributing to how you feel.
• Offer ways to change these in order to improve your mood and build on your own coping strategies.
• Support you to engage with self-help materials, proven to be effective in reducing low mood and anxiety, in order to improve your wellbeing.
• Encourage you to practice learning from each session, which will require some commitment but you will have the skills to use going forward in your life.
• Signpost you to other helpful agencies and services if appropriate.

PWP sessions can help with:

• low mood and poor motivation;
• Anxiety, worry and feeling overwhelmed;
• panic and avoidance, helping you gradually face your fear;
• understanding and challenging unhelpful thinking;
• problem solving;
• confidence and assertiveness;
• sleep problems.

What will PWP treatment involve?

PWP treatment is brief, time limited and up to six sessions, focusing on the specific strategies that will be the most beneficial for you. Typically sessions tend to be fortnightly, but may vary if felt therapeutically beneficial. You will be asked to complete tasks in between sessions to help you implement new coping strategies into your life, practising these skills regularly will help you manage stress after treatment ends.

What is CBT?

CBT can help you understand your problem(s) and why they may persist.

• The ‘C’ in CBT refers to the term ‘cognitive’. Within this type of therapy there is a focus on identifying our unhelpful thoughts, beliefs and thinking processes and working to try to adjust them.
• The ‘B’ in CBT refers to the term ‘behavioural’ and again, within this type of therapy there is a focus on acknowledging what behaviours might be unhelpful to ourselves in the long term and to trying out and practicing alternatives.

CBT is based on the concept that our thoughts, behaviours, emotions and physical sensations are all connected so by modifying some of our thoughts and behaviours we can bring about improvements in the distressing emotions and physical sensations we experience.

CBT can help with:

• Depression - which can be characterised by negative thoughts, loss of interest, low mood, low motivation and reduced activity levels;
• Agoraphobia – fearing being in situations that it might be difficult to get out of and where help might not be available when wanted;
• being very focussed on perceived flaws in your appearance – a feature of Body Dysmorphic Disorder (BDD);
• feeling anxious and worrying about lots of different things (may be Generalised Anxiety Disorder (GAD));
• fears, worrying, checking, seeking reassurance, excessive reading or avoidance of information in relation to health – common elements of health anxiety;
• Obsessive Compulsive Disorder (OCD) – intrusive, wanted thoughts and compulsive behaviours that we think we must do;
• fears about having panic attacks (potentially Panic Disorder);
• Post Traumatic Stress Disorder (PTSD) usually characterised by flashbacks to historical events that were traumatic;
• significant fears of being around or interacting with other people and being judged negatively which could be Social Anxiety Disorder;
• phobias where there are specific and strong fears of certain things;
• psychological distress which is linked with physical health problems.

What will CBT involve?

• Goals will be discussed and the focus of the work will be agreed collaboratively in a structured way.
• You may be asked to complete in between session tasks to help you implement new coping strategies into your life, practising these skills regularly will help you manage stress after treatment ends.
• CBT therapy is a brief, time limited approach, and is offered as six sessions initially, and can then be reviewed.
• Each session will usually be weekly and 50 minutes long, but this may change as treatment progresses.

CBT-I is a psychological therapy for adults with insomnia which has been proven to work effectively in a whole range of research trials. Recent evidence suggests that sleep interventions can also reduce low mood and anxiety alongside improving quality of sleep. To complete the programme, individuals need to be able to complete daily sleep diaries for the duration of the programme in order for both practitioner and patient to have a clear and shared understanding of the individual's sleep.

CBT-I consists of eight sessions, each designed to address different aspects of insomnia.

1. Introduction to the sleep diary: by keeping a sleep diary we can help identify both helpful and unhelpful patterns. It will also help us identify the best sleep schedule for you.

2. Sleep rescheduling: we aim to look at the best sleep and wake times to try to get you back into a sleep routine whilst reducing unwanted time awake in bed.

3. Stimulus control: this session helps you to manage the worry and frustrations associated with being awake in bed during the night.

4. Sleep hygiene: this session looks at how your daytime and night-time routines and behaviours, as well as your sleep environment, can impact on the sleep you are getting so we can maximize the opportunities for sleep.

5. Cognitive control: we aim to help manage the racing mind at night by putting the day to bed before you go to bed.

6. Distraction techniques: techniques that you can use if you are in bed and are awake to stop you from having lots of intrusive thoughts.

7. Other cognitive techniques: this session looks at any additional techniques you might require to help manage the worry, stress and anxiety that builds up during the night if you are awake.

8. Review and relapse prevention: this session focusses on ways to protect your sleep in the future and how you can best manage your sleep.

What is counselling?

• It is a talking therapy with a qualified counsellor who will provide a safe space to help you to talk through, begin to understand and come to terms with what is troubling you and how best to manage more effectively.
• It’s about helping you to express and explore your feelings in a safe and confidential space.
• Provides an opportunity to work towards living your life in a way that is most meaningful and satisfying to you.

Counselling can help with:

• Depression (mild to moderate);
• relationship difficulties;
• bereavement, grief and loss (prolonger reaction);
• adjustment to life events - illness, career/job related;
• low self-esteem;
• mild anxiety related issues;
• mild trauma related issues.

What will counselling involve?

• The counselling offered is a NICE recommended brief and time limited of up to eight sessions which will be approximately up to 50 minutes each and usually weekly.
• Counselling can be accessed face to face, online or by telephone.
• Reflect upon and process what you have explored in sessions in the time between sessions.
• There might be times when your counsellor may suggest some reading, activity, or self-help exercises that could be helpful for you.

If you are worried about finding a suitable job or you are feeling worried or depressed because of difficulties at work, we can refer you to one of our Employment Advisors for help and support if this is something that you feel you need. You can access employment support if you are receiving talking therapy, ask your practitioner about employment support at your next appointment.

We will help if you are unemployed and looking for work by:

• offering careers advice and guidance;
• arranging work placements or tasters;
• identifying suitable training courses;
• creating a CV, searching for jobs or filling in job applications;
• completing a better off in work calculation;
• arranging a referral for welfare benefits advice.

We will help you if you’re absent from work on sick leave by:

• discussing reasonable adjustments with you and your employer;
• assessing your job role and recommending changes;
• managing your health and wellbeing at work;
• giving you and your employer strategies to manage how you feel at work;
• helping you to deal with difficult relationships at work.

We will help you if you're struggling to cope at work by:

• identifying solutions to improve your wellbeing at work;
• mediation with your employer or line manager;
• supporting occupational health advice and assessments;
• providing advice to you and your employer about the Equality Act 2010.

EMDR is a psychological therapy designed for working with distressing traumatic memories. The theory behind EMDR is that distress and psychological difficulties caused by traumatic experiences have not been stored in the memory properly and are unprocessed or blocked. These traumatic memories may need to become processed or unblocked, and EMDR is one psychological therapy used to do.

There is good evidence that EMDR is an effective treatment for post-traumatic stress disorder (PTSD) and is recommended by the National Institute for Health and Care Excellence (NICE) for PTSD but not for military veterans when the trauma is consequent to their military service. We only use EMDR as one of the treatment choices for PTSD in addition to Trauma Focussed Cognitive Behavioural Therapy.